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The “infodemic” is one of the main obstacles in the fight against the COVID-19 pandemic. In order to face it, health literacy (HL) is essential since it allows for knowledge about COVID-19 and the practice of preventive measures to be fostered. This is especially relevant in university students due to their idiosyncrasy. This study aims to evaluate the level of HL related to COVID-19 (HLC), risk perception, misinformation, and the attitudes and behaviors adopted to prevent the spread of coronavirus in Spanish university students. An online questionnaire was administered to 499 Spanish university students. The HLC index presented a mean of 33.89 out of 50; a total of 63.8% had an inadequate level of HLC. They practiced a mean of 7.54 out of 9 preventive behaviors, and the mean knowledge score was 10.40 out of 13. The HLC showed significantly different scores for the degree, the practice of preventive measures, and some sources of information. The level of HL correlates with the adoption of preventive measures. The higher the severity and perceived susceptibility, the more preventive measures are taken by the students. Therefore, there is a need to strengthen the HL skills of university students and address the dissemination of misinformation. Although caution should be taken when generalizing these results due to the limitations inherent within a cross-sectional study and the convenience sampling, our results can guide the establishment of health education strategies and policies for the management of the infodemic in pandemic situations, according to this target population.

The aim of this study was to measure of health literacy in the migrant population and establish a type of immigrant profile with a higher risk of presenting low levels of health literacy.A cross-sectional descriptive study.Health literacy was measured in a total of 278 immigrants using HLS-EU-Q16. An inferential descriptive and multiple regression analysis was carried out.65.1% having inadequate and problematic health literacy. Significant correlations were found between health literacy and length of stay in Spain (r = .398), age (r = .178p) and perceived social status (r = .151). Participants with shorter length of stay (β = .405 1), without health sciences education (β = .205) and low education level (β = .182) had limited health literacy.

BACKGROUND Background: Heart failure (HF) is becoming a global epidemic. To promote healthy behaviors and facilitate the strengthening of the provision of health services in these patients, it is essential to prioritize their opinions and needs. Mobile health applications seem to be an effective tool in the care of these patients. User-centered design and the Information Systems Research (ISR) perspective are well-established approaches to developing mobile applications that are responsive to the needs of these patients. OBJECTIVE Objective: The aim of this study was to provide practical information regarding needs, preferences of content, and format of an App to assist the self-management in patients with multi-morbidity and HF. METHODS Methods: This three phases study was conducted in Spain. Six integrative reviews, a qualitative methodology based on Van Manen's hermeneutic phenomenology through semi-structured interviews and user stories were used. A total of 20 patients were included in this study. Data collection continued until data saturation was reached. All data were transcribed verbatim and analyzed using a framework approach. Thematic analysis technique following the methods of Braun and Clarke was used for emerging themes. RESULTS Results: The integrative reviews conducted included practical recommendations to include in the content and format of the App and helped create the interview guide. Interviews revealed 15 subthemes, related to the domains of food and nutrition, medication and treatment, rehabilitation and physical activity, signs and symptoms, self-management, and emotional management. These subthemes captured the meaning of narratives offering contextual insights into the development of the App. The main effective mechanisms of multicomponent interventions for patients with HF must contain: i) components that increase the patient's understanding of HF, ii) self-care, iii) self-efficacy, participation of the family / caregiver, iv) psychosocial well-being, and v) professional support and use of technology. User stories revealed that patients prioritized improvements in direct contact with health services in case of emergency (90%), in nutritional information (70%), type of exercises in order to improve their physical condition (75%), and information about food and drugs interaction (60%). As a transversal element, in a large part of the user stories, was highlighted the importance of motivation messages (60%). CONCLUSIONS Conclusions: A 3-phases process integrating theoretical basis, evidence from integrative reviews, and research findings from target users has been considered a guide for future App development. CLINICALTRIAL ClinicalTrials.gov NCT04725526 INTERNATIONAL REGISTERED REPORT RR2-10.2196/35945

Background The COVID-19 pandemic has highlighted the importance of health literacy to make informed preventive decisions. A specific COVID-19 health literacy questionnaire (CHL-Q) is included in the COVID-19 Snapshot Monitoring WHO initiative to conduct behavioral insights studies related to COVID-19. The objective was to assess the psychometric properties of a Spanish version of the COVID-19 Health Literacy Questionnaire (CHL-Q). Methods Data quality, acceptability, internal consistency, and construct and structural validity were analyzed. A Rasch analysis was also performed. This cross-sectional, observational study was conducted on the Spanish general population after the first wave of the pandemic and after the end of the general lockdown by an online survey agency. 1033 participants (inclusion criteria were being 18 years or older and living in Spain), was extracted from a panel of approximately 982,000 participants. The sampling was stratified matching the Spanish general population in terms of age, gender, and area of residence. The CHL-Q includes 9 items and assesses people's knowledge, motivation and competencies to access, understand, evaluate, and apply information about COVID-19 in order to make informed decisions. Results CHL-Q index presented a mean of 33.89 (SD = 9.4), and good fit to the Rasch model (χ2(32) = 34.672, p = 0.342, person separation index = 0.77), with ordered thresholds, unidimensionality, item local independence, and no item bias by sex, age or education level. The CHL-Q showed significant different scores by level of education, experience of infection, confusion related to COVID-19 information and adherence to preventive measures. We found a statistically significant correlation between the CHL-Q index and the total number of preventive measures adopted, COVID-19 knowledge, and information seeking behaviour. The Cronbach´s alpha was 0.87 and the item total corrected correlation, 0.49–0.68. Conclusions The Spanish version of CHL-Q is a short, adequate, and reliable instrument to measure COVID-19 related health literacy in the Spanish general population. Measuring the CHL in the population can be useful to evaluate whether public authorities, media and the medical and scientific community have been able to reach the population to offer the information in the terms they need it.

The aims of this study were (1) to develop a multimodal intervention according to the NLN Jeffries Simulation Theory planned to improve attitudes and empathy towards older adults in undergraduate nursing students using theoretical contents, age simulation suits, and storytelling of old participants, and (2) to evaluate the influence of the simulation flow on the effectiveness of this intervention in improving attitudes and empathy towards older adults.The increase in longevity in recent decades has led to an increase in the demand for professionals linked to the care of the older adults. Some studies indicate that health care professionals lack empathy and understanding toward older adults. Therefore, it is essential to introduce innovative teaching strategies to improve attitudes and empathy toward older adults in future health professionals.A crossover randomised controlled trial.A three-period crossover randomised controlled trial with an experimental group, a control group (that transitions to a delayed experimental group) was conducted on 70 nursing students after the initial 73 were allocated. A multimodal intervention was used that, in addition to geriatric nursing theory, incorporated complex age simulation suit and student-older adult interaction. Pre-test and post-test data were obtained through the Jefferson Scale of Empathy and Kogan's Attitudes towards Older People Scale. Thus, students in the experimental group 1 received the following simulation flow: Geriatric Nursing Theory + Seminar with age simulation suit + student-older adult interaction. The students in the delayed experimental group 2 received this order: Geriatric Nursing Theory +Seminar without Age simulation suit + student-older adult interaction + Age simulation suit.Statistically significant differences were observed in both empathy (t = 3.155, p = 0.001, d = 0.782), and attitudes (t=3.256, p=0.001, d=0.803) when comparing control group scores (who only received the theoretical contents of the seminar) and experimental group 1 scores after receiving the full multimodal simulation (i.e. a seminar wearing an age simulation suit + volunteer interaction with an older adult). Regarding the order of educational strategies in the simulation flow, there were significant differences in the empathy scores found when both groups had received the full intervention. Accordingly, training with age simulation suits followed by storytelling provides better scores in empathy than in the opposite direction (t = 2.028, p = 0.048, d = 0.54).The use of a multimodal intervention, implementing an age simulation suit and the narration of an older adult's life experiences (in this order), improves attitudes and empathy.

The genus Azorella, as currently circumscribed, with 58 species, is taxonomically complex. Therefore, the typification of its names is particularly important for the correct delimitation of its species. Recent taxonomic revisions within the group contributed to the nomenclature in this respect, but as part of the studies for the Flora of Argentina project, many names in Azorella still need typifications. To resolve typifications, protologues and available original material for all names were studied, and decisions were made following the International Code of Nomenclature for algae, fungi, and plants, and based on our expertise on the taxonomy of the group. As a result, 27 lectotypes, and 4 neotypes are designated here.

Health literacy (HL) is a result of health promotion and education that has been included as a nursing intervention since 2013. It was proposed, as a nursing activity, to “determine health literacy status at initiation of contact with the patient through informal and/or formal assessments”. Because of that, the outcome ‘Health Literacy Behaviour’ has been incorporated in the sixth edition of the Nursing Outcomes Classification (NOC). It collects the patient’s different HL levels and allows them to be identified and evaluated in a social and health context. Nursing outcomes are helpful and provide relevant information for the evaluation of nursing interventions. Objectives: To validate the contents of the nursing outcome ‘Health Literacy Behaviour (2015)’ in order to use them in nursing care plans, and to evaluate their psychometric properties, application level, and effectiveness in nursing care to detect low health literacy patients. Methods: a methodological two-phased study: (1) an exploratory study and content validation by expert consensus, who will evaluate revised content of nursing outcomes; (2) methodological design by clinical validation. Conclusion: The validation of this nursing outcome in NOC will enable the generation of a helpful tool that would facilitate nurses to set individualised and efficient care interventions and identify low health literacy populations.

BACKGROUND Patients with multimorbidity and complex health needs are defined as a priority by the World Health Organization (WHO) and the European Union. There is a need to develop appropriate strategies with effective measures to meet the challenge of chronicity, reorienting national health systems. The increasing expansion of mobile health (mHealth) interventions in patient communication, the reduction of health inequalities, improved access to health care resources, adherence to treatment, and self-care of chronic diseases all point to an optimistic outlook. However, only few mobile apps demonstrate their effectiveness in these patients, which is diminished when they are not based on evidence, or when they are not designed by and for users with different levels of health literacy (HL). OBJECTIVE This study aims to evaluate the efficacy of an mHealth intervention relative to routine clinical practice in improving HL and self-management in patients with multimorbidity with heart failure (HF) and complex health needs. METHODS This is a randomized, multicenter, blinded clinical trial evaluating 2 groups, namely, a control group (standard clinical practice) and an intervention group (standard clinical practice and an ad hoc designed mHealth intervention previously developed), for 12 months. RESULTS The contents of the mHealth intervention will address user-perceived needs based on the development of user stories regarding diet, physical exercise, cardiac rehabilitation, therapeutic adherence, warning signs and symptoms, and emotional management. These contents have been validated by expert consensus. The creation and development of the contents of the mHealth intervention (app) took 18 months and was completed during 2021. The mobile app is expected to be developed by the end of 2022, after which it will be applied to the experimental group as an adjunct to standard clinical care during 12 months. CONCLUSIONS The trial will demonstrate whether the mobile app improves HL and self-management in patients with HF and complex health needs, improves therapeutic adherence, and reduces hospital admissions. This study can serve as a starting point for developing other mHealth tools in other pathologies and for their generalization to other contexts. CLINICALTRIAL ClinicalTrials.gov NCT04725526; https://tinyurl.com/bd8va27w INTERNATIONAL REGISTERED REPORT DERR1-10.2196/35945

Una reciente circunscripción de Azorella reduce los géneros Schizeilema, Stilbocarpa, Huanaca, Laretia, y Mulinum a su sinonimia. En base a la integración de estudios morfológicos, revisiones taxonómicas y filogenias moleculares, se propone la división de Azorella en dos subgéneros: Azorella y Andinae. Estos dos grupos están fuertemente soportados en todas las filogenias y representan el primer evento de divergencia en el género, que resultó en historias evolutivas independientes, por lo que es importante resaltar estas diferencias. El subgénero Azorella incluye 23 especies herbáceas con una distribución en zonas australes del Hemisferio Sur, incluyendo la Patagonia, Australia, Nueva Zelanda e islas subantárticas; reúne a los géneros anteriormente reconocidos Huanaca, Schizeilema y Stilbocarpa y a las tres especies de Azorella Sect. Azorella. Por otro lado, el subgénero Andinae comprende 35 especies con una distribución principalmente sudamericana y dominante en regiones elevadas de los Andes y en la estepa Patagónica; reúne a las restantes especies tradicionalmente tratadas en Azorella, más Mulinum y Laretia. Se aporta por primera vez una descripción morfológica de Azorella, según su circunscripción actual, y una clave para diferenciar a los dos subgéneros. Dado que para todas las especies del subgénero Andinae se dispone de un conocimiento amplio e integrado de la morfología, anatomía y de su distribución geográfica, se proporciona una clave para todas las especies y variedades del subgénero, así como listas de sinónimos y observaciones taxonómicas. Además, se realizan 6 combinaciones nuevas y se corrigen errores nomenclaturales. A recent circunscription of Azorella reduced the genera Schizeilema, Stilbocarpa, Huanaca, Laretia, and Mulinum to its synonymy. Based on the integration of morphological studies, taxonomic revisions and molecular phylogenies, we propose here the division of Azorella into two subgenera: Azorella and Andinae. These two groups are strongly supported in all phylogenies, and represent the first divergence event in the genus, resulting in independent evolutionary histories, so it is important to highlight these differences. The subgenus Azorella includes 23 herbaceous species with a distribution in austral regions of the Southern Hemisphere, including Patagonia, Australia, New Zealand and the subantarctic islands; it comprises the formerly recognized genera Huanaca, Schizeilema, Stilbocarpa, and the three species of Azorella Sect. Azorella. On the other hand, the subgenus Andinae includes 35 woody species mainly of South American distribution and in high altitude regions of the Andes and Patagonia; it includes the remaining species traditionally treated in Azorella, plus Mulinum and Laretia. A morphological description of Azorella, as circuncribed today, and a key to differentiate the two subgenera are provided for the first time. Given the current thorough and integrated knowledge of the morphology, anatomy, and geographic distribution of all species of subgenus Andinae, a key is provided for all its species and varieties, as well as lists of synonyms and taxonomic observations. In addition, we publish 6 new combinations, and correct nomenclatural errors. Fil: Fernández, Martina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Instituto de Investigaciones en Biodiversidad y Medioambiente. Universidad Nacional del Comahue. Centro Regional Universidad Bariloche. Instituto de Investigaciones en Biodiversidad y Medioambiente; Argentina Fil: Calviño, Carolina Isabel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Instituto de Investigaciones en Biodiversidad y Medioambiente. Universidad Nacional del Comahue. Centro Regional Universidad Bariloche. Instituto de Investigaciones en Biodiversidad y Medioambiente; Argentina

Background Empathy has been reported to produce a positive effect on improving patient health outcomes, becoming a fundamental skill in any health personnel-patient relationship. Objective To evaluate the effectiveness of an intervention designed to improve the nursing students´ empathy, the learning perception, the improvement of the perception in the understanding of the content, and in the degree of difficulty as well as the acquisition of skills. Design Multicentre randomised controlled trial. Setting This research was conducted at two schools of nursing at a public university in the Southwest of Spain. Participants 116 nursing students were randomly assigned to an experimental or a control group (delayed intervention group once the post-training analysis was completed) during the second semester of the 2015/2016 academic year. Methods Pre-test, post-test, and follow-up data were obtained for each group using a simulated clinical interview. Empathy was the primary outcome (The Consultation and Relational Empathy Measure, Jefferson Scale of Empathy student version, Reynolds Empathy Scale, and Carkhuff Scale). The students' perceived knowledge, the learning perception, the self-esteem (Rosenberg Self-Esteem Scale) and the understanding of the content and acquisition of skills (ad-hoc questions) were also analysed. Results The results were improved in all the measures conducted in the experimental groups at the different centres after the intervention. The mean post-test simulation scores were higher than the pre-test with statistically significant differences. The results were maintained in the follow-up. The student's perception of learning and the perception of understanding of the content and the acquisition of skills were improved as well. Conclusion The study support that training in empathic competence is effective.

Health literacy is a social determinant of the basic health of populations and is especially important to enhancing and developing the empowerment of migrant populations. To evaluate the effectiveness of an mHealth intervention to improve the cognitive and social skills that enable migrants to access and use health services, we developed a quasi-experimental design to encompass a single group of enrolled immigrants (N = 93). They completed preintervention and postintervention questionnaires of the European Health Literacy Survey Questionnaire, the self-created questionnaire HL-APP-Q14 (Health Literacy App Questionnaire), and a practical simulation test. Health literacy improved significantly after the intervention, increasing from a problematic level (mean, 9.55 [SD, 4.35]) to a sufficient level (mean, 14.03 [SD, 2.68]). Differences were statistically significant for males and females as well as for participants of all nationalities, except the Chinese group. The application e_SaludAble empowered the migrant participants through the improvement of their health literacy.

Background Patients with multimorbidity and complex health needs are defined as a priority by the World Health Organization (WHO) and the European Union. There is a need to develop appropriate strategies with effective measures to meet the challenge of chronicity, reorienting national health systems. The increasing expansion of mobile health (mHealth) interventions in patient communication, the reduction of health inequalities, improved access to health care resources, adherence to treatment, and self-care of chronic diseases all point to an optimistic outlook. However, only few mobile apps demonstrate their effectiveness in these patients, which is diminished when they are not based on evidence, or when they are not designed by and for users with different levels of health literacy (HL). Objective This study aims to evaluate the efficacy of an mHealth intervention relative to routine clinical practice in improving HL and self-management in patients with multimorbidity with heart failure (HF) and complex health needs. Methods This is a randomized, multicenter, blinded clinical trial evaluating 2 groups, namely, a control group (standard clinical practice) and an intervention group (standard clinical practice and an ad hoc designed mHealth intervention previously developed), for 12 months. Results The contents of the mHealth intervention will address user-perceived needs based on the development of user stories regarding diet, physical exercise, cardiac rehabilitation, therapeutic adherence, warning signs and symptoms, and emotional management. These contents have been validated by expert consensus. The creation and development of the contents of the mHealth intervention (app) took 18 months and was completed during 2021. The mobile app is expected to be developed by the end of 2022, after which it will be applied to the experimental group as an adjunct to standard clinical care during 12 months. Conclusions The trial will demonstrate whether the mobile app improves HL and self-management in patients with HF and complex health needs, improves therapeutic adherence, and reduces hospital admissions. This study can serve as a starting point for developing other mHealth tools in other pathologies and for their generalization to other contexts. Trial Registration ClinicalTrials.gov NCT04725526; https://tinyurl.com/bd8va27w International Registered Report Identifier (IRRID) DERR1-10.2196/35945

Improving health literacy (HL) is critical for addressing health inequalities. Low literacy rates are believed to be more prevalent in ethnic minorities, which may have an impact on people&rsquo, s health. For measures to be implemented in this regard, HL must be evaluated to obtain specific indicators. Our aim, therefore, was to develop a version of the European Health Literacy Survey Questionnaire (HLS-EU-Q16), which is recommended to be used with vulnerable populations, suited to Arabic/French-speaking migrants who reside in south-eastern Spain, and to explore its psychometric properties for assessing health literacy in this population. A cross-sectional survey was carried out in a convenient sample of 205 migrants. The structural validity was calculated by a confirmatory factorial analysis (CFA), which suggested appropriate adjustment indicators, and which indicated that the three-dimensional model is adequately adjusted to the data obtained in the study. The coefficient omega showed high internal consistency in the three HL dimensions (health care, disease prevention, and health promotion). Concurrent validity presented a significant correlation with the Newest Vital Sign test (r = 0.390, p &lt, 0.001). The multigroup CFA showed that the heterogeneity of the sample used was not a problem for establishing the structural validity of the scale. The Arabic/French version showed good construct validity.

Introducción y objetivos: Azorelloideae es una de las cuatro subfamilias monofiléticas de Apiaceae y actualmente comprende 17 géneros. En el contexto de la revisión de la subfamilia para el proyecto de Flora Argentina, se encontraron 15 nombres pertenecientes a Asteriscium, Bolax, Bowlesia, Diposis y Pozoa, que requieren tipificaciones. M&M: Para resolver las tipificaciones, se examinaron los protólogos y el material original de todos los nombres, y las decisiones se tomaron siguiendo el Código Internacional de Nomenclatura para Algas, Hongos y Plantas, y a partir de nuestro conocimiento de la taxonomía del grupo. Resultados y Conclusiones: Se designan 14 lectotipos y un neotipo, y se brindan justificaciones para cada selección. Como resultado, todos los nombres de Azorelloideae incluidos en Flora Argentina, tienen seleccionado un ejemplar permanente de referencia, lo cual es un paso esencial para la correcta identificación de las especies.

Species of Alnus (alders) have become invaders in several parts of the world. Here we report the presence of three naturalized alien species: A. glutinosa, A. incana and A. rubra from several populations in nature reserves of northwestern Patagonia, an area of remarkably high biodiversity. Alnus glutinosa had been cited previously for Chile and southern Argentina, but A. incana and A. rubra are here reported for the first time. As we found morphological variation within and among the populations of these introduced species that makes their discrimination difficult, we used chloroplast (trnH-psbA) and nuclear ribosomal (ITS) DNA sequences to confirm their identifications from morphological characteristics. Results from nuclear and chloroplast sequence data confirm the morphological tentative identification of the three species and remark the utility of molecular information together with morphology for the detection of introduced species of taxonomically difficult groups. The invasive characteristics of these alien tree species are discussed in relation to the conservation of the nature reserves where they are found. Fil: Calviño, Carolina Isabel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Instituto de Investigaciones en Biodiversidad y Medioambiente. Universidad Nacional del Comahue. Centro Regional Universidad Bariloche. Instituto de Investigaciones en Biodiversidad y Medioambiente; Argentina Fil: Edwards, Priscila. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Instituto de Investigaciones en Biodiversidad y Medioambiente. Universidad Nacional del Comahue. Centro Regional Universidad Bariloche. Instituto de Investigaciones en Biodiversidad y Medioambiente; Argentina Fil: Fernández, Martina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Instituto de Investigaciones en Biodiversidad y Medioambiente. Universidad Nacional del Comahue. Centro Regional Universidad Bariloche. Instituto de Investigaciones en Biodiversidad y Medioambiente; Argentina Fil: Relva, Maria Andrea. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Instituto de Investigaciones en Biodiversidad y Medioambiente. Universidad Nacional del Comahue. Centro Regional Universidad Bariloche. Instituto de Investigaciones en Biodiversidad y Medioambiente; Argentina Fil: Ezcurra, Cecilia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Instituto de Investigaciones en Biodiversidad y Medioambiente. Universidad Nacional del Comahue. Centro Regional Universidad Bariloche. Instituto de Investigaciones en Biodiversidad y Medioambiente; Argentina

Background Health literacy is considered a social health determinant that influences improvement in health, patient empowerment and reduction in inequalities. There is a lack of health literacy interventions for vulnerable social groups (i.e. immigrants), and nurses have shown little familiarity with the concept. Aim This study aimed to identify and analyse whether interventions directed at immigrant populations improve the functional (basic reading, writing and arithmetic skills), interactive (social and cognitive skills) and critical (advanced cognitive and social skills in critically analyzing information and making informed decisions) dimensions of health literacy, taking into account the role played by nursing in these interventions. Methods A systematic review of four databases including PubMed, PsycINFO, the Cochrane Library and ERIC was conducted to identify relevant articles published between 2000 and 2015. Thirty-four articles met the inclusion criteria, and nine articles used a validated instrument. Results Few specific health literacy interventions for immigrant populations were found. The main findings of the studies showed positive changes in functional health literacy. However, the interventions were less effective in improving interactive and critical health literacy. Limitations Several of the findings of this review were based on studies that had their own limitations. The assessment of the articles was not blinded, and the review was restricted to articles written in Spanish and English. Conclusions The interventions studied were reported as being effective in improving health literacy in immigrants, particularly the functional aspects. Regarding the role played by nursing, this review observed little involvement. Implications for Nursing and Health Policy It is important for educational strategies to include health literacy dimensions. The concept of health literacy should be included as a Nursing Outcomes Classification and in its subsequent validation taxonomy. To promote community health, health literacy must be a prioritized objective of health management and policies.

The genus Laretia Gillies & Hook. comprises a single species, L. acaulis (Cav.) Gillies & Hook., of xerophilous subshrubs that form flat compact cushions. It is endemic to southern South America and is distributed through the high Andes of San Juan and Mendoza provinces in Argentina, and Atacama to Maule regions in Chile. Descriptions of Laretia are available only from the protologue and from a few regional floras; these are not comprehensive and are based on few specimens. Moreover, the actual geographic distribution of the genus has been questioned. In this work we present a taxonomic treatment for Laretia that includes field work, analysis of the protologue, and an exhaustive revision of herbarium material. We also analyze and describe the morphology and anatomy of its fruits because of their diagnostic importance in the family. We provide a detailed morphological description, ecological and ethnobotanical information, and illustrations of the genus. Additionally, we present a map that shows t...

(1) Background: Obesity is a global health problem, and its prevention must be a priority goal of public health, especially considering the seriousness of the problem among children. It is known that fetal and early postnatal environments may favor the appearance of obesity in later life. In recent years, the impact of the programs to prevent obesity in childhood has been scarce. The aim of this research is to evaluate the effectiveness of an intervention based on the concept of early programming. (2) Methods: Non-randomized controlled trial design. Inclusion criteria are: two-year-old infants whose gestational period begins in the 14 months following the start of the intervention, and whose mothers have made the complete follow-up of their pregnancy in the same clinical unit of the study. The intervention will be developed over all the known factors that affect early programming, during pregnancy up to 2 years of life. Data will be collected through a data collection sheet by the paediatricians. A unibivariate and multivariate analysis of the data will be carried out. (3) Ethics and dissemination: The trial does not involve any risk to participants and their offspring. Signed informed consent is obtained from all participants. Ethical approval has been obtained. (4) Results: It is expected that this study will provide evidence on the importance of the prevention of obesity from the critical period of the first 1000 days of life, being able to establish this as a standard intervention in primary care.

Effective empathy training interventions based on scientific evidence becomes essential. A theoretical framework should guide the proposed interventions and be coherent with the evaluation of the dimensions taking in account that empathy is currently a multidimensional concept. The study aimed to determine, in health care professionals and/or students, what is the effectiveness of experiential versus humanistic training, in terms of improvement of empathic ability (dimensions) and maintenance over time of what has been learned, and to establish the degree of coherence between the proposed theoretical model and the trained and evaluated dimensions. A systematic review using six databases was performed. The data were synthesised, and the risk of bias was analysed using the Equator Guidelines. Twenty-three articles were selected. Further evidence of the effectiveness of experiential intervention against humanistic educational strategies was observed. Most studies were not based on a solid theoretical framework and, in these cases, inconsistency between empathic trained dimensions and those evaluated was detected. Although a better understanding of training time variable is required, middle-term interventions are recommended. Increasing the multicentre controlled trials; specifying the intervention that includes the empathy dimensions; triangulating the data from health professionals, patients, and external observers; and including monitoring, becomes a necessity.

A new species, Oxypetalum marchesii, from rocky grassland environments of Uruguay, is here described, illustrated, and compared to morphologically similar species. Data on its habitat, distribution, ecology, and conservation status are also provided. Based on its cpDNA, O. marchesii clearly corresponds to the recently re-circumscribed and morphologically diverse genus Oxypetalum. This species is mostly characterized by its creeping, non-twining habit, widely ovate and shortly petiolate hirsute leaves, relatively large flowers with pale greyish corollas, and short stylar-head appendage that is included within a corona formed of oblong-lanceolate, bifurcate lobes. The conservation status of this species is considered vulnerable because of its small geographic range and restricted population size. Fil: González, Andrés. Museo Nacional de Historia Natural. Departamento de Botánica; Uruguay Fil: Fernández, Martina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Instituto de Investigaciones en Biodiversidad y Medioambiente. Universidad Nacional del Comahue. Centro Regional Universidad Bariloche. Instituto de Investigaciones en Biodiversidad y Medioambiente; Argentina Fil: Ezcurra, Cecilia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Instituto de Investigaciones en Biodiversidad y Medioambiente. Universidad Nacional del Comahue. Centro Regional Universidad Bariloche. Instituto de Investigaciones en Biodiversidad y Medioambiente; Argentina

Azorella, Laretia and Mulinum are taxonomically complex, and good candidates to study evolutionary radiations in the Andes and the importance of hybridizations. Previous phylogenetic studies of subfamily Azorelloideae agree that Azorella and Mulinum as currently conceived are not monophyletic, and hence a revision of their circumscription is necessary. However, these phylogenies were based only on chloroplast DNA sequence data. Here, phylogenetic relationships within Azorelloideae were inferred using sequence data from five chloroplast DNA (rps16 intron, trnQ-rps16, rps16-trnKUUU 5′ -exon, trnGGCC-trnSGCU and rpL32-trnLUAG), and from nuclear rDNA ITS regions to assess the monophyly of Azorella and Mulinum and discuss generic re-circumscriptions, determine hybridization and radiation events, identify and characterize important lineages, and propose hypotheses on evolution of key morphological characters. In total, 121 accessions of Azorelloideae were analyzed. Phylogenetic analyses of the different genomes were conducted separately and combined, with and without indels, using maximum parsimony, maximum likelihood, and Bayesian methods. To analyze the incongruence between plastid and nuclear-derived trees a consensus network from strongly supported nodes from cpDNA and ITS trees was constructed. Internode certainty values were calculated to evaluate the reliability of the relationships estimated from the individual cpDNA and ITS data sets and to examine the degree of conflict within the total evidence data set. Azorella and Mulinum were confirmed as not monophyletic. Except three Azorella species, the remaining azorellas, all species of Mulinum, and Laretia form a monophyletic group, designated here as Andean-Patagonian. The three species of Azorella that are not part of the Andean-Patagonian lineage are grouped together with Huanaca and Schizeilema in another lineage, designated here as Austral. Within the Andean-Patagonian clade, three major lineages can be recognized: Diversifolia, Trifurcata, and Spinosum. Each of these lineages have different leaf morpho-anatomies, Diversifolia species being more mesomorphic compared to species of Trifurcata, and species of Spinosum being the most xeromorphic. Hybridizations have been important in the evolution of the group, especially within Diversifolia, with at least six reticulation events resulting in putative homoploid and allopolyploid hybrid species. Evidence from branch lengths and low sequence divergences suggest a rapid radiation in the Spinosum group, probably associated with the acquisition of wings in the fruits. Fil: Fernández, Martina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Instituto de Investigaciones en Biodiversidad y Medioambiente. Universidad Nacional del Comahue. Centro Regional Universidad Bariloche. Instituto de Investigaciones en Biodiversidad y Medioambiente; Argentina Fil: Ezcurra, Cecilia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Instituto de Investigaciones en Biodiversidad y Medioambiente. Universidad Nacional del Comahue. Centro Regional Universidad Bariloche. Instituto de Investigaciones en Biodiversidad y Medioambiente; Argentina Fil: Calviño, Carolina Isabel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Instituto de Investigaciones en Biodiversidad y Medioambiente. Universidad Nacional del Comahue. Centro Regional Universidad Bariloche. Instituto de Investigaciones en Biodiversidad y Medioambiente; Argentina

Delimiting species is an important, but frequently difficult aspect of systematics that should be addressed using data from multiple sources. Here we combine morphometric analyses and environmental characteristics to delimit species in the South Andean and Patagonian taxonomically difficult species-group composed by Mulinum spinosum, M. echinus and M. leptacanthum (Apiaceae-Azorelloideae). Molecular phylogenies have shown that these three species form part of a polytomy together with other Mulinum species, and therefore these data are not useful for their delimitation. We include measurements of 25 morphometric variables from 163 herbarium specimens and perform univariate and multivariate principal component analysis (PCA) and discriminant analysis (DA) to establish the limits amongst the three mostly sympatric, morphologically similar, and phylogenetically unresolved species. We also use 19 bioclimatic and three geographic variables from localities of the specimens to infer environmental characteristics of the taxa and test their relation with morphological variation. Morphological evidence supports the inclusion of M. echinus within the morphologically and climatically variable M. spinosum, and rejects its recognition as a distinct taxon at any rank. On the contrary, M. leptacanthum is considered a morphologically distinct species, generally restricted to high altitude areas of the southern Andes with a cooler and wetter climate. Within the widespread M. spinosum, environmental gradients of precipitation and temperature relate to morphological gradients (e.g., in leaf and inflorescence sizes, in leaf acicularity, and in fruit-wing width). These last results showed that the large morphological variation in vegetative and reproductive characteristics of this species that grows in arid and semiarid habitats are related to regional climatic gradients that have probably been important in the evolution of this species' plasticity, diversification, and differentiation. Fil: Fernández, Martina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Instituto de Investigaciones en Biodiversidad y Medioambiente. Universidad Nacional del Comahue. Centro Regional Universidad Bariloche. Instituto de Investigaciones en Biodiversidad y Medioambiente; Argentina Fil: Ezcurra, Cecilia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Instituto de Investigaciones en Biodiversidad y Medioambiente. Universidad Nacional del Comahue. Centro Regional Universidad Bariloche. Instituto de Investigaciones en Biodiversidad y Medioambiente; Argentina Fil: Calviño, Carolina Isabel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Instituto de Investigaciones en Biodiversidad y Medioambiente. Universidad Nacional del Comahue. Centro Regional Universidad Bariloche. Instituto de Investigaciones en Biodiversidad y Medioambiente; Argentina