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Barbara Badanta,1,* Isabel Álvarez-Pérez,2 Patricia Bonilla Sierra,3 María González-Cano-Caballero,4,* Giancarlo Lucchetti,5 Rocío de Diego-Cordero1,* 1Department of Nursing; Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain; 2Faculty of Nursing, Physiotherapy and Podiatry. University of Seville, Seville, Spain; 3Department of Health Sciences, Universidad Técnica Particular de Loja (UTPL), Loja, Ecuador; 4Department of Nursing; Faculty of Health Sciences, University of Granada, Granada, Spain; 5Department of Medicine; School of Medicine, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil*These authors contributed equally to this workCorrespondence: María González-Cano-Caballero, Department of Nursing, Faculty of Health Sciences, University of Granada, Av. de la Ilustración, 60, Granada, 18071, Spain, Email mariagcc@ugr.esAbstract: This study aims to investigate the current evidence for the use of complementary and alternative medicine (CAM) in fibromyalgia (FM). A systematic review was conducted searching for PubMed, Scopus, CINAHL, PsycInfo, and Web of Science databases. Randomized controlled trials published up to December 2023 in peer-reviewed journals were included. Methodological quality was assessed by the Quality Assessment of Controlled Intervention Studies tool. A total of 216 articles were identified and 15 constituted the final sample. The type of CAM most used was traditional Chinese medicine (60%), and the most common instrument used was the Fibromyalgia Impact Questionnaire (60%). Our review was grouped into four themes based on the origin of the therapies: 1) Traditional Chinese Medicine; 2) Japanese natural harmonization (eg, Reiki); 3) Ayurvedic Medicine; and 4) Other non-drug therapies. Our systematic review showed that there is a wide range of CAMs used to treat FM. Most of the clinical trials have shown significant results for the effectiveness of these interventions in both physical and mental health outcomes of FM as compared to control groups. However, the heterogeneity of the interventions and outcomes warrants further studies on this topic.Keywords: complementary therapies, fibromyalgia treatment, nonpharmacological interventions, traditional medicine

Background: The current mental health state of healthcare professionals and students during the COVID-19 pandemic in Ecuador remains understudied and how to improve their mental health is a challenge.Objective: This study aimed to explore the anxiety and depressive symptomatology among healthcare students and professionals in Ecuador and to examine the role of psychological inflexibility, loneliness, and psychological stress as predictors of anxiety and depression symptoms.Methods: A total of 191 undergraduate and graduate healthcare students in clinical practice (early-career healthcare professionals) in Ecuador were surveyed between January and March 2021 using standardized measures of psychological stress (PSS), psychological inflexibility (AAQ), loneliness (UCLA), alcohol consumption (AUDIT-C), and anxiety and depressive symptomatology (PHQ). Macro Process for SPSS (models 4 and 7) were used to test mediation effects.Results: Alcohol consumption varied between men and women and anxiety and depression symptomatology was generally low among the sample. Psychological inflexibility and loneliness mediated the impact of stress on anxiety and depressive mood in participants, regardless of gender and previous personal history of COVID-19.Discussion: Implications of psychological inflexibility and the prevention and coping with stress in healthcare professionals during COVID-19 are further discussed.

Esta revisión describió el desarrollo de los cuidados paliativos en Latinoamérica basado en la educación, disponibilidad de opioides, investigación, políticas públicas e implementación de servicios.

Analysis and prediction of structural instabilities in open pit mines are an important design and operational consideration for ensuring safety and productivity of the operation. Unstable wedges and blocks occurring at the surface of the pit walls may be identified through three-dimensional (3D) image analysis combined with the discrete fracture network (DFN) approach. Kinematic analysis based on polyhedral modelling can be used for first pass analysis but cannot capture composite failure mechanisms involving both structurally controlled and rock mass progressive failures. A methodology is proposed in this paper to overcome such limitations by coupling DFN models with geomechanical simulations based on the discrete element method (DEM). Further, high resolution photogrammetric data are used to identify valid model scenarios. An identified wedge failure that occurred in an Australian coal mine is used to validate the methodology. In this particular case, the failure surface was induced as a result of the rock mass progressive failure that developed from the toe of the structure inside the intact rock matrix. Analysis has been undertaken to determine in what scenarios the measured and predicted failure surfaces can be used to calibrate strength parameters in the model.

The eastern limestone cliff of Mount Néron (French Alps) was the theater for two medium-size rockfalls between summer and winter 2011. On 14 August 2011, a ~2000 m3 rock compartment detached from the cliff, fell 100 m below and propagated down the slope. Although most of the fallen rocks deposited on the upper part of the slope, some blocks of about 15 m in size were stopped by a ditch and an earthen barrier after a run-out of 800 m. An unstable overhanging ~2600 m3 compartment remained attached to the cliff and was blasted on 13 December 2011. During this artificially triggered event, 7 blocks reached the same ditch, with volumes ranging from 0.8 to 12 m3. A semi-permanent seismic array located about 2.5 km from the site recorded the two events, providing a unique opportunity to understand and to compare the seismic phases generated during natural and artificially triggered rockfalls. Both events have signal duration of ~100 s with comparable maximum amplitudes recorded at large distances (computed local magnitude of 1.14 and 1.05, respectively), most of the energy lying below 20 Hz. Remote sensing techniques (photogrammetry and lidar) were employed before and after the provoked rockfall, allowing the volume and fracturing to be characterized. This event was filmed by two video cameras, and the generated ground motions were recorded using two temporary 3C seismic sensors and three seismic arrays deployed at the slope toe. Videos and seismogram processing provided estimates of the propagation velocity during the successive rockfall phases, which ranges from 12 to 30 m s−1. The main seismic phases were obtained from combined video and seismic signal analyses. The two most energetic phases are related to the ground impact of fallen material after free fall, and to individual rock block impacts into the ditch and the earthen barrier. These two phases are characterized by similar low-frequency content but show very different particle motions. The discrete element technique allowed reproducing the key features of the rockfall dynamics, yielding propagation velocities compatible with experimental observations.

Context: Progress in palliative care (PC) necessarily involves scientific development. However, research conducted in South America (SA) needs to be improved., Objectives: To develop a set of recommendations to advance PC research in SA., Methods: Eighteen international PC experts participated in a Delphi study. In round one, items were developed (open-ended questions); in round two, each expert scored the importance of each item (from 0 to 10); in round three, they selected the 20 most relevant items. Throughout the rounds, the five main priority themes for research in SA were defined. In Round three, consensus was defined as an agreement of ≥75%., Results: 60 potential suggestions for overcoming research barriers in PC were developed in round one. Also in Round one, 88.2% (15 of 17) of the experts agreed to define a priority research agenda. In Round two, the 36 most relevant suggestions were defined and a new one added. Potential research priorities were investigated (open-ended). In Round three, from the 37 items, 10 were considered the most important. Regarding research priorities, symptom control, PC in primary care, public policies, education and prognosis were defined as the most relevant., Conclusion: Potential strategies to improve scientific research on PC in SA were defined, including stimulating the formation of collaborative research networks, offering courses and workshops on research, structuring centers with infrastructure resources and trained researchers, and lobbying governmental organizations to convince about the importance of palliative care. In addition, priority research topics were identified in the region., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

There is limited knowledge about inequalities regarding palliative care access among patients with intellectual disability. The present scoping review aimed to identify the existing barriers that limit access to palliative care (PC) in patients with intellectual disability., Methods: We conducted a literature review on publications since 2014 from three databases (MEDLINE, Biomed Central, and Elsevier Scopus), along with hand searches in scientific journals. The review included peer-reviewed studies written in English and Spanish language with quantitative and qualitative study designs. The participants were patients with intellectual disability and health professionals who had worked with them or had experience in palliative care., Results: 22 studies met the selection criteria. The barriers identified were under referral to palliative care, reduced access, communication, and limited knowledge and experience by health professionals., Conclusion: Patients with intellectual disability do not get referred to PC frequently. Health professionals and caregivers do not recognize when it is necessary to make a referral, and they need to improve their communication abilities. Also, health care workers need more training in PC, pain management, anticipation of death, and use of opioids. More research and education on the palliative care needs and care for patients with intellectual disabilities is needed., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

The new infection by coronavirus has supposed a challenge to all health systems worldwide, affecting our psychosocial health. Education as we knew it has changed, which is why university students, attending Health Sciences courses in this case, have been affected by the pandemic. This study aimed to analyze the impact of the preventative measures and restrictions associated with COVID-19 on multiple mental health and psychological well-being indicators in Health Sciences students at the University of Seville. A descriptive and cross-sectional pilot study in the University of Seville by means of an online questionnaire elaborated was conducted. Of the final sample ( n = 68), more than 60% of the students acknowledged having received specific training by their university and/or health institution where they perform practices on COVID-19 measures; however, they negatively emphasized not having received psychosocial aid or support in most of the cases (94.12%). As the health situation imposed by COVID-19 is considered long-lasting, the proposal is to plan short- and long-term strategies for promotion and intervention in the mental health of students and future health care workers.

Ecuador assumed the commitment of including Palliative Care (PC) in its health policies. In 2014, the Ministry of Public Health (Ministerio de Salud Pública, MSP) approved the Clinical Practice Guide for Palliative Care ( Guía de Práctica Clínica sobre Cuidados Paliativos , GPCCP), with application at the national level, as a mandatory internal regulation in all institutions belonging to the National Health System. In 2021, there is no evidence about the degree of implementation. The objective was to evaluate the implementation (I) of the GPCCP guide and the knowledge (C) of the health personnel working in the Zone 7 Health Centers (HCs). This is a cross-sectional, descriptive, and prospective study. A total of 292 professionals were interviewed: managers (38), physicians (150), and nurses (104). Three surveys based on the GPCCP guide were elaborated: one for the implementation, which was applied to the individuals in charge, and the others to assess the health professionals' knowledge. The SPSS program was used, version 25. In the three groups, more than half of the participants had no training in PC, 91.2% of the HCs have the GPCCP guide, there is PC medical history (MH) in 38.2%, and morphine is used in 14.7%. The implementation of the GPCCP guide was inadequate in 52.9% of the cases. Only 25% treat the agony symptoms and 30%, delirium; 4.4% acknowledge the use of morphine in dyspnea, and 13.3% identify the subcutaneous route as the first choice for hydration at the end-of-life phase. Strategies to implement the GPCCP guide and to improve the health personnel's knowledge must be implemented in Zone 7 centers.

Background: The current mental health state of healthcare professionals and students during the COVID-19 pandemic in Ecuador remains understudied and how to improve their mental health is a challenge. Objective: This study aimed to explore the anxiety and depressive symptomatology among healthcare students and professionals in Ecuador and to examine the role of psychological inflexibility, loneliness, and psychological stress as predictors of anxiety and depression symptoms. Methods: A total of 191 undergraduate and graduate healthcare students in clinical practice (early-career healthcare professionals) in Ecuador were surveyed between January and March 2021 using standardized measures of psychological stress (PSS), psychological inflexibility (AAQ), loneliness (UCLA), alcohol consumption (AUDIT-C), and anxiety and depressive symptomatology (PHQ). Macro Process for SPSS (models 4 and 7) were used to test mediation effects. Results: Alcohol consumption varied between men and women and anxiety and depression symptomatology was generally low among the sample. Psychological inflexibility and loneliness mediated the impact of stress on anxiety and depressive mood in participants, regardless of gender and previous personal history of COVID-19. Discussion: Implications of psychological inflexibility and the prevention and coping with stress in healthcare professionals during COVID-19 are further discussed., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Bonilla-Sierra, Manrique-G, Hidalgo-Andrade and Ruisoto.)

Advanced Chronic Kidney Disease (ACKD) supposes a public health problem in Ecuador that requires a comprehensive approach. In view of the scarcity of studies on the subject in this country, the objective of this research was to determine the signs and symptoms associated with the patients' physical, social and psychological spheres that allow properly developing palliative care. A longitudinal, prospective and observational study was conducted with ACKD patients. In order to assess the symptomatic burden and suffering of these patients, the Edmonton Symptom Assessment System Revised: renal (ESAS-r) for renal patients and the Distress Thermometer (DT) were used. The sample consisted of a total of 246 patients. The most common symptoms that affect them, causing them suffering in their daily lives, are those related to well-being, difficulty falling asleep and itching. It is necessary that health professionals adapt care measures and help patients undergoing renal treatment, especially those who have suffered the disease for a longer period of time, in order to alleviate the patients' suffering and therefore improve their daily lives. To such an end, a care plan could be designed that includes early palliative care.

Objective: This study aimed at exploring the compassion attitudes and needs for awareness and training related to a compassionate approach for Medicine, Nursing, and Psychology students, as well as for the academic and administration personnel from the Universidad Técnica Particular de Loja (UTPL, Ecuador) Health Sciences area. Methods : A cross-sectional observational study, based on a self-administered questionnaire through a sample of 788 UPTL students. STROBE guidelines were followed and applied. Results: A positive correlation was found between life engagement and compassion for others, from others, and self-compassion. The Nursing students were those who reported having previous experiences of contact with people with an advanced disease or in an end-of-life situation and having received some type of training compared to Medicine and Psychology students and lecturers (faculty members). Differences were found on the "self-compassion" and "compassion for others" subscales, noting a higher level of compassion among Psychology students. Conclusions : To implement the philosophy of compassionate universities it is necessary to design trainings that include the students, the faculty members, and the administrative staff, centered on sensitization and training about assistance, care, and accompaniment at the end of life, as well as cultivating compassion in the workplace.

(1) Background: This study aimed to explore the symptoms, functional status, and depression in patients with chronic diseases in Loja, Ecuador. (2) Methods: A cross-sectional study was carried out with patients over 60 years old having at least one chronic disease and cared for in healthcare centers of the Health Ministry of Ecuador or living in associated geriatric centers. (3) Results: The sample comprised 283 patients with a mean age of 76.56 (SD 7.76) years. The most prevalent chronic diseases were chronic obstructive pulmonary disease, followed by arterial hypertension and diabetes. Patients with a joint disease had the worst scores for the majority of the symptoms assessed with the Edmonton Scale. Cancer, dementia, and arterial hypertension contributed the most to the dependence levels assessed with the Barthel Index. Dementia contributed the most to the poor performance status evaluated with the Karnofsky Performance Status. Cancer and diabetes contributed the most to depression. Patients with a higher number of chronic diseases reported worse functional status. (4) Conclusions: Targeted interventions to address symptoms, functional status, and depression in patients with chronic diseases are needed.

Objective: Change Pain Latin America (CPLA) was created to enhance chronic pain understanding and develop pain management improving strategies in this region. During its seventh meeting (August 2016), the main objective was to discuss tramadol's role in treating pain in Latin America. Furthermore, potential pain management consequences were considered, if tramadol was to become more stringently controlled., Methods: Key topics discussed were: main indications for prescribing tramadol, its pharmacological characteristics, safety and tolerability, effects of restrictions on its availability and use, and consequent impact on pain care quality., Results: The experts agreed that tramadol is used to treat a wide spectrum of non-oncological pain conditions (e.g. post-surgical, musculoskeletal, post-traumatic, neuropathic, fibromyalgia), as well as cancer pain. Its relevance when treating special patient groups (e.g. the elderly) is recognized. The main reasons for tramadol's high significance as a treatment option are: its broad efficacy, an inconspicuous safety profile and its availability, considering that access to strong analgesics - mainly controlled drugs (classical opioids) - is highly restricted in some countries. The CPLA also agreed that tramadol is well tolerated, without the safety issues associated with long-term nonsteroidal anti-inflammatory drug (NSAID) use, with fewer opioid-like side effects than classical opioids and lower abuse risk., Conclusions: In Latin America, tramadol is a valuable and frequently used medication for treating moderate to severe pain. More stringent regulations would have significant impact on its availability, especially for outpatients. This could cause regression to older and frequently inadequate pain management methods, resulting in unnecessary suffering for many Latin American patients.

Cancer is a major public health issue. Poor pain management has devastating consequences that seriously affect quality of life, diminish functionality and place a huge emotional burden on patients and their relatives. A group of Latin American opinion leaders were invited to participate in a meeting to discuss areas associated with cancer pain. The expert panel reviewed the latest literature to draft region-specific guidelines for effective pain management. The guidelines make recommendations on tailoring treatment to the specific type of pain and provide local physicians with the state-of-the art findings in the field. Management should be with pharmacological approaches (nonopioid, adjuvant and opioid analgesics, as well as oncologic therapies and interventional procedures) and nonpharmacological approaches.

Aim: Latin-American experts in the use of opioids in patients with chronic nononcologic pain (CNOP) have updated existing recommendations to current Latin-American reality., Methods: Several key opinion leaders from Latin America participated in a face-to-face meeting in Guatemala (April 2015) to discuss the use of opioids in CNOP. Subgroups of experts worked on specific topics, reviewed the literature and shaped the final manuscript., Results: The expert panel developed guidelines taking into consideration the utility of both opioid and nonopioid analgesics and factors pertaining to their efficacy, safety, adherence, administration and risks for abuse/addiction., Conclusion: Latin-American guidelines for the use of opioids in CNOP should improve pain relief and patients' quality of life by increasing access to these effective agents.