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Drawing on a mixed-methods cross-cultural study undertaken in five locations in Argentina, Denmark, Hong Kong, England and the United States in 2018, this paper explores how children (aged five and seven) conceive of playfulness. Following a card-sorting task, 387 children selected familiar activities that they felt were most representative of play and not-play and explained their reasons. The children's justifications were fully transcribed, and five corpora were created (one per site). Lexicometry was applied, generating sets of the characteristic responses per age in each site. In-depth qualitative interpretation of these modal responses revealed nine dimensions across play and not-play: pleasure, social context, materials, movement, agency, risk, goal, time and focus. Commonalities revealed that children's ideas around play are not aligned with specific activities but with the sense of agency in a secure physical and social context when carrying out an activity experienced as an end in itself. Implications for playful pedagogies highlight the need to open up play with opportunities for children's choice and initiative, confident exploration and immersion in the activities in which they participate. [Spanish translation by Mercè Rius.]

Introduction: Critical congenital heart disease (CCHD) is a term that refers to ductus-dependent structural anomalies of the heart that may be fatal or require invasive management in the first month of life., Objective: To know the prevalence and distribution of CCHD among newborns in Argentina, compared to other countries, and the proportion of prenatal detection and perinatal mortality., Material and Methods: Data provided by the National Network of Congenital Anomalies (Red Nacional de Anomalías Congénitas de Argentina, RENAC) for the 2009-2018 period and by other surveillance systems in the United States, Europe, and Colombia were used. For Argentina, the proportion of prenatal detection, perinatal mortality, and CCHD prevalence in newborns by jurisdiction and health system subsector were analyzed., Results: The prevalence of CCHD was 11.46 (95% confidence interval: 11.02-11.92) every 10 000 births. Prenatal detection was possible in 43.93% of cases, and perinatal mortality was 25%. Tetralogy of Fallot was the most frequent specific defect. The prevalence of CCHD and percentage of prenatal detection was significantly lower in the public subsector, whereas perinatal mortality was higher in this subsector. The prevalence of CCHD was lower than in the United States (NBDPN) and European (EUROCAT) registries. The Bogotá Registry showed different specific prevalence values., Conclusion: The prevalence of CCHD is lower than what has been observed in other countries, and even lower in the public sector of Argentina. The need to improve prenatal detection and implement pulse oximetry among newborns as a mandatory and universal screening is emphasized.

Summary: Out-of-hospital cardiac arrest is a serious public health problem worldwide. The annual incidence is estimated at around 400 000 cases in Europe and the United States, and survival rates scarcely reach 10%. However, there is considerable variation between countries and even between regions that share a similar health care system within a single country. Information recorded by the Out-of-Hospital Spanish Cardiac Arrest Registry (OHSCAR) provides information on care provided by emergency ambulance services, final health outcomes after cardiac arrest cases (including variations), the possibility of organ donation, and the impact of the COVID-19 pandemic. This paper presents the OHSCAR report for Spanish emergency services for the year 2022.

Introduction: Neuropsychiatric symptoms are common in patients with mild cognitive impairment and dementia. This symptomatology can appear or be exacerbated with changes in routine and in the patient's usual environment. The lockdown situation during the COVID-19 pandemic has meant a drastic and unexpected change in the daily life of the general population, with a particular impact on the most physically and mentally vulnerable groups, including patients with cognitive impairment., Aim: To know the impact of lockdown measures imposed due to the COVID-19 pandemic on neuropsychiatric symptomatology in people with mild cognitive impairment and dementia., Materials and Methods: Exploratory systematic review, in accordance with the PRISMA guidelines, of Pubmed and Psycinfo databases papers published from January 2020 to April 2021 which related confinement due to COVID-19 with the presentation or worsening of neuropsychiatric symptoms in patients with mild cognitive impairment mild or dementia., Results: Worsening of neuropsychiatric symptoms was observed in patients with dementia and mild cognitive impairment, especially agitation/aggression, anxiety, depression and apathy. Neuropsychiatric symptoms were more common in patients with dementia than in those with mild cognitive impairment, although their typology varied depending on the severity of dementia., Conclusions: During lockdown a worsening in the psychobehavioral area has been observed in people with mild cognitive impairment or dementia. Therefore, considerations arise on the need of promoting social contact in people with mild cognitive impairment and dementia, avoiding situations of isolation and low stimulation.

The role that environmental factors can play in preventing and controlling the Covid-19 epidemic was explored and compared to that of influenza. Papers cited by the U.S. National Academy of Sciences were discussed, which indicate that temperature and humidity in the environment can influence the intensity of the spread of the disease. The fact that influenza viruses and coronaviruses appeared seasonally, prevailing in the winter and declining in the summer, was illustrated. It was discussed that ultraviolet light in the environment can contribute to the control of the spread of the virus. A study was cited to suggest that particulate matter contributes to increased infection mortality, and that it increases in summer in some regions, countering the health effects of humidity and temperature. Data generated by online electronic tools was compared with surveillance reports generated by the U.S. Centers for Disease Control and Prevention. The epidemic began stronger in northern hemisphere countries during the northern winter. (Evidence that the epidemic intensified during the southern winter is not disputed.) The incidence declined in the northern hemisphere during the summer, except for the U.S., where cases doubled. Evidence suggests that the high degree of SARS-CoV-2 infection counteracts the role that environmental factors may play in Covid-19 control.

Objective: this study examined scholarly output relating to nursing advocacy contributions toward influencing policy by authors in countries of the Pan American Health Organization., Method: the study utilizes a bibliographic analysis of papers indexed in Scopus authored by PAHO member state scholars. VOSviewer conducted coauthor and cooccurrence analysis to generate visualizations of the relationships between authors, countries of origin and keywords., Results: 7,773 papers with 21,523 authors met the inclusion criteria. An increase of publications on policy starting in 1962 was found. Co-authorship identified a fragile relationships structure with few authors bridging networks of collaboration. By country of origin, 22 of 35 member states contributed to policy literature; 17 in a connected network and 5 contributing but neither connected to peers nor other member states. Keyword analysis identified 20 specific data clusters., Conclusion: our findings are aligned with the Nursing Now Campaign. This bibliographic analysis provides an important benchmark into current policy advocacy activity in PAHO against which future progress in the region can be assessed. There is scope for greater collaboration amongst authors and this could be targeted toward engagement of nurses in member states not-yet or only partially active in this space.

Background: In the scientific literature, the impacts of plateletpheresis on leukogram parameters are not clear, with a high divergence in the studies that have evaluated changes in leukocytes. The objective of this paper was to meta-analyze the effect of plateletpheresis on the leukocyte count, based on studies published between 1980-2018., Methods: Systematic review with meta-analysis of random effects for the difference of means. The phases of the PRISMA guide were applied with 132 search strategies in Pubmed, Scielo, Science direct and Scopus. Reproducibility and evaluation of methodological quality were guaranteed. Heterogeneity was evaluated with Galbraith and Dersimonian and Laird's, publication bias with Funnel Plot and Begg; sensitivity analysis, accumulated meta-analysis and Forest Plot were carried out., Results: Nineteen studies were included with 2,358 donors, mostly from India, United States, Turkey, Germany and Austria. A mean difference of -0,80 x109⁄L (IC95%= -1,96; 0,36x109⁄L) between the predonation value and the value immediately after donation was founded; no publication bias was found and the conclusion presented good sensitivity since it does not vary with the elimination of studies in successive phases., Conclusions: The donation of platelets by apheresis does not affect the leukocyte count in the donors, in the last century there were reports of reductions in this parameter, explained by the blood loss in the cases used for the procedure and by effects produced in the blood cells by the biomaterials; however, at present the high safety of plateletpheresis for the white blood cell count is evidenced.

En: International guidelines recommend adapting military health care protocols to emergencies involving multiple intentional-injury victims in civilian environments. Adaptations can reflect similarities in types of injuries or issues of provider safety and that arise in military and some civilian emergencies. Because more experience with such incidents has been gained in the United States, most of the literature on this topic discusses emergency medical systems that differ from the ones operating in the autonomous communities of Spain, where varying resources and procedures are mandated by local authorities charged with preparing for emergencies. However, common elements are present, offering a framework and principles to apply when drafting evidence-based plans for effective, efficient response to multiple-victim emergencies. We think that participants at each point in the chain of survival must have clear missions and understand the roles they play in the various zones that comprise the scene of an emergency. Therefore this consensus paper attempts to define the relevant principles and roles for participants at all levels, from occasional first responders up to staff at trauma referral centers.

Health care raises structural issues in a democratic society, such as the role assigned to the central government in the management of health risk and the redistributive consequences generated by the implementation of social insurance. These are often cause of strong political controversy. This paper examines the United States of America health reform, popularly known as "ObamaCare". Its three main elements, namely individual mandate, creation of new health insurance exchanges, and the expansion of Medicaid, generated a redistribution of health risks in the insurance market of that country after almost a century of frustrated legislative efforts to guarantee minimum universal coverage. The article proposes that a change of this magnitude in the United States will produce effects in a forthcoming parliamentary discussion on the health reform in Chile, which still maintains a highly deregulated private health system.

The high unemployment rates observed in the United States during the recent economic crisis, that moreover vary between ethnic groups, make it relevant to inquire into how this problem is linked to the mental health of employed and unemployed persons. Therefore, in this paper the relationship between unemployment and mental health among Mexican immigrants, Mexicans born in the US, and other Hispanics in comparison with non-Hispanic native whites and Afro-Americans in the US is analyzed. To achieve this objective prevalence, prevalence ratios and odds ratios for the population between 18 and 65 years of age in the labor force was calculated using data from the 1999 and 2009 National Health Interview Surveys. It was seen that in times of crisis the prevalence of Non-Specific Psychological Disorders (NSPD) in the labor force increased in all ethnic groups. The prevalence ratios indicate that the unemployed face a higher risk of suffering from NSPD than the employed, especially for the non-Mexican Hispanics. Mexican immigrants, in contrast, show the lowest risks.

Physicians have conducted research on syphilis for centuries, seeking to understand its etiology and the means of transmission as well as find ways to prevent and cure the disease. Their research practices often strayed from today's ethical standards. In this paper we review ethical aspects of the long history of research on syphilis with emphasis on the experiments performed in the 20th century. The description of research around the time of World War II covers medical experiments carried out in US prisons and in the experimentation centers established by Japanese doctors in occupied territory, as well as experiments in Nazi Germany and the treatment of syphilitics there., (Copyright © 2013 Elsevier España, S.L.U. and AEDV. All rights reserved.)