Percepções dos alunos de Enfermagem sobre flipped classroom e avaliação contínua na sala de aula de Gestão de Enfermagem

Introduction: Although the training of nurses in administration and leadership has an important repercussion on the present and the future of the profession, teaching methods are still traditional in many cases. Flipped classroom is a widely used method in nursing education but studies about its application to Nursing Administration and Management are limited. Method: Qualitative study by means of anonymous survey (dichotomous and open questions). Results: 92 % of students were shown to be satisfied with the teaching methodology and 92.9 % with the assessment. Only 31.5 % had used it previously but 83 % would like to use it in more subjects. The students showed that the methodology used had improved their opinion about the content and had increased their perception its usefulness. Conclusion: The participating students have been shown to be satisfied with flipped method and continuous assessment. These teaching strategies can help motivate nursing students towards the subject of Nursing Administration and Management, which can encourage them to pursue postgraduate training and professional practice in this area.Introducción: Si bien la formación de enfermeros en Administración y Gestión tiene una importante repercusión en el presente y el futuro de la profesión, los métodos de enseñanza siguen siendo tradicionales en muchos casos. El aula invertida es un método ampliamente utilizado en la educación de enfermería, pero los estudios sobre su aplicación a la administración y gestión de enfermería son limitados. Método: Estudio cualitativo mediante cuestionario anónimo (preguntas dicotómicas y abiertas). Resultados: El 92 % de los estudiantes se mostró satisfecho con la metodología de enseñanza y el 92,9 % con la evaluación. Solo el 31,5 % lo había usado anteriormente, pero al 83 % le gustaría usarlo en más sujetos. Los estudiantes demostraron que la metodología utilizada había mejorado su opinión sobre el contenido y había aumentado su percepción útil del mismo. Conclusión: Los estudiantes participantes han demostrado estar satisfechos con el método de aula invertida. Estas estrategias de enseñanza pueden ayudar a motivar a los estudiantes de enfermería hacia la asignatura de Administración y Gestión de los Servicios de Enfermería, lo que puede animarlos a realizar una formación de posgrado y una práctica profesional en esta área.Introdução: Embora a educação de Enfermagem em Administração e Gestão tenha um grande impacto no presente e futuro da profissão, os métodos de ensino continuam a ser tradicionais em muitos casos. A sala de aula invertida é um método amplamente utilizado na educação em Enfermagem, mas os estudos sobre a sua aplicação à Administração e Gestão de Enfermagem são limitados. Método: Estudo qualitativo utilizando um questionário anônimo (perguntas dicotômicas e abertas). Resultados: 92% dos estudantes ficaram satisfeitos com a metodologia de ensino e 92,9% com a avaliação. Apenas 31,5% já o tinha utilizado antes, mas 83% gostariam de  utilizá-lo em mais assuntos. Os estudantes mostraram que a metodologia utilizada havia melhorado a sua opinião sobre o conteúdo e aumentado a sua percepção útil do conteúdo. Conclusão: Os estudantes participantes mostraram-se satisfeitos com o método invertido e com a avaliação contínua. Estas estratégias de ensino podem ajudar a motivar os estudantes de Enfermagem para a disciplina de Administração e Gestão de Enfermagem, o que pode encorajá-los a empreender uma educação de pós-graduação e prática profissional nesta área

The Effects of the Mediterranean Diet on Biomarkers of Vascular Wall Inflammation and Plaque Vulnerability in Subjects with High Risk for Cardiovascular Disease. A Randomized Trial

Adherence to the Mediterranean diet (MD) is associated with reduced morbidity and mortality due to cardiovascular disease. However, how the MD exerts its effects is not fully known. Aim: To assess the 12-month effects of two enhanced MDs compared to a low-fat diet on inflammatory biomarkers related to atherosclerosis and plaque vulnerability in a subcohort of the PREDIMED (Prevencion con Dieta Mediterranea) study. Methods: A total of 164 participants at high risk for cardiovascular disease were randomized into three diet groups: MD supplemented with 50 mL/d of extra virgin olive oil (MD+EVOO) or 30 g/d of nuts (MD+Nuts) and a low-fat diet. Changes in classical cardiovascular risk factors, inflammatory biomarkers of atherosclerosis and plaque vulnerability were measured after 12 months of intervention. Results: Compared to participants in the low-fat diet group, those receiving MD+EVOO and MD+Nuts showed a higher decrease in systolic (6 mmHg)and diastolic (3 mmHg) blood pressure (P = 0.02; both), as well as a reduction of 10% and 8% in LDL-cholesterol (P = 0.04), respectively. Patients in the MD+Nuts group showed a significant reduction of 34% in CD40 expression on monocyte surface compared to low-fat diet patients (P = 0.03). In addition, inflammatory biomarkers related to plaque instability such as C-reactive protein and interleukin-6 were reduced by 45% and 35% and 95% and 90% in the MD+EVOO and MD+Nuts groups, respectively (P<0.05; all) compared to the low-fat diet group. Likewise, sICAM and Pselectin were also reduced by 50% and 27%, respectively in the MD+ EVOO group (P = 0.04) and P-selectin by 19% in MD+Nuts group (P = 0.04) compared to the low-fat diet group. Conclusions: Adherence to the MD is associated with an increase in serum markers of atheroma plaque stability which may explain, at least in part, the protective role of MD against ischemic heart disease

Changes in plasma total saturated fatty acids and palmitic acid are related to pro-inflammatory molecule IL-6 concentrations after nutritional intervention for one year

Systemic inflammation is associated with an increased risk of non-communicable diseases, such as cardiovascular diseases and diabetes. Circulating fatty acids (FA) are known to be related to these conditions, possibly through their role in inflammation, although different types of FAs can have opposite effects on inflammatory mediators. The aim of the present study was to analyze the association of plasma FAs with inflammatory biomarkers in a PREDIMED trial subsample after one year of intervention. In a one-year longitudinal study of 91 participants of the PREDIMED trial (Barcelona-Clinic center), plasma FAs and inflammatory biomarkers were analyzed using gas chromatography and ELISA, respectively. In baseline plasma, a multivariable-adjusted ordinary least squares regression model showed that n-3 polyunsaturated FAs concentrations were inversely associated with concentrations of soluble intercellular adhesion molecule-1 (sICAM-1) and E-selectin, whereas the level of the most abundant saturated FA, palmitic acid, was directly associated with concentrations of interleukin-6 (IL-6) (β = 0.48 pg/mL, 95% CI: 0.03, 0.93 per 1-SD increase, p-value = 0.037). After one year of nutritional intervention, changes of plasma diet-derived total saturated FAs and palmitic acid were directly associated with changes in IL-6 (β = 0.59 pg/mL [95% CI: 0.28, 0.89] per 1-SD, p-value = 0.001; β = 0.64 pg/mL, 95% CI: 0.31, 0.98, p-value = 0.001), respectively, after correction for multiple testing. Our findings suggest that saturated FAs of dietary origin, especially palmitic acid, are directly involved in the increase of IL-6 in plasma

Abundance, movements and biodiversity of flying predatory insects in crop and non-crop agroecosystems

[EN] Predatory insects are key natural enemies that can highly reduce crops pest damage. However, there is a lack of knowledge about the movements of flying predatory insects in agroecosystems throughout the year. In particular, it is still unclear how these predators move from crop to non-crop habitats, which are the preferred habitats to overwinter and to spread during the spring and if these predators leave or stay after chemical treatments. Here, the Neuroptera, a generalist, highly mobile, flying predator order of insects, was selected as model. We studied the effects of farming management and the efficiency of edge shelterbelts, ground cover vegetation, and fruit trees canopy on holding flying predatory insects in Mediterranean traditional agroecosystems. Seasonal movements and winter effects were also assessed. We evaluated monthly nine fruit agroecosystems, six organic, and three pesticides sprayed, of 0.5-1 ha in eastern Spain during 3 years using two complementary methods, yellow sticky traps and aspirator. Results show surprisingly that the insect abundance was highest in pesticide sprayed systems, with 3.40 insects/sample versus 2.32 insects/sample in organic systems. The biodiversity indices were highest in agroecosystems conducted under organic management, with S of 4.68 and D of 2.34. Shelterbelts showed highest biodiversity indices, S of 3.27 and D of 1.93, among insect habitats. Insect species whose adults were active during the winter preferred fruit trees to spend all year round. However, numerous species moved from fruit trees to shelterbelts to overwinter and dispersed into the orchard during the following spring. The ground cover vegetation showed statistically much lower attractiveness for flying predatory insects than other habitats. Shelterbelts should therefore be the first option in terms of investment in ecological infrastructures enhancing flying predators.Sorribas Mellado, JJ.; González Cavero, S.; Domínguez Gento, A.; Vercher Aznar, R. (2016). Abundance, movements and biodiversity of flying predatory insects in crop and non-crop agroecosystems. Agronomy for Sustainable Development. 36(2). doi:10.1007/s13593-016-0360-3S362Altieri MA, Letourneau DK (1982) Vegetation management and biological control in agroecosystems. Crop Prot 1:405–430. doi: 10.1016/0261-2194(82)90023-0Altieri MA, Schmidt LL (1986) The dynamics of colonizing arthropod communities at the interface of abandoned, organic and commercial apple orchards and adjacent woodland habitats. Agric Ecosyst Environ 16:29–43. doi: 10.1016/0167-8809(86)90073-3Bengtsson J, Ahnström J, Weibull A (2005) The effects of organic agriculture on biodiversity and abundance: a meta-analysis. J App Ecol 42:261–269. doi: 10.1111/j.1365-2664.2005.01005.xBianchi F, Booij CJH, Tscharntke T (2006) Sustainable pest regulation in agricultural landscapes: a review on landscape composition, biodiversity and natural pest control. Proc R Soc B 273:1715–1727. doi: 10.1098/rspb.2006.3530Chaplin-Kramer RM, Rourke E, Blitzer EJ, Kremen C (2011) A meta-analysis of crop pest and natural enemy response to landscape complexity. Ecol Lett 14:922–932. doi: 10.1111/j.1461-0248.2011.01642.xCrowder DW, Northfield TD, Strand MR, Snyder WE (2010) Organic agriculture promotes evenness and natural pest control. Nature 466:109–112. doi: 10.1038/nature09183Dogramaci M, DeBano SJ, Kimoto C, Wooster DE (2011) A backpack-mounted suction apparatus for collecting arthropods from various habitats and vegetation. Entomol Exp et Appl 139:86–90. doi: 10.1111/j.1570-7458.2011.01099.xDuelli P, Studer M, Marchland I, Jakob S (1990) Population movements of arthropods between natural and cultivated areas. Biol Conserv 54:193–207. doi: 10.1016/0006-3207(90)90051-PEilenberg J, Hajek A, Lomer C (2001) Suggestions for unifying the terminology in biological control. BioControl 46:387–400. doi: 10.1023/A:1014193329979Forman RTT, Baudry J (1984) Hedgerows and hedgerow networks in landscape ecology. Environ Manage 8:495–510. doi: 10.1007/BF01871575Gurr GM, Wratten SD, Luna JM (2003) Multi-function agricultural biodiversity: pest management and other benefits. Basic Appl Ecol 4:107–116. doi: 10.1078/1439-1791-00122Hole DG, Perkins AJ et al (2005) Does organic farming benefit biodiversity? Biol Conserv 122:113–130. doi: 10.1016/j.biocon.2004.07.018Landis DA, Wratten SD, Gurr GM (2000) Habitat management to conserve natural enemies of arthropod pests in agriculture. Annu Rev Entomol 45:175–201. doi: 10.1146/annurev.ento.45.1.175Long RF, Corbett A, Lamb C, Reberg-Horton C, Chandler J, Stimmann M (1998) Beneficial insects move from flowering plants to nearby crops. Calif Agr 52:23–26. doi: 10.3733/ca.v052n05p23Östman Ö, Ekbom B, Bengtsson J (2001) Landscape heterogeneity and farming practice influence biological control. Basic App Ecol 2:365–371. doi: 10.1078/1439-1791-00072Pantaleoni RA, Ticchiati V (1988) I Neurotteri delle colture agrarie: osservazioni sulle fluttuazioni stagionali di populazione in frutteti. Boll dell’Ist di Entomol 43:43–57Panzer R, Schwartz MW (1998) Effectiveness of a vegetation-based approach to insect conservation. Conserv Biol 12:693–702. doi: 10.1111/j.1523-1739.1998.97051.xParedes D, Cayuela L, Gurr G, Campos M (2013) Effect of non-crop vegetation types on conservation biological control of pests in olive groves. PeerJ 1:1–16. doi: 10.7717/peerj.116Pekar S, Michalko R, Loverre P, Líznarová E, Cernecká L (2015) Biological control in winter: novel evidence for the importance of generalist predators. J Appl Ecol 52:270–279. doi: 10.1111/1365-2664.12363Pollard KA, Holland JM (2006) Arthropods within the woody element of hedgerows and their distribution pattern. Agric Forest Entomol 8:203–211. doi: 10.1111/j.1461-9563.2006.00297.xRand TA, Tylianakis JM, Tscharntke T (2006) Spillover edge effects: the dispersal of agriculturally subsidized insect natural enemies into adjacent natural habitats. Ecol Lett 9:603–614. doi: 10.1111/j.1461-0248.2006.00911.xSilva EB, Franco JC, Vasconcelos T, Branco M (2010) Effect of ground cover vegetation on the abundance and diversity of beneficial arthropods in citrus orchards. Bull Entomol Res 100:489–499. doi: 10.1017/S0007485309990526Smukler SM, Sánchez-Moreno S et al (2010) Biodiversity and multiple ecosystem functions in an organic farmscape. Agric Ecosyst Environ 139:80–97. doi: 10.1016/j.agee.2010.07.004Stelzl M, Devetak D (1999) Neuroptera in agricultural ecosystems. Agric Ecosyst Environ 74:305–321. doi: 10.1016/S0167-8809(99)00040-7Straub CS, Finke DL, Snyder WE (2008) Are the conservation of natural enemy biodiversity and biological control compatible goals? Biol Control 45:225–237. doi: 10.1016/j.biocontrol.2007.05.013Thierry D, Deutsch B, Paulian M, Villenave J, Canard M (2005) Typifying ecosystems by using green lacewing assemblages. Agron Sustain Dev 25:473–479. doi: 10.1051/agro:2005047Thomas CFG, Parkinson L, Griffiths GJK, García AF, Marshall EJP (2001) Aggregation and temporal stability of carabid beetle distributions in field and hedgerow habitats. J App Ecol 38:100–116. doi: 10.1046/j.1365-2664.2001.00574.xVillenave J, Thierry D, Mamun A, Lode T, Rat-Morris E (2005) The pollens consumed by common green lacewings Chrysoperla spp. in cabbage crop environment in western France. Eur J Entomol 02:547–552, 10.14411/eje.2005.078You M, Hou Y, Liu Y, Yang G, Li Z, Cai H (2004) Non-crop habitat manipulation and integrated pest management in agroecosystems. Acta Entomol Sinica 47:260–268 (http://www.insect.org.cn/EN/Y2004/V47/I2/260

A genome-wide association study follow-up suggests a possible role for PPARG in systemic sclerosis susceptibility

Introduction: A recent genome-wide association study (GWAS) comprising a French cohort of systemic sclerosis (SSc) reported several non-HLA single-nucleotide polymorphisms (SNPs) showing a nominal association in the discovery phase. We aimed to identify previously overlooked susceptibility variants by using a follow-up strategy.&lt;p&gt;&lt;/p&gt; Methods: Sixty-six non-HLA SNPs showing a P value &#60;10-4 in the discovery phase of the French SSc GWAS were analyzed in the first step of this study, performing a meta-analysis that combined data from the two published SSc GWASs. A total of 2,921 SSc patients and 6,963 healthy controls were included in this first phase. Two SNPs, PPARG rs310746 and CHRNA9 rs6832151, were selected for genotyping in the replication cohort (1,068 SSc patients and 6,762 healthy controls) based on the results of the first step. Genotyping was performed by using TaqMan SNP genotyping assays. Results: We observed nominal associations for both PPARG rs310746 (PMH = 1.90 × 10-6, OR, 1.28) and CHRNA9 rs6832151 (PMH = 4.30 × 10-6, OR, 1.17) genetic variants with SSc in the first step of our study. In the replication phase, we observed a trend of association for PPARG rs310746 (P value = 0.066; OR, 1.17). The combined overall Mantel-Haenszel meta-analysis of all the cohorts included in the present study revealed that PPARG rs310746 remained associated with SSc with a nominal non-genome-wide significant P value (PMH = 5.00 × 10-7; OR, 1.25). No evidence of association was observed for CHRNA9 rs6832151 either in the replication phase or in the overall pooled analysis.&lt;p&gt;&lt;/p&gt; Conclusion: Our results suggest a role of PPARG gene in the development of SSc

Right Paraduodenal Hernia in an Adult Patient: Diagnostic Approach and Surgical Management

Paraduodenal hernia, a rare congenital anomaly which arises from an error of rotation of the midgut, is the most common type of intraabdominal hernia. There are two variants, right and left paraduodenal hernia, the right being less common. We report the case of a 41-year-old patient with a right paraduodenal hernia with a 6-month history of intermittent episodes of intestinal obstruction. Diagnosis was established by CT scan and upper gastrointestinal series with small bowel follow-through. In a planned laparotomy, herniation of the small bowel loops through the fossa of Waldeyer was found. Division of the lateral right attachments of the colon opened the hernia sac widely, replacing the pre- and postarterial segments of the intestine in the positions they would normally occupy at the end of the first stage of rotation during embryonic development. Six months after the surgery, after an uneventful recovery, the patient remains free of symptoms

Statistical and biological gene-lifestyle interactions of MC4R and FTO with diet and physical activity on obesity: new effects on alcohol consumption

Background Fat mass and obesity (FTO) and melanocortin-4 receptor (MC4R) and are relevant genes associated with obesity. This could be through food intake, but results are contradictory. Modulation by diet or other lifestyle factors is also not well understood. Objective To investigate whether MC4R and FTO associations with body-weight are modulated by diet and physical activity (PA), and to study their association with alcohol and food intake. Methods Adherence to Mediterranean diet (AdMedDiet) and physical activity (PA) were assessed by validated questionnaires in 7,052 high cardiovascular risk subjects. MC4R rs17782313 and FTO rs9939609 were determined. Independent and joint associations (aggregate genetic score) as well as statistical and biological gene-lifestyle interactions were analyzed. Results FTO rs9939609 was associated with higher body mass index (BMI), waist circumference (WC) and obesity (P<0.05 for all). A similar, but not significant trend was found for MC4R rs17782313. Their additive effects (aggregate score) were significant and we observed a 7% per-allele increase of being obese (OR = 1.07; 95%CI 1.01-1.13). We found relevant statistical interactions (P<0.05) with PA. So, in active individuals, the associations with higher BMI, WC or obesity were not detected. A biological (non-statistical) interaction between AdMedDiet and rs9939609 and the aggregate score was found. Greater AdMedDiet in individuals carrying 4 or 3-risk alleles counterbalanced their genetic predisposition, exhibiting similar BMI (P = 0.502) than individuals with no risk alleles and lower AdMedDiet. They also had lower BMI (P = 0.021) than their counterparts with low AdMedDiet. We did not find any consistent association with energy or macronutrients, but found a novel association between these polymorphisms and lower alcohol consumption in variant-allele carriers (B+/−SE: −0.57+/−0.16 g/d per-score-allele; P = 0.001). Conclusion Statistical and biological interactions with PA and diet modulate the effects of FTO and MC4R polymorphisms on obesity. The novel association with alcohol consumption seems independent of their effects on BMI

Olive oil intake and risk of cardiovascular disease and mortality in the PREDIMED Study

It is unknown whether individuals at high cardiovascular risk sustain a benefit in cardiovascular disease from increased olive oil consumption. The aim was to assess the association between total olive oil intake, its varieties (extra virgin and common olive oil) and the risk of cardiovascular disease and mortality in a Mediterranean population at high cardiovascular risk. Methods: We included 7,216 men and women at high cardiovascular risk, aged 55 to 80 years, from the PREvencion con DIeta MEDiterranea (PREDIMED) study, a multicenter, randomized, controlled, clinical trial. Participants were randomized to one of three interventions: Mediterranean Diets supplemented with nuts or extra-virgin olive oil, or a control low-fat diet. The present analysis was conducted as an observational prospective cohort study. The median follow-up was 4.8 years. Cardiovascular disease (stroke, myocardial infarction and cardiovascular death) and mortality were ascertained by medical records and National Death Index. Olive oil consumption was evaluated with validated food frequency questionnaires. Multivariate Cox proportional hazards and generalized estimating equations were used to assess the association between baseline and yearly repeated measurements of olive oil intake, cardiovascular disease and mortality. Results: During follow-up, 277 cardiovascular events and 323 deaths occurred. Participants in the highest energy-adjusted tertile of baseline total olive oil and extra-virgin olive oil consumption had 35% (HR: 0.65; 95% CI: 0.47 to 0.89) and 39% (HR: 0.61; 95% CI: 0.44 to 0.85) cardiovascular disease risk reduction, respectively, compared to the reference. Higher baseline total olive oil consumption was associated with 48% (HR: 0.52; 95% CI: 0.29 to 0.93) reduced risk of cardiovascular mortality. For each 10 g/d increase in extra-virgin olive oil consumption, cardiovascular disease and mortality risk decreased by 10% and 7%, respectively. No significant associations were found for cancer and all-cause mortality. The associations between cardiovascular events and extra virgin olive oil intake were significant in the Mediterranean diet intervention groups and not in the control group. Conclusions: Olive oil consumption, specifically the extra-virgin variety, is associated with reduced risks of cardiovascular disease and mortality in individuals at high cardiovascular risk

Empirically-derived food patterns and the risk of total mortality and cardiovascular events in the PREDIMED study

BACKGROUND & AIMS: There is little evidence on post hoc-derived dietary patterns (DP) and all-cause mortality in Southern-European populations. Furthermore, the potential effect modification of a DP by a nutritional intervention has not been sufficiently assessed. We assessed the association between a posteriori defined baseline major DP and total mortality or cardiovascular events within each of the three arms of a large primary prevention trial (PREDIMED) where participants were randomized to two active interventions with Mediterranean-type diets or to a control group (allocated to a low-fat diet). DESIGN: We followed-up 7216 participants for a median of 4.3 years. A validated 137-item food-frequency questionnaire was administered. Baseline DP were ascertained through factor analysis based on 34 predefined groups. Cox regression models were used to estimate multivariable-adjusted hazard ratios (HR) for cardiovascular disease (CVD) or mortality across quartiles of DP within each of the three arms of the trial. RESULTS: We identified two major baseline DP: the first DP was rich in red and processed meats, alcohol, refined grains and whole dairy products and was labeled Western dietary pattern (WDP). The second DP corresponded to a 'Mediterranean-type' dietary pattern (MDP). During follow-up, 328 participants died. After controlling for potential confounders, higher baseline adherence to the MDP was associated with lower risk of CVD (adjusted HR for fourth vs. first quartile: 0.52; 95% CI (Confidence Interval): 0.36, 0.74; p-trend <0.001) and all-cause mortality (adjusted HR: 0.53; 95% CI: 0.38, 0.75; p-trend <0.001), regardless of the allocated arm of the trial. An increasing mortality rate was found across increasing quartiles of the WDP in the control group (allocated to a low-fat diet), though the linear trend was not statistically significant (p = 0.098). CONCLUSIONS: Higher adherence to an empirically-derived MDP at baseline was associated with a reduced risk of CVD and mortality in the PREDIMED trial regardless of the allocated arm. The WDP was not associated with higher risk of mortality or cardiovascular events