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A randomized, open-label, controlled clinical trial was designed to assess the effectiveness of a motivational intervention based on the 5 R's model (relevance, risks, rewards, roadblocks, and repetition) delivered by specialized inflammatory bowel disease nurses every 3 months over a 1-year period as compared with patients who were followed regularly. Patients diagnosed with Crohn disease, aged 18 years or older, who reported being active smokers with Internet access at home and an e-mail address were eligible. A total of 144 patients (72 per group) were included (50% women, median age 40 years). They smoked a median of 10 cigarettes per day (range = 1-40) and had been smoking for a median of 22 years (range = 1-51). Motivation to quit (Richmond test) was low in 73 patients, moderate in 39 patients, and high in 32 patients. Statistically significant differences between the study groups in the predisposition to change, motivation to quit, and tobacco withdrawal were not found. However, 14 patients (20.9%) in the intervention group and 9 patients (13.2%) among controls stopped smoking at the end of the study. These findings support a higher trend toward smoking cessation associated with the motivational intervention 5 R's. This behavioral strategy can aid patients with Crohn disease to quit smoking., Competing Interests: Conflicts of Interest: None to be disclosed., (Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Gastroenterology Nurses and Associates.)

Aim: To detect possible changes in perception of the nurse work environment, job satisfaction and burnout between the years 2009 and 2014 among nurses working in the Spanish National Health System., Background: The global economic crisis has had a great impact on nurses in the Spanish National Health Service: tougher working conditions, lower pay and a reduction in social benefits. It is not known whether these changes affect the nurses' work environment, job satisfaction and burnout., Method: Comparative, cross-sectional study performed in seven hospitals in the Spanish National Health System between 2009 and 2014, through 1,454 surveys of nurses working in internal medicine, surgery and intensive care., Results: Nurses participating in the second period (2012-2014) were more satisfied with their current job (p = 0.001), perceived their work environment to be more favourable (p < 0.001) and had lower levels of burnout (p < 0.01). Professional factors as 'autonomy at work,' 'opportunities for advancement,' 'professional status' and 'nursing foundations for quality care,' as well as 'collegial nurse-physician relations' and 'nurse participation in hospital affairs' were the most important variables associated with these topics., Conclusions: Professional factors may influence these changes more than labour conditions and remuneration aspects., Implications for Nursing Management: In times of economic recession, encouraging interpersonal relationships, autonomy and participation in decision-making may improve the work environment, satisfaction and burnout of nurses., (© 2019 John Wiley & Sons Ltd.)

Background: Fetal occiput posterior position in labor is associated with more painful and prolonged labor, and an increase in both maternal and fetal morbidity. The aim of this study is to assess whether the modified Sims position on the side of the fetal spine increases the rotation to occiput anterior position in women with epidural analgesia and a fetus in persistent occiput posterior (POP) position., Methods: This is an open, randomized controlled, clinical trial. One hundred and twenty women in labor with fetuses in POP position were included. The diagnosis was performed through digital vaginal examination and confirmed with an ultrasound scan. Women were randomized into the free position group or the modified Sims on the side of the fetal spine. The primary outcome was rotation to occiput anterior, and secondary outcomes were type of delivery, postpartum perineal condition, perinatal results, and maternal satisfaction., Results: In pregnant women undergoing labor in the Sims position, fetuses in POP rotated to occiput anterior in 50.8% of cases, whilst in the free position group, the rotation occurred in 21.7% (P = .001). The rate of vaginal deliveries was higher in the Sims group compared with the free position group (84.7% vs 68.3%, P = .035)., Discussion: The modified Sims position is a maternal posture intervention efficient in POP rotation, which decreases cesarean delivery rate. It is a simple and noninvasive intervention, reproducible, and well tolerated by pregnant women., (© 2018 Wiley Periodicals, Inc.)

Objective: The main objective of this study was to determine the relationship between the characteristics of nurses' work environments in hospitals in the Spanish National Health System (SNHS) with nurse reported quality of care, and how care was provided by using different shifts schemes. The study also examined the relationship between job satisfaction, burnout, sleep quality and daytime drowsiness of nurses and shift work., Methods: This was a multicentre, observational, descriptive, cross-sectional study, centred on a self-administered questionnaire. The study was conducted in seven SNHS hospitals of different sizes. We recruited 635 registered nurses who worked on day, night and rotational shifts on surgical, medical and critical care units. Their average age was 41.1 years, their average work experience was 16.4 years and 90% worked full time. A descriptive and bivariate analysis was carried out to study the relationship between work environment, quality and safety care, and sleep quality of nurses working different shift patterns., Results: 65.4% (410) of nurses worked on a rotating shift. The Practice Environment Scale of the Nursing Work Index classification ranked 20% (95) as favourable, showing differences in nurse manager ability, leadership and support between shifts (p=0.003). 46.6% (286) were sure that patients could manage their self-care after discharge, but there were differences between shifts (p=0.035). 33.1% (201) agreed with information being lost in the shift change, showing differences between shifts (p=0.002). The Pittsburgh Sleep Quality Index reflected an average of 6.8 (SD 3.39), with differences between shifts (p=0.017)., Conclusions: Nursing requires shift work, and the results showed that the rotating shift was the most common. Rotating shift nurses reported worse perception in organisational and work environmental factors. Rotating and night shift nurses were less confident about patients' competence of self-care after discharge. The most common nursing care omissions reported were related to nursing care plans. For the Global Sleep Quality score, difference were found between day and night shift workers., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Background: Mechanical ventilation (MV) is one of the most utilised techniques in the intensive care unit (ICU), but it can cause sequelae that can negatively influence the patient's health-related quality of life (HRQL). Nursing-sensitive outcomes (NSOs) can also influence the HRQL. Assessing the HRQL of mechanically ventilated patients admitted to an ICU and its relation to nurse-sensitive outcomes will give healthcare professionals with valuable information to improve patient care., Methods: Prospective longitudinal cohort study in which all patients admitted to the ICU at Hospital Universitari Vall d'Hebron who undergo MV for more than 48 h will be included. The study will last 12 consecutive months. HRQL will be assessed by the completion of the SF-36 and the Saint Georges Respiratory Questionnaire. Pre-admission HRQL assessment will be performed by the main caregiver, and after ICU discharge, the assessment will be performed by the patient him/herself. The same questionnaires will also be completed one year after ICU discharge. Other variables (sociodemographic and those related to reason for ICU admission, ICU length of stay, MV, ICU stressors and NSO) will be included in a multiple regression model to assess their relation to the patient's HRQL., Discussion: This study will show the relationship between the HRQL perceived by patients and their main caregiver, what the HRQL is one year after discharge from ICU, and what the impact of MV, NSO and ICU stressors and other clinical outcomes on the patient's HRQL is. Determining mechanically ventilated patients' HRQL and its relation to NSO and ICU stressors as well as other clinical variables will enable early nursing interventions to try to minimise possible sequelae and improve the patient's welfare., Trial Registration: ClinicalTrials.gov ID:NCT02636660Registration Date: 17th December 2015.

Objective: To analyze the relationship between burden of disease during 2007-2009 and public funding of research in health in Spain during 2008-2010., Method: Descriptive cross-sectional study of burden of disease and funding allocated for research in diseases in the Spanish National Health System., Results: A review was made of a total of 6,573 project titles funded for the years 2008, 2009 and 2010. During this period, a total of 472.7 million Euros were assigned as grants for research projects. Malignant tumors and neuropsychiatric diseases were the illnesses with greatest funding support. During the study period, it was estimated that there was a total of 15,253,331.3 disability-adjusted life years (DALYs) in Spain, with neuropsychiatric diseases being the category representing most DALYs with 4,396,900 (28.8%). The relationship between funding and DALYs was obtained with a Pearson r equal to 0.759 (p<0.001). The study of congenital diseases had higher funding per DALY than any other disease with an investment of 290.4€/DALY. Among these, the study of cleft palate and esophageal atresia, with ratios of 3,432.7€/DALY and 3,387.6€/DALY respectively, obtained the greatest funding., Conclusions: The study shows that the relative distribution of economic resources in the study period is consistent with the burden suffered by the Spanish population. This relationship is altered by the funding of the study of congenital anomalies, because of the low number of projects in this area., (Copyright © 2013 Elsevier España, S.L. All rights reserved.)

Objective: to evaluate the efficacy of an intervention combining videoconferencing and telephone contact compared to standard post partum care of recent mothers attending health centres in Catalonia were recorded., Design: multicentre, randomised parallel controlled clinical trial., Participants and Setting: 1598 post partum women with Internet access attending eight 'Attention to Sexual and Reproductive Health' (Catalan acronym ASSIR) units at Primary Health Care centres, in Catalonia (Spain)., Intervention: at each of the eight ASSIR units, 100 women were randomly assigned to the intervention group (IG) and 100 to the control group (CG). Women in the IG could consult midwives by videoconference or telephone and could also receive standard care. Women in the control group received standard care from midwives at their health centres or at home., Measures: number and type of visits, reasons for consultation, type of feeding at six weeks and women's satisfaction with the intervention on a scale of 1 to 5., Findings: 1401 women were studied (80.9% of the initial sample), 683 in the IG and 718 in the CG. Two hundred and seventy-six women (40.4%) used videoconferencing or telephone in the IG. The mean total visits, virtual and face-to-face, was higher in IG women than in controls (2.74 versus 1.22). IG women made fewer visits to the health centre (mean=1) than CG women (mean=1.17). Both differences were statistically significant, with p<0.001 and p=0.002 respectively. The prevalence of breast feeding was similar in the two groups (IG 64.5%, and CG 65.4%). The mean overall satisfaction of women with midwife care was very high in both groups (IG 4.77, CG 4.76)., Conclusions and Implications for the Practice: virtual care via videoconferencing is effective for post partum women. It reduces the number of health centre visits and allows mothers to consult health staff immediately and from their own home., (© 2013 Elsevier Ltd. All rights reserved.)

Aims: To determine how prevalent circadian rhythm impairments are in nurses working in medical, surgical and intensive care units in five Spanish hospitals and how the quality of night-time sleeping and sleepiness affect the nurses' morning and evening chronotypes., Background: Shift work is a recognized work pattern for nurses in all countries. Given the important role that nurses play in hospital care, it is vital to establish what repercussions this has on the nurses' working schedules and how any disturbance in circadian rhythm affects patient safety., Design: A multicentre, observational, descriptive and cross-sectional study in seven hospitals in the Spanish National Health System., Method: A stratified sample of 1,300 nurses is being collected in three types of units: medical, surgical and intensive care. The 3-year study started in January 2012 and will continue until December 2014, with no exclusion criteria. The Kronowise(®) will be used to monitor the nurses' circadian rhythms, by recording their activity, position and wrist temperature. We will also use three questionnaires to evaluate sleep quality, daytime drowsiness and chronotype: (a) Pittsburg Sleep Quality Index; (b) Epworth Daytime Sleepiness Scale; and (c) Morning and Evening Questionnaire. Data will be collected from each hospital and statistical analysis will be carried out using the SPSS 19.0., Discussion: The study findings will show the current state of the nurses' circadian rhythms and how shift work can affect them and their job performance. Funding for this 3-year study was granted in December 2011 by the Spanish Health Research Fund (PI 11/00646, Health Ministry). This project is also funded by the Instituto de Salud Carlos III (RETICEF, RD12/0043/0011, RD12/0043/0006)., (© 2013 John Wiley & Sons Ltd.)

The care of people who live with chronic diseases is currently a priority on the roadmaps of all health care services. Within these strategies, there needs to be a specific approach required for a population group that is defined by having multiple diseases and the associated comorbidity. This group is especially vulnerable, fragile, and require very complex care, which uses up a high quantity of social health resources. The estimated prevalence in Spain is 1.4% in the general population, and approximately 5% in people over 64 years. The social and healthcare of this population requires a person-centered approach, as a paradigm of caring for the patients and not of the diseases. The models must leap from the segmented approach to diseases to a holistic and integrated vision, taking into account the social and psycho-affective situation, the experience of the patient, the family context, and the approach of human experience/response that these processes produce. The health professionals need support tools that can guide them and help in making clinical decisions in this population group. The clinical practice guidelines for the approach of patients with co-morbidity and multiple diseases have numerous limitations. Expert recommendations in this sense, lead us to a multidisciplinary approach, with self-care and self-health management as a cross-cutting element of healthcare., (Copyright © 2013 Elsevier España, S.L. All rights reserved.)

Objective: The objective of this study is to evaluate the content validity of the Iberian Spanish version of the questionnaire The Practice Environment Scale of the Nursing Work Index (PES-NWI) by using the Content Validity Indexing (CVI)., Methods: A descriptive cross-sectional observational study was conducted. The Spanish version of the questionnaire was translated from the American English instrument through forward and back translation processes. Experts evaluated the translated items through content validity indexing. Once the assessments were completed, CVI indicators were calculated: number of agreements, item Content Validity Index and overall content validity and modified kappa coefficient of the instrument., Results: The overall content validity of the instrument was 0.82. The average modified kappa coefficient of the items was 0.80, with a rating of 'excellent'. Only 4 of the items were rated as weak or poor., Conclusions: The study demonstrates that the content validity of the Spanish version of the PES-NWI is acceptable. Some results indicate that some items have cross-cultural applicability challenges that need to be addressed in future research studies. Use of the instrument in other Spanish language speaking countries should be taken with caution since some words may not reflect the language of the healthcare systems there., (© 2013 Elsevier Inc. All rights reserved.)

Objective: To determine the profile of nurses in public hospitals in Murcia and to assess how they perceive their work environment, the quality of care and their level of burnout (the RN4CAST project repetition)., Material and Methods: A cross-sectional descriptive study was carried out in 8 hospitals in Murcia. Data were collected between 2009 and 2010 from 687 nurses (stratified by the type of unit) using a self-completed questionnaire with 149 items covering variables related to sociodemographics; work; perception of the work place (PES-NWI); burnout (Maslach Burnout Inventory); and the quality of patient care, and patient safety., Analysis: Non parametric tests, for two samples or k samples according to the comparison., Results: A total of 495 questionnaires were collected (72%). Most respondents were female (80.4%) having a mean age of 34.1 (SD=7.1) years, and they had been working for 9.4 (SD=7.4) years. Just over one-quarter (25.7%) had carried out more than 300 hours of training in the previous 24 months. The patient/nurse ratio was 11.7 (SD=3.6), varying between hospitals. The nurses reported 25% of hospitals as having an unfavorable work environment, whereas 37.5% had favorable ones; large hospitals were less highly valued. Few respondents intended to give up their jobs (16.8%). Burnout levels revealed emotional exhaustion in 18.4% of respondents; depersonalization in 7.5%, and personal fulfillment in 28.8%. Perception of quality varied between centers and the perception of adverse effects was more favorable in small hospitals., Conclusions: Our professionals were generally satisfied, but given the unfavorable work environment, measures should be adopted for improving well-being and reducing weaknesses., (Copyright © 2012 SECA. Published by Elsevier Espana. All rights reserved.)

Objective: To know if there are differences between the critical care units and the medical-surgical care units regarding the perception of the nurses working in National Health System hospitals about their work environment, burnout level and job satisfaction., Method: A cross-sectional study was conducted with 6,417 nurses from the medical-surgical care units and with 1,122 nurses from critical care units of 59 Spanish hospitals with more than 150 beds. Socio-demographic, job satisfaction, perception of work environment (Practice Environment Scale of the Nursing Work Index [PES-NWI questionnaire]) and burnout measured with the Maslach Burnout Inventory (MBI) data were collected., Results: The PES-NWI showed differences in 4 out of its 5 factors. It showed better values in medical-surgical units in all the factors, except for Staffing and resource adequacy (P<.001), where critical care units showed a mean level of agreement of 2.41 versus 2.19 for the medical-surgical units. Regarding burnout, this was higher in the medical-surgical care units (P=.039) where 23% (952) of the nurses had high levels. Job satisfaction was lower in the critical care units (P=.044) with 70% (578) of nurses being very or strongly satisfied., Conclusions: The opinion of the nurses, working in critical care units about their hospital is unfavorable. They showed lower levels of burnout than those working in medical-surgical units., (Copyright © 2013 Elsevier España, S.L. y SEEIUC. All rights reserved.)

Objective: To analyze the relationship between the work environment and burnout of nurses and the quality of care for patient safety at the Spanish National Health System Hospitals included in SENECA and RN4CAST studies., Method: Descriptive study with a secondary analysis that compares data of 984 patient records, 1469 patient, and 1886 professional surveys from SENECA project, with 2139 nurses' surveys from RN4CAST study, in 24 hospitals. Adverse events data related to care, and patient's and professional's perception of safety were compared with work environment (measured by the Nursing Work Index) and burnout (measured by Maslach Burnout Inventory)., Results: There was a statistically significant relation of pain with «Staffing and resource adequacy» (r=-0,435, p=0,03) and nosocomial infection with «Nursing foundations for quality of care» (r=-0,424; p=0,04) and «Nurse participation in hospital affairs» (r=-0,516, p=0,01) of the Nursing Work Index. The hospital classification obtained from the Nursing Work Index was associated with the patients' perception of safety (r=0,66, p<0,01). Professionals' perception of participation in patient safety issues was associated with the five factors of the Nursing Work Index (r ∈ [|0,41|-|0,78 |], p<0,046) and with Maslach emotional exhaustion (r=-0,518, p=0,01)., Conclusions: The organizations that foster a supportive work environment will have patients that perceive safer care. In addition, proper resource management could decrease the occurrence of adverse events such as pain., (Copyright © 2012 Elsevier España, S.L. All rights reserved.)

Background: The importance of the practice environment in the provision of care and its relation with patient outcomes and nurse-reported outcomes, support the need to have an instrument to measure such practice environment., Objective: To evaluate the validity and reliability of the Spanish version of the Practice Environment Scale of the Nursing Work Index (PES-NWI), determining the content validity, test-retest reliability, internal consistency and construct validity., Design: A cross-sectional survey of bedside care nurses undertaken in 2009 in medical, surgical and critical care wards of 33 Spanish National Health Service hospitals with more than 150 beds., Methods: The validation process followed the internationally recognized guidelines about psychometric properties of instruments: translation and back-translation, content validity, test-retest reliability, internal consistency and construct validity. Other study variables included, like nurses' intention to leave and job satisfaction., Results: The Intraclass Correlation Coefficient (ICC) for an overall score on the 31 item questionnaire was 0.87 (CI 95%: 0.85-0.89). Cronbach's alpha was 0.90 (CI 95%: 0.87-0.93). The weighted Kappa Index obtained for each of the items ranges from 0.24 (CI 95%: 0.22-0.26) to 0.51 (CI 95%: 0.49-0.53). The Content Validity Index score ranges from 0.5 for the item "Opportunities for advancement" to 1. Five of the terms attain this maximum level of agreement: "Active staff development or continuing education programs for nurses", "Enough registered nurses on staff to provide quality patient care", "Enough staff to get the work done", "Management that listens and responds to employee concerns" and "Collaboration between nurses and physicians"., Conclusions: The validation process indicates that the Spanish version of the PES-NWI is valid and reliable in its current version and it can be used to measure the practice environment of Spanish nurses working in clinical practice in hospitals of the Spanish NHS., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Objective: To appraise the perception of Registered Nurses working at Spanish National Health System (SNHS) hospitals about work environment, quality of care and burnout., Method: Cross-sectional study addressed to 7539 nurses in 59 Spanish public hospitals over 150 beds belonging to the NHS between 2009 and 2010. Data was collected on: socio-demographic and academic background, job satisfaction, perception of work environment (PES-NWI) and burnout (MBI)., Results: Among 7539 questionnaires, 5654 were collected (75%). The nurses' average age was 37,5 (SD=9,5) years old, 88% (4929) were female and they had a median of 12 years of experience. The patient/nurse ratio was 11/1. 26% of nurses (1468) showed their intention to leave the hospital. 55% of nurses (3080) showed moderate job satisfaction. The work environment was unfavorable for 48% (2729) of nurses. 22% (1091) showed high burnout levels., Conclusions: The results show a high nurses' participation, who relate moderate job satisfaction. However, on PES-NWI, nearly half of nurses show an unfavorable work environment., (Copyright © 2012 Elsevier España, S.L. All rights reserved.)

Aims and Objective: To examine attitudes towards research and perceived barriers and facilitators of research utilisation in clinical practice in a broad cross-section of Spanish nurses., Background: Nurses' attitudes towards research are critical in determining whether study findings are used to improve practice., Design: Cross-sectional comparative survey in Hospitals, Primary Care Centres and University-affiliated schools of nursing., Methods: Surveys were completed by 917 nurses: 69 who received funding from the Spanish national agency (1998-2004) and a nationally representative sample of 848 nurses who did not have the same research experience (the Comparison group). Two instruments (BARRIERS and Attitudes towards nursing research) were translated and culturally adapted for use in Spain. A descriptive analysis of demographic and practice characteristics was performed. Total scale scores, as well as subscale scores, were computed and compared across the two groups using one-way analysis of variance (anova) and multivariate analysis of variance (manova) with post hoc tests. Pearson product-moment correlation coefficients were computed between the total tool scores and subscales measuring barriers and attitudes in both groups., Results: The investigators differed from other nurses on several demographic and work characteristics (more males, older age and more likely to work a fixed day shift schedule). On the whole, investigators showed more favourable attitudes but perceived several elements as posing greater barriers to research utilisation than the Comparison groups. Across all respondents, issues related to the quality of research were rated as the greatest barriers to research utilisation, followed by organisational barriers, barriers involving the communication of findings and finally, those related to nurses' values, awareness and skills., Conclusions: Very similar profiles of perceptions and attitudes regarding research were found in these samples of Spanish nurses relative to those from other countries in earlier reports. Nurses who had experience conducting research demonstrated more favourable research-related attitudes and perceived barriers differently than those without such experience., Relevance to Clinical Practice: Understanding different organisational and experience perspectives is important to identify challenges and opportunities to ensure research utilisation in clinical practice., (© 2011 Blackwell Publishing Ltd.)

Objective: To identify barriers to the utilization of research as perceived by Spanish nurses in clinical practice and by nurses who have been principal investigators of a research project funded by the national health research funding agency., Method: Cross-sectional, descriptive and observational study conducted in 2006 in hospitals, primary care health centres and nursing schools from the 17 Spanish Regions. Principal investigators of at least one project funded by the national health research funding agency between 1998 and 2004 were also included. A Spanish version of The BARRIERS to Research Utilization Scale was used. Socio-demographic and occupational variables were gathered with a questionnaire developed by the research team, which was self-administered., Results: A final sample of 854 out of 1,026 registered nurses (83.43%), and 69 principal investigator nurses out of 86 (80.23%) completed the survey. Highest rated barriers in the group of clinical practicing nurses were: "There is insufficient time on the job to implement new ideas" (mean=3.13; SD=1.08), "The nurse is unaware of the research" (mean=2.84; SD=1.14). Amongst principal investigators, the items rated highest were "The nurse is unaware of the research" (mean=3.12; SD=1.15) "The nurse does not feel capable of evaluating the quality of the research" (mean=2.97; SD=0.88)., Conclusions: Clinical nurses tend to believe that time pressures stand in the way of implementing research findings in practice. Results are consistent with studies in other countries and maintained over time., (Copyright (c) 2009 Elsevier España, S.L. All rights reserved.)

Objective: Identify the knowledge and attitudes on pain by nurses in general surgery and oncology units in Level III hospitals, and to find out if there are any differences between groups., Method: A multicentre, observational, analytical and cross-sectional study conducted in the general surgery and oncology units in 5 Spanish level III hospitals. Study subjects were all nurses working in these units. We collected demographic variables, as well as employment and training on the level of pain. To assess the knowledge and attitudes the Nurses' Knowledge and Attitudes Survey Regarding Pain questionnaire was used., Results: Of the 236 questionnaires delivered, 170 were successfully completed (72%). A total of 96 nurses (58%) indicated that they had received specific training on pain. A large majority, 85% (145) felt that patients should not have pain, and 14.7% (25) said it was normal that they should have moderate or intense pain. A total of 93.8% (152) were in agreement that the person to assess the intensity of pain more accurately is the patient, 46% (74) considered that 10% of patients exaggerated the intensity of pain. The majority, 61.9% (52), did not know the equivalence between oral and intravenous morphine. The overall median of correct answers, of which there was 37 in the questionnaire, was 18 (min=0, max=28), categorized as a score of 0 to 10, the median was 5 (min=0, max=8)., Conclusions: The level of knowledge that the nurses studied had on pain was not very high. Specific training is required and its impact evaluated.

The general ageing of the world population at the beginning of the XXI century is an established fact, and in the next few years it will be a topic for debate and of interest to the public and, in particular, among health professionals. The Internet, as an inexhaustible information source of a different kind, could be a useful resource for consulting and updating for these professionals. The main health sciences sources that are available on the Internet are presented and commented upon. These may be useful for those professionals who wish to identify the most relevant information on ageing.

Objective: To determine and prioritize the research competencies that should be acquired by nurses in distinct educational (graduate, masters, doctorate) and clinical practice settings (basic, intermediate and advanced) and in specialized training., Method: An observational, descriptive, cross sectional study was performed in 2006. The generic and specific competencies for each of the 7 above-mentioned settings were established and sent by electronic mail to a group of experts who were asked to evaluate each competency on a scale from 1 to 5 (1 = not important, 5 = very important)., Results: Evaluations were received from 34 (74%) of the 46 experts contacted. Of the general competencies, those receiving the highest scores, with a median of 5 points, were "ethical commitment" and "ability to work in a team". Among the specific competencies, those most highly scored were "awareness of the need to base nursing practice on the results of scientific research", "ability to critically read the scientific literature" and "ability to base nursing practice on the results of scientific research and the best available evidence". For doctorates and advanced-level nursing, most of the competencies, both general and specific, obtained a median score of 5 points., Conclusions: The most highly scored competencies were those relating to critical thinking, ethics and information analysis at each of the three levels of nursing training. Knowledge of English and interpersonal skills were less highly valued.

Background: Although mucosal leishmaniasis is a prominent disease, it has been studied only to a limited extent. It is classically treated with parenteral antimony or, as a last resort, amphotericin B., Methods: We treated Bolivian mucosal leishmaniasis due to Leishmania braziliensis with the oral agent miltefosine, 2.5 mg/kg/day for 28 days, and followed-up for 12 months., Results: Seventy-two patients were evaluable. The cure rate for the 36 patients who had "mild" disease (i.e., affecting nasal skin and nasal mucosa) was 83%. The cure rate for the 36 patients who had more extensive disease (involving the palate, pharynx, and larynx) was 58%. Patients refused to be randomized to parenteral agents, but the cure rate for an almost contemporary group who was receiving amphotericin B (45 mg/kg over 90 days) was 7 (50%) of 14., Conclusions: In this unrandomized trial, oral miltefosine was at least as effective as heroic doses of parenteral amphotericin B. The cure rate for miltefosine was approximately equivalent to historical cure rates using parenteral pentavalent antimony for mild and extensive disease in neighboring Peru. Although gastrointestinal side reactions do occur with miltefosine, its toxicity profile is superior to that of antimony and far superior to that of amphotericin B--in part because of the inherent attractiveness of oral versus parenteral agents. Our results suggest that miltefosine should be the treatment of choice for mucosal disease in North and South America.

The purpose of this study was to examine the prevailing pattern of introduction of nonmilk foods into the diets of children in Cuba and to assess the degree to which this pattern deviates from internationally accepted recommendations. A cross-sectional study was carried out using a simple random sample of 6,688 children under 1 year of age from all over Cuba. The data were analyzed through logistic regression. The study was carried out in 1990 using the pyramidal structure of the national public health system for the collection of data. Through the status quo method, information was obtained on consumption of four representative foods--juice, vegetables, meat, and fish--and some data were gathered on the child. Consumption prevalence rates were estimated at the beginning and the end of the age ranges (in days) that WHO considers optimum for the introduction of these foods. A marked divergence was found between recommended and actual practice. The recommendations were followed in 3% of the cases for juice, 9% for vegetables, 4% for meat, and 25% for fish. It is noteworthy that noncompliance with the recommendations basically takes the form of early introduction of these foods. The exception is vegetables, which are introduced considerably later than recommended, a fact that seems to reflect a cultural distaste for this food.