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Introduction Burnout refers to a constellation of feelings of exhaustion, depersonalization, and low sense of personal accomplishment that develops secondary to long-term occupational stress. Several studies have identified that health care professionals are a high-risk occupational group for burnout, but knowledge about this syndrome among midwives has not been fully explored. The purpose of this study was to perform a systematic review of the prevalence and levels of burnout among midwives and analyze the related factors. Methods The following databases were searched: CINAHL, LILACS, MEDLINE, ProQuest, PsycINFO, SciELO, and Scopus. Any date of publication was acceptable. Literature from different countries was included. Studies were appraised for quality following the recommendations of the Oxford Centre for Evidence-Based Medicine. Results The literature review identified 27 studies with a total of N = 5612 midwives. The main factors related to burnout were working conditions such as work overload, lack of autonomy, and professional recognition. Midwives who had less than 10 years of experience were more vulnerable to burnout than those who had more than 10 years' experience. With regard to the subcategories of burnout (emotional exhaustion, depersonalization and perceived personal achievement), midwives who did not live with a partner were more vulnerable low levels of personal accomplishment when compared with midwives who were living with a partner. The most significant protective factors against burnout were good leadership and the use of continuity models of care. Discussion Midwives had moderate levels of emotional exhaustion and low levels of personal accomplishment. Working conditions were identified as the main modifiable factors related to burnout syndrome. Intervention programs for midwives should be aimed at reducing emotional exhaustion and enhancing personal accomplishment.

PurposeThe goal of the article is twofold: to determine the effectiveness of monetary incentives for disclosing personal information and to confirm the existence of a “bite the bullet” effect whereby people more easily accept providing personal data if they become aware of the requirement when the purchasing decision is almost taken.Design/methodology/approachAn experiment in which participants made a real purchase on the AliExpress marketplace was carried out. They were asked to login either via the Facebook button or by creating a username and password. A different reimbursement of the price paid for their purchase was offered in each case. This information was presented either at the beginning of the purchasing process or just before completing the purchase order.FindingsThe monetary incentive proved to work well. The “bite the bullet” effect could not be assessed because many participants willingly gave their data to the company even if they had decided not to buy anything.Practical implicationsFrom a managerial perspective, this is good news. This is a calamity from a policy perspective. More experiments carried out in real settings are needed as a first step for reconsidering public action.Social implicationsWhile people continue to publicly declare that they have privacy concerns, their behavior could not be further removed from such concerns.Originality/valueExperiment in a completely real setting, in which participants made a purchase using their own credit card.

BACKGROUND AND OBJECTIVES: Experimental data suggest that trace elements, such as arsenic (As), cadmium (Cd), and selenium (Se) can influence the bone remodeling process. We evaluated the cross-sectional association between As, Cd, and Se biomarkers with bone mineral density (BMD) measured at the calcaneus, in a representative sample of a general population from Spain. As secondary analyses we evaluated the associations of interest in subgroups defined by well-established BMD determinants, and also conducted prospective analysis of osteoporosis-related incident bone fractures restricted to participants older than 50 years-old. METHODS: In N=1365 Hortega Study participants > 20 years-old, urine As and Cd were measured by inductively coupled-plasma mass spectrometry (ICPMS); plasma Se was measured by atomic absorption spectrometry (AAS) with graphite furnace; and BMD at the calcaneus was measured using the Peripheral Instaneuous X-ray Imaging system (PIXI). As levels were corrected for arsenobetaine (Asb) to account for inorganic As exposure. RESULTS: The median of total urine As, Asb-corrected urine As, urine Cd, and plasma Se was 61.3, 6.53 and 0.39 μg/g creatinine, and 84.9 μg/L, respectively. In cross-sectional analysis, urine As and Cd were not associated with reduced BMD (T-score < −1 SD). We observed a non-linear dose-response of Se and reduced BMD, showing an inverse association below ~105 μg/L, which became increasingly positive above ~105 μg/L. The evaluated subgroups did not show differential associations. In prospective analysis, while we also observed a U-shape dose-response of selenium with the incidence of osteoporosis-related bone fractures, the positive association above ~105 μg/L was markedly stronger, compared to the cross-sectional analysis. CONCLUSIONS: Our results support that Se, but not As and Cd, was associated to BMD-related disease. The association of Se and BMD-related disease was non-linear, including a strong positive association with osteoporosis-related bone fractures risk at the higher Se exposure range. Considering the substantial burden of bone loss in elderly populations, additional large prospective studies are needed to confirm the relevance of our findings to bone loss prevention in the population depending on Se exposure levels.

Health science students will play an important role in helping their patients to assess health information and thus to examine their health literacy level is crucial. We aimed to assess the health literacy (HL) status and its potential association with health behaviours. A cross-sectional study was conducted in 381 students (mean age of 20.68 ± 3.89 years). The HL questionnaire (HLS-EU-Q47) and the Health-Promoting Lifestyle Behaviors (HPLP-II) were used. The overall mean HL score was 36.52 ± 7.73. About 30.2% of students have inadequate or problematic HL. The HPLP-II total score (β = 0.188, 95% CI = 0.024, 0.352), physical activity (β = 0.062, 95% CI = 0.009, 0.116) and health responsibility domains (β = 0.042, 95% CI = -0.001, 0.086) were significantly associated with HL. Most health science students, as future healthcare providers, need to improve health literacy skills. Health literacy was linked to health behaviours, supporting the importance of including focus on health literacy in higher education curriculum.

To analyse the effect of mindfulness training on levels of burnout among nurses.Burnout syndrome is a common occupational hazard for nursing staff. Mindfulness training has been proposed as a valid intervention for burnout.Systematic review and meta-analysis.The CINAHL, LILACS, Medline, ProQuest, PsycINFO, Scielo and Scopus databases were consulted, using the search equation 'Nurs * AND burnout AND mindfulness'. There was no restriction on the year of publication.Papers were selected for analysis in accordance with the PRISMA guidelines. The meta-analysis was carried out using Review Manager 5.3 software.The sample was of 17 articles including 632 nurses. Mindfulness training reduces levels of burnout, producing lower scores for emotional exhaustion and depersonalization and higher for personal accomplishment. The differences in the means were 1.32 (95% CI: -9.41-6.78), 1.91 (95% CI: -4.50-0.68) and 2.12 (95% CI: -9.91-14.14), respectively, between the intervention and control groups.Mindfulness training reduces the emotional burden and hence levels of burnout, among nurses. However, further randomized clinical trials are required.目的: 分析正念训练对护士职业倦怠程度的影响。 背景: 倦怠综合征对护理人员来说是一种常见的职业危害。而正念训练被认为是一种有效的职业倦怠干预措施。 设计: 系统评估与荟萃分析。 数据来源: 通过使用搜索方程‘Nurs*和倦怠与正念’在CINAHL、LILACS、Medline、ProQuest、Psychinfo、Scielo和Scopus数据库中进行检索(不限制文献出版年份)。 评估方法: 根据PRISMA指南选择论文进行分析。使用Review Manager 5.3软件进行荟萃分析。 结果: 共选取17篇文献,包括632名护士。结果显示,正念训练可降低职业倦怠程度,而情绪衰竭和人格解体得分较低,个人成就感得分较高。干预组和对照组之间的平均值差异分别为1.32(95%CI:-9.41-6.78)、1.91(95%CI:-4.50-0.68)和2.12(95%CI:-9.91-14.14)。 结论: 正念训练可减轻护士的情绪负担,从而降低其职业倦怠程度。然而,还需开展进一步的随机临床试验进行验证。.

Coronary heart disease is the leading cause of death and disability worldwide. Traditionally, cardiac rehabilitation programmes are offered after cardiac events to aid recovery, improve quality of life, and reduce adverse events. The objective of this review was to assess the health-related quality of life, after a supervised cardiac rehabilitation programme, of patients who suffered a myocardial infarction. A systematic review was carried out in the CINAHL, Cochrane, LILACS, Medline, Scopus, and SciELO databases, according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Randomised controlled trials were selected. Meta-analyses were performed for the Short Form Health Survey SF-36, Myocardial Infarction Dimensional Assessment Scale (MIDAS), MacNew Heart Disease-Health-Related Quality of Life (HRQL) questionnaire, and European Quality of Life-Visual Analogue Scale (EuroQol-VAS) with the software Cochrane RevMan Web. Ten articles were found covering a total of 3577 patients. In the meta-analysis, the effect size of the cardiac rehabilitation programme was statistically significant in the intervention group for physical activity, emotional reaction, and dependency dimensions of the MIDAS questionnaire. For the control group, the score improved for SF-36 physical functioning, and body pain dimensions. The mean difference between the control and intervention group was not significant for the remaining dimensions, and neither for the MacNew Heart Disease-HRQL and EuroQol-VAS questionnaires. Supervised cardiac rehabilitation programmes were effective in improving health-related quality of life, however, there was a potential variability in the interventions; therefore, the results should be interpreted with caution. This study supports the importance of providing care and evaluating interventions via the supervision of trained health professionals, and further randomised clinical trials are needed to analyse the positive changes in mental and physical health outcomes.

El plomo (Pb) es un metal pesado altamente tóxico de importancia industrial cuya presencia continúa siendo un riesgo en el ambiente. Las concentraciones de este metal sobrepasan los límites establecidos por las agencias gubernamentales, amenazando la salud de la población, principalmente en los países en desarrollo. El Pb afecta a varios sistemas del organismo, incluyendo al reproductor. En este trabajo se revisan las investigaciones sobre sus efectos tóxicos en los ovarios, abordando estudios realizados in vivo e in vitro en mamíferos, principalmente rata, ratón y humanos, desde el año 2000 al 2020. Entre los principales hallazgos se encuentran las modificaciones del balance óxido-reducción (REDOX) celular, la separación de las células de la granulosa que conforman al folículo y el aumento de la atresia folicular, entre otros, que alteran los procesos reproductores. La realización de más estudios interdisciplinarios ayudará a mejorar la comprensión de los mecanismos de acción del Pb en el ovario y el riesgo a la salud reproductora femenina.

All sky-cameras are devices with a very high potential in order to study atmospheric phenomena and were originally designed to obtain the cloud cover. However, methods based in different approaches produce significant differences in the results. State-of-art methods usually offer better performance, thanks to computer vision and machine learning (ML) techniques, than traditional algorithms based on channel ratios using both fixed and adaptive thresholds to classify the pixels of one image as cloud or cloud free. We have developed a cloud cover adaptive threshold algorithm base on Probability Density Function (PDF) of the Blue to Red Ratio (BRR), standing out in: simplicity; ease of implementation; compatibility with any sky-camera in terms of technical requirement and type of image acquisition. The goal of this study is to compare our algorithm with a most fashionable method based on Machine learning, discovering the pros and cons of each one and weather ultimately less can be more. The comparison has been done using a set of 1-year HDR imagery database, representing a wider range of atmospheric scenarios such as clear sky, cloudy, partly cloudy and different types of aerosol conditions and clouds such as cirrus, cumulus, stratum and nimbus. To stablish a quantitative comparison of both methods, a limited set of images has been chosen. The PDF method show better agreement than our ML implementation, with a better performance for all weather conditions, in comparison against our cloud cover database.

The radiative closure methodologies to obtain Cloud Optical Depth (COD) from Remote Sensing techniques have traditionally relied on one-dimensional (1D) assumptions. These assumptions might be far away from the radiation transport over a realistic three-dimensional (3D) atmosphere, especially in cloudy conditions, as the natural inhomogeneities of clouds are not conveniently represented and treated in 1D models. The differences between the 1D and 3D approaches manifests in the 3D effects: a) the plane-parallel albedo bias and, b) the horizontal transport effect. The plane-parallel albedo bias is usually addressed by means of the Independent Pixel approximation (IPA), that considers each pixel radiatively independent from the others. Nevertheless, the IPA neglects the horizontal transport, entailing bias in the retrievals. In this work, we use the advantages of 3D radiative transfer (RT) to analyze COD and parameterize the 3D biases in terms of the plane-parallel approach. Detailed 3D RT simulations using MYSTIC are performed over two Highly Resolved Large Eddy Simulations cloud fields of known optical thickness. The output radiance is analyzed by a 1D IPA inversion retrieval based on a radiative closure to obtain the COD. The comparison between the retrieved COD fields for diverse illumination conditions and the real COD allow us to study the 3D effects separately and evaluate the retrieval. Our results show radiation enhancement in cloud edges depending on solar, viewing and cloud geometries, that induces a COD underestimation. The 1D approach works well for overcast conditions and underestimates the COD in broken clouds scenarios.

Type 2 diabetes mellitus (DM2) is a highly prevalent disease, the progression of which depends on high blood glucose levels, which are reflected in the level of glycosylated haemoglobin (HbA1c). Appropriate health education equips patients with the knowledge and skills to control their glucose and HbA1c levels to avoid long-term complications. This study was set up to compare the results of an intensive (360 min) educational intervention to improve HbA1c parameters in patients with DM2 with those of a usual 90 min intervention. For this purpose, healthcare personnel led a quasi-experimental study of 249 diabetics: 171 in the control group, and 78 in the intervention group. In the control group, the mean HbA1c value decreased from 6.97 to 6.75, while in intervention group it fell from 8.97 to 8.06. The before and after mean difference between both groups was compared with a Wilcoxon test, and the results statistically significant (W = 4530, p &lt, 0.001), indicating a higher reduction of HbA1c in the intervention group. We concluded that the intensive health education provided by nurses during the consultation helped improve HBA1c levels in persons with DM2.

Pesticides have been considered as potential chemical mutagens, however, little is known about toxic and genotoxic effects during pesticide application in Zamora-Jacona, Michoacan State in Mexico. This study sought to determine DNA damage and cholinesterase activities inhibitions in 54 agricultural workers exposed to complex mixtures of pesticides vs. control group (26 individuals) using Comet assay in peripheral whole blood, micronucleus (MN) test in oral mucosa cells, Cytokinesis-blocked MN assay in lymphocytes (L-CBMNcyt) and measuring AChE and BChE activities in whole blood and plasma samples, respectively. Exposed subjects demonstrated significantly elevated levels of primary (Comet assay: tail intensity, tail length, tail moment, Olive tail moment) and permanent DNA damage (MN assay: in blood/buccal cells, frequencies of nuclear buds, binucleated cells, cells with condensed chromatin, karyorrhexis, pyknosis, and karyolysis). However, inhibition of cholinesterase activities (AChE and BChE) was not observed in the workers. Confounding factors including sex, age, BMI, working exposure period, protection level, smoking habit (cigarettes per day units), alcohol consumption (weekly), medication, were considered in the analysis. These combined techniques demonstrated usefulness in the health hazards risks pesticide exposure assessment and suggested the need for periodic monitoring together with the education and the training of occupational workers for the safe application of potentially harmful pesticides.

A respiratory syncytial virus (RSV) is the major cause of respiratory tract infection in children under 5 years. However, RSV infection in the European Region of the World Health Organization has not been systematically reviewed. The aim was to determine the prevalence and factors associated with RSV in children under 5 years of age in European regions. A systematic review and meta-analysis was performed. CINAHL, Medline, LILACS, ProQuest, SciELO, and Scopus databases were consulted for studies published in the last 5 years, following Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The search equation was “respiratory syncytial virus AND (newborn OR infant OR child) AND (prevalence OR risk factors)”. Studies reporting the prevalence of RSV were eligible for inclusion in the meta-analysis. A total of 20 articles were included. The meta-analytic prevalence estimation of RSV, with a sample of n = 16,115 children, was 46% (95% CI 34–59%). The main risk factors were age, male gender, winter season, and environmental factors such as cold temperatures, higher relative humidity, high concentrations of benzene, exposure to tobacco, and living in urban areas. Robust age-specific estimates of RSV infection in healthy children should be promoted in order to determine the optimal age for immunization. In addition, it is necessary to analyse in greater depth the potentially predictive factors of RSV infection, to be included in prevention strategies.

Institutional Review Board Statement: The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Ethics Committee of the Andalusian Health Service (LUNG CA SURV 2180-N-20)., Data Availability Statement: The data presented in this study are available on request from the corresponding author. The data are not publicly available due to ethical., Background: Lung cancer is typically diagnosed in an advanced phase of its natural history. Explanatory models based on epidemiological and clinical variables provide an approximation of patient survival less than one year using information extracted from the case history only, whereas models involving therapeutic variables must confirm that any treatment applied is worse than surgery in survival terms. Models for classifying less than one year survival for patients diagnosed with lung cancer which are able to identify risk factors and quantify their effect for prognosis are analyzed. Method: Two stepwise binary logistic regression models, based on a retrospective study of 521 cases of patients diagnosed with lung cancer in the Interventional Pneumology Unit at the Hospital “Virgen de las Nieves”, Granada, Spain. Results: The first model included variables age, history of pulmonary neoplasm, tumor location, dyspnea, dysphonia, and chest pain. The independent risk factors age greater than 70 years, a peripheral location, dyspnea and dysphonia were significant. For the second model, treatments were also significant. Conclusions: Age, history of pulmonary neoplasm, tumor location, dyspnea, dysphonia, and chest pain are predictors for survival in patients diagnosed with lung cancer at the time of diagnosis. The treatment applied is significant for classifying less than one year survival time which confirms that any treatment is markedly inferior to surgery in terms of survival. This allows to consider applications of more or less aggressive treatments, anticipation of palliative cares or comfort measures, inclusion in clinical trials, etc.

Aims The aim of this review and meta-analysis is to analyse the effectiveness of nursing interventions for the management of preoperative anxiety in adults. Background The perioperative process is a stressful situation for many people who are going to be operated and it can generate feelings of anxiety. Also, preoperative anxiety can appear in the perioperative period. Nursing management of preoperative anxiety through individualized interventions can be effective for reducing anxiety. Design A systematic review with meta-analysis was performed. Data sources CINAHL, CUIDEN, Pubmed, ProQuest and Scopus databases were consulted without restriction per year of publication. The search was conducted in February 2020. Review methods Experimental studies on nursing management in preoperative anxiety with adults sample (>18 years) published in English and/or Spanish were included. All types of surgery were included in the review. A random effects meta-analysis was performed to estimate the effect size for preoperative anxiety measured with STAI. Results After the selection process n = 9 quantitative studies with nursing interventions for preoperative anxiety were included. A preoperative educational and informative interview was used in six studies, one study used empathic interview, one used motivational interview and one used hand massage. The meta-analysis, including four studies using nursing interviews, had a sample of n = 419 in the intervention group and n = 445 in the control group. The mean difference in preoperative state anxiety measured with the STAI was in favour of the nursing intervention. Conclusion Nursing interventions for patients who are going to be operated seems to have a positive impact in their preoperative anxiety. However, due to the low number of studies and the heterogeneity of the sample, more research is needed about the topic.

Attention deficit/hyperactivity disorder (ADHD) is one of the most frequent neurodevelopmental disorders in childhood and adolescence. Choosing the right treatment is critical to controlling and improving symptoms. An innovative ADHD treatment is neurofeedback (NF) that trains participants to self-regulate brain activity. The aim of the study was to analyze the effects of NF interventions in children with ADHD. A systematic review was carried out in the CINAHL, Medline (PubMed), Proquest, and Scopus databases, following the PRISMA recommendations. Nine articles were found. The NF improved behavior, allowed greater control of impulsivity, and increased sustained attention. In addition, it improved motor control, bimanual coordination and was associated with a reduction in theta waves. NF combined with other interventions such as medication, physical activity, behavioral therapy training, or attention training with brain–computer interaction, reduced primary ADHD symptoms. Furthermore, more randomized controlled trials would be necessary to determine the significant effects.

Background: Respiratory syncytial virus (RSV) is the major cause of respiratory tract infection in children under 5 years. However, RSV infection in the European region of the World Health Organization has not been systematically reviewed. Aim: To determine the prevalence and factors associated with RSV in children under 5 years of age in European regions. Methods: A systematic review and meta-analysis was performed. CINAHL, Medline, LILACS, ProQuest, SciELO and Scopus databases were consulted for studies publisehd in the last 5 years, following Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The search equation was “respiratory syncytial virus AND (newborn OR infant OR child) AND (prevalence OR risk factors). Studies reporting the prevalence of RSV were eligible for inclusion in the meta-analysis. Findings: A total of 21 articles were included with a total sample of n = 24,465 children. The meta-analytic prevalence estimation of RSV, with a sample of n = 16,115 children, was 46% (95% CI 34–59%). The main risk factors were age, male gender, winter season and environmental factors such as cold temperatures, higher relative humidity, high concentrations of benzene and ozone, exposure to tobacco and living in urban areas. Interpretation: Robust age-specific estimates of RSV infection in healthy children should be promoted in order to determine the optimal age for immunization. In addition, it is necessary to analyze in greater depth the potentially predictive factors of RSV infection, to be included in prevention strategies. Funding Statement: None. Declaration of Interests: We declare no competing interests.

Lung cancer (LC) is the second most common cause of death in men after prostate cancer, and the third most recurrent type of tumor in women after breast and colon cancers. Unfortunately, when LC symptoms begin to appear, the disease is already in an advanced stage and the survival rate only reaches 2%. Thus, there is an urgent need for early diagnosis of LC using specific biomarkers, as well as effective therapies and strategies against LC. On the other hand, the influence of metals on more than 50% of proteins is responsible for their catalytic properties or structure, and their presence in molecules is determined in many cases by the genome. Research has shown that redox metal dysregulation could be the basis for the onset and progression of LC disease. Moreover, metals can interact between them through antagonistic, synergistic and competitive mechanisms, and for this reason metals ratios and correlations in LC should be explored. One of the most studied antagonists against the toxic action of metals is selenium, which plays key roles in medicine, especially related to selenoproteins. The study of potential biomarkers able to diagnose the disease in early stage is conditioned by the development of new analytical methodologies. In this sense, omic methodologies like metallomics, proteomics and metabolomics can greatly assist in the discovery of biomarkers for LC early diagnosis.

Currently, one of the main public health problems among children and adolescents is poor adherence to healthy habits, leading to increasingly high rates of obesity and the comorbidities that accompany obesity. Early interventions are necessary, and among them, the use of gamification can be an effective method. The objective was to analyse the effect of game-based interventions (gamification) for improving nutritional habits, knowledge, and changes in body composition. A systematic review and meta-analysis were performed in CINAHL, EMBASE, LILACS, MEDLINE, SciELO, and Scopus databases, following the PRISMA recommendations. There was no restriction by year of publication or language. Only randomized controlled trials were included. Twenty-three articles were found. After the intervention, the consumption of fruit and vegetables increased, as well as the knowledge on healthy food groups. The means difference showed a higher nutritional knowledge score in the intervention group 95% CI 0.88 (0.05–1.75). No significant effect of gamification was found for body mass index z-score. Gamification could be an effective method to improve nutritional knowledge about healthier nutritional habits. Promoting the development of effective educational tools to support learning related to nutrition is necessary in order to avoid and prevent chronic diseases.

Coronary heart disease is a public health problem and is one of the leading causes of loss of quality of life, disability, and death worldwide. The main procedure these patients undergo is cardiac catheterisation, which helps improve their quality of life, symptoms of myocardial ischemia, and ventricular function, thus helping increase the survival rate of su erers. It can also, however, lead to physical consequences, including kidney failure, acute myocardial infarction, and stroke. The objective of this study was to analyse how coronary artery bypass grafting (CABG) influences quality of life. A systematic review and meta-analysis were conducted using the CINAHL, PubMed, Scopus, and Cuiden databases in June 2020. A total of 7537 subjects were included, 16 in the systematic review and 3 in the meta-analysis. The studies analysing quality of life using the SF questionnaire showed improvements in the quality of physical and mental appearance, and those using the NHP questionnaire showed score improvements and, in some cases, di erences in quality of life between women and men. This operation seems to be a good choice for improving the quality of life of people with coronary pathologies, once the possible existing risks have been assessed., Clinical Medicine and Health Public Programme of University of Granada, Spain B 12.56.1

Finding methods to improve people’s diabetes control and management is important to prevent its complications and maintain the quality of life. The aim of this review was to assess the effect of games on the blood glucose level (glycated hemoglobin (HbA1c)). A systematic review and meta-analysis were made. Pubmed, Scopus, and CINAHL databases were consulted in July of 2020. Ten studies were selected as a final sample, most of them being clinical trials using games to improve diabetes control. Half of the studies had samples between 8 and 14.9 years old and the other half between 57 and 65 years old. The studies informed about using applications/games for mobile phones, game consoles, and board games for diabetes education and management. The meta-analysis was performed with 4 studies showing a mean difference of 0.12 (CI 95% 0.57, 0.33) of HbA1c in favor of the intervention group with p > 0.05. Games are positive for diabetes health education and promoting healthier lifestyle, but their impact on HbA1c is low.

Background Smartphones are technological devices that have a great impact on people's daily lives changing their habits and behaviors. The utilities and capabilities of these devices are increasing and the foresight is that this tendency will grow in the next years. However, the problematic use of the smartphone has increased dangerously, interfering with the clinical practice of healthcare professionals. Objective To conduct a systematic review and a meta-analysis to estimate the prevalence of smartphone addiction, also known as nomophobia, in nursing students and to identify its related factors and its negative effects. Design Systematic Review and Meta-analysis. Data sources The literature search was done in CINAHL, Proquest, Pubmed, Scopus and Web of Science databases. Review methods The search equation was “(nomophobia OR smartphone) AND nurs* student*”. n = 16 articles were identified. Results The meta-analytic estimation of nomophobia or smartphone addiction was 22% (CI95% 18%–26%] in a sample of n = 2780 nursing students. Smartphone usability is very extended during the clinical practice by nursing students. They indicated using the device or watching other students distracted with their smartphone. Some variables related to excessive use in nursing students are lower sleep quality, lower self-esteem, higher social distress, lower perceived social support or lower communication skills between others. Conclusions The main use of the smartphone by nursing students is for communication with other people and some of them indicate that it can be a distraction.

Objective Hodgkin and non-Hodgkin lymphoma patients are at high risk of experiencing anxiety because the clinical processes and therapies they undergo produce strong adverse effects. In this review we discuss the prevalence of anxiety among these patients and examine the methods used for data collection, intervention frequency, types of instruments used to recognize anxiety, and data collection purposes, both in Hodgkin and non-Hodgkin lymphoma survivors and patients being treated or diagnosed with these diseases. Methods This systematic review and meta-analysis of the literature was carried out using the following sources: PubMed, Scopus, LILACS, and PsycINFO. Results The meta-analysis sample was n = 2,138 and the overall prevalence of anxiety was 19% (95% CI [12%, 25%]). According to the Egger test, there were no publication biases and no studies were eliminated after the sensitivity analysis. The I2 for the heterogeneity analysis was 92.6%. Conclusions Hodgkin and non-Hodgkin lymphoma patients are vulnerable to suffering anxiety. It is important to focus on the psychological effect of anxiety during remission or current cancer treatments because they can affect patient outcomes. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Introduction We evaluated the in vitro activity of the combination of ceftaroline with daptomycin, linezolid and vancomycin against methicillin-resistant Staphylococcus aureus and coagulase-negative Staphylococcus (CNS). Material and methods We analysed 70 staphylococcal strains (31 S. aureus and 39 CNS) with the Etest using the MIC:MIC ratio method and calculation of fractional inhibitory concentration indexes. Results The combination of ceftaroline with daptomycin showed an additive effect (53.2%) and synergy (6.6%) against methicillin-susceptible S. aureus, and an additive effect (81.2%) against methicillin-resistant S. aureus (MRSA). This combination also showed an additive effect against 33% of linezolid-susceptible CNS and was not synergistic against linezolid-resistant CNS. The combination of ceftaroline with vancomycin was synergistic (87%) and ceftaroline with linezolid was additive (37%) against MRSA. Conclusions The combinations of ceftaroline with daptomycin, vancomycin or linezolid showed additive and/or synergistic effects against methicillin-resistant Staphylococcus.

When it comes to understanding the behavior of people when deciding whether to disclose personal information, just anecdotal evidence clearly suggests the need for experimental approaches. In spite of this, in the about fifteen years since the research on online privacy behavior emerged as a distinct field of scientific enquiry, experiments are but a few when compared to surveys and theoretical approaches, even adopting a broad definition of experiment. This article reviews all the experiments already done in the area and it also proposes a research agenda. Experimental techniques not only guide the building of descriptive theories but also serve to demonstrate or prove the adequacy of assumptions present in normative theory.

Objective To determine the prevalence of high levels of emotional exhaustion and depersonalization and low personal accomplishment in nursing professionals in oncology services. Methods A meta-analytical study was performed. The search was carried out in March 2017 in Pubmed, CINAHL, Scopus, Scielo, Proquest, CUIDEN, and LILACS databases. Studies using Maslach Burnout Inventory for the assessment of burnout were included. Results The total sample of oncology nurses was n = 9959. The total number of included studies was n = 17, with n = 21 samples for the meta-analysis of emotional exhaustion and n = 18 for depersonalization and low personal accomplishment. The prevalence of emotional exhaustion and of depersonalization was 30% (95% CI = 26%-33%) and 15% (95% CI = 9%-23%), respectively, and that of low personal performance was 35% (95% CI = 27%-43%). Conclusions The are many oncology nurses with emotional exhaustion and low levels of personal accomplishment. The presence and the risk of burnout among these staff members are considerable.

This paper investigates the evolution of the telecommunications policy agenda by means of text mining forty years –from 1976 to 2016– of papers in the journal Telecommunications Policy. Text mining techniques help identify the key topics, the dominant combinations of concepts and the main areas of research within this multidisciplinary –technical, economic, social, policy– discipline. In addition they depict an evolution of the policy agenda more nuanced than the conventional public service, pre-competition and post-liberalisation stages typical of telecommunications. Also, in combination with bibliometric information, the results display the relationships between areas of research and methodologies, countries and authors’ background, all together providing a deeper understanding of the past, present and future avenues for research in telecommunications policy.

To assess burnout levels in oncology nurses, to evaluate at what stage of burnout suffering they are and to analyze the relationship between burnout with personality factors.A quantitative, observational, cross-sectional multicenter study was done. Oncology nurses (n = 101) from the Andalusian Health Service (Andalusia, Spain) were included. The main variables were personality factors, assessed with the NEO-FFI questionnaire, anxiety and depression, assessed with the Educational-Clinical Questionnaire: Anxiety and Depression, and burnout, evaluated with the Maslach Burnout Inventory. Student t-statistic was used for hypothesis contrasts and Pearson's correlation coefficient was used to establish the association between personality factors and burnout.According to the burnout phases model, 29.6% of the sample is in the most severe phases. Emotional exhaustion and depersonalization are positively correlated with neuroticism and negatively correlated with agreeableness, conscientiousness, extraversion and openness. Personal accomplishment has a negative correlation with neuroticism and negative correlations with agreeableness, conscientiousness, extraversion and openness. Finally, emotional exhaustion and depersonalization have a positive correlation with anxiety and depression, while personal accomplishment has a negative correlation with anxiety and depression.A significant number of oncology nurses are in the most severe stages of burnout suffering. Personality factors have a key role in burnout development. The importance of personality factors in burnout development should be taken into account.

Background: The interaction of cadmium with genes involved in oxidative stress, cadmium metabolism and transport pathways on albuminuria can provide biological insight on the relationship between cadmium and albuminuria at low exposure levels. Objectives: We tested the hypothesis that specific genotypes in candidate genes may confer increased susceptibility to cadmium exposure. Methods: Cadmium exposure was estimated by inductively coupled plasma mass spectrometry (ICPMS) in urine from 1397 men and women aged 18–85years participating in the Hortega Study, a representative sample of a general population from Spain. Urine albumin was measured by automated nephelometric immunochemistry. Abnormal albuminuria was defined as urine albumin greater than or equal to 30mg/g. Results: The weighted prevalence of abnormal albuminuria was 6.3%. The median level of urine cadmium was 0.39 (IQR, 0.23–0.65) μg/g creatinine. Multivariable-adjusted geometric mean ratios of albuminuria comparing the two highest to the lowest tertile of urine cadmium were 1.62 (95% CI, 1.43–1.84) and 2.94 (95% CI, 2.58–3.35), respectively. The corresponding odds ratios of abnormal albuminuria were 1.58 (0.83, 3.02) and 4.54 (2.58, 8.00). The association between urine cadmium and albuminuria was observed across all participant subgroups evaluated including participants without hypertension, diabetes or chronic kidney disease. We observed Bonferroni-corrected statistically significant interactions between urine cadmium levels and polymorphisms in gene SLC30A7 and RAC1. Conclusions: Increasing urine cadmium concentrations were cross-sectionally associated with increased albuminuria in a representative sample of a general population from Spain. Genetic variation in oxidative stress and cadmium metabolism and transport genes may confer differential susceptibility to potential cadmium effects. Keywords: Urine cadmium, Albuminuria, Gene-environment interaction, Population-based survey

The trihalomethanes (TTHMs) and others disinfection by-products (DBPs) are formed in drinking water by the reaction of chlorine with organic precursors contained in the source water, in two consecutive and linked stages, that starts at the treatment plant and continues in second stage along the distribution system (DS) by reaction of residual chlorine with organic precursors not removed. Following this approach, this study aimed at developing a two-stage empirical model for predicting the formation of TTHMs in the water treatment plant and subsequently their evolution along the water distribution system (WDS). The aim of the two-stage model was to improve the predictive capability for a wide range of scenarios of water treatments and distribution systems. The two-stage model was developed using multiple regression analysis from a database (January 2007 to July 2012) using three different treatment processes (conventional and advanced) in the water supply system of Aljaraque area (southwest of Spain). Then, the new model was validated using a recent database from the same water supply system (January 2011 to May 2015). The validation results indicated no significant difference in the predictive and observed values of TTHM (R 2 0.874, analytical variance

Objectives Hyperglycaemia is a common metabolic disorder in very-low-birth-weight (VLBW) infants and is associated with increased morbidity and mortality. The objective is to describe the incidence, duration, episodes and distribution of hyperglycaemia during the first 7 days of life of VLBW infants. Methods This is a prospective cohort study of 60 newborns weighing Results Incidence of hyperglycaemia recorded with the CGMS was 36.6% (95%CI: 24.6–50.1). In almost 74.6±5.48% of these cases the duration of the episode exceeded 30 min and in 45.25% (95%CI: 2.26–57.82) it exceeded 2 h. The condition occurred most frequently during the first 72 h of life. One-fifth of cases were not detected with scheduled capillary tests and 84.6% of these had hyperglycaemic episode durations of 30 min or more. Agreement between the two techniques was very good (r=0.90, p Conclusions A CGMS could be useful during the first week of life in VLBW infants due to the high incidence and significant duration of hyperglycaemia and the high proportion of cases that remain undetected. The advantage of the CGMS is that it is able to detect hyperglycaemic episodes that the capillary test does not.

The prevalence of burnout in midwives has been briefly studied. Given the negative effects of burnout syndrome in the physical and mental health, and also related to the quality of care provided, rates of absenteeism and sick leave; identifying related factors for the syndrome are needed. The aim was to determine the prevalence, levels, and factors related to the burnout syndrome, measured with the Copenhagen Burnout Inventory in midwives. A systematic review and meta-analysis were selected from CINAHL, LILACS, ProQuest, PsycINFO, PubMed, SciELO, and Scopus databases, with the search equation “burnout AND (midwife OR midwives OR nurses midwives)”. Fourteen articles were found with a total of 8959 midwives. Most of the studies showed moderate levels of personal burnout. The prevalence obtained was 50% (95% CI = 38–63) for personal burnout; 40% (95% CI = 32–49) for work-related burnout; and 10% (95% CI = 7–13) for client-related burnout. Midwives’ age, less experience, and living alone constitute the main related factors, as well as, the scarcity of resources, work environment, and the care model used. Most midwives present personal and work-related burnout, which indicates a high risk of developing burnout. Personal factors and working conditions should be taken into account when assessing burnout risk profiles of midwives.

Palliative care nurses are exposed to hard situations, death, and duel feelings in their daily practice. These, and other work stressors, can favor burnout development. Thus, it is important to analyze the prevalence and risk factors of burnout in palliative care nurses and estimate its prevalence. A systematic review and meta-analysis was done with quantitative primary studies. n = 15 studies were included with n = 6 studies including information for the meta-analysis. The meta-analytic prevalence estimation of emotional exhaustion was 24% (95% CI 16–34%), for depersonalization was 30% (95% CI 18–44%) and for low personal accomplishment was 28% with a sample of n = 693 palliative care nurses. The main variables related with burnout are occupational variables followed by psychological variables. Some interventions to improve working conditions of palliative care nurses should be implemented to reduce burnout.

Millimeter wave (mm-wave) is today’s breakthrough frontier for emerging wireless mobile cellular networks, wireless local and personal area networks, simultaneous energy/data transfer, wearable networks, vehicular communications and radar. Directive antennas emerge as a key component in most of these applications driven by the requirement to meet stringent link budget specifications and/or provide good imaging resolution. Many practical scenarios, (requiring e.g. continuous service when an obstacle blocks the line of sight, tracking of mobile terminals placed on a moving vehicle or scanning within a given field of view) further poses the need for antennas with beam-steering capabilities. Coupled with commercial viability constraints, the development of mm-wave directive antenna systems with beam-steering capabilities that also maintain compatibility with low-cost mass-manufacturing process and easy integration with the front-end has emerged as a key challenge for both communication and sensing applications. Among the traditional in-package directive antenna solutions, phased arrays involve a cumbersome feeding network which is impractical for mass-market mm-wave applications. Reflector and lens antenna architectures, although compatible with a simpler feeding network, are bulky and typically require mechanical reconfiguration to perform beam scanning, adding significant complexity and cost, increase power consumption and significantly limiting the scanning speed.

Introduction: Diabetes mellitus is a chronic endocrine-metabolic disease, the evolution of which is closely related to people’s self-control of glycemic levels through nutrition, exercise, and medicines. Aim: To determine whether smartphone apps can help persons with diabetes to improve their % levels of glycosylated hemoglobin. Method: A systematic review and meta-analysis were done. ProQuest, Pubmed/Medline, and Scopus databases were used. The search equation used was “(Prevention and Control) AND Diabetes Mellitus AND Smartphones”. The inclusion criteria applied were clinical trials, conducted in 2014−2019. Results: n = 18 studies were included in the review. The studies tried different applications to monitor glycemia and support patients to improve glycosylated hemoglobin (HbA1c) levels. More than half of the studies found statistically significant differences in HbA1c in the intervention group compared with the control group. Eleven studies were included in the meta-analysis and the study sample was n = 545 for the experimental group and n = 454 for the control group. The meta-analytic estimation of the HbA1c % level means differences between intervention and control group was statistically significant in favour of the intervention group with a mean difference of −0.37 (−0.58, −0.15. 95% confidence interval). Conclusion: Smartphone apps can help people with diabetes to improve their level of HbA1c, but the clinical impact is low.

The aim of this study was to analyze social networks’ information about the anti-vaccine movement. A systematic review was performed in PubMed, Scopus, CINAHL and CUIDEN databases. The search equations were: “vaccine AND social network” and “vaccine AND (Facebook[title] OR Twitter[title] OR Instagram[title] OR YouTube[title])”. The final sample was n = 12, including only articles published in the last 10 years, in English or Spanish. Social networks are used by the anti-vaccine groups to disseminate their information. To do this, these groups use different methods, including bots and trolls that generate anti-vaccination messages and spread quickly. In addition, the arguments that they use focus on possible harmful effects and the distrust of pharmaceuticals, promoting the use of social networks as a resource for finding health-related information. The anti-vaccine groups are able to use social networks and their resources to increase their number and do so through controversial arguments, such as the economic benefit of pharmaceuticals or personal stories of children to move the population without using reliable or evidence-based content.

[EN] In hematological malignancies, leukemias or myelomas, malignant cells present bone marrow (BM) homing, in which the niche contributes to tumor development and drug resistance. BM architecture, cellular and molecular composition and interactions define differential microenvironments that govern cell fate under physiological and pathological conditions and serve as a reference for the native biological landscape to be replicated in engineered platforms attempting to reproduce blood cancer behavior. This review summarizes the different models used to efficiently reproduce certain aspects of BM in vitro; however, they still lack the complexity of this tissue, which is relevant for fundamental aspects such as drug resistance development in multiple myeloma. Extracellular matrix composition, material topography, vascularization, cellular composition or stemness vs. differentiation balance are discussed as variables that could be rationally defined in tissue engineering approaches for achieving more relevant in vitro models. Fully humanized platforms closely resembling natural interactions still remain challenging and the question of to what extent accurate tissue complexity reproduction is essential to reliably predict drug responses is controversial. However, the contributions of these approaches to the fundamental knowledge of non-solid tumor biology, its regulation by niches, and the advance of personalized medicine are unquestionable., PROMETEO/2016/063 project is acknowledged. The CIBER-BBN initiative is funded by the VI National R&D&I Plan 2008-2011, Iniciativa Ingenio 2010, Consolider Program. CIBER actions are financed by the Instituto de Salud Carlos III with assistance from the European Regional Development Fund. This work was also supported by the Spanish Ministry of Science, Innovation and Universities through Grant FPU17/05810 awarded to Sandra Clara-Trujillo.

Background: Hospitalization disrupts children’s lives and can produce feelings such as anxiety, fear, or pain. Playing is an important part of children’s lives. Thus, it is necessary to ensure holistic care during the process, including play therapy. The aim of this study was to analyze the e ect of therapeutic play in hospitalized children. Methods: Asystematic review was performed. The search was conducted in CINAHL (Cumulative Index of Nursing and Allied Health Literature), CUIDEN, and PubMed (Medline). The search equation was “pediatric nurs* AND play therapy”. The search was performed in March 2020. Results: n = 14 studies were included in the review. The studies reveal that the application of therapeutic play in hospitalized children decreases postoperative pain, improves behavior and attitude, and reduces anxiety during the hospital stay. Conclusions: play therapy has a beneficial impact on the care of hospitalized children and should be implemented in pediatric units after assessing the resources and training needed for pediatric nurses

Background: Hypoglycemia is common in very low birth weight neonates and may have adverse effects. Material and Method: Sixty preterm infants were monitored using continuous glucose monitoring (CGM...

A cross-sectional study was conducted to investigate the association between body composition parameters as well as body mass index (BMI), and dietary energy density in a population of 538 young adults. Fat mass, fat mass percent, fat-free mass, and visceral fat were measured using a body composition analyzer. Daily energy intake was assessed using a 72-hr diet recall, and dietary energy density was calculated. Significant differences in dietary energy density among underweight, normal-weight and overweight/obesity young adults were identified ( M = 1.42, SD = 0.26 vs. M = 1.52, SD = 0.46 vs. M = 1.66, SD = 0.53, p = .002). Dietary energy density was associated with BMI (β = .961; CI 95% = 0.335, 1.586; p = .0030), fat mass percent (β = 1.921; CI 95% = 0.707, 3.135; p = .002), and fat mass (β = 2.146; CI 95% = 0.827, 3.466; p = .001). Dietary energy density might be considered as an important aspect in the obesity nutritional education programs in young people.

Lung Cancer (LC) has a high mortality, because of the late diagnosis, which implies less probability of healing. During the development of the cancer some trace elements (metals or metalloids), have an important role activating or inhibiting enzymatic reactions. Our study is based on the study of trace elements as early biomarkers (BM) of LC; studying samples of blood, urine a bronchoalveolar lavage (BAL). We design a transversal study with 48 patients with LC and 39 controls divided in Healthy (C) and Lung Disease no Cancer (LDnC). We analyze concentrations of 11 metals of high and low molecular mass (V, Cr, Mn, Fe, Co, Cu, Zn, Se, Mo, Cd y Pb) in three kind of samples, using mass inductive-spectrometry technique. For statistics were used four different analyses: a)Mann-Whitney U test, to compare concentrations of different elements on the 3 groups. b)Spearman’s test to found correlations between altered element on LC group. c)Partial least squares-discriminant analysis, to determine which elements are more influents. d)Area under the curve to found specificity and sensibility of the altered metals and its role as BM. We obtained clear discrimination between groups on the 3 kind of samples, using over expressed or reduced levels of metals on LC group that could be used as BM. Vanadium and chrome are over expressed on LC group; and we know they’re related to metabolic process of cancer. Also we propose BM based on metal dyshomeostases, like in serum (V/Mn, V/Pb, V/Zn, Cr/Pb), in urine (Cr/Cd, Mn/Cd, V/Cd, Co/Cd, Cd/Pb) and in BAL (V/Cu). Correlations between different metal elements shown differences between patients with LC and the control groups (C, LDnC); what could imply that this elements could be used as early BM of LC.

Nurses in primary health care (PHC) have multiple responsibilities but must often work with limited resources. The study’s aim was to estimate burnout levels among PHC nurses. A Quantitative, observational, cross-sectional, multicentre study of 338 nurses working in PHC in the Andalusian Public Health Service (Spain) is presented. A total of 40.24% of the nurses studied had high levels of burnout. The dimensions of emotional exhaustion and depersonalisation were significantly associated with anxiety, depression, neuroticism, on-call duty and seniority-profession and inversely related to agreeableness. In addition, depersonalisation was significantly associated with gender, and emotional exhaustion correlated inversely with age. Personal achievement was inversely associated with anxiety and depression and positively correlated with agreeableness, extraversion and responsibility. There is a high prevalence of burnout among nurses in PHC. Those most likely to suffer burnout syndrome are relatively young, suffer from anxiety and depression and present high scores for neuroticism and low ones for agreeableness, responsibility and extraversion., Funding for this study was provided by the Andalusian Government Excellence Project (P11HUM-7771)

Background: Although burnout levels and the corresponding risk factors have been studied in many nursing services, to date no meta-analytical studies have been undertaken of obstetrics and gynecology units to examine the heterogeneity of burnout in this environment and the variables associated with it. In the present paper, we aim to determine the prevalence, levels, and related factors of burnout syndrome among nurses working in gynecology and obstetrics services. Methods: A systematic review and meta-analysis of the literature were carried out using the following sources: CINAHL (Cumulative Index of Nursing and Allied Health Literature), LILACS (Latin American and Caribbean Health Sciences Literature), Medline, ProQuest (Proquest Health and Medical Complete), SciELO (Scientific Electronic Library Online), and Scopus. Results: Fourteen relevant studies were identified, including, for this meta-analysis, n = 464 nurses. The following prevalence values were obtained: emotional exhaustion 29% (95% CI: 11&ndash, 52%), depersonalization 19% (95% CI: 6&ndash, 38%), and low personal accomplishment 44% (95% CI: 18&ndash, 71%). The burnout variables considered were sociodemographic (age, marital status, number of children, gender), work-related (duration of the workday, nurse-patient ratio, experience or number of miscarriages/abortions), and psychological (anxiety, stress, and verbal violence). Conclusion: Nurses working in obstetrics and gynecology units present high levels of burnout syndrome. In over 33% of the study sample, at least two of the burnout dimensions considered are apparent.

Context: Biallelic mutations in NEUROG3 are known to cause early-onset malabsorptive diarrhea due to congenital anendocrinosis and diabetes mellitus at a variable age. No other endocrine disorders have been described so far. We report four patients with homozygous NEUROG3 mutations who presented with short stature and failed to show any signs of pubertal development. Case Description: Four patients (two males, two females) were diagnosed with homozygous mutations in NEUROG3 on the basis of congenital malabsorptive diarrhea and diabetes. All four had severe short stature and failed to develop secondary sexual characteristics at an appropriate age, despite some having normal body mass index. The absence of gonadal function persisted into the third decade in one patient. Upon testing, both basal and stimulated LH and FSH levels were low, with the remaining pituitary hormones within the normal range. Magnetic resonance imaging scans of the hypothalamic-pituitary axis did not reveal structural abnormalities. A diagnosis of hypogonadotropic hypogonadism was made, and replacement therapy with sex hormones was started. Conclusions: The high reproducibility of this novel phenotype suggests that central hypogonadism and short stature are common findings in patients with mutations in NEUROG3. Growth rate needs to be carefully monitored in these patients, who also should be routinely screened for hypogonadism when they reach the appropriate age. NEUROG3 mutations expand on the growing number of genetic causes of acquired hypogonadotropic hypogonadism., Patients with neurogenin 3 deficiency show congenital diarrhea and diabetes. We describe four patients who showed hypogonadotropic hypogonadism, short stature and diabetes due to mutations in NEUROG3