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Using humor as a caregiving strategy can help professionals perceive daily and work-related events from a more optimistic and light-hearted perspective. The main objective of this study was to analyze humor styles among health care professionals. A cross-sectional and correlational design was employed. Data were collected using the Humor Styles Questionnaire, which measures four humor styles: affiliative, self-enhancing, aggressive, and self-defeating humor. Health care professionals scored higher in positive humor than negative humor. Age exhibited a negative correlation with positive humor. Significant differences were observed between marital status and affiliative and self-enhancing humor, professional category and hospital unit with aggressive humor, shift work and self-enhancing humor, and type of contract and experience with affiliative humor. Health care professionals employ various humor styles based on their social and work contexts. It is crucial for health care professionals to receive training in the use of positive humor to consciously avoid humor styles that can hinder well-being. [ABSTRACT FROM AUTHOR]

Introduction: Chronic non-communicable diseases, including diseases of mental origin such as Alzheimer's, affect all age groups and countries. These diseases have a major impact on the patient and their family environment. It is interesting that different questionnaires are measured in the same direction, given that different health questionnaires are used to measure caregiver burden. Objectives: To identify which type of intervention is the most appropriate to improve the health of the primary caregiver in patients with dementia. To understand the role played by the nurse within multidisciplinary teams and to know whether the different questionnaires used in the studies measure caregiver health in the same direction. Methods: A systematic search of the published and gray literature was carried out without restriction of the language used in the studies. Caregiver burden of patients with dementia, receiving an intervention to improve caregiver burden, was assessed. Standardized mean difference was used as the effect size measure, and there were possible causes of heterogeneity in the effect size. Results: In total, 1512 records were found, and 39 articles with 4715 participants were included. We found individual information with an effect of 0.48 (CI95%: 0.18; 0.79; I2 = 0%); group therapy with an effect of 0.20 (CI95%: 0.08; 0.31; I2 = 6%); workshops with an effect of 0.21 (CI95%: 0.01; I2 = 48%) and 0.32 (CI95%: 0.01; 0.54; I2 = 0%) when a nurse intervenes; respite care with an effect of 0.22 (CI95%: 0.05; 0.40; I2 = 66%); individual therapy with an effect of 0.28 (CI95%: 0.15; 0.4; I2 = 68%); and support groups with an effect of 0.07 (CI95%: 0; 0.15; I2 = 78%). Conclusions: The magnitude of the effects of the interventions has been low–moderate. Different instruments are not associated with the magnitude of the effect. The presence of nurses improves the effect of the intervention on caregivers when it is carried out in the form of workshops. [ABSTRACT FROM AUTHOR]

Introduction: Dolutegravir + rilpivirine (DTG + RPV) is an effective antiretroviral therapy regimen approved in clinical guidelines as a switch therapy for virologically suppressed people with HIV. Our study aimed to compare the effectiveness and tolerability of DTG + RPV in women and men in real‐world clinical practice. Methods: This was a retrospective analysis of treatment‐experienced people with HIV from a large HIV unit who switched to DTG + RPV. We analysed treatment effectiveness, rates of adverse events and discontinuation, and metabolic changes after 48 weeks of treatment. HIV‐RNA levels <50 copies/mL were analysed at 48 weeks using both intention‐to treat analysis (where missing data were interpreted as failures) and per‐protocol analysis (excluding those with missing data or changes due to reasons other than virological failure). Outcomes were compared between women and men based on sex at birth. Results: A total of 307 patients were selected (71 women and 236 men). No transgender people were included. At baseline, women had lived with HIV infection and received antiretroviral therapy for longer than men (23.2 vs 17.4 years and 18.9 vs 14.2 years, respectively). In the intention‐to‐treat analysis, 74.6% (95% confidence interval [CI] 63.4–83.3%) of women and 83.5% (95% CI 78.2–87.7) of men had HIV‐RNA <50 copies/mL. In the per‐protocol analysis, 96.4% (95% CI 87.7–99) of women and 99% (95% CI 98.9–99.7) of men had HIV‐RNA levels <50 copies/mL. Two women and two men had HIV‐RNA >50 copies/mL at 48 weeks. Discontinuation due to adverse events was more frequent in women than in men: 12.7% vs 7.2% (p < 0.02). Neuropsychiatric and gastrointestinal events were the most frequently reported. A median (interquartile range) weight gain of 1.9 kg (0–4.2) in women and 1.2 kg (−1–3.1) in men was reported (median of differences between baseline visit and week 48); the remaining changes in metabolic parameters were neutral. Conclusions: DTG + RPV exhibited good and similar virological effectiveness in women and men in real‐world settings. However, poorer tolerability and more treatment interruptions were observed in women. [ABSTRACT FROM AUTHOR]

Background: This article aims to share the initial experience of the preperitoneal eTEP approach and its potential benefits in a selected group of patients. The eTEP Rives-Stoppa is a proven minimally invasive surgical technique for the treatment of ventral midline and off-midline hernias that has shown to be a solid, durable, and reproducible repair. The preperitoneal eTEP repair is a surgical technique that brings together the extraperitoneal access surgery with a preperitoneal repair for primary midline hernias avoiding posterior rectus sheath division and preservation of the retrorectus space while being able to treat simultaneous diastasis recti. Methods: The analysis included 33 patients operated with the preperitoneal eTEP approach from September 2022 to September 2023 in patients with primary small to medium (< 4 cm) midline hernias, single or multiple defects with or without diastasis recti. Age, gender, hernia characteristics, operative time, and surgical site occurrences will be discussed, as well as fine details and landmarks in the operative technique. Results: 33 consecutive patients were operated, 19 female (57.5%) and 14 males (42.5%) between 32 and 63 years of age, the most common comorbidity found was obesity (BMI > 30). In 70% of the cases, operative time was 90 min ± 25 min. The average hospital stay was one day, while 12 went home the same day, and so far, no reoccurrences have been reported. Conclusions: We believe the preperitoneal eTEP approach for small to medium primary midline hernias is an effective and solid repair that combines excellent features of proven surgical techniques and eliminates the need for posterior rectus sheath division while saving the retrorectus space, among other benefits that will be discussed. The reproducibility of the technique remains to be proven. [ABSTRACT FROM AUTHOR]

Suicide is a serious public health problem, with a global mortality rate of 1.4% of all deaths worldwide and the leading cause of unnatural death in Spain. Clinical simulation has proven to be a beneficial tool in training nursing students. Such experiences allow them to develop cognitive and affective skills that are fundamental for the detection of warning signs and the use of interventions in cases of people who want to take their own lives. Working in a mental health environment can be difficult for nursing students; therefore, the purpose of this study was to explore the perceptions of nursing students on the approach, management, and intervention of suicidal crisis through clinical mental health simulation. Methods: qualitative descriptive phenomenological study through focus groups and reflective narratives in a sample of 45 students. A thematic analysis was performed using ATLAS-ti. Results: After the analysis, three themes were obtained: (a) management and handling of emotions, (b) identification of suicide motives, and (c) intervention in suicidal crisis. Discussion: Clinical simulation in mental health allows students to exercise clinical judgment reasoning, detect warning signs for a better treatment approach, and provide tools for effective intervention and management of patient care. The results of this study indicate that nursing students face challenges in approaching mental health clinical simulation due to a lack of prior exposure. [ABSTRACT FROM AUTHOR]

The barriers faced by people with intellectual disabilities are many. One of the areas in which many problems have been identified is the sexual domain. This descriptive study aims to analyze the attitudes of the family environment, professional carers, and the general population toward their sexuality. A cross-sectional descriptive study was carried out between 2022 and 2023, using convenience sampling among family members and carers from different centers working with people with intellectual disabilities in Spain, and among the general population not related to people with intellectual disabilities. A total of 583 responses were received and significant differences were found for all variables, with the variables related to family or work proximity being those that provided the most significant and relevant results. It was observed that the male sex has a more paternalistic attitude and that in rural areas there is a more permissive attitude towards the sexuality of people with intellectual disabilities. People who work with people with disabilities have more positive attitudes towards this group, while direct relatives have more paternalistic attitudes. Nursing care in the community and specialized centers should be based on an adequate therapeutic relationship and personalized care. [ABSTRACT FROM AUTHOR]

Background The healthy immigrant paradox has found wide support in the literature. To evaluate this hypothesis that immigrants have better health outcomes than the native population, this study aimed to compare the premature cancer mortality between the native and immigrant populations in Spain. Methods We obtained the 2012–15 cause-specific mortality estimates from administrative records and participant characteristics data from the 2011 Spanish census. Using Cox proportional hazards regression models, we calculated the risks of mortality of the native and immigrant populations, and the latter populations' risk based on their regions of origin, and determined the effects of covariates of interest on the calculated risk. Results Our results show that the risk of premature cancer mortality is lower among immigrants than among natives, and this gap is higher among men than among women. There is a lower mortality rate among Latin American immigrants (Latino men are 81% less likely to die prematurely from cancer than native-born men, and Latino women are 54% less). Moreover, despite social class disparities, immigrants' advantage in cancer mortality remained constant and decreased with increasing length of residence in the host country. Conclusions This study provided novel evidence on the 'healthy immigrant paradox', associated with the fact that migrants are favorably selected at origin, cultural patterns of the societies of origin and, in the case of men, there is some convergence or an 'unhealthy' integration that explains the fact that this advantage over natives is lost with more years of residence in Spain. [ABSTRACT FROM AUTHOR]

Background: Psychomotor agitation is increased psychomotor activity, restlessness and irritability. People with psychomotor agitation respond by overreacting to intrinsic and extrinsic stimuli, experiencing stress and/or cognitive impairment. the aim was to analyse the association of nursing diagnoses with the disinhibition dimension, the aggressiveness dimension and the lability dimension of the Corrigan Agitated Behaviour Scale. Methods: This study was conducted in Spain using a multicentre cross-sectional convenience sample of 140 patients who had been admitted to psychiatric hospital units and had presented an episode of psychomotor agitation between 2018 and 2021. Results: The Corrigan Agitated Behaviour Scale was used to assess psychomotor agitation. Associated nursing diagnoses, violence directed at professionals and the environment are shown to be predictive values for the severity of the agitation episode. Moderate-severe psychomotor agitation episodes are shown as predictors of violence directed mainly at professionals and the environment. Conclusions: There is an urgent need for mental health nurses to have knowledge of the extended clinic in order to care for users and improve their health conditions in dealing with people, with their social, subjective and biological dimension. [ABSTRACT FROM AUTHOR]

Objective. To examine the association between low life satisfaction with past-year dental visits in a rural-urban national sample of 50-year-old Mexican adults with diabetes mellitus (DM). Methods. Data are drawn from the Mexican Health and Aging Study (MHAS), a cross-sectional study conducted in 2018 involving 3,592 older adults aged 50 years and older and living in urban and rural areas in Mexico. Life satisfaction was measured using the Satisfaction with Life Scale (SWLS) and past-year dental visits dichotomized as none and ≥1 dental visits. The Poisson regression analyses were used to assess the association, adjusting for confounders. Results. 62.9% were women, mean age was 65.5 (±9.6), and 16.5% lived in a rural area, while the female subjects continue to present a higher probability of visiting a dentist (PR = 1.28 (95% CI 1.08–1.51)). In terms of age, the ≥70-year group presented 28% lower possibility of visiting a dentist (PR = 0.72 (95% CI 0.60–0.86)). The interaction showed that adults ≥50 years who reside in a rural area and have low life satisfaction were 40% less likely to have visited a dentist in the last year (PR = 0.60 (95% CI 0.37–0.98)) than adults ≥50 years who reside in an urban area and have high life satisfaction. Conclusions. The present study highlights the association between low life satisfaction and past-year dental visits in rural populations. Therefore, rurality should be considered a possible confounder in analysis of life satisfaction in the older adult population. [ABSTRACT FROM AUTHOR]

Spanish legislation obliges the public administration to ensure equal opportunities and support for access to higher education for people with disabilities. This work has one central goal: to analyse and understand the causes for the potential inequality for people with disabilities in accessing higher education in Spain and the barriers they encounter during their academic life. This paper focuses on the differences in inclusive education between people with disabilities and people without disabilities by sex, age, and type of university. A mixed research design is used: qualitative research of two focus groups and fourteen interviews to sixteen students with disabilities; and statistical analysis of the Social Integration and Health Survey 2012, using two-way and multi-way cross-tables. There are significant differences between presence of disability and learning variables. Controlling by sex and age, almost every age-group is significant. Using sex as independent variable, and controlling by disability, there is no relationship with the variables relating to barriers to accessing education; therefore, the larger differences by sex are in the group of people without disabilities. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to determine the reliability and validity of the Humour Styles Questionnaire (HSQ) in a sample of Spanish healthcare professionals. Design: A cross‐sectional study. Methods: The version of HSQ translated into Spanish by Cayssials and Pérez was used to validate on a sample of healthcare professionals (N = 250). The reliability analysed the Crombach's α coefficient and Pearson's correlation coefficient between the factors and the total scale score. The Exploratory Factor Analysis was carried out with Kaiser's criteria for the extraction of factors with Varimax rotation. Results: HSQ in this study sample reproduced the similar structure of the original version with four factors (affiliative, self‐enhancing, aggressive and self‐defeating humour). These factors explained 44.46% of the total variance and Cronbach's ranged from 0.64–0.79. Global HSQ scale reliability was 0.82. Conclusion: The HSQ is a valid and reliable instrument for assessing humour in healthcare professionals. [ABSTRACT FROM AUTHOR]

People with Down syndrome (DS) have gait deficits because motor milestones are usually reached later. Decreased gait speed or reduced stride length are some of the main deficits. The main objective of the present work was to assess the reliability of the 10-Meter Walk Test (10MWT) in adolescents and young adults with DS. The objective has been to analyze the construct validity of the 10MWT with the Timed up and go (TUG) test. A total of 33 participants with DS were included. Reliability was verified by intraclass correlation coefficient (ICC). The agreement was analyzed by the Bland-Altman method. Finally, construct validity was evaluated through Pearson correlation coefficient. The 10MWT intra-rater and inter-rater reliability were good (ICC between 0.76 until 0.9) and excellent (ICC > 0.9), respectively. The minimal detectable change for intra-rater reliability was 0.188 m/s. Also, it has demonstrated moderate construct validity (r > 0.5) considering the TUG test. The 10MWT has shown high intra- and inter-rater reliability and validity in adolescent and adults with SD and a moderate construct validity between TUG test and 10MWT. [ABSTRACT FROM AUTHOR]

BACKGROUND: Prenatal exposure to persistent organic pollutants (POPs) may contribute to the development of childhood obesity and metabolic disorders. However, little is known about whether the maternal nutritional status during pregnancy can modulate these associations. OBJECTIVES: The main objective was to characterize the joint associations and interactions between prenatal levels of POPs and nutrients on childhood obesity. METHODS: We used data from to the Spanish INfancia y Medio Ambiente–Environment and Childhood (INMA) birth cohort, on POPs and nutritional biomarkers measured in maternal blood collected at the first trimester of pregnancy and child anthropometric measurements at 7 years of age. Six organochlorine compounds (OCs) [dichlorodiphenyldichloroethylene, hexachlorobenzene (HCB), β-hexachlorocyclohexane ( β-HCH) and polychlorinated biphenyls 138, 153, 180] and four per- and polyfluoroalkyl substances (PFAS) were measured. Nutrients included vitamins (D, B12, and folate), polyunsaturated fatty acids (PUFAs), and dietary carotenoids. Two POPs–nutrients mixtures data sets were established: 푎) OCs, PFAS, vitamins, and carotenoids (푛=660), and 푏) OCs, PUFAs, and vitamins (푛=558). Joint associations of mixtures on obesity were characterized using Bayesian kernel machine regression (BKMR). Relative importance of biomarkers and two-way interactions were identified using gradient boosting machine, hierarchical group lasso regularization, and BKMR. Interactions were further characterized using multivariate regression models in the multiplicative and additive scale. RESULTS: Forty percent of children had overweight or obesity. We observed a positive overall joint association of both POPs-nutrients mixtures on overweight/obesity risk, with HCB and vitamin B12 the biomarkers contributing the most. Recurrent interactions were found between HCB and vitamin B12 across screening models. Relative risk for a natural log increase of HCB was 1.31 (95% CI: 1.11, 1.54, 푝Interaction =0.02) in the tertile 2 of vitamin B12 and in the additive scale a relative excess risk due to interaction of 0.11 (95% CI: 0.02, 0.20) was found. Interaction between perfluorooctane sulfonate and β-cryptoxanthin suggested a protective effect of the antioxidant on overweight/obesity risk. CONCLUSION: These results support that maternal nutritional status may modulate the effect of prenatal exposure to POPs on childhood overweight/ obesity. These findings may help to develop a biological hypothesis for future toxicological studies and to better interpret inconsistent findings in epidemiological studies. [ABSTRACT FROM AUTHOR]

Background: Urinary tract infection (UTI) is one of the most common bacterial infections in childhood and is associated with long-term complications. We aimed to assess the effect of adjuvant dexamethasone treatment on reducing kidney scarring after acute pyelonephritis (APN) in children. Methods: Multicenter, prospective, double-blind, placebo-controlled, randomized clinical trial (RCT) where children from 1 month to 14 years of age with proven APN were randomly assigned to receive a 3-day course of either an intravenous corticosteroid (dexamethasone 0.30 mg per kg/day) twice daily or placebo. The late technetium 99 m-dimercaptosuric acid scintigraphy (> 6 months after acute episode) was performed to assess kidney scar persistence. Kidney scarring risk factors (vesicoureteral reflux, kidney congenital anomalies, or urinary tract dilatation) were also assessed. Results: Ninety-one participants completed the follow-up and were finally included (dexamethasone n = 49 and placebo n = 42). Both groups had similar baseline characteristics. Twenty participants showed persistent kidney scarring after > 6 months of follow-up without differences in incidence between groups (22% and 21% in the dexamethasone and placebo groups, p = 0.907). Renal damage severity in the early DMSA (β = 0.648, p = 0.023) and procalcitonin values (β = 0.065 p = 0.027) significantly modulated scar development. Vesicoureteral reflux grade showed a trend towards significance (β = 0.545, p = 0.054), but dexamethasone treatment showed no effect. Conclusion: Dexamethasone showed no effect on reducing the risk of scar formation in children with APN. Hence, there is no evidence for an adjuvant corticosteroid treatment recommendation in children with APN. However, the study was limited by not achieving the predicted sample size and the expected scar formation. Trial registration: Clinicaltrials.gov, NCT02034851. Registered in January 14, 2014. "A higher resolution version of the Graphical abstract is available as Supplementary information." [ABSTRACT FROM AUTHOR]

Objectives It is widely acknowledged that the experience of pain is promoted by both genetic susceptibility and environmental factors such as engaging in physical activity (PA), and that pain-related cognitions are also important. Thus, the purpose of the present study was to test the association of 64 polymorphisms (34 candidate genes) and the gene–gene, gene–PA and gene–sedentary behaviour interactions with pain and pain-related cognitions in women with FM. Methods Saliva samples from 274 women with FM [mean (s. d.) age 51.7 (7.7) years] were collected for extracting DNA. We measured PA and sedentary behaviour by accelerometers for a week, pain with algometry and questionnaires, and pain-related cognitions with questionnaires. To assess the robustness of the results, a meta-analysis was also performed. Results The rs6311 and rs6313 polymorphisms (5-hydroxytryptamine receptor 2A, HTR2A) were individually related to algometer scores. The interaction of rs4818 (catechol-O-methyltransferase, COMT) and rs1799971 (opioid receptor μ gene, OPRM1) was related to pain catastrophizing. Five gene–behaviour interactions were significant: the interactions of sedentary behaviour with rs1383914 (adrenoceptor alpha 1A, ADRA1A), rs6860 (charged multivesicular body protein 1A, CHMP1A), rs4680 (COMT), rs165599 (COMT) and rs12994338 (SCN9A) on bodily pain subscale of the Short Form 36. Furthermore, the meta-analysis showed an association between rs4680 (COMT) and severity of FM symptoms (codominant model, P -value 0.032). Conclusion The HTR2A gene (individually), COMT and OPRM1 gene–gene interaction, and the interactions of sedentary behaviour with ADRA1A , CHMP1A , COMT and SCN9A genes were associated with pain-related outcomes. Collectively, findings from the present study indicate a modest contribution of genetics and gene–sedentary behaviour interaction to pain and pain catastrophizing in women with FM. Future research should examine whether reducing sedentary behaviour is particularly beneficial for reducing pain in women with genetic susceptibility to pain. [ABSTRACT FROM AUTHOR]

Background: Research has generally found a significant inverse relationship in mortality risk across socioeconomic (SE) groups. This paper focuses on Spain, a country for which there continues to be very little evidence available concerning retirement pensioners. We draw on the Continuous Sample of Working Lives (CSWL) to investigate disparities in SE mortality among retired men aged 65 and above over the longest possible period covered by this data source: 2005–2018. We use the initial pension income (PI) level as our single indicator of the SE status of the retired population. Methods: The mortality gradient by income is quantified in two ways: via an indicator referred to as "relative mortality", and by estimating changes in total life expectancy (LE) by PI level at ages 65 and 75 over time. We show that, should the information provided by the relative mortality ratio not be completely clear, a second indicator needs to be introduced to give a broad picture of the true extent of inequality in mortality. Results: The first indicator reveals that, for the period covered and for all age groups, the differences in death rates across PI levels widens over time. At older age groups, these differences across PI levels diminish. The second indicator shows that disparities in LE at ages 65 and 75 between pensioners in the lowest and highest income groups are relatively small, although slightly higher than previously reported for Spain. This gap in LE widens over time, from 1.49 to 2.54 years and from 0.71 to 1.40 years respectively for pensioners aged 65 and 75. These differences are statistically significant. Conclusions: Along with other behavioral and structural aspects, a combination of factors such as the design of the pension system, the universality and quality of the health system, and high levels of family support could explain why LE inequalities for retired Spanish men are relatively small. To establish the reasons for this increased inequality in LE, more research needs to be carried out. An analysis of all Spanish social security records instead of just a sample would provide us with more information. [ABSTRACT FROM AUTHOR]

Background: The role of the critical shoulder angle (CSA) as a risk factor for rotator cuff tear (RCT) remains controversial. Studies on the association between the CSA and RCT show considerable differences in design, and this could be responsible for the variation in study results. Purpose: To (1) describe the reliability of CSA measurement and (2) evaluate the results of the studies reporting the association between the CSA and RCT using meta-analytical techniques to explore potential sources of variation of study results. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: MEDLINE, EMBASE, and CINAHL electronic databases were searched through June 30, 2019. Case-control and cross-sectional studies reporting the association of the CSA and RCT were selected. The weighted mean difference in the CSA was estimated using a random-effects model. Prediction interval was computed to better express uncertainties in the effect estimate. Metaregression and subgroup analyses were performed to explore potential sources of heterogeneity. Results: A total of 14 studies, including 1154 cases and 1271 controls, were identified. Of these studies, 79% (11/14) assessed the reliability of the CSA measurement, demonstrating an excellent intraobserver (range, 0.91-0.99) and interobserver (range, 0.87-0.99) reliability. Compared with controls, cases with RCT showed larger measurements of the CSA (3.3° [95% CI, 2.3°- 4.4°]). However, there was a high heterogeneity (I 2 = 93%), and the 95% prediction interval (-0.4° to 7.1°) included no difference in the CSA. Results of the metaregression analysis showed a significant association of several methodological aspects with the heterogeneity. The difference in the CSA tended to be larger when only full-thickness tears were included, when no specific defined criterion for assessing radiographic viewing perspective was used, in studies with smaller sample sizes, and in studies at higher risk of bias. Conclusion: While the CSA can be reliably measured, the difference in the CSA between cases and controls varied from very large to modest or almost no difference. Several determinants of heterogeneity were determined. Owing to this heterogeneity, it is difficult to gain an insight into the strength and exact nature of the association between the CSA and RCT with the current evidence. [ABSTRACT FROM AUTHOR]

The aim of this study was to analyze the degree of agreement comparing number and distance covered in different acceleration and deceleration sections registered by a video tracking system (MEDIACOACH) and a GPS device (WIMU PRO) during official competition. Data from a Spanish professional club were registered over the course of a season. First, the descriptive statistics presented more bursts of accelerations and decelerations in WIMU PRO than in MEDIACOACH, whereas the distances covered recorded by both systems were similar. Second, negative relationships were found (i.e., negative bias) comparing WIMU PRO to MEDIACOACH in the number of accelerations and decelerations between 0/1 m/s2 and ½ m/s2 (p < 0.05), and in the distances covered in accelerations and decelerations (p < 0.05) between 0/1 m/s2 and in accelerations and decelerations registered between 2/3 m/s2 and more than 3 m/s2. Moreover, the differences in means (i.e., standardized mean bias) across the two devices were trivial (> 0.19) and small (0.2–0.59) for most variables. The standardized typical errors in the estimate (TEE) were moderate (0.3–0.59) and small to moderate (0.1–0.29 to 0.3–0.59), respectively. Also, the Intra class Correlation Coefficients (ICCs) for agreement and consistency between systems showed good and excellent values (> 0.90). The magnitude of change in means (%) between systems, defined as the percentage change between the numbers or values, was below 14% and 7% for number and distances covered, respectively. All scores in the smallest worthwhile change were lower than 9% and in the coefficients of variation were lower than 95% and 15%, respectively. Thus, both systems demonstrated an acceptable degree of agreement and could be useful in analyzing players' acceleration demands in professional soccer. However, caution is required when interpreting the results and a comparison with a gold standard is required in order to validate both systems. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the attitudes towards deceased multi‐organ donation and transplantation among nurses within the critical care units of the six public tertiary transplant hospitals in Madrid, Spain. Background: Spain has a rate of 49 donations per million population, whereas Madrid has a lower donation rate of 34.2 per million population. Nurses generate social opinion, and their attitude can be one of the barriers against organ donation. Method: An observational descriptive study was conducted among critical care units' nurses. The measuring instrument was the Collaborative International Donor Project in Organ Donation and Transplantation. Data were collected from January to October 2019, and a statistical analysis was performed. Results: A total of n = 313 questionnaires achieved a response rate of 51%. Of the intensive care unit nurses surveyed, 85% had a favourable opinion towards the donation of their organs being affected by psychosocial variables related to social variables with respect to family, religion and attitude towards the body. Conclusion: The intensive care unit nurses of the Madrid transplant hospitals maintain a favourable attitude towards organ donation and transplantation. It is necessary to implement specialized training and periodically evaluate training in this sector. To maintain and improve the attitude towards organ donation, family discussion among health personnel should be encouraged. Religion influences the attitude of nurses and donation rates. Implication for nursing and health policy: Intensive care nurses' attitude towards organ donation is influenced by social variables. This study shows that the attitude is positive but improvable. These findings contribute to promote awareness of the lack of organs and the benefits of organ donation. [ABSTRACT FROM AUTHOR]

This study examined the effects of a large-scale flipped learning (FL) approach in an undergraduate course of Digestive System Diseases. This prospective non-randomized trial recruited 404 students over three academic years. In 2016, the course was taught entirely in a Traditional Lecture (TL) style, in 2017 half of the course (Medical topics) was replaced by FL while the remaining half (Surgical topics) was taught by TL and in 2018, the whole course was taught entirely by FL. Academic performance, class attendance and student's satisfaction surveys were compared between cohorts. Test scores were higher in the FL module (Medical) than in the TL module (Surgical) in the 2017 cohort but were not different when both components were taught entirely by TL (2016) or by FL (2018). Also, FL increased the probability of reaching superior grades (scores >7.0) and improved class attendance and students' satisfaction. The holistic FL model is more effective for teaching undergraduate clinical gastroenterology compared to traditional teaching methods and has a positive impact on classroom attendances. [ABSTRACT FROM AUTHOR]

Media can be a powerful communication tool to promote breastfeeding programs, influence mother's breastfeeding behaviour, and generate support among stakeholders for breastfeeding. Yet, there is little information on how media coverage influences a country's breastfeeding enabling environment. This study addressed this gap by conducting a retrospective content analysis of documents published between January 1, 2017 and January 1, 2018 to analyse the media coverage related to breastfeeding in Mexico. Content analysis was based on the breastfeeding gear model and a strategic planning technique to identify strengths, weaknesses, opportunities, and threats for enabling the national breastfeeding environment. Media coverage of breastfeeding was more frequent in August (36% of all documents). The top three topics commonly covered by the media were advocacy events promoting breastfeeding, promotion campaigns, and changes in breastfeeding legislation and policy. In general, the media coverage focused on strengths of specific breastfeeding policies. There was limited news coverage of key factors that negatively influenced or threatened the breastfeeding environment. Findings support the need to design strategies to engage the media covering in more depth and breadth diverse aspects of breastfeeding protection, promotion, and support efforts in Mexico. [ABSTRACT FROM AUTHOR]

Background: The Goldman dilemma presented athletes with a Faustian bargain that guaranteed winning an Olympic gold medal in their sport but resulted in certain death 5 years later. Athletes’ responses to Goldman’s bargain were reported from 1982 to 1995. Several studies subsequently evaluated people’s willingness to accept the bargain proposed in the Goldman question. Our study updates Goldman’s question using contingent-behavior questions, a preference-elicitation method widely applied in economics, marketing and psychology to understand people’s choice behavior. Contingent-behavior questions ask people to evaluate hypothetical tradeoffs between outcomes when real-world decisions are unobservable, nonexistent, or unreliable.Methods: A web-enabled survey was conducted with athletes in 50 sports between June, 2012 and April, 2013. Athletes were invited by their sport governing bodies in the United States to complete the online survey. Responses from 2888 athletes were collected. Our reformulation elicited athletes’ willingness to accept a performance-enhancing drug (PED) associated with the risk of a realistic fatal event, not certain death. A double-bounded dichotomous-choice question format was used to elicit athletes’ maximum acceptable mortality risk (MAMR) for winning an Olympic gold medal. Data were analyzed using an interval regression model to estimate the implicit probability of accepting a continuous risk level. MAMR was defined as the mortality risk level with a 0.50 probability of acceptance.Results: Estimated mean MAMRs varied between 7 and 14% across athletes in different ranks and sports. Elite athletes were generally the most willing to accept a fatal cardiovascular risk to win a gold medal in the Olympics. This range was similar to the levels of risk that patients accept for life-changing interventions.Conclusions: Results suggest that very few athletes would be expected to accept a PED in the bargain postulated by the Goldman dilemma. Risk tolerance among elite athletes suggest they may be more aware of the potential financial and nonfinancial benefits of such a win, and/or less optimistic about their potential to move up in the level of competition without the use of PEDs. [ABSTRACT FROM AUTHOR]

Tobacco use is a major threat to public health. Current guidelines suggest that healthcare professionals in the emergency department provide routine smoking cessation screening and interventions. Evidence suggests that an educational intervention among registered nurses in the emergency department may increase education and referral for smoking cessation of patients who use tobacco products. An educational module regarding smoking cessation counseling was provided to registered nurses in the emergency department at a private hospital in South Florida. A pre- and postintervention self-reported survey evaluated changes in nurses asking about tobacco use; advising to quit; assessing readiness, assisting, and arranging follow-up for patients who smoke to quit; and encouraging pharmacological agents. All participating nurses screened for tobacco use most of the time before and after the intervention. However, the number of nurses who assessed readiness, assisted, arranged follow-up for patients and encouraged the use of pharmacological agents increased significantly in the postsurvey. Study findings agree with previous research indicating that nurses routinely screen for tobacco and advise to quit. However, implementing smoking cessation education and referral resources may better equip registered nurses in the emergency department to take an active role initiating follow-up interventions for patients who screen positive for tobacco use. Educational interventions among these nurses can increase knowledge of and utilization of existing resources to help patients quit. [ABSTRACT FROM AUTHOR]

The aim of our study was to determine the prevalence of anatomical variants of bronchial arteries using computed tomographic angiography in a population of northeastern Mexico. An observational, transversal, descriptive, comparative, retrospective study was performed using 139 imaging studies of Mexican patients in which we evaluated the following parameters from the left and right bronchial arteries: artery origin, branching pattern, arterial ostium, vertebral level of origin, diameter, and mediastinal trajectory. The anatomies of the bronchial arteries were similar in both genders, except distribution for vertebral origin level (p  0.006) and the diameter (p  0.013). Left and right arteries were similar, except for the mediastinal trajectory in reference to the esophagus (p<0.001) as well as the arterial diameter (p<0.001) and lumen diameter. [ABSTRACT FROM AUTHOR]

BACKGROUND: The exposome constitutes a promising framework to improve understanding of the effects of environmental exposures on health by explicitly considering multiple testing and avoiding selective reporting. However, exposome studies are challenged by the simultaneous consideration of many correlated exposures. OBJECTIVES: We compared the performances of linear regression -- based statistical methods in assessing exposome-health associations. METHODS: In a simulation study, we generated 237 exposure covariates with a realistic correlation structure and with a health outcome linearly related to 0 to 25 of these covariates. Statistical methods were compared primarily in terms of false discovery proportion (FDP) and sensitivity. RESULTS: On average over all simulation settings, the elastic net and sparse partial least-squares regression showed a sensitivity of 76% and an FDP of 44%; Graphical Unit Evolutionary Stochastic Search (GUESS) and the deletion/substitution/addition (DSA) algorithm revealed a sensitivity of 81% and an FDP of 34%. The environment-wide association study (EWAS) underperformed these methods in terms of FDP (average FDP, 86%) despite a higher sensitivity. Performances decreased considerably when assuming an exposome exposure matrix with high levels of correlation between covariates. CONCLUSIONS: Correlation between exposures is a challenge for exposome research, and the statistical methods investigated in this study were limited in their ability to efficiently differentiate true predictors from correlated covariates in a realistic exposome context. Although GUESS and DSA provided a marginally better balance between sensitivity and FDP, they did not outperform the other multivariate methods across all scenarios and properties examined, and computational complexity and flexibility should also be considered when choosing between these methods. CITATION: Agier L, Portengen L, Chadeau-Hyam M, Basagaña X, Giorgis-Allemand L, Siroux V, Robinson O, Vlaanderen J, González JR, Nieuwenhuijsen MJ, Vineis P, Vrijheid M, Slama R, Vermeulen R. 2016. A systematic comparison of linear regression -- based statistical methods to assess exposome-health associations. Environ Health Perspect 124:1848 -- 1856; http://dx.doi. org/10.1289/EHP172 [ABSTRACT FROM AUTHOR]

Objective. To compare structural damage assessed by conventional radiography and tendon damage assessed by musculoskeletal US (MSUS) at wrist and ankle in RA patients. Methods. We evaluated 72 consecutive patients [56 (77.8%) females] with RA. The MSUS evaluation consisted in a B-mode examination of bilateral extensor carpi ulnaris and tibialis posterior tendons. Tendon damage was defined and scored according to OMERACT. A total score for the tendon damage score (TDS) was calculated by summing the grades for each tendon. For the radiographic evaluations we used the van der Heijde score; a total radiographic score (RTS) was calculated by summing a bone erosion score (ERS) and a joint space narrowing score (JSNS). Results. We evaluated 288 tendons. The mean (S.D.) of TDS was 2.3 (1.8). Fifty-four (75%) patients presented tendon damage of at least one tendon. From all evaluated tendons, 134 (46.5%) had no tendon damage, 146 (50.7%) had grade 1 and 8 (2.8%) had grade 2 tendon damage. The mean (S.D.) for RTS was 91.4 (97), for ERS was 47.3 (61.9) and for JSNS was 44.1 (37.2). We found a significant correlation between disease duration and both TDS and RTS (r = 0.413 and r = 0.560, respectively; P< 0.0001). We found a good significant correlation between TDS and all variables of radiographic structural damage (RTS, r=0.65; ERS, r= 0.637; JSNS, r=0.618; P< 0.001). Conclusion. The MSUS assessment of only four tendons can be an additional feasible method to assess structural damage in RA patients. [ABSTRACT FROM AUTHOR]

Background. The aims of this study were to assess patients’ preferences to wait or start systemic treatment and understand how patients would make tradeoffs between certain severe adverse events (AEs) and additional months of progression-free survival (PFS). Materials and Methods. Adults in France, Germany, and Spain with a diagnosis of DTC and who have had at least one RAI treatment completed a direct-elicitation question and a discrete-choice experiment (DCE) online. The direct-elicitation question asked respondents whether they would opt out of treatment when their tumor is RAI-R. In the DCE, respondents chose between 12 pairs of hypothetical RAI-R DTC treatment profiles. Profiles were defined by magnitudes of efficacy (PFS) and safety (severe hand-foot skin reaction [HFSR], severe proteinuria, and severe hypertension). A main-effects random-parameters logit model was estimated. Results. 134 patients completed the survey. Most patients (86.6%) opted for treatment rather than “wait and see” decision. Patients placed a greater weight on the risk of severe hypertension than the risk of proteinuria and HFSR. Conclusions. DTC patients showed preference toward treatment for RAI-R DTC over watchful waiting. Patients’ concerns about the risk of severe hypertension appeared to have had a greater effect on patients’ choice than severe proteinuria or HFSR. [ABSTRACT FROM AUTHOR]

El principal objetivo del estudio fue examinar perfiles de padres respecto a la presión/implicación y apoyo a las necesidades psicológicas básicas (NPB) sobre la motivación y aburrimiento desarrollado por jóvenes deportistas. La muestra estuvo formada por 301 padres y sus respectivos 301 hijos (M = 13.92; DT = 2.04), quiénes pertenecían a deportes colectivos (n = 191) e individuales (n = 128). Se midieron en padres la percepción de implicación y presión, al igual que el apoyo a las NPB, mientras que la motivación autodeterminada y el aburrimiento en la práctica fueron variables valoradas en adolescentes. Los resultados muestran la existencia de dos perfiles (perfil adaptativo, que estaba compuesto por el apoyo a las NPB y bajos niveles de presión, y perfil desadaptativo, que estaba formado por altos niveles de presión y bajos valores de apoyo a las NPB), y una relación entre el perfil desataptativo de los padres y la motivación de los niños y su aburrimiento en la práctica. Asimismo, se demostró que los padres con un perfil adaptativo realizaban menos actividad física durante la semana. Para concluir, se destaca la importancia de que los padres generen bajos niveles de presión y alta implicación en la práctica deportiva de sus hijos, así como promover el apoyo a las NPB, así como incrementar sus niveles de actividad física, con el objetivo de mejorar la motivación de los jóvenes deportistas y descender los niveles de aburrimiento en la práctica. [ABSTRACT FROM AUTHOR]

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Objective. The aim of this study was to investigate the influence of the pharmacokinetics of s.c. anti-TNF agents on the grade of US-detected synovitis in RA patients.Methods. Fifty RA patients were prospectively recruited from the Biologic Therapy Unit of our hospital. Inclusion criteria were being in treatment with s.c. anti-TNF agents and having had neither changes in therapy nor local corticosteroid injections in the previous 3 months. Patients underwent clinical, laboratory [28-joint DAS (DAS28) and Simplified Disease Activity Index (SDAI)] and US assessment at two time points, i.e. at peak plasma drug concentration and at trough plasma drug concentration. US assessments were performed blindly to the anti-TNF agent, the administration time and the clinical and laboratory data. Twenty-eight joints were investigated for the presence and grade (0–3) of B-mode synovitis and synovial power Doppler signal. Global indices for B-mode synovitis (BSI) and Doppler synovitis (DSI) were calculated for 12 joints and for wrist-hand-ankle-foot joints. B-mode US remission was defined as a BSI <1 and Doppler US remission as a DSI <1.Results. There were no significant differences between the clinical, laboratory and B-mode and Doppler US parameters at peak time and trough time (P = 0.132–0.986). There were no significant differences between the proportion of patients with active disease and those in remission according to DAS28, SDAI, B-mode US and Doppler US at peak time and trough time assessments (P = 0.070–1).Conclusion. Our results suggested that s.c. anti-TNF pharmacokinetics do not significantly influence US-scored synovitis in RA patients. [ABSTRACT FROM PUBLISHER]

Objective To investigate the difference in the presence of trigger points ( TrPs) between patients with chronic nonspecific low back pain ( LBP) and healthy people, and to determine the relationship of TrPs with the intensity of ongoing pain, disability, and sleep quality. Design A cross-sectional study. Setting The role of TrPs in LBP has not been determined. Patients Forty-two patients with nonspecific LBP (50% women), aged 23-55 years old, and 42 age- and sex-matched controls participated. Outcome Measures TrPs were bilaterally explored within the quadratus lumborum, iliocostalis lumborum, psoas, piriformis, gluteus minimus, and gluteus medius muscles in a blinded design. TrPs were considered active if the subject recognized the local and referred pain as familiar symptoms, and TrPs were considered latent if the pain was not recognized as a familiar symptom. Pain measures were collected with a numerical pain rate scale, disability was assessed with the Roland- Morris questionnaire, and sleep quality was determined with the Pittsburgh Sleep Quality Index. Results Patients with nonspecific LBP exhibited a greater disability and worse sleep quality than healthy controls ( P < 0.001). Patients with nonspecific LBP exhibited a mean of 3.5 ± 2.3 active TrPs. Further, patients with nonspecific LBP showed a greater ( P < 0.001) number of latent TrPs (mean: 2.0 ± 1.5) than healthy controls (mean: 1.0 ± 1.5). Active TrPs in the quadratus lumborum, iliocostalis lumborum, and gluteus medius muscles were the most prevalent in patients with nonspecific LBP. A greater number of active TrPs was associated with higher pain intensity (rs = 0.602; P < 0.001) and worse sleep quality (rs = 0.338; P = 0.03). Conclusions The local and referred pain elicited by active TrPs in the back and hip muscles contributes to pain symptoms in nonspecific LBP. Patients had higher disability and worse sleep quality than controls. The number of active TrPs was associated with pain intensity and sleep quality. It is possible that a complex interaction among these factors is present in patients with nonspecific LBP. [ABSTRACT FROM AUTHOR]

Inflammation is a strong predictor of increased morbidity and mortality in hemodialysis (HD) patients. Paricalcitol, a selective vitamin D receptor activator used for prevention and treatment of secondary hyperparathyroidism, has shown anti-inflammatory properties in experimental studies, although clinical data are scarce. In an open-label, prospective, single center, pilot study, 25 stable HD patients, previously receiving calcitriol, completed 12 weeks of therapy with oral paricalcitol. Serum and peripheral blood mononuclear cell (PBMC) expression profiles of inflammatory cytokines were analyzed. Serum interleukin (IL)-1, IL-10, and IL-18 did not change, unlike high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), and IL-6, which experienced a significant mean percent decrease of 14.3%, 4.7%, and 5%, respectively. There was a significant reduction in the TNF-α/IL-10 and the IL-6/IL-10 ratios ( P < .05). Serum intact parathyroid hormone concentration experienced a mild but significant reduction. In addition, expression levels of TNF-α and IL-6 decreased by 19.1% ( P < .01) and 17.5% ( P < .001), respectively, whereas expression of IL-10 increased by 17.7% ( P < .01) after treatment. In conclusion, paricalcitol administration to HD patients is associated with a beneficial effect on the inflammatory cytokine serum and gene expression profile of PBMC. This effect may contribute to the survival benefits of paricalcitol observed in clinical studies. [ABSTRACT FROM AUTHOR]

Background: Adherence to treatment, a public health issue, is of particular importance in chronic disease therapies. Primary care practices offer ideal venues for the effective care and management of these conditions. The aim of this study is to assess adherence to treatment and related-factors among patients with chronic conditions in primary care settings. Methods: A cross-sectional study was conducted among 299 adult patients with ≥1 chronic condition(s) and prescribed medication in primary healthcare centers of Spain. The Morisky-Green-Levine questionnaire was used to assess medication adherence via face-to-face interviews. Crude and adjusted multivariable logistic regression models were used to analyze factors associated with adherence using the Multidimensional Model proposed by the World Health Organization — social and economic, healthcare team and system-related, condition-related, therapy-related, and patient-related factors. Results: The proportion of adherent patients to treatment was 55.5%. Older age (adjusted odds ratio 1.31 per 10-year increment, 95% CI 1.01–1.70), lower number of pharmacies used for medication refills (0.65, 95% CI 0.47–0.90), having received complete treatment information (3.89, 95% CI 2.09–7.21), having adequate knowledge about medication regimen (4.17, 95% CI 2.23–7.80), and self-perception of a good quality of life (2.17, 95% CI 1.18–4.02) were independent factors associated with adherence. Conclusions: Adherence to treatment for chronic conditions remained low in primary care. Optimal achievement of appropriate levels of adherence through tailored multifaceted interventions will require attention to the multidimensional factors found in this study, particularly those related to patients' education and their information needs. [ABSTRACT FROM AUTHOR]

Individuals with tumours showing mismatch repair (MMR) deficiency not linked to germline mutations or somatic methylation of MMR genes have been recently referred as having 'Lynch-like syndrome' (LLS). The genetic basis of these LLS cases is unknown. MUTYH-associated polyposis patients show some phenotypic similarities to Lynch syndrome patients. The aim of this study was to investigate the prevalence of germline MUTYH mutations in a large series of LLS patients. Methods wo hundred and twenty-five probands fulfilling LLS criteria were included in this study. Screening of MUTYH recurrent mutations, whole coding sequencing and a large rearrangement analysis were undertaken. Age, sex, clinical, pathological and molecular characteristics of tumours including KRAS mutations were assessed. Results We found a prevalence of 3.1% of MAP syndrome in the whole series of LLS (7/225) and 3.9% when only cases fulfilling clinical criteria were considered (7/178). Patients with MUTYH biallelic mutations had more adenomas than monoallelic (P=0.02) and wildtype patients (P<0.0001). Six out of nine analysed tumours from six biallelic MUTYH carriers harboured KRAS-p.G12C mutation. This mutation was found to be associated with biallelic MUTYH germline mutation when compared with reported series of unselected colorectal cancer cohorts (P<0.0001). Conclusions A proportion of unexplained LLS cases is caused by biallelic MUTYH mutations. The obtained results further justify the inclusion of MUTYH in the diagnostic strategy for Lynch syndrome-suspected patients. [ABSTRACT FROM AUTHOR]