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Marta Mellides González,1 Marta Elena Losa Iglesias,2 Inmaculada Corral-Liria,2 Ricardo Becerro-de-Bengoa-Vallejo,3 Eva Maria Martinez-Jimenez,3 Sandra Fares-Medina,2 Sara González-Martín,2 Marta San-Antolín,4 Raquel Jiménez-Fernández2 1Hospital Universitario 12 de Octubre, Usera, Madrid, 28041, Spain; 2Faculty of Health Sciences, Universidad Rey Juan Carlos, Alcorcon, 28922, Spain; 3Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, 28040, Spain; 4Department of Psychology, Universidad de Valladolid, Valladolid, 47002, SpainCorrespondence: Inmaculada Corral-Liria, Faculty of Health Sciences, Universidad Rey Juan Carlos, Alcorcon, 28922, Spain, Email inmaculada.corral.liria@urjc.esObjective: To evaluate the moral distress (MD)in health professionals of pediatric and adult units to show how the complexity of care in the pediatric field causes the professionals who carry out their activity in these units to present a higher level of moral distress and a worse climate ethical.Design: Observational study with health professionals who currently work in Spanish Hospitals.Methods: A 58-item questionnaire was electronically distributed which included sociodemographic and employment characteristics, the Spanish version of the Measure of Moral Unrest for Healthcare Professionals (MMD-HP-SPA) and the Hospital Ethical Climate Survey (HECS).Results: A total of 169 health professionals completed the questionnaire. The moral distress was significantly higher among nurses than among physicians and nursing assistant care technicians. Focusing on the type of unit, moral distress it was only significantly higher for those physicians treating adult patients compared to those treating pediatric patients. Regarding the total score of the HECS survey, the medical group shows higher scores compared to the nursing group.Conclusion: Statistically significant differences have been found only in the medical group that treats adult patients, presenting a higher level of moral unrests than the pediatrician group. The MMD-HP-SPA questionnaire is a valid and useful instrument to detect MD in our hospital units in order to be able to implement strategies/interventions that improve the ethical climate and other factors that can mitigate and prevent this MD.Keywords: moral unrest, ethical climate, surveys, questionnaires, pediatrics

This study explores a range of informal health-seeking behaviors, including the use of Fang Traditional Medicine (FTM) for medical or cultural afflictions in Equatorial Guinea (EQ), the therapeutic methods used, the health problems handled, the learning process, traditional medicine user profiles and the social images of Fang Traditional Healers (FTHs). Ethnography was employed as a qualitative strategy using emic-etic approaches. Semi-structured interviews were conducted with 45 individuals, including 6 community leaders, 19 tribal elders, 7 healthcare professionals, 11 FTHs and 2 relatives of traditional healers in 5 districts of EQ. FTM offers a cure for malaria and treatments for reproductive health issues, bone fractures and cultural illnesses. Several methods used to learn FTM are based on empirical observation, and without the need for traditional schooling, unlike with Western medical professionals: for example, watching a family member, or the spirits or ancestors, can reveal healing knowledge. Materials from forests, including tree barks and plants, and rituals are used to keep Fang populations healthy; in addition, two rituals known as " osuiñ " and " etoak " (infusions of tree barks with the blood of sacrificed animals) are the most commonly used treatments. In addition, elders and women are the most active consumers of FTM. FTM plays a relevant role in curing medical and cultural afflictions in Fang communities. The informal health-seeking behavior among the Fang community is conditioned by the explanation model of illness.

Background: The coronavirus 2019 (COVID-19) pandemic has prompted several changes in teaching methods in addition to the ways of learning by students., Objective: To check whether a relationship between factors, such as resilience, self-esteem, depression, anxiety, academic stressors, and a change in teaching methods and learning since the first epidemic outbreak exists., Materials and Methods: This study was a cross-sectional descriptive one with a non-random sample of nursing degree teachers who did or did not participate in clinical activities but had been teaching online since the start of the pandemic. Data were collected with online questionnaires validated for self-completion with Google Forms., Results: Regarding the analysis of the descriptive data of each scale, we can verify that data indicate very high levels of resilience and self-esteem in the normal range with minimal levels of depression, moderate anxiety, and finally not worrying about sources of stress in teachers. Also, negative correlations were found between the 10 Connor-Davidson Resilience Scale, Beck Depression Inventory (BDI 2), Beck Anxiety Inventory (BAI), and Scale of Sources of Stress in Teachers with a statistical significance of p < 0.001. The Rosenberg Self-Esteem Scale also showed negative correlations with the three previously mentioned scales with a statistical significance of p < 0.001. Finally, positive correlations between the Beck (BDI 2), Beck (BAI), and Sources of Stress in Teachers scales and between the Rosenberg Self-Esteem scale and the 10 CD RISC scale were found ( p < 0.001)., Discussion: Our study shows that nursing degree teachers combine teaching with activities and presented moderate levels of anxiety, depression, and tolerance to academic stressors and were able to maintain optimal levels of self-esteem and resilience, indicating that these two factors act as protectors against these stressors., Tweetable Abstract: Nursing teachers presented moderate levels of anxiety, depression, and academic stressors due to optimal levels of self-esteem and resilience., 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 © 2022 Losa-Iglesias, Jimenez-Fernandez, Corral-Liria, Herraiz-Soria, Rodriguez-Vazquez and Becerro-De-Bengoa-Vallejo.)

Gender-based violence is considered a serious social and public health problem. Overcoming this situation implies a process that results in the favorable biopsychosocial rehabilitation of the resilience of women. The objective of this study was to analyze the tools, resources and personal and psychosocial mechanisms used by women survivors of gender-based violence. The design was an interpretative phenomenology. It was carried out with 22 women who have overcome gender-based violence. Data were collected through personal interviews and narration. The results were grouped into four themes: "Process of violence", "Social resources for coping and overcoming GBV", "Personal tools for coping and overcoming GBV" and "Feelings identified, from the abuse stage to the survival stage". Several studies concluded that overcoming abuse is influenced by the women's social network, and it can be the action of these people determining their survival to gender violence. Despite the recognized usefulness of these available resources, it would be desirable to strengthen them in order to be able to drive more women toward survival, assuming a strengthening of coping and overcoming, without forgetting the importance of other support mechanisms, such as their family and group therapies.

In 1994, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) included "culture-bound syndromes" in its classification of psychiatric disorders and associated them with disease processes that manifest in behavioural or thought disorders that develop within a given cultural context. This study examines the definitions, explanatory models, signs and symptoms, and healthcare-seeking behaviours common to Fang culture-bound syndromes (i.e., kong, eluma, witchcraft, mibili, mikug, and nsamadalu). The Fang ethnic group is the majority ethnic group in Equatorial Guinea. From September 2012 to January 2013, 45 key Fang informants were selected, including community leaders, tribal elders, healthcare workers, traditional healers, and non-Catholic pastors in 39 of 724 Fang tribal villages in 6 of 13 districts in the mainland region of Equatorial Guinea. An ethnographic approach with an emic-etic perspective was employed. Data were collected using semi-structured interviews, participant observation and a questionnaire that included DHS6 key indicators. Interviews were designed based on the Cultural Formulation form in the DSM-5 and explored the definition of Fang cultural syndromes, symptoms, cultural perceptions of cause, and current help-seeking. Participants defined "Fang culture-bound syndromes" as those diseases that cannot be cured, treated, or diagnosed by science. Such syndromes present with the same signs and symptoms as diseases identified by Western medicine. However, they arise because of the actions of enemies, because of the actions of spirits or ancestors, as punishments for disregarding the law of God, because of the violation of sexual or dietary taboos, or because of the violation of a Fang rite of passage, the dzas, which is celebrated at birth. Six Fang culture-bound syndromes were included in the study: 1) Eluma, a disease that is targeted at the victim out of envy and starts out with sharp, intense, focussed pain and aggressiveness; 2) Witchcraft, characterized by isolation from the outside, socially maladaptive behaviour, and the use of hallucinogenic substances; 3) Kong, which is common among the wealthy class and manifests as a disconnection from the environment and a lack of vital energy; 4) Mibili, a possession by evil spirits that manifests through visual and auditory hallucinations; 5) Mikug, which appears after a person has had contact with human bones in a ritual; and 6) Nsamadalu, which emerges after a traumatic process caused by violating traditions through having sexual relations with one's sister or brother. The therapeutic resources of choice for addressing Fang culture-bound syndromes were traditional Fang medicine and the religious practices of the Bethany and Pentecostal churches, among others. Among African ethnic groups, symbolism, the weight of tradition, and the principle of chance in health and disease are underlying factors in the presentation of certain diseases, which in ethno-psychiatry are now referred to as culture-bound syndromes. In this study, traditional healers, elders, healthcare professionals, religious figures, and leaders of the Fang community in Equatorial Guinea referred to six such cultural syndromes: eluma, witchcraft, kong, mibili, mikug, and nsamadalu. In the absence of a multidisciplinary approach to mental illness in the country, the Fang ethnic group seeks healthcare for culture-bound syndromes from traditional healing and religious rites in the Evangelical faiths., Competing Interests: The authors have declared that no competing interests exist.