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At least one in three adults has multiple chronic conditions. The assistance of patients with chronic conditions is mandatory. This is one of the main tasks of the primary care physicians. The approach in these patients is challenging, as there are many barriers at different levels (sanitary system, healthcare professionals and patients). In addition, COVID-19 pandemic has worsened this situation even more. Therefore, it is necessary to take actions that try to improve this state. For this purpose, with the aim to find solutions/recommendations that may be helpful to attain a better diagnosis, treatment and follow-up of patients with chronic diseases, a group of experts of SEMERGEN have tried to identify the problems in the attention to these patients, searching for potential solutions and areas of improvement. The present document has specifically focused on four prevalent chronic conditions in primary care: dyslipidemia, arterial hypertension, chronic venous disease and depression., (Copyright © 2022 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: Explore patients' perceptions during a supervised exercise program and detect the barriers and facilitators that influence exercise adherence after the supervision period., Design: A qualitative observational study with three focus groups as the main data collection technique was conducted. SITE: Primary Health centers of Bizkaia., Participants: Out of the 175 randomized patients in the hybrid effectiveness-implementation trial, a sample of 19 patients from the intervention group were included in the qualitative study (12 advanced-stage onco-haematological patients and seven with severe mental disorders)., Methods: Content analysis of the generated transcripts was performed by combining a deductive approach, based on the domains of the PRACTIS theoretical framework, and an inductive one, based on the postulates of the Grounded Theory., Results: The data analysis showed that participants were satisfied with the EfiKroniK program and that the main identified benefits were discovery of the benefits of physical exercise, the psychological and emotional management of the disease, the benefits from peer communication and emotional support, and the break from routine of their illness. Participants decreased the levels of physical exercise at the end of the supervision6 due to the confluence of several barriers., Conclusion: A supervised exercise program carried out in Primary Care contributed to the improvement of the quality of life as well as the emotional and social well-being of patients with advanced-stage diseases. Our study identified potential barriers and facilitators associated with exercise participation and its continuity, however, it is necessary to encourage inter-sectoral coordination within the socio-health system to promote integrated and continuous care for chronic patients., (Copyright © 2022 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: The Nursing Process is the scientific method specific to the nursing discipline. However, although in recent years it has rapidly expanded in certain areas, this has not been the case in special units such as the intensive care unit., Objective: To determine the reasons nurses show little awareness of incorporating nursing methodology in intensive care units., Method: Literature review conducted between November and December 2020 in the databases Pubmed, Cinahl, Cuiden, Lilacs, Cochrane, Sicelo, Web of Science, in addition to a search of grey literature and electronic journals. Boolean operators AND and OR were used and the temporal limiter of the last 10 years (2010-2020) was applied., Results: A total of 20 articles were selected. Intensive Care Units nurses perceived a lack of knowledge on how to use nursing methodology. This problem begins in university education and continues in the institutions with little continuing education. Nurses' work overload takes time from being able to use this tool, which is among the lowest of their priorities., Conclusions: Research studies are required on solutions that, in the nurses' words, could be useful in tackling this problem, and on the impact that training programmes in methodology have on its application in practice., (Copyright © 2022 Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC). Published by Elsevier España, S.L.U. All rights reserved.)

Aim: To evaluate the perception of barriers in healthcare and the impact of intravitreal injections in patients with neovascular age-related macular degeneration (nAMD)., Methods: Cross-sectional study including 108 patients with nAMD in treatment with intravitreal injections. The patients answered a questionnaire with 26 questions (score from 1 to 5) divided in three sections: 1) the disease and its treatment with injections, 2) healthcare barriers and 3) new technologies., Results: The mean age was 80.4 ± 7.0 years and visual acuity (VA) was 75.2 ± 12.4 letters. The main barriers in healthcare were long waiting times (72%), followed by other comorbidities (10%). Some 63% of patients have to wait between 3 and 5 h to attend their clinical visit. Significant anxiety due to the injections (2.8 ± 1.3) was observed, being present in 71% of the cases the day before. A great fear of blindness and losing independence was observed (4.4 ± 0.9 and 4.3 ± 1.1), with no differences in relation to VA, age or sex (p ≥ 0.135). Moreover, 28% of the patients reported that it was quite or very difficult for them to attend the clinical visit, with 69% of the total showing great interest in having a diagnostic device at home., Conclusion: The nAMD and its treatment represent a significant burden on patients, among whom there is a great fear of blindness and of losing their independence, the main barrier being the long waiting time for the clinical visit., (Copyright © 2021 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.)

Background: GlobalSurg is an international group of researchers whose purpose is to conduct and disseminate robust collaborative, international and multicenter studies., Objective: To expose the necessary strategies and the barriers crossed in conducting massive multicenter studies in surgery., Method: During the second semester of 2020, the study Surg-Week Prospective International Cohort Study was carried out. Surg-Week has been the largest international study in the field of surgery to date, with 141,582 patients included. A total of 4975 mini-teams, of between 1 and 5 members, collected data from 116 countries on all continents., Results: The creation of an official website for the study, reports with relevant information via email or groups via WhatsApp, formation of a Dissemination Committee of the protocol, delivery of webinars on recent team publications, appointment of leaders at the national and international level, and outreach through partnerships, were the strategies used for the development of the research. However, the barriers turned out to involve different aspects., Conclusions: Collaborative work allows establishing networks between different professionals with the goal of improving the quality of management, health policies and care of our patients in a timely manner of constant change.

Patient safety has become a central component of quality of care. One of the best known and most widely used security tool in all work settings is the checklist. The checklist is a tool that helps to not forget any step during the performance of a procedure, to do tasks with an established order, to control the fulfilment of a series of requirements or to collect data in a systematic way for its subsequent analysis. It is an aid to improve the efficiency of teamwork, promote communication, decrease variability, standardize care and improve patient safety. Main barriers to implementation are reviewed: staff attitudes, hierarchies, poor design, inadequate training, duplication with other work lists, work overload, cultural barriers, lack of replication or checklist closing time. Finally, its applications in Pediatrics are reviewed starting from the most widespread, the safety checklist of pediatric surgery, checklists in neonatal critical units, for safe delivery, for risk procedures, in pediatric intensive care and for pathology time-dependent emergent, e.g. pediatric trauma. It is necessary to highlight the role of leadership in the implantation of a checklist in any area of Pediatrics. There must be one or more people from the team with the support of the Heads of Service and Managers who lead the training of the personnel, direct the implementation of the LV, evaluate the results, inform the rest of the team and can modify the processes depending on the problems found., (Copyright © 2020 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.)

Crop damage is the most common impact of negative interactions between people and elephants and poses a significant threat to rural livelihoods and conservation efforts. Numerous approaches to mitigate and prevent crop damage have been implemented throughout Africa and Asia. Despite the documented high efficacy of many approaches, losses remain common, and in many areas, damage is intensifying. We examined the literature on effectiveness of crop-damage-mitigation strategies and identified key gaps in evaluations. We determined there is a need to better understand existing solutions within affected communities and to extend evaluations of effectiveness beyond measurement of efficacy to include rates of and barriers to adoption. We devised a conceptual framework for evaluating effectiveness that incorporates the need for increased emphasis on adoption and can be used to inform the design of future crop-damage mitigation assessments for elephants and conflict species more widely. The ability to prevent crop loss in practice is affected by both the efficacy of a given approach and rates of uptake among target users. We identified the primary factors that influence uptake as local attitudes, sustainability, and scalability and examined each of these factors in detail. We argue that even moderately efficacious interventions may make significant progress in preventing damage if widely employed and recommend that wherever possible scientists and practitioners engage with communities to build on and strengthen existing solutions and expertise. When new approaches are required, they should align with local attitudes and fit within limitations on labor, financial requirements, and technical capacity., (© 2019 Society for Conservation Biology.)

A key obstacle to conservation success is the tendency of conservation professionals to tackle each challenge individually rather than collectively and in context. We sought to prioritize barriers to conservation previously described in the conservation literature. We undertook an online survey of 154 practitioners from over 70 countries to ascertain the most important barriers to conservation they faced. We used statistical analyses to identify the key impediments to conservation success and to examine whether these were affected by organizational attributes. Twenty-one barriers were identified. The importance ascribed to those was influenced by continent of operation and organization size, but not by organization age or autonomy (from larger parent organizations). We found the most important barriers to consider when undertaking conservation action were wider issues (e.g., population growth, consumerism, favoring development, and industrial-scale activity), operating environment (e.g., lack of political will, ineffective law enforcement, weak governments, corruption, safety and security), community attributes (e.g., dynamics, conflicts, and education levels), and the way conservation is undertaken (overconfidence, lack of funding, and externally set agendas). However, we advise against applying a one-size-fits-all approach. We propose that conservationists account for the complex socioecological systems they operate in if they are to achieve success., (© 2019 Society for Conservation Biology.)

Introduction: Lifestyle changes in medical nutrition therapy (MNT) are associated to HbA1c decreases ranging from 0.3 to 2%. Evidence shows that people with barriers are less likely to adhere to a long-term nutritional plan. Little information is available on the barriers that prevent the implementation of a healthy nutritional plan, and the strategies used to overcome them., Objective: To report the longitudinal changes in perceptions of barriers to adherence to a nutritional plan in T2DM., Methods: A prospective cohort study with intervention. Follow-up was assessed at two years, and all patients received comprehensive care according to the CAIPaDi model. A questionnaire was used to detect the most common barriers to adherence to a nutritional plan at baseline and at 3 months and 1 and 2 years of follow-up. The analysis included data from 320 patients with complete evaluations from baseline to 2 years. Patients with T2DM aged 53.8±9.1 years (55.9% women), BMI 29.2±4.4kg/m 2 , and time since the diagnosis 1 (0-5) years were included in the study., Results: At baseline, 78.4% of patients reported any barrier that limited adherence to a nutritional plan. The most common were "Lack of information on an adequate diet" (24.7%), "I eat away from home most of the time" (19.7%), and "Denial or refusal to make changes in my diet" (14.4%). After a structured nutritional intervention including strategies to eliminate each barrier, a 37% reduction (p<0.001) was seen in barriers at 2 years of follow-up. Patients with persistent barriers at two years had a greater proportion of HbA1c values >7% (24.7%) and triglyceride levels >150mg/dL (27.5%) out of the control range as compared to those with no barriers (11.6% and 14.4% respectively, p<0.05)., Conclusions: Identification of barriers to adherence to a nutritional plan may allow healthcare professionals design interventions with the specific behavioral components needed to overcome such barrier, thus improving adherence to the nutritional plan with the resultant long-term changes., (Copyright © 2019 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.)

Conservation practitioners have long recognized ecological connectivity as a global priority for preserving biodiversity and ecosystem function. In the early years of conservation science, ecologists extended principles of island biogeography to assess connectivity based on source patch proximity and other metrics derived from binary maps of habitat. From 2006 to 2008, the late Brad McRae introduced circuit theory as an alternative approach to model gene flow and the dispersal or movement routes of organisms. He posited concepts and metrics from electrical circuit theory as a robust way to quantify movement across multiple possible paths in a landscape, not just a single least-cost path or corridor. Circuit theory offers many theoretical, conceptual, and practical linkages to conservation science. We reviewed 459 recent studies citing circuit theory or the open-source software Circuitscape. We focused on applications of circuit theory to the science and practice of connectivity conservation, including topics in landscape and population genetics, movement and dispersal paths of organisms, anthropogenic barriers to connectivity, fire behavior, water flow, and ecosystem services. Circuit theory is likely to have an effect on conservation science and practitioners through improved insights into landscape dynamics, animal movement, and habitat-use studies and through the development of new software tools for data analysis and visualization. The influence of circuit theory on conservation comes from the theoretical basis and elegance of the approach and the powerful collaborations and active user community that have emerged. Circuit theory provides a springboard for ecological understanding and will remain an important conservation tool for researchers and practitioners around the globe., (© 2018 Society for Conservation Biology.)

Introduction: Refusal of physicians to prescribe insulin to their patients has been scarcely evaluated; the delay in treatment intensification hinders adequate and quality care., Objective: To identify the perception of primary care physicians about barriers to initiate insulin treatment in patients with diabetes., Method: Using the Smith Index and multivariate analysis, the relevance and grouping of concepts related to barriers to insulin prescription were assessed in 81 family doctors., Results: Only 35.8% of physicians showed confidence for prescribing insulin; almost half of them rated treatment intensification between moderately and little important (39.5% and 6.2%). Barriers were related to the physician (39.5%), the patient (37%), insulin treatment (11.1%) and the institution (6.2%); 6.2 % of physicians did not perceive any barrier. The barriers were grouped in 5 factors that explained 62.48% of the variance: patient cultural level, lack of medical skills, fear of adverse events, insecurity and lack of training., Conclusion: Clinical inertia was not the result of a complex medical condition or patient comorbidities, but of doctor's perception and confidence in his/her clinical and communication skills., (Copyright: © 2019 SecretarÍa de Salud.)

Introduction: Treatment adherence is crucial in inflammatory bowel disease (IBD) to prevent relapses and complications. In Mexico, there is not a validated tool to assess adherence in patients with IBD., Objective: To translate the beliefs about medicines questionnaire (BMQ) and self-efficacy for appropriate medication use scale (SEAMS) instruments, as well as to determine their validity, reliability and sensitivity in IBD-diagnosed Mexican patients., Method: After informed consent was obtained, 149 IBD-diagnosed patients were included. The instruments were translated into Spanish and were subsequently applied during medical consultation. For SEAMS, exploratory factorial analysis and ROC curve analysis were carried out and Cronbach's alpha was determined; for the BMQ, Cohen's kappa coefficient and its predictive capacity were employed., Results: Seventy-five women (50.3%) were included, with an average age of 44 years. The SEAMS scale showed a single factor that was highly reliable (Cronbach's alpha = 0.92) and a cutoff point of 33 to identify adherent patients. The "adherence" and "recall barrier" dimensions of the BMQ were adequate adherence predictors., Conclusions: The SEAMS and BMQ Spanish versions are valid for measuring self-efficacy and barriers to pharmacological treatment adherence in Mexican patients with IBD., (Copyright: © 2019 SecretarÍa de Salud.)

Aims: To estimate the number of patients that have access to treatment of hepatitis C with direct-acting antivirals in Argentina and evaluate the factors associated with the lack of access., Materials and Methods: A cross-sectional cohort study was conducted that included all the consecutive prescriptions of direct-acting antivirals issued at health centers that participated in the ECHOTM telemedicine project directed by the Hospital Italiano de Buenos Aires, within the time frame of January 2016 and February 2017., Results: A total of 143 treatment prescriptions were included and overall access was 70% (95% CI 62-77%). The only independent factor associated with a lack of treatment access was coverage by a public healthcare system (OR 4.98 [95% CI 2.05- 12.09])., Conclusion: Patients with hepatitis C that were covered by a public healthcare system had a 4 times higher chance of not having access to treatment with direct-acting antivirals than patients covered by other healthcare systems (private insurance or the social welfare system)., (Copyright © 2018 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.)

Objectives: Situational analysis of lymphatic filariasis (LF) morbidity and its management in Ahanta West, Ghana, to identify potential barrier to healthcare for LF patients., Methods: Lymphoedema and hydrocoele patients were identified by community health workers from a subset of villages, and were interviewed and participated in focus group discussions to determine their attitudes and practices towards managing their morbidity, and their perceived barriers to accessing care. Local health professionals were also interviewed to obtain their views on the availability of morbidity management services in the district., Results: Sixty-two patients (34 lymphoedema and 28 hydrocoeles) and 13 local health professionals were included in the study. Lymphoedema patients predominantly self-managed their conditions, which included washing with soap and water (61.8%), and exercising the affected area (52.9%). Almost 65% of patients had sought medical assistance at some stage, but support was generally limited to receiving tablets (91%). Local health professionals reported rarely seeing lymphoedema patients, citing stigma and lack of provisions to assist patients as a reason for this. Almost half of hydrocoele patients (44%) chose not to seek medical assistance despite the negative impact it had on their lives. Whilst surgery itself is free with national health insurance, 63% those who had not sought treatment stated that indirect costs of surgery (travel costs, loss of earnings, etc.) were the most prohibitive factor to seeking treatment., Conclusions: The information obtained from this study should now be used to guide future morbidity strategies in building a stronger relationship between the local health services and LF patients, to ultimately improve patients' physical, psychological and economic wellbeing., (© 2015 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.)

Objective: To document the lived experiences of people with both poor mental health and suboptimal adherence to antiretroviral therapy in high HIV prevalence settings., Methods: In-depth qualitative interviews were conducted with 47 (female = 31) HIV-positive adults who scored above the cut-point on a locally validated scale for common mental disorders (CMDs). Purposive sampling was used to recruit participants with evidence of poor adherence. Six additional key informant interviews (female = 6) were conducted with healthcare workers. Data were collected and analysed inductively by an interdisciplinary coding team., Results: The major challenges faced by participants were stressors (poverty, stigma, marital problems) and symptoms of CMDs ('thinking too much', changes to appetite and sleep, 'burdened heart' and low energy levels). Thinking too much, which appears closely related to rumination, was the symptom with the greatest negative impact on adherence to antiretroviral therapy among HIV-positive adults with CMDs. In turn, thinking too much was commonly triggered by the stressors faced by people living with HIV/AIDS, especially poverty. Finally, participants desired private counselling, access to income-generating activities and family engagement in mental health care., Conclusions: Better understanding of the local expression of mental disorders and of underlying stressors can inform the development of culturally sensitive interventions to reduce CMDs and poor adherence to antiretroviral therapy., (© 2015 John Wiley & Sons Ltd.)

Purpose: To understand the potential barriers, motivators and enablers in dispensing multifocal contact lenses (MFCL)., Method: Two focus group discussions were conducted to design questionnaires regarding the prescribing habits for multifocal contact lenses (MFCL). Questions on potential barriers and motivators were included. The questionnaires were distributed among 133 eye care practitioners across Mumbai, India. Practitioners fitting one or less patient per month with MFCL completed the survey describing potential barriers, while those who prescribed more MFCL's per month completed the survey describing enablers and motivators., Results: Responses from 102 practitioners were received. Most common potential barriers in prescribing MFCL were increased chair time (75%), lack of readily available trials (69%) and limitation in power range (63%). Lack of awareness among patients (90%) was the most common barrier from patients' outlook. Professional satisfaction (88%) and better business proposition (82%) were observed as main motivators while availability of the trials (84%) and correct patient selection (82%) were the major enablers. Graduate Optometrists felt dispensing MFCL did not offer a good business proposition (p=0.02). Experienced practitioners were observed to be least motivated (p=0.01) and believed that their patients found these lenses expensive (p=0.02)., Conclusion: To enhance the MFCL practice, barriers like lack of awareness and limitations in power range must be addressed. Trial lens availability may motivate practitioners to prescribe MFCL. Further probing is required to understand lack of motivation among experienced practitioners., (Copyright © 2014 Spanish General Council of Optometry. Published by Elsevier Espana. All rights reserved.)

Objective: The aim of this study was to determine the influence of perception of the environment in physical activity habits of schoolchildren (aged 9-11 years) in the province of Cuenca, Spain., Methods: Using a phenomenological perspective drawings were analyzed individual about their environment and places you normally would from a purposive sample of 32 students of 4th and 5th year of primary education. These same students participated in seven focus groups with a script aimed to obtain information on their perception of the environment and its influence on physical activity habits., Results: After analyzing four categories emerged: residence, urban configuration, displacements/commuting and sense of belonging or membership to the neighborhood. The students perceived that reside in gated communities or in rural areas facilitates physical activity of schoolchildren, while residing in neighborhoods and cities less accessible, feeling of insecurity traffic, make car journeys, and the sense of not belonging or membership to the neighborhood were perceived by children as barriers to being active., Conclusions: The perception of the environment influences physical activity habits of schoolchildren in the province of Cuenca. Changes in physical activity patterns of schoolchildren cannot take place without considering the context in which the individual exists, so specific strategies are needed that take into account the urban environment to promote physical activity of schoolchildren., (Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.)