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Aim: To design and validate a tool to assess a woman's perception of whether she has experienced a situation of abuse or disrespect during childbirth attendance: "Childbirth Abuse and Respect Evaluation-Maternal Questionnaire" (CARE-MQ)., Methods: Multidisciplinary panel of experts (gynecologists, midwives, mothers) participated in creating CARE-MQ. A cross-sectional study was carried out on 901 Spanish women who had given birth between 1 and 3 months before to determine psychometric characteristics. Finally, an exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and a convergent validity study were carried out with the Quality Questionnaire from the Patient's Perspective-Intrapartum (QPP-I), and a reliability study using internal consistency (Cronbach's α) and coefficient of intraclass correlation (CCI)., Findings: The KMO test gave a value of 0.935, and Bartlett's sphericity test was <0.001. The EFA identified four components ("Emotional Abuse", "Inadequate Professionalism", "Physical Abuse" y "Lost contact") that explained 55.16 % of variance. In the CFA, a good fit was observed for most of the evaluated indicators. CARE-MQ correlated negatively with QPP-I (Spearman's rho = -0.641, 95 % CI: -0.679, -0.600; p < 0.001) and was statistically associated with variables related to childbirth experience (p < 0.005) such as the use of a birth plan, use of regional analgesia, type of birth, episiotomy, presence of severe tears, skin-to-skin contact, length of hospital stay and postpartum surgical intervention. Cronbach's α value was 0.903. The ICC of absolute agreement after administering the questionnaire one week after was 0.927 (95 % CI: 0.85-0.97)., Conclusions: CARE-MQ is a valid and reliable instrument to evaluate the perception of a woman regarding the situation of abuse and/or disrespect that she may have experienced during birth in a population of Spanish postpartum women., Competing Interests: Declaration of competing interest No conflict of interest has been declared by the author(s)., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: The objective was to develop and validate a predictive model of initiation of breastfeeding in the first hour after delivery., Methods: Retrospective cohort study on women who gave birth between 2013 and 2018 in Spain. For data collection, an ad hoc questionnaire was designed to be filled in by the mothers, which was distributed to the different Spanish breastfeeding associations which, in turn, shared it with their associate partners. The development of the predictive model was made on a cohort of 3218 women (2/3) and was validated on a cohort of 1609 women (1/3). Mothers whose children were admitted to hospital at the time of birth were excluded. A multivariate analysis was performed by means of logistic regression, and predictive ability was determined by areas under the ROC curve (AUC)., Results: 81.0 % (2608) women started breastfeeding in the first hour in the derivation cohort, and 80.1 % (1289) in the validation cohort. The predictive factors in the final model were: the highest number of children and skin-to-skin contact at birth as flattering factors, while dystocic delivery reduced the likelihood of the onset of breastfeeding. The predictive ability (ROC AUC) in the derivation cohort was 0.89 (CI 95 %: 0.87-0.90), while in the validation cohort it was 0.89 (CI 95 %: 0.87-0.92)., Conclusions: This three-variable predictive model has excellent predictive ability in both the derivation cohort and the validation cohort. This model can identify women who are at high risk of non-initiating breastfeeding within the first hour after delivery., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

To understand the experience, training, and needs of midwives in their approach to perinatal grief. A descriptive cross-sectional study was carried out using an online questionnaire with 26 questions related to institutional management and individual clinical practices in the care of a perinatal loss was developed by a team of midwives from the Hospital "La Mancha-Centro" of Alcazar de San Juan (Ciudad Real). Strobe checklist was followed. A total of 267 midwives participated. A total of 92.1% (246) of the centers had specific protocols for action, but each professional applied their own criteria. The presence of a perinatal psychology team was nonexistent according to 88% (235) of those surveyed. Regarding their training and professional experience, 16.5% (44) of the midwives had never received training. Only 4.1% (11) of the midwives felt very prepared to care for women with a perinatal loss. Among the factors associated with greater application of recommended practices in the face of perinatal death by midwives were being a woman, having prior training on care during perinatal death, and a greater perception of preparation (p < 0.05). The perception of lack of preparation on the part of midwives in the accompaniment of these families was high., (© 2024 The Authors. Nursing & Health Sciences published by John Wiley & Sons Australia, Ltd.)

Aim: To determine the degree of satisfaction for each academic year and according to the type of simulation performed (simulated patient actor/advanced simulator) among nursing students after the use of clinical simulation., Introduction: Clinical simulation is currently being incorporated in a cross-cutting manner throughout undergraduate nursing education. Its implementation requires a novel curricular design and educational changes throughout the academic subjects., Design: A cross-sectional descriptive study was performed., Methods: During the academic years 2018-2019 and 2019-2020, 425 students completed the High-Fidelity Simulation Satisfaction Reduced Scale for Students based on 25 questions and six factors, with a total score between 0 and 125. In total, 91 simulation sessions were performed among students who had different degrees of clinical and previous experience with simulation as well as standardized patient versus advanced simulator. A bivariate analysis was performed, comparing the total scores and the different subscales by sex, previous experience, academic year, and simulation methodology. Linear regression was used for both bivariate and multivariate analysis., Results: The mean scale score was 116.8 (SD=7.44). The factor with the highest score was "F2: feedback or subsequent reflection", with a mean score of 14.71 (SD=0.73) out of 15. Fourth year students scored the highest (mean=119.17; SD=5.28). Students who underwent simulation training with a simulated patient actor presented a higher level of overall satisfaction (p<0.05) (Mean=120.31; SD=4.91), compared to students who used an advanced simulator (Mean=118.11; SD=5.75)., Conclusions: Satisfaction with the simulation program was higher in fourth-year students compared to first-year students and was also higher when a simulated patient actor was used compared to an advanced simulator. The most highly valued aspect was the subsequent debriefing or reflective process., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Aim: Different clinical practice guidelines include recommendations on how to prevent and repair obstetric perineal trauma, as well as the use of episiotomy. To evaluate the variability in midwives' professional practices for preventing and repairing perineal trauma, as well as the professional factors that may be associated with the restrictive use of episiotomy., Design: Observational cross-sectional study., Methods: Three hundred five midwives completed an anonymous questionnaire developed by the authors and distributed across various midwifery scientific societies. The main outcomes measured were the frequencies of adopting specific practices related to perineal injury prevention and repair, episiotomy technique and restrictive episiotomy use (<10%). Odds ratios (OR) and adjusted odds ratios (aOR) with 95% confidence intervals were estimated., Results: Intrapartum perineal massage was not normally used by 253 (83%) of midwives, and 186 (61%) applied compresses soaked in warm water to the perineum. Regarding episiotomy, there was a great deal of variability, noting that 129 (42.3%) adopted a restrictive use of this procedure, 125 (41%) performed it between 10% and 20%, while 51 midwives (16.7%) performed it in more than 20% of cases. In addition, 165 (54.1%) midwives followed an incision angle of 60º. Concerning tears, 155 (50.8%) usually sutured first-degree tears and 273 (89.5%) always sutured second-degree tears. Midwives attending home births (aOR = 6.5; 95% CI: 2.69-15.69), working at a teaching hospital (aOR = 3.69; 95% CI: 1.39-9.84), and the ones who recently completed their professional training (aOR = 3.58; 95% CI: 1.46-8.79) were significantly more likely to adopt a restrictive use of episiotomy., Conclusions: There is a significant variability in Spanish midwives' practices for preventing and repairing perineal tears. Moreover, the restrictive use of episiotomy is associated with midwives attending home births, working in teaching hospitals and having recent professional training., Patient or Public Contribution: No patient or public contribution., (© 2024 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Cancer has long been viewed as a genetic disease of cumulative mutations. This notion is fuelled by studies showing that ageing tissues are often riddled with clones of complex oncogenic backgrounds coexisting in seeming harmony with their normal tissue counterparts. Equally puzzling, however, is how cancer cells harbouring high mutational burden contribute to normal, tumour-free mice when allowed to develop within the confines of healthy embryos. Conversely, recent evidence suggests that adult tissue cells expressing only one or a few oncogenes can, in some contexts, generate tumours exhibiting many of the features of a malignant, invasive cancer. These disparate observations are difficult to reconcile without invoking environmental cues triggering epigenetic changes that can either dampen or drive malignant transformation. In this Review, we focus on how certain oncogenes can launch a two-way dialogue of miscommunication between a stem cell and its environment that can rewire downstream events non-genetically and skew the morphogenetic course of the tissue. We review the cells and molecules of and the physical forces acting in the resulting tumour microenvironments that can profoundly affect the behaviours of transformed cells. Finally, we discuss possible explanations for the remarkable diversity in the relative importance of mutational burden versus tumour microenvironment and its clinical relevance., (© 2024. Springer Nature Limited.)

Background: There are recommendations based on scientific evidence on care in the second stage of labor, but it is not known to what degree the professionals comply with these recommendations., Objective: The aim of this study is to examine the variability in clinical practices among midwives during the second stage of labor, including positions, mobility, practices, and the maximum time allowed before initiating active pushing, and to assess their adherence to clinical practice guidelines., Methods: A cross-sectional observational study. A self-designed questionnaire was developed and distributed online through scientific societies. The main variables studied were professional and work environment characteristics, maternal positions and mobility, practices during this stage, maximum time to start active pushing and duration of the second stage of labor. Descriptive statistics were calculated using SPSS 24.0., Results: Regarding the woman's position during childbirth, 80.3% (245) of midwives frequently or always allow the woman to choose her birthing position. Furthermore, 44.6% (136) of professionals prefer using side-lying positions for the mother. Regarding drinking fluids during childbirth, 51.1% (156) of midwives allowed the woman to drink the amount of liquids she wanted, whereas 11.1% (34) said that they would allow them to do so however, this was against the protocol of their hospital. When inquiring about the Kristeller maneuver, it was reported to be excessively performed in 35.1% (107) of cases for fetal bradycardia, 33.1% (101) for maternal exhaustion, and 38.4% (117) to avoid instrumental birth. Finally, a great variability was observed in the time criteria used for the initiation of active pushing and the maximum duration of the second stage of labor., Conclusions: Certain practices, such as the Kristeller maneuver, are overused among midwives, with great variability in the use of certain procedures, the waiting times to initiate pushing and completion of the second stage of labor. Further training and awareness campaigns are needed for professionals to apply evidence-based care., (© 2024. The Author(s).)

Background: Pelvic floor dysfunction encompasses conditions like urinary and fecal incontinence, pelvic organ prolapse, and pelvic pain, significantly affecting women's quality of life. Despite its prevalence, few studies have adopted a qualitative approach to understanding women's perceptions and emotions regarding these issues. This study aims to delve into how women with pelvic floor disorders perceive their condition and its impact on their daily lives. Methods: We analyzed qualitative data from interviews with 160 women suffering from pelvic floor dysfunctions. Using inductive qualitative content analysis, we systematically examined the data to identify variations, differences, and similarities. Results: The analysis revealed four primary themes in the women's narratives: "Physical Impacts", "Emotional and Psychological Impacts", "Social and Relational Impacts", and "Sexual Health Impacts", along with 12 subthemes. The findings predominantly highlight how pelvic floor dysfunctions detrimentally affect women's quality of life and emotional well-being, instilling fear and insecurity in daily activities, compounded by sleep disturbances and sexual dysfunction. Conclusions: Women living with pelvic floor dysfunction face multifaceted challenges that adversely affect various aspects of their lives, diminishing their overall quality of life. This includes notable impacts on sleep, physical, and sexual activities. However, not all affected women report these issues, often due to fear of stigma, choosing instead to conceal their struggles in an effort to maintain an appearance of normalcy.

To determine the usefulness of combining two methodologies (OSCE and escape room) in a scenario simulation to evaluate a subject, and determine the evaluation of the students of this experience. An observational cross-sectional study was carried out with students enrolled in a sexual and reproductive health-care course as a part of their nursing degree. The students had to solve four clinical cases based on the contents of the teaching practices of the subject by solving clues that led them to carry out procedures and techniques and provide care in scenario simulators. Students evaluated the experience using the GAMEX (Gameful Experience in Gamification) scale. Mean differences were estimated with their respective 95% confidence intervals. A total of 124 students participated. Of these, 63.7% (79) solved the clinical cases with their knowledge and skills. Most (80.6%, 100) students stated that they completely remembered and applied the knowledge of the topic during the game. Almost all (98.4%, 122) would recommend this experience. The dimensions with the best rating on the GAMEX scale were "fun", with an average score of 4.7 points (0.49), followed by "critical thinking", with 4.2 (0.59). Women presented statistically better scores than men (mean difference: 1.58; 95% CI: 0.55, 2.61). The OSCE combined with an escape room using scenario simulations may be a useful tool to evaluate the subject. In addition, the students were satisfied, had fun, and recommended the experience. This study was not registered.

Background: Pelvic floor dysfunction in women encompasses a wide range of clinical disorders: urinary incontinence, pelvic organ prolapse, fecal incontinence, and pelvic-perineal region pain syndrome. A literature review did not identify any articles addressing the prevalence of all pelvic floor dysfunctions., Objective: Determine the prevalence of the group of pelvic floor disorders and the factors associated with the development of these disorders in women., Material and Methods: This observational study was conducted with women during 2021 and 2022 in Spain. Sociodemographic and employment data, previous medical history and health status, lifestyle and habits, obstetric history, and health problems were collected through a self-developed questionnaire. The Pelvic Floor Distress Inventory (PFDI-20) was used to assess the presence and impact of pelvic floor disorders. Pearson's Chi-Square, Odds Ratio (OR) and adjusted Odds Ratio (aOR) with their respective 95% confidence intervals (CI) were calculated., Results: One thousand four hundred forty-six women participated. Urinary incontinence occurred in 55.8% (807) of the women, fecal incontinence in 10.4% (150), symptomatic uterine prolapse in 14.0% (203), and 18.7% (271) reported pain in the pelvic area. The following were identified as factors that increase the probability of urinary incontinence: menopausal status. For fecal incontinence: having had instrumental births. Factors for pelvic organ prolapse: number of vaginal births, one, two or more. Factors for pelvic pain: the existence of fetal macrosomia., Conclusions: The prevalence of pelvic floor dysfunction in women is high. Various sociodemographic factors such as age, having a gastrointestinal disease, having had vaginal births, and instrumental vaginal births are associated with a greater probability of having pelvic floor dysfunction. Health personnel must take these factors into account to prevent the appearance of these dysfunctions., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Introduction: During the pandemic, nurses have undergone a high level of professional burnout, suffering emotional exhaustion, depersonalization, and lack of personal realization., Objective: The object of this study is to understand in depth, through a phenomenological study of Giorgi, the perceptions on commitment and professional development of frontline nurses during the first and second waves of the COVID-19 pandemic., Method: Qualitative study designed and analyzed using Giorgi's phenomenological focus. For data collection, semi-structured interviews were utilized in a theoretical sample of frontline nurses who worked in public hospitals of Extremadura and Madrid, Spain, until saturation of data. The interviews were conducted between the months of May and December 2020 following an outline of topics. The analysis was based on the phenomenological focus of Giorgi and was supported by the software Atlas-Ti 8.0., Results: A total of 14 nurses participated in this study. Two main themes emerged to explain the perceptions of the nurses: (1) the professional commitment of the nurses during the pandemic and (2) the effects of the pandemic on professional development; seven subcategories were also identified., Conclusion: The social and professional development of nurses is important. If nurses feel that they are quality professionals, this will enable them to protect their psychosocial health and increase professional commitment toward their patients in difficult situations such as pandemics. The results of this study may serve as a guide for better understanding the problems and needs of nurses as healthcare providers. This may help administrators in the generation of solutions for the establishment of a safe and reliable work environment, which will in turn promote a healthcare system that can efficiently respond to future catastrophes.

Background: Clinical simulation provides a practical and effective learning method during the undergraduate education of health professions. Currently there is only one validated scale in Spanish to assess nursing students' satisfaction with the use of high-fidelity simulation, therefore, our objective is to validate a brief version of this scale in undergraduate nursing students with or without clinical experience., Method: A cross-sectional descriptive study was performed. Between 2018 and 2020, the students from all academic courses of the Fundación Jiménez Díaz nursing school completed the satisfaction scale at the end of their simulation experiences. To validate this scale, composed of 33 items and eight dimensions, exploratory factor analysis (EFA) of the principal components was performed, the internal consistency was studied using Cronbach's alpha, and the corrected item-test correlation of each of the items of the total scale was reviewed., Results: 425 students completed the scale, after the exploratory factor analysis, a scale consisting of 25 items distributed into six subscales, each containing between two and six items, explained a variance of 66.5%. The KMO test (Kaiser-Meyer-Olkin) obtained a value of 0.938, Bartlett's sphericity test was < 0.01 and Goodness of Fit Index (GFI) was 0.991., Conclusion: The modified ESSAF scale, reduced from 33 to 25 items and divided into six subscales, is as valid and reliable as the original scale for use in nursing students of different levels, with, or without clinical experience., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Volume imaging visualizes the three-dimensional (3D) complexity of tumors to unravel the dynamic crosstalk between cancer cells and the heterogeneous landscape of the tumor microenvironment (TME). Tissue clearing and intravital microscopy (IVM) constitute rapidly progressing technologies to study the architectural context of such interactions. Tissue clearing enables high-resolution imaging of large samples, allowing for the characterization of entire tumors and even organs and organisms with tumors. With IVM, the dynamic engagement between cancer cells and the TME can be visualized in 3D over time, allowing for acquisition of 4D data. Together, tissue clearing and IVM have been critical in the examination of cancer-TME interactions and have drastically advanced our knowledge in fundamental cancer research and clinical oncology. This review provides an overview of the current technical repertoire of fluorescence volume imaging technologies to study cancer and the TME, and discusses how their recent applications have been utilized to advance our fundamental understanding of tumor architecture, stromal and immune infiltration, vascularization and innervation, and to explore avenues for immunotherapy and optimized chemotherapy delivery., Competing Interests: HM is an inventor on a UK patent application 1818567.8 on clearing solutions for tissue clearing and three-dimensional 3D imaging. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be constructed as a potential conflict of interest., (Copyright © 2023 Almagro and Messal.)

Segmenting cells within cellular aggregates in 3D is a growing challenge in cell biology due to improvements in capacity and accuracy of microscopy techniques. Here, we describe a pipeline to segment images of cell aggregates in 3D. The pipeline combines neural network segmentations with active meshes. We apply our segmentation method to cultured mouse mammary gland organoids imaged over 24 h with oblique plane microscopy, a high-throughput light-sheet fluorescence microscopy technique. We show that our method can also be applied to images of mouse embryonic stem cells imaged with a spinning disc microscope. We segment individual cells based on nuclei and cell membrane fluorescent markers, and track cells over time. We describe metrics to quantify the quality of the automated segmentation. Our segmentation pipeline involves a Fiji plugin that implements active mesh deformation and allows a user to create training data, automatically obtain segmentation meshes from original image data or neural network prediction, and manually curate segmentation data to identify and correct mistakes. Our active meshes-based approach facilitates segmentation postprocessing, correction, and integration with neural network prediction., Competing Interests: Declaration of interests C.D. has filed a patent application on dual-view oblique plane microscopy and has a licensed granted patent on oblique plane microscopy., (Copyright © 2023 Biophysical Society. Published by Elsevier Inc. All rights reserved.)

Objective: To determine patient difficulties and concerns when performing IBC (Intermittent Bladder Catheterisation), as well as the evolution of adherence, quality of life, and emotional state of patients one year after starting IBC., Method: A prospective, observational, multicentre study conducted in 20 Spanish hospitals with a one-year follow-up. Data sources were patient records and the King's Health Questionnaire on quality of life, the Mini-Mental State Examination (MMSE), and the Hospital Anxiety and Depression Scale (HADS). Perceived adherence was measured using the ICAS (Intermittent Catheterization Adherence Scale) and perceived difficulties with IBC were assessed using the ICDQ (Intermittent Catheterization Difficulty Questionnaire). For data analysis, descriptive and bivariate statistics were performed for paired data at three points in time (T1: one month, T2: three months, T3: one year)., Results: A total of 134 subjects initially participated in the study (T0), becoming 104 subjects at T1, 91 at T2, and 88 at T3, with a mean age of 39 years (standard deviation = 22.16 years). Actual IBC adherence ranged from 84.8% at T1 to 84.1% at T3. After one year of follow-up, a statistically significant improvement in quality of life ( p ≤ 0.05) was observed in all dimensions with the exception of personal relationships. However, there were no changes in the levels of anxiety ( p = 0.190) or depression ( p = 0.682) at T3 compared to T0., Conclusions: Patients requiring IBC exhibit good treatment adherence, with a significant proportion of them performing self-catheterisation. After one year of IBC, a significant improvement in quality of life was noted, albeit with a significant impact on their daily lives and their personal and social relationships. Patient support programmes could be implemented to improve their ability to cope with difficulties and thus enhance both their quality of life and the maintenance of their adherence.

B cells are frequently found in the margins of solid tumours as organized follicles in ectopic lymphoid organs called tertiary lymphoid structures (TLS) 1,2 . Although TLS have been found to correlate with improved patient survival and response to immune checkpoint blockade (ICB), the underlying mechanisms of this association remain elusive 1,2 . Here we investigate lung-resident B cell responses in patients from the TRACERx 421 (Tracking Non-Small-Cell Lung Cancer Evolution Through Therapy) and other lung cancer cohorts, and in a recently established immunogenic mouse model for lung adenocarcinoma 3 . We find that both human and mouse lung adenocarcinomas elicit local germinal centre responses and tumour-binding antibodies, and further identify endogenous retrovirus (ERV) envelope glycoproteins as a dominant anti-tumour antibody target. ERV-targeting B cell responses are amplified by ICB in both humans and mice, and by targeted inhibition of KRAS(G12C) in the mouse model. ERV-reactive antibodies exert anti-tumour activity that extends survival in the mouse model, and ERV expression predicts the outcome of ICB in human lung adenocarcinoma. Finally, we find that effective immunotherapy in the mouse model requires CXCL13-dependent TLS formation. Conversely, therapeutic CXCL13 treatment potentiates anti-tumour immunity and synergizes with ICB. Our findings provide a possible mechanistic basis for the association of TLS with immunotherapy response., (© 2023. The Author(s).)

This study examines and determines the prevalence of obstetric violence (OV) as perceived by midwives, as well as their knowledge of it and the professional factors that could be associated with the perception of OV. A cross-sectional study was conducted of 325 midwives in 2021 in Spain. Almost all (92.6%, 301) the midwives knew the term OV, but 74.8% (214) did not believe OV to be the same as malpractice. Moreover, 56.9% (185) stated they had rarely observed OV, and 26.5% (86) regularly observed OV. Most midwives consider physical aggression to be OV, in comparison, not providing information to women was only considered unacceptable treatment. The clinical practice considered the most grave within the context of OV was an instrumental birth or cesarean section without clinical justification. In addition, 97.5% (317) believed that raising awareness on the subject is one of the fundamental points to reducing this problem. Certain factors, such as less work experience, female gender, attendance at home births, and previous training in OV, were associated with an increased perception of situations as OV ( p < 0.005). A high percentage of midwives perceived specific clinical practices (e.g., indicate cesarean section without clinical justification or perform the Kristeller maneuver) as OV, and certain characteristics of the professional profile, such as the professional experience or the sex of the midwife, were associated with an increased perception of OV. Most midwives knew the term OV but did not consider that it could pertain to some behaviors included in the international definitions of OV, such as the lack of information provided to a woman or the non-identification of the midwife, among others.

The COVID-19 pandemic has caused ethical challenges and dilemmas in care decisions colliding with nurses' ethical values. This study sought to understand the perceptions and ethical conflicts faced by nurses working on the frontline during the first and second waves of the COVID-19 pandemic and the main coping strategies. A qualitative phenomenological study was carried out following Giorgi's descriptive phenomenological approach. Data were collected through semi-structured interviews until data saturation. The theoretical sample included 14 nurses from inpatient and intensive care units during the first and second waves of the pandemic. An interview script was used to guide the interviews. Data were analyzed following Giorgi's phenomenological method using Atlas-Ti software. Two themes were identified: (1) ethical conflicts on a personal and professional level; and (2) coping strategies (active and autonomous learning, peer support and teamwork, catharsis, focusing on care, accepting the pandemic as just another work situation, forgetting the bad situations, valuing the positive reinforcement, and humanizing the situation). The strong professional commitment, teamwork, humanization of care, and continuous education have helped nurses to deal with ethical conflicts. It is necessary to address ethical conflicts and provide psychological and emotional support for nurses who have experienced personal and professional ethical conflicts during COVID-19.

Aims and Objectives: To evaluate the commitment and level of self-perceived training in evidence-based practice among students of the Nursing degree of five Spanish universities., Background: In university Health Sciences degrees, evidence-based clinical practice can directly or indirectly impact the quality of care, the cost of the service provided and the safety of clinical practice., Design: Multicentre cross-sectional observational study according to STROBE guidelines., Methods: The evidence-based skills in Practice questionnaire (CACH-PBE, for its acronym in Spanish) and the Utrecht Work Engagement Student Scale (UWES-9S) were used. The study was performed in five Spanish universities (Alicante, Castilla La Mancha, Jaen, Huelva and Seville) from October to December 2020, with 755 participants (Nursing students)., Results: A total mean score of 91.9 points (SD = 11.81) was observed for the CACH-PBE questionnaire and of 36.8 points (SD = 8.48 points) for the UWES-9S. In addition, the multivariate analysis predicted that variables such as sex, academia, university, intention to do a Master or Doctorate degree, the level of work engagement, and the previous training in evidence-based clinical practice were associated with a greater perception of evidence-based practice., Conclusion: The sample of Nursing degree students has intermediate-high levels of knowledge, skills and attitudes regarding evidence-based practice and work commitment, with differences observed between each of the universities., Relevance to Clinical Practice: Nursing students should develop from intermediate to high levels of knowledge, skills and attitudes regarding evidence-based practice and work commitment. There are various actions to promote EBP, such as the incorporation of a specific course covering the subject into the nursing curriculum, and the selection, for clinical practices, of care units that implemented evidence-based care., (© 2022 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

Background: Prevention and treatment of peristomal skin problems should be a priority for nurses caring for ostomates, even when the assessment of lesions must be done remotely., Objective: To measure the level of agreement on assessment, diagnosis and care indications for peristomal skin lesions using remote imaging among nurses in Spain., Design: Prospective observational multicentre study to assess the diagnostic validity and inter- and intraobserver agreement between nurses in peristomal skin lesions. Data were collected between March and October 2019., Settings and Participants: The research sample consisted of a group of 39 nurses with expertise in the care of ostomates., Methods: A panel of experts established a list of 24 common signs/findings, 15 diagnostic options and 35 treatment approaches for peristomal skin lesions. Three expert stoma therapy nurses compiled the clinical cases, which they described thoroughly and documented with photographs. The 39 participating nurses evaluated the cases in two rounds to measure inter and intraobserver agreement., Results: A high or very high level of agreement (κ > 0.61) was observed for the following signs: encrustation, nodules, mucocutaneous separation and varicose veins; for the following diagnoses: mucocutaneous dehiscence, allergic contact dermatitis, encrustation and varicose veins (caput medusae); for the following treatments: recommending a diet rich in vitamin C/blueberries, applying acetic acid dressings, applying cold and topical tacrolimus treatment., Conclusions: The most easily identifiable lesions were those most prevalent and with visible signs. There was a lower level of agreement in identifying lesions for which photographs required additional information (laboratory data, description of signs and symptoms, type of diet and level of self-care). It is important to train nurses caring for ostomates to correctly describe ostomy-related lesions, which is important for nursing records, continuity of care and telehealth care., (© 2022 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

In order to determine the perception of ostomized patients about the performance and safety of the new one-piece device Moderma Flex, as well as the evolution of peristomal skin health after its use. The pre- and post-experimental multicenter study after the use of the Moderma Flex one-piece ostomy device on 306 ostomized people from 68 hospitals in Spain. We used a self-made questionnaire on the usefulness of different parts of the device and the perception of peristomal skin improvement. The sample was composed of 54.6% (167) men and had an average age of 64.5 years (standard deviation = 15.43). The type of device most commonly used according to its opening was closed by 45.1% (138). In addition, for the type of barrier, the most frequently used is the flat one; 47.7% (146) and 38.9% (119) used a model of soft convexity. A total of 48% scored with the highest assessment in the perception of skin improvement. The percentage of patients with peristomal skin problems decreased from 35.9% at the first visit to less than 8% after the use of Moderma Flex. Further, 92.4% (257) had no skin problems, the most frequent being erythema. The use of the Moderma Flex device seems to be related to a reduction in peristomal skin complications and a perception of improvement.

Aim: To understand the perceptions of National Health System nurses who have been working on the frontline of the psychological impact of caring for people with COVID-19 during the first and second waves., Methods: A qualitative study, the design and analysis of which was based on phenomenology. For data collection, a semi-structured interview was administered to a sample of nurses who worked on the frontline in public hospitals in Extremadura and Madrid, Spain. The interviews, which followed a script including various topics, were conducted between May and November 2020 so as to include the experiences of the first and second waves of the pandemic. Sample collection continued until data saturation. The data were analysed following the phenomenological method of Giorgi with the help of the Atlas-Ti software., Results: Two main themes emerged from the data analysis that explained the nurses' perceptions: (i) the main psychological repercussions of being frontline carers (anxiety, fear, stress, impotence, frustration, and an increase in obsessions and obsessive behaviours) and (ii) psychological coping strategies (collapse in the face of the situation, dissociative amnesia, leaning on colleagues and working as a team, resigning oneself, perceiving the situation as a war, and being aware of psychological repercussions)., Discussion: Caring as the first line causes great psychological repercussions for nurses. It is necessary to implement psychological and emotional support programmes to address the post-traumatic stress that nurses can suffer., Competing Interests: Declaration of competing interest No conflict of interest has been declared by the author(s)., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Pancreatic ductal adenocarcinoma (PDAC) shows pronounced epithelial and mesenchymal cancer cell populations 1-4 . Cellular heterogeneity in PDAC is an important feature in disease subtype specification 3-5 , but how distinct PDAC subpopulations interact, and the molecular mechanisms that underlie PDAC cell fate decisions, are incompletely understood. Here we identify the BMP inhibitor GREM1 6,7 as a key regulator of cellular heterogeneity in pancreatic cancer in human and mouse. Grem1 inactivation in established PDAC in mice resulted in a direct conversion of epithelial into mesenchymal PDAC cells within days, suggesting that persistent GREM1 activity is required to maintain the epithelial PDAC subpopulations. By contrast, Grem1 overexpression caused an almost complete 'epithelialization' of highly mesenchymal PDAC, indicating that high GREM1 activity is sufficient to revert the mesenchymal fate of PDAC cells. Mechanistically, Grem1 was highly expressed in mesenchymal PDAC cells and inhibited the expression of the epithelial-mesenchymal transition transcription factors Snai1 (also known as Snail) and Snai2 (also known as Slug) in the epithelial cell compartment, therefore restricting epithelial-mesenchymal plasticity. Thus, constant suppression of BMP activity is essential to maintain epithelial PDAC cells, indicating that the maintenance of the cellular heterogeneity of pancreatic cancer requires continuous paracrine signalling elicited by a single soluble factor., (© 2022. The Author(s), under exclusive licence to Springer Nature Limited.)

The 3D architecture of tissues bearing tumors impacts on the mechanical microenvironment of cancer, the accessibility of stromal cells, and the routes of invasion. A myriad of intrinsic and extrinsic forces exerted by the cancer cells, the host tissue, and the molecular and cellular microenvironment modulate the morphology of the tumor and its malignant potential through mechanical, biochemical, genetic, and epigenetic cues. Recent studies have investigated how tissue architecture influences cancer biology from tumor initiation and progression to distant metastatic seeding and response to therapy. With a focus on carcinoma, the most common type of cancer, this review discusses the latest discoveries on how tumor architecture is built and how tissue morphology affects the biology and progression of cancer cells., Competing Interests: Declaration of interests The authors declare no conflicts of interest., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: To determine the relationship between perceived obstetric violence and the risk of postpartum depression (PPD)., Design: A cross-sectional observational study SETTING: During 2019 in Spain PARTICIPANTS: 782 women who had given birth in the preceding 12 months in Spain., Measurements: Online questionnaires were distributed to the women via their midwives and women's associations. The questionnaire included sociodemographic and clinical variables, and questions regarding the mothers' perception of obstetric violence globally and in its different forms: verbal, physical and psycho-affective. The response rate was 93.65%. Crude and adjusted odds ratios (OR and aOR, respectively) were estimated using binary logistic regression. Risk of PPD was estimated by the Edinburgh Postnatal Depression Scale (EPDS)., Findings: The mean EPDS score was 8.34 points (standard deviation: 3.80), with 25.4% (199) at risk of PPD (≥ 10 points). Risk factors for PPD included, multiparity (aOR: 1.62, 95% CI:1.10-2.39), newborn NICU admission (aOR: 1.93, 95% CI: 1.06-3.51), experiencing verbal obstetric violence (aOR: 2.02, 95% CI: 1.35-3.02), and psycho-affective obstetric violence (aOR: 2.65, 95% CI: 1.79-3.93). The perception of support during pregnancy, birth, and the puerperium was found to be a protective factor: aOR 0.15 (95% CI: 0.04-0.54) for women who perceived enough support and aOR 0.13 (95% CI: 0.0-0.45) for women who received much support KEY CONCLUSIONS: One in four women are at risk of PPD. Multiparous women, those whose newborn required NICU admission, those who lacked partner support, and those who experienced verbal or psycho-affective obstetric violence had a higher prevalence of PPD risk., Funding: The authors declare that this study was conducted without funding., Competing Interests: Conflict of interest statement All authors listed meet the authorship criteria according to the latest guidelines of the International Committee of Medical Journal Editors. All authors are in agreement with the manuscript. Authors must declare any financial support or relationships that may pose conflict of interest. This includes any financial arrangements authors have with a company whose product figures prominently in the submitted manuscript or with a company making a competing product., (Copyright © 2022. Published by Elsevier Ltd.)

The benefits of exclusive breastfeeding are well known for both mother and baby. Despite this, rates of exclusive breastfeeding remain low. The present study aimed to determine the factors associated with the maintenance of this type of feeding after being discharged from the hospital after childbirth. A cross-sectional study was carried out with 1200 postpartum women in Spain. Sociodemographic, obstetric, and neonatal data were collected. Odds ratios (OR) and adjusted odds ratios (aOR) with 95% confidence intervals were calculated. Early breastfeeding initiation was identified as a factor that favors breastfeeding after hospital discharge (aOR: 2.47; 95%CI: 1.77, 3.45). Other factors that favor breastfeeding after discharge included the woman feeling very supported by her partner during pregnancy, childbirth, and the puerperium (aOR: 2.54; 95%CI:1.30, 5.00) and having previously breastfed other children (aOR: 1.97; 95%CI: 1.40, 2.76). Among the factors that hindered exclusive breastfeeding after discharge were multiple or twin pregnancies (aOR: 0.31; 95%CI 0.12, 0.83), induction of labor (aOR: 0.73; 95%CI: 0.53, 0.99), admission of the newborn to the neonatal intensive care unit (NICU) (aOR: 0.31; 95%CI 0.19, 0.52), using epidural pain relief during labor (aOR: 0.41; 95%CI: 0.27, 0.64), or a preterm newborn (aOR: 0.38; 95%CI: 0.21, 0.69). For all these reasons, it is essential to promote certain practices such as the early start of breastfeeding or the induced onset of labor, among others, in order to promote the maintenance of exclusive breastfeeding beyond hospital discharge after childbirth.

The transition to college is a decisive stage for the acquisition of eating habits that continue into adulthood. The aim of this study is to assess the consumption of healthy elements of the Mediterranean diet in a group of university students and to evaluate whether the consumption pattern was related to sex, Body Mass Index (BMI), food addiction or the amount of physical activity performed. A total of 515 nursing students participated. The Mediterranean diet adherence questionnaire (PREDIMED), the food addiction scale (YFAS 2.0) and the International Physical Activity Questionnaire (IPAQ) were completed. For data analysis, multivariate analysis was performed with multiple linear regression and adjusted for sex, age, and BMI. The results showed that females consumed various types of meats (white/red, processed) in a healthier proportion (p < 0.05). Students that consumed more than one per day (unhealthy) of red/processed meats (mean difference (MD) = −0.49; 95% CI: −0.83; −0.15), soft drinks (MD = −0.82; 95% CI: 82−1.36; −0.27) and pastries (MD = −0.63; 95% CI: −0.97; −0.30) displayed higher food addiction scores. In addition, students who skipped breakfast also scored higher on food addiction (MD = 0.75; 95% CI: 0.31−1.19). Higher values of physical activity were observed in those who presented a healthy consumption of vegetables (MD = 140.86; 95% CI: 72.71−209.02), fruit (MD = 145.78; 95% CI: 69.35−222.21), legumes (MD = 136.46; 95% CI: 60.43−212.50) and nuts (MD = 74.36; 95% CI: 14.23−134.49). Students who consumed more red or processed meats, more pastries and more soft drinks had higher values of food addiction, while those who consumed more vegetables, fruits, legumes, and nuts had more minutes of physical activity per week. These findings invite us to insist on expanding knowledge regarding the health benefits of consuming a Mediterranean-type diet as a whole. The healthy consumption of fish, fruit and legumes should also be emphasized, especially among university students.

To describe the experiences and expectations of Spanish women regarding breastfeeding and the support they receive from healthcare professionals, family, and friends during the breastfeeding journey, A qualitative study using an empirical-phenomenological approach was conducted. Primiparous women that had already given birth were interviewed using a purposive and snowball sampling. In-depth interviews were conducted between 1 January and 30 April 2020. The interviews were transcribed verbatim and analysed using Haase's adaptation of Colaizzi's phenomenological method. We recruited 14 women who had recently become mothers. Three major themes describing experiences of infant feeding by maternal lactation were identified-institutional influences, establishing breastfeeding, and cessation of breastfeeding-as well as the following 10 categories: hospital routines, lactation concerns (amount and infant nutrition), antenatal breastfeeding decision, embarrassment to breastfeed, and normalisation of breastfeeding. Prior education and support were identified as key elements in possible breastfeeding support strategies.

The visualization of whole organs and organisms through tissue clearing and fluorescence volumetric imaging has revolutionized the way we look at biological samples. Its application to solid tumours is changing our perception of tumour architecture, revealing signalling networks and cell interactions critical in tumour progression, and provides a powerful new strategy for cancer diagnostics. This Review introduces the latest advances in tissue clearing and three-dimensional imaging, examines the challenges in clearing epithelia - the tissue of origin of most malignancies - and discusses the insights that tissue clearing has brought to cancer research, as well as the prospective applications to experimental and clinical oncology., (© 2021. Springer Nature Limited.)

Objective: Our objective was to determine and describe the opinion and attitudes of patients and their families regarding the limitation of therapeutic effort and advanced directives in critical patients and whether end-of-life planning occurs. Religious affiliation, education level, and pre-admission quality of life were also evaluated to determine whether they may influence decisions regarding appropriate therapeutic effort., Methods: A prospective, observational and descriptive study, approved by the center's ethical committee, was carried out with 257 participants (94 patients and 163 family members) in the intensive care unit (ICU). A questionnaire regarding the opinions of patients and relatives about situations of therapeutic appropriateness in case of poor prognosis or poor quality of life was used. The questionnaire had three sections. In the first section, sociodemographic features were investigated. In the second section, information was collected on the quality of life and functional situation before ICU admission (taking as a reference the situation one month before admission) assessed by the Karnofsky scale, Barthel index, and the PAEEC scale (Project for the Epidemiological Analysis of Critical Care Patients). The third section aimed to determine whether the family knew the patient's opinion regarding his/her end of life., Results: Of those interviewed, 62.2% would agree to limit treatment in case of poor prognosis or poor quality of future life. In contrast, 37.7% considered that they should fight for life, even if it is irretrievable. Only 1.6% had advanced directives registered, 43.9% of the participants admitted deterioration in their quality of life before ICU admission, 18.2% with moderate-severe deterioration. Our study shows that the higher the educational level, the lower the desire to fight for life when it is irretrievable and the greater the agreement to limit treatment. Besides, those participants not affiliated with a religion were significantly less likely to fight for life, including when irretrievable, than Catholics and were more likely to agree to limit treatment., Conclusions: More than half of the participants would agree to limit treatment in the case of a poor prognosis. Our results indicate that patients do not prepare for the dying process well in advance. Religion and educational level were determining factors for the choice of procedures at the end of life, both for patients and their families.

The Linear Ubiquitin Chain Assembly Complex (LUBAC), composed of HOIP, HOIL-1L, and SHARPIN, promotes tumor necrosis factor (TNF)-dependent NF-κB signaling in diverse cell types. HOIL-1L contains an Npl4 Zinc Finger (NZF) domain that specifically recognizes linear ubiquitin chains, but its physiological role in vivo has remained unclear. Here, we demonstrate that the HOIL-1L NZF domain has important regulatory functions in inflammation and immune responses in mice. We generated knockin mice ( Hoil-1l T201A;R208A/T201A;R208A ) expressing a HOIL-1L NZF mutant and observed attenuated responses to TNF- and LPS-induced shock, including prolonged survival, stabilized body temperature, reduced cytokine production, and liver damage markers. Cells derived from Hoil-1l T201A;R208A/T201A;R208A mice show reduced TNF-dependent NF-κB activation and incomplete recruitment of HOIL-1L into TNF Receptor (TNFR) Complex I. We further show that HOIL-1L NZF cooperates with SHARPIN to prevent TNFR-dependent skin inflammation. Collectively, our data suggest that linear ubiquitin-chain binding by HOIL-1L regulates immune responses and inflammation in vivo ., Competing Interests: The authors declare no competing interests., (© 2021 The Author(s).)

In the early stages of the 2019 coronavirus pandemic in Spain, the Spanish health system was overwhelmed, mainly due to a lack of personnel, and many hospital centers collapsed by following avalanche of patients with COVID-19; this meant that the National System of Health called for fourth-year nursing students to come to the hospital as health care personnel. Our aim was to describe the perceptions and experiences of a sample of nursing students during the early stages of the outbreak. We conducted a qualitative study with an empirical-phenomenological approach. Twenty nursing students in their final year of study in Spain were recruited using purposive and snowball sampling. They participated in in-depth interviews between 20 April and 10 May 2020. The interviews were transcribed and then analyzed using Haase's adaptation of Colaizzi's phenomenological method. Four main themes emerged from data analysis: "social responsibility and pride as a health worker", "pressure caused by working with COVID-19 patients", "feeling defenseless and let down", and "personal growth as a health worker". These main themes were further divided into 11 theme categories. Due to an intense work day for several days in a row, the students were tired and mentally exhausted. Even so, they managed to overcome any difficulties, demonstrating their professional dedication and resilience. Greater preparatory support should be provided to safeguard the well-being of these future healthcare providers. More intensive preparatory training is necessary for health sciences students to facilitate crisis preparedness and effective crisis management. It is necessary to implement support from healthcare systems, including sufficient personal protective equipment, as well as contracts that accurately reflect the work they do. It is necessary for nursing supervisors to have effective communication in the performance of their functions with nursing students; this dialogue helps to clearly explain which are the functions that students must perform when they are carrying out their internships. There is also a need for preparatory training in managing infectious diseases such as COVID-19.

Aim: To examine women's evaluations of quality of care from their perspectives., Background: Assessing women's satisfaction with the quality of care they receive during childbirth is an important component of care quality that should be analysed. Evidence suggests that childbirth experience has an important impact on women's health. Therefore, taking into account the perceptions of women about quality is a means to improve care. However, studies examining care quality in this setting remain scarce., Design: Mixed-methods explanatory sequential design., Methods: A national survey with a sample of 1082 participants, and 15 semi-structured interviews. Data collection occurred between January 2017 and January 2019. Quantitative data were obtained through a validated scale, the Quality from the Patient's Perspective-Intrapartal questionnaire, whose score can range from 1 (minimum satisfaction) to 4 (maximum satisfaction). Semi-structured interviews were conducted for qualitative data. Descriptive statistics, group comparison and qualitative content analysis were included in data analysis., Results: The mean score on the QPP-I tool was high (3.13; SD 0.74). Variables that had the most influence on the experience were type of birth, type of perineal trauma, admission of the baby, time since birth, home-birth, parity and duration of labour. Data from the qualitative interviews identified five themes that explained women's experiences with the quality of care. Previous expectations influence the emotions they have regarding the experience. Relationships with professionals and their social skills are fundamental for the evaluation of quality. The separation of the newborn appears as a factor that worsens the appreciation of women. Good pain management and continuity of care by specialists are also named as key elements of the quality of care., Conclusion: Findings demonstrate that experience with childbirth care is of utmost importance for women. They also show the indisputable need to listen to their opinions and assessments when lines of improvement of quality are identified., Impact: This study provides information that can improve the care that women receive during their childbirths. Using their opinions will make them feel an active part of the system and in this way, we will be closer to achieve excellence in our services., (© 2021 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Background: This study aimed to determine whether there is an association between clinical practices carried out during spontaneous vaginal birth (SVB), or clinical situations that arise during vaginal birth, and the incidence of post-traumatic stress disorder (PTSD)., Methods: A cross-sectional study with 839 puerperal women in Spain was conducted. The Perinatal Post-traumatic Stress Disorder Questionnaire (PPQ) was administered online. The relationship between the risk of postpartum PTSD and various intrapartum complications was studied in addition to practices or procedures performed during the intrapartum period., Results: PTSD (PPQ scores ≥19) was identified in 8.1% (68) of the women who participated. Among the risk factors for PTSD was a concerning intrapartum FHR tracing (adjusted OR: 2.24, 95% CI: 1.07-4.66). Other intrapartum practices also put women at risk of PTSD, including the administration of an enema (aOR: 7.01, 95% CI: 2.14-23.01), being required to stay lying down throughout the labor and birth (aOR: 5.75, 95% CI: 3.25-10.19), artificial amniorrhexis without consent (aOR: 2.28, 95% CI: 1.31-3.97), administration of synthetic oxytocin without consent (aOR: 2.18, 95% CI: 1.26-3.77), fundal pressure during pushing (aOR: 3.14, 95% CI: 1.72-5.73), repeated vaginal examinations performed by different people (aOR: 4.84, 95% CI: 2.77-8.47), and manual removal of the placenta without anesthesia (aOR: 3.45, 95% CI: 1.81-6.58)., Conclusions: Various intrapartum clinical practices, all related to dehumanized treatment, and intrapartum complications, were associated with an increased risk of PTSD. There is a need to eradicate obstetric mistreatment and to increase access to evidence-informed, respectful care in Spain. Care practitioners need to better appreciate their roles in preventing PTSD., (© 2021 Wiley Periodicals LLC.)

Background: In recent years, the concept of obstetric violence has become visible among women and professionals, but its prevalence and the factors with which it is related in our healthcare environment are unknown., Aim: To determine the prevalence of obstetric violence in the Spanish healthcare system and identify the associated factors., Methods: A cross-sectional observational study was conducted during 2019 and included 899 women who had given birth in the last 12 months. An online questionnaire was distributed through midwives and women associations in Spain. The questionnaire included sociodemographic, clinical, and assistance practices variables. The primary outcome variable was obstetric violence and its verbal, physical, and psycho-affective types. Crude odds ratios (OR) and adjusted OR (ORa) were estimated using binary logistic regression., Results: Obstetric violence was reported by 67.4% (606) of the women; 25.1% (226) verbal, 54.5% (490) physical, and 36.7% (330) psycho-affective. Overall obstetric violence was observed more frequently in women who attended maternal education programme (ORa 1.56, 95% CI 1.05-2.32), those who presented a birth plan but it was not respected (ORa 2.82, 95% CI 1.27-6.29), those who received regional analgesia (ORa 1.61, 95% CI 1.13-2.30), those who required an urgent caesarean section (ORa 3.46, 95% CI 1.79-6.69), underwent an episiotomy (ORa 3.34, 95% CI 2.21-5.38), and whose newborn was admitted to an intensive care unit (ORa 2.73, 95% CI: 1.21-6.15). The presentation of a birth plan was observed as protective factors, and the possibility of skin-to-skin (ORa 0.34, 95% CI 0.18-0.62) and felt respected (ORa 0.61, 95% CI 0.43-0.85)., Conclusions: Two out of three women perceive having suffered obstetric violence during childbirth. Practices such as skin-to-skin contact, and the use of respected birth plans, were protective factors against obstetric violence., (Copyright © 2020 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Intermittent bladder catheterization (IBC) involves regular urine draining using a catheter, which is removed immediately after urinary elimination. It allows for the patient's urological health to be managed and their renal function to be preserved, and it promotes autonomy. Compliance with the prescribed number of daily catheterizations, which must be conducted by the patient, and infection prevention measures are crucial. To identify the patients requiring IBC, and to determine their adherence (whether they followed the prescribed guidelines and their difficulty in carrying out the procedure, as well as to assess how the IBC influences their quality of life and state of mind after receiving self-care training from a specialized nurse), we carried out a prospective, multicenter observational study in 24 Spanish hospitals with one month of monitoring and a sample of 99 patients. The sources of information were the patients' clinical records, the King's Health Questionnaire, the Mini-Mental State Examination (MMSE), and the hospital anxiety and depression scale (HADS). Descriptive and bivariate statistics were used to analyses the paired data. After recruitment ( n = 99), 79 patients completed the questionnaire at a mean age of 35.2 years (SD = 20.5 years). In total, 53.5% (53) of the sample consisted of men and 32.3% (32) had neurological damage as the reason for prescription; 67% (67.7) performed self-catheterization and 86.7% adhered to the IBC. After one month of monitoring, a statistically significant improvement in quality of life was observed in all criteria, with the exception of personal relationships ( p < 0.005), as well as an improvement in anxiety and depression levels ( p < 0.001). Patients who require IBC show good adherence to the IBC with a significant percentage of self-catheterization. After one month of IBC, a significant improvement in the patients' quality of life and mood was observed. These results could be attributed to adequate patient training and adequate personalization of the IBC materials by the specialized nurses.

Congenital microcephaly (MCPH) is a neurodevelopmental disease associated with mutations in genes encoding proteins involved in centrosomal and chromosomal dynamics during mitosis. Detailed MCPH pathogenesis at the cellular level is still elusive, given the diversity of MCPH genes and lack of comparative in vivo studies. By generating a series of CRISPR/Cas9-mediated genetic KOs, we report here that - whereas defects in spindle pole proteins (ASPM, MCPH5) result in mild MCPH during development - lack of centrosome (CDK5RAP2, MCPH3) or centriole (CEP135, MCPH8) regulators induces delayed chromosome segregation and chromosomal instability in neural progenitors (NPs). Our mouse model of MCPH8 suggests that loss of CEP135 results in centriole duplication defects, TP53 activation, and cell death of NPs. Trp53 ablation in a Cep135-deficient background prevents cell death but not MCPH, and it leads to subcortical heterotopias, a malformation seen in MCPH8 patients. These results suggest that MCPH in some MCPH patients can arise from the lack of adaptation to centriole defects in NPs and may lead to architectural defects if chromosomally unstable cells are not eliminated during brain development.

Background: The benefits of breastfeeding for both mother and newborn have been widely demonstrated. However, breastfeeding rates at discharge are lower than recommended, so being able to identify women at risk of not breastfeeding at discharge could allow professionals to prioritise care., Objective: To develop and validate a predictive model of exclusive breastfeeding at hospital discharge., Design: Retrospective cohort study on women who gave birth between 2014 and 2019 in Spain., Data Sources: The data source was a questionnaire distributed through the Spanish breastfeeding associations. The development of the predictive model was made on a cohort of 3387 women and was validated on a cohort of 1694 women. A multivariate analysis was performed by means of logistic regression, and predictive ability was determined by areas under the ROC curve (AUC)., Results: 80.2% (2717) women exclusively breastfed at discharge in the derivation cohort, and 82.1% (1390) in the validation cohort. The predictive factors in the final model were: maternal age at birth; BMI; number of children; previous breastfeeding; birth plan; induced birth; epidural analgesia; type of birth; prematurity; multiple pregnancy; macrosomia; onset of breastfeeding within the first hour; and skin-to-skin contact. The predictive ability (ROC AUC) in the derivation cohort was 0.76 (CI 95%: 0.74-0.78), while in the validation cohort it was 0.74 (CI 95%: 0.71-0.77)., Conclusions: A predictive model of exclusive maternal breastfeeding at hospital discharge has been developed, based on thirteen variables, with satisfactory predictive ability in both the derivation cohort and the validation cohort according to the Swets' criteria. This model can identify women who are at high risk of not breastfeeding at hospital discharge., Competing Interests: Declaration of Competing Interest No conflict of interest has been declared by the author(s)., (Copyright © 2021. Published by Elsevier Ltd.)

To determine the association between experiencing obstetric violence and the incidence of postpartum post-traumatic stress disorder (PTSD). A cross-sectional study with puerperal women was conducted in Spain following ethical approval. The Perinatal Posttraumatic Stress Disorder Questionnaire (PPQ) was administered online. Sociodemographic, clinical, and obstetric violence variables and the risk of dichotomized PTSD (low/high) were studied by bivariate and multivariate analysis with binary logistic regression. 955 women were invited to participate. 53 women refused to participate, three did not complete all survey questions and, finally, 899 women were included. The risk of PTSD (score ≥ 19) using the PPQ was 12.7% (114). The mean score was 9.10 points (SD = 8.52). Risk factors identified were having a delivery plan that was not respected (aOR: 2.85, 95% CI 1.56-5.21), elective caesarean delivery (aOR: 2.53, 95% CI 1.02-2.26), emergency caesarean section (aOR: 3.58, 95% CI 1.83-6.99), admission of the newborn to the neonatal intermediate care unit (aOR: 4.95, 95% CI 2.36-10.36), admission to the intensive care unit (aOR: 2.25, 95% CI 1.02-4.97), formula feeding on discharge (aOR: 3.57, 95% CI 1.32-9.62), verbal obstetric violence (aOR: 5.07, 95% CI 2.98-8.63), and psycho-affective obstetric violence (aOR: 2.61, 95% CI 1.45-4.67). Various clinical practices were identified with the risk of PTSD, highlighting various types of obstetric violence. Partner support and early breastfeeding were identified as protective factors. Sensitizing professionals is essential to prevent the risk of PTSD.

The prevalence of overweight and obesity is increasing in our society, with a complex, multifactorial origin, and associated with greater morbidity and mortality in the population. Food addiction (FA) is a common disorder in overweight/obese people, which appears to be increasingly common in young people. This study analyzed food addiction in a group of young university students and to examine its association with body composition, quality of sleep, adherence to the Mediterranean diet, physical activity/sedentary habits, tobacco or alcohol consumption, and health status. A total of 536 undergraduate nursing students participated in a questionnaire that included the Yale Food Addiction Scale (YFAS 2.0). Up to 6.4% of the students presented FA. Statistically significant associations were observed in the variables for sleep quality odds ratio (OR) 4.8 (95% confidence interval (CI): 1.66-13.87), anxiety/depression OR 8.71 (95% CI: 3.93-19.27), body mass index (BMI) OR 8.32 (95% CI: 3.81-18.15) and sedentary lifestyle OR 2.33 (95% CI: 1.09-5.01). A predictive model was developed after binary logistic regression (area under the ROC curve 0.84 (95% CI: 0.77-0.91). Students with FA presented higher BMI values, worse sleep quality, anxiety or depression problems, and more time spent in sedentary behaviors.

The tumour suppressor FBW7 is a substrate adaptor for the E3 ubiquitin ligase complex SKP1-CUL1-F-box (SCF), that targets several oncoproteins for proteasomal degradation. FBW7 is widely mutated and FBW7 protein levels are commonly downregulated in cancer. Here, using an shRNA library screen, we identify the HECT-domain E3 ubiquitin ligase TRIP12 as a negative regulator of FBW7 stability. We find that SCF FBW7 -mediated ubiquitylation of FBW7 occurs preferentially on K404 and K412, but is not sufficient for its proteasomal degradation, and in addition requires TRIP12-mediated branched K11-linked ubiquitylation. TRIP12 inactivation causes FBW7 protein accumulation and increased proteasomal degradation of the SCF FBW7 substrate Myeloid Leukemia 1 (MCL1), and sensitizes cancer cells to anti-tubulin chemotherapy. Concomitant FBW7 inactivation rescues the effects of TRIP12 deficiency, confirming FBW7 as an essential mediator of TRIP12 function. This work reveals an unexpected complexity of FBW7 ubiquitylation, and highlights branched ubiquitylation as an important signalling mechanism regulating protein stability.

To determine the psychometric properties of the Perinatal Post-Traumatic Stress Disorder (PTSD) Questionnaire (PPQ) in Spanish. A cross-sectional study of 432 Spanish puerperal women was conducted, following ethical approval. The PPQ was administered online through midwives' associations across Spain. The Edinburgh Postnatal Depression Scale was used to diagnose postnatal depression for examining criterion validity. Data were collected on sociodemographic, obstetric, and neonatal variables. An exploratory factorial analysis (EFA) was performed with convergence and criterion validation. Internal consistency was evaluated using Cronbach's α. The EFA identified three components that explained 63.3% of variance. The PPQ's convergence validation associated the risk of PTSD with variables including birth plan, type of birth, hospital length of stay, hospital readmission, admission of the newborn to care unit, skin-to-skin contact, maternal feeding at discharge, maternal perception of partner support, and respect shown by healthcare professionals during childbirth and puerperium. The area under the ROC curve for the risk of postnatal depression (criterion validity) was 0.86 (95% CI 0.82-0.91). Internal consistency with Cronbach's α value was 0.896. The PPQ used when screening for PTSD in postpartum Spanish women showed adequate psychometric properties.

Background: During the COVID-19 pandemic health crisis, in some countries such as Spain, nursing students have offered to provide health assistance, but the role they have played, their degree of preparedness to face the situation, and what must be improved in their training to be ready for these situations is unknown., Objective: Describe the experience and perceptions of students of the Nursing university degree during their participation as health support in the COVID-19 health crisis in Spain., Design: We conducted a cross-sectional survey study., Method: 503 students enrolled in the 4th course of the Nursing degree in Spain during the months of March and April 2020. An online questionnaire was developed, based on a pilot study and distributed through the Nursing Association, students' unions and students' associations. Variables were used to describe their participation, degree of preparedness and training needs to determine how to improve training through descriptive statistics, as well as nonparametric tests to analyse the relationship between training and degree of preparedness nursing students. Results are reported according to the STROBE Statement., Results: 73.2% (368) of students offered to participate in healthcare aid, of which 225 were actively involved. 27.8% carried out nursing tasks without supervision, and 47.7% assisted COVID-19 patients as any other nurse. Only 3.4% felt very prepared to work in the field of intensive care, finding that those students who perceived a higher degree of preparedness had received previous training in personal protective equipment and mechanical ventilation (p < 0.005). The highest scores for training activities that may improve their preparedness were simulations to improve levels of anxiety and stress when managing critical patients, simulation in ventilatory support and mandatory practices in services where ventilators are used., Conclusions: Although three out of four students were willing to provide health assistance, they recognise that they were not specially prepared in the field of intensive care and demand training with simulation to improve anxiety and stress levels in the management of critical patients and simulation in ventilatory support., Relevance to Clinical Practice: Students have been vital resources for our health system and society when they have been needed. It is now up to us, both teachers and health authorities, to share their efforts by implementing the necessary improvements in training and safety measures not only because these affects the health and safety of the patient, but because they will be essential parts in future pandemics., (© 2021 John Wiley & Sons Ltd.)

Postpartum post-traumatic stress disorder (PTSD) is not a specific process but can last for months and may manifest itself during any subsequent pregnancies or even become chronic. This study aimed to determine the factors associated with long-term PTSD symptoms one year after delivery. A cross-sectional study was conducted on 1301 Spanish puerperal women. Data were collected on sociodemographic, obstetric, and neonatal variables. The Perinatal Post-Traumatic Stress Disorder Questionnaire (PPQ) was administered online through midwives' associations across Spain. Crude odds ratio (OR) and adjusted odds ratio (aOR) and their 95% confidence intervals were calculated. A PPQ score ≥ 19 (high-risk) was recorded for 13.1% (171) of the participants. Identified risk factors were not respecting a birth plan (aOR = 1.89 (95% CI 1.21-2.94)), formula-feeding of the baby at discharge (aOR = 2.50 (95% CI 1.20-5.17)), postpartum surgical intervention (aOR = 2.23 (95% CI 1.02-4.85)), hospital readmission (aOR = 3.45 (95% CI 1.21-9.84)), as well as verbal obstetric violence (aOR = 3.73 (95% CI 2.52-5.53)) and psycho-affective obstetric violence (aOR = 3.98 (95% CI 2.48-6.39)). During childbirth, some clinical practices, such as formula-feeding of the newborn at discharge or types of obstetric violence towards the mother, were associated with a higher risk of PTSD symptoms one year after delivery.

The creation of videos in teaching has a high educational potential and is a challenge that can motivate students. There is little evidence on the use of this method when applied to the creation of digital stories. Thus, the aim of this study was to measure student satisfaction with the creation of audiovisual material through digital storytelling, measure its usefulness, and evaluate its impact on their motivation to study the subject. As a secondary objective, we intended to determine the influence of this learning experience on raising awareness of society toward mental illnesses by measuring the impact by the number of views on social networks. A cross-sectional descriptive study design was used. The participants were 90 third-year nursing students enrolled in the subject "Psychiatric Nursing". The students created eight themed videos (depression, suicide, anxiety, anorexia, mobile phone addiction, obsessive-compulsive disorder, drug addiction, schizophrenia). The students were then asked to complete an ad hoc questionnaire on the matter. A total of 90% of the nursing students thought that creating the videos improved the acquisition of nursing knowledge, 91.2% replied that they would like to use the method in other subjects on the degree in nursing syllabus, and 67.8% thought that their clinical skills improved after using narrated digital stories to create videos. Students acknowledged that this training activity helped them feel better prepared and helped them better understand the subject. They believe that this teaching technique is more stimulating and more enjoyable than the conventional system, giving them more motivation to study the subject. Students acknowledge that the experience gained from this initiative has helped them feel better prepared and helped them better understand the subject, and they think that it will be a useful resource in the future as it has improved the process of the creation of audiovisual material through digital storytelling.

Advances in light-sheet and confocal microscopy now allow imaging of cleared large biological tissue samples and enable the 3D appreciation of cell and protein localization in their native organ environment. However, the sample preparations for such imaging are often onerous, and their capability for antigen detection is limited. Here, we describe FLASH (fast light-microscopic analysis of antibody-stained whole organs), a simple, rapid, fully customizable technique for molecular phenotyping of intact tissue volumes. FLASH utilizes non-degradative epitope recovery and membrane solubilization to enable the detection of a multitude of membranous, cytoplasmic and nuclear antigens in whole mouse organs and embryos, human biopsies, organoids and Drosophila. Retrieval and immunolabeling of epithelial markers, an obstacle for previous clearing techniques, can be achieved with FLASH. Upon volumetric imaging, FLASH-processed samples preserve their architecture and integrity and can be paraffin-embedded for subsequent histopathological analysis. The technique can be performed by scientists trained in light microscopy and yields results in <1 week.

This study aimed to develop and validate two predictive models of postpartum post-traumatic stress disorder (PTSD) risk using a retrospective cohort study of women who gave birth between 2018 and 2019 in Spain. The predictive models were developed using a referral cohort of 1752 women (2/3) and were validated on a cohort of 875 women (1/3). The predictive factors in model A were delivery type, skin-to-skin contact, admission of newborn to care unit, presence of a severe tear, type of infant feeding at discharge, postpartum hospital readmission. The area under curve (AUC) of the receiver operating characteristic (ROC) in the referral cohort was 0.70 (95% CI: 0.67-0.74), while in the validation cohort, it was 0.69 (95% CI: 0.63-0.75). The predictive factors in model B were delivery type, admission of newborn to care unit, type of infant feeding at discharge, postpartum hospital readmission, partner support, and the perception of adequate respect from health professionals. The predictive capacity of model B in both the referral cohort and the validation cohort was superior to model A with an AUC-ROC of 0.82 (95% CI: 0.79-0.85) and 0.83 (95% CI: 0.78-0.87), respectively. A predictive model (model B) formed by clinical variables and the perception of partner support and appropriate treatment by health professionals had a good predictive capacity in both the referral and validation cohorts. This model is preferred over the model (model A) that was formed exclusively by clinical variables.

Background: Parents' decisions about how to feed their newborns are influenced by multiple factors. Our objective was to identify the factors that can influence the decision to breastfeed., Methods: Cross-sectional observational online study was conducted in Spain on women who gave birth between 2013 and 2018. The total number of participants was 5671. Data collection was after approval by the ethics committee in 2019. The data were collected retrospectively because the information was obtained from women who were mothers during the years 2013-2018. An online survey was distributed to breastfeeding associations and postpartum groups. Multivariate analysis with binary logistic regression was done to calculate the Adjusted Odds Ratios (aOR). The main result variable was "intention to breastfeed"., Results: Ninety-seven percent (n = 5531) of women made the decision to breastfeed prior to giving birth. The internet played a role in deciding to breastfeed in 33.7% (n = 2047) of women, while 20.1% (n = 1110) said the same thing about their midwife. We identified five significant factors associated with the mother's prenatal decision to breastfeed: attending maternal education (aOR 2.10; 95% CI 1.32, 3.34), having two (aOR 0.52; 95% CI 0.28, 0.99) and three children (aOR 0.24; 95% CI 0.10, 0.59), previous breastfeeding experience (aOR 6.99; 95% CI 3.46, 14.10), support from partner (aOR 1.58; 95% CI 1.09,2.28) and having a condition during pregnancy (aOR 0.62; 95% CI 0.43, 0.91)., Conclusions: Factors related with previous breastfeeding experience and education for mothers are decisive when it comes to making the decision to breastfeed. Given the proven influence that partners have in decision-making, it is important for them to be fully involved in the process.

To evaluate the association between prolonged second stage of labor and the risk of adverse neonatal outcomes with a systematic review and meta-analysis. PubMed, Scopus and EMBASE were searched using the search strategy "Labor Stage, Second" AND (length OR duration OR prolonged OR abnormal OR excessive). Observational studies that examine the relationship between prolonged second stage of labor and neonatal outcomes were selected. Prolonged second stage of labor was defined as 4 h or more in nulliparous women and 3 h or more in multiparous women. The main neonatal outcomes were 5 min Apgar score <7, admission to the Neonatal Intensive Care Unit, neonatal sepsis and neonatal death. Data collection and quality assessment were carried out independently by the three reviewers. Twelve studies were selected including 266,479 women. In nulliparous women, a second stage duration greater than 4 h increased the risk of 5 min Apgar score <7, admission to the Neonatal Intensive Care Unit and neonatal sepsis and intubation. In multiparous women, a second stage of labor greater than 3 h was related to 5 min Apgar score <7, admission to the Neonatal Intensive Care Unit, meconium staining and composite neonatal morbidity. Prolonged second stage of labor increased the risk of 5 min Apgar score <7 and admission to the Neonatal Intensive Care Unit in nulliparous and multiparous women, without increasing the risk of neonatal death. This review demonstrates that prolonged second stage of labor increases the risk of neonatal complications in nulliparous and multiparous women.

Regular physical activity is related to many factors in a university student's environment. The coronavirus pandemic and the resulting lockdown have restricted many elements of our environment. The aim of this study was to evaluate students' physical activity and sedentary behaviour at two points in time: before and during the coronavirus lockdown. As a secondary aim, we also wanted to look at changes resulting from other factors (alcohol, tobacco, diet, stages of change, symptoms of anxiety/depression and sociodemographic characteristics). We conducted an observational, cross-sectional, pre-post study with two cut-off points. Two hundred and thirteen students took part in the study. The main dependent variables were physical activity and sitting time, measured using the International Physical Activity Questionnaire-Short Form (IPAQ-SF). Parametric and non-parametric tests were used for paired and unpaired data, as well as group-stratified analysis. During lockdown, both weekly physical activity (MD: -159.87; CI: -100.44, -219.31) and weekly sitting time increased (MD: -106.76; CI: -71.85, -141.67). In the group analysis, differences were observed in relation to gender, year of study, BMI, alcohol consumption, tobacco use, symptoms of anxiety/depression, Mediterranean diet, living situation and stage of change. The results showed an increase in both physical activity and sitting time globally and by group.