[ES] Salmonella es una de las principales causas de toxiinfecciones alimentarias en el mundo. En Europa, en el último año tuvo lugar un total de 94.203 casos de salmonelosis, de los cuales 8.730 fueron en España. La principal fuente de la infección son los productos de origen animal, principalmente los huevos y la carne de pollo. Los Programas Nacionales de Control de Salmonella, han logrado reducir la prevalencia de la bacteria a nivel de campo. Sin embargo, cada año siguen surgiendo nuevos casos de salmonelosis en la especie humana, y se sigue detectando la presencia de la bacteria en las explotaciones avícolas. Por ello, se continúan buscando nuevas alternativas en la lucha contra la bacteria, como puede ser el empleo de bacteriófagos. Los bacteriófagos o fagos son virus ubicuos en el ambiente que están ampliamente distribuidos en la naturaleza. Son microorganismos que atacan específicamente a bacterias, alterándolas hasta destruirlas. Estas características hacen de los fagos una herramienta muy prometedora para la eliminación de Salmonella en explotaciones avícolas como medida complementaria a la limpieza y desinfección, y como una herramienta más de control para incluir en las buenas prácticas de higiene a nivel de campo. En este contexto, en esta tesis doctoral hemos centrado nuestros estudios en conocer la diversidad fágica en las explotaciones avícolas y estudiar la aplicación de la terapia fágica para el control de Salmonella como medida complementaria a la limpieza y desinfección. Para ello, se realizaron tres experimentos durante el periodo de enero de 2017 y diciembre de 2019, en los que se aislaron y multiplicaron fagos de muestras procedentes de granjas avícolas. El objetivo del primer experimento fue evaluar la prevalencia de fagos frente a Salmonella en granjas comerciales de gallinas ponedoras y broilers. Los resultados de este estudio indican que las granjas avícolas podrían representar una importante fuente de fagos de Salmonella. Además, se ha observado una estrecha relación entre la prevalencia de fagos frente a Salmonella y la prevalencia de serotipos de Salmonella en las granjas avícolas, lo que sugiere que los fagos coexisten con su serotipo. su concentración y aplicarlos frente a las mismas granjas avícolas positivas a Salmonella. El objetivo del segundo experimento fue evaluar el efecto de los fagos contra Salmonella Infantis y Salmonella Enteritidis en las superficies de las granjas, y evaluar la aplicación del procedimiento de los fagos como desinfectante contra Salmonella en las condiciones de campo. Se observó una reducción de la concentración de S. Infantis y S. Enteritidis en las superficies de la nave en 4,55 log10 UFC/mL y 3,85 log10 UFC/mL, respectivamente. La mayor reducción para ambos serotipos se obtuvo el 5º día después de la primera aplicación. Estos resultados ponen de manifiesto que los fagos podrían ser una herramienta prometedora para utilizar en combinación con los procedimientos de limpieza y desinfección. Por último, el objetivo del tercer experimento fue evaluar la aplicación experimental de los autofagos para el control de S. Enteritidis en una granja de gallinas ponedoras contaminada de forma natural. Este estudio pone en evidencia que los autofagos se podrían emplear, no solo como una medida para reducir la excreción de Salmonella por parte de los animales infectados, sino como medida complementaria en la limpieza y desinfección de las instalaciones con una gran eficacia. Además, el hecho de que el autofago eliminara la Salmonella del medio ambiente, aún con los animales en el interior de la nave, podría evitar la re-contaminación horizontal entre animales infectados y no infectados. Los resultados más relevantes que se han obtenido de esta tesis doctoral es que el sector avícola dispone de una herramienta prometedora, económica y ecológica capaz de reducir significativamente la prevalencia de Salmonella cuando las medida / [EN] Millions of human salmonellosis cases are reported worldwide every year, and the disease results in thousands of deaths. In 2018, a total of 94,203 confirmed cases in humans were reported in Europe of which 8,730 were in Spain. The main source of infection is poultry products as eggs and chicken meat. National Salmonella Control Programmes have succeeded in reducing the prevalence of the bacteria at the field level. However, new cases of salmonellosis in humans continue to emerge every year and the presence of the bacterium continues to be detected in poultry farms. Therefore, new alternatives continue to be sought in the fight against the bacteria, such as the use of bacteriophages. Bacteriophages or phages are ubiquitous viruses in the environment and are widely distributed in nature. They are microorganisms that specifically attack bacteria, altering them until they are destroyed. These characteristics make phages a very promising tool for the elimination of Salmonella in poultry farms as a complementary tool for cleaning and disinfection, and as another control tool to be included in good hygiene practices at field level. Thus, in this doctoral thesis, we have focused our studies on determining the phage diversity in poultry farms and studying the application of phage therapy for the control of Salmonella as a complementary measure to cleaning and disinfection. To this end, three experiments were carried out during the period from January 2017 to December 2019, where phages were isolated, purified, and multiplied from different samples taken from poultry farms and their epidemiology was studied. The objective of the first experiment was to assess Salmonella-phage prevalence in commercial poultry farms in terms of the production livestock type: layers or broilers. The results of this study indicated that poultry farms could represent an important source of Salmonella phages. Moreover, we have shown a close relationship between Salmonella phage prevalence and Salmonella serovar prevalence in poultry farms, suggesting that phages co-exist within their serovar. The purpose of the second experiment was to assess the effect of phages against Salmonella Infantis and Salmonella Enteritidis on farm surfaces and evaluate phage application procedure as sanitiser against Salmonella in field conditions. Results showed S. Infantis and S. Enteritidis decreased by 4.55 log10 CFU/mL and 3.85 log10 CFU/mL, respectively; the maximum reduction in Salmonella was on the 5th day, after 108 PFU/mL and 103 PFU/mL phage application. These results highlight phages as a promising tool together with cleansing and disinfection. However, more studies are needed to demonstrate their efficacy as sanitisers in poultry farms. Finally, the aim of the third experiment was to assess the application of autophages for the control of S. Enteritidis in a naturally contaminated laying hen farm. This study shows that autophages could be used not only as a measure to reduce the excretion of Salmonella by infected animals but also as a complementary measure in the cleaning and disinfection of the facilities. In addition, the fact that autophages eliminated the Salmonella from the environment, even with the animals inside the facility, could avoid horizontal transmission of Salmonella among infected and non-infected animals. The most relevant results obtained from this doctoral thesis are that the poultry sector has a promising, economic and ecological tool, as phage therapy, able to significantly reduce the prevalence of Salmonella when current measures cannot eliminate it from poultry farms. / [CA] Salmonella és una de les principals causes de toxiinfeccions alimentàries en el món. En A Europa, en l'últim any es van reportar 94.203 casos, dels quals 8.730 es van produir a Espanya. La principal font d'infecció són els productes d'origen animal, principalment els ous i la carn de pollastre. Els Programes Nacionals de Control de Salmonella han aconseguit reduir la prevalença a nivell de camp. No obstant, cada any continuen sorgint nous casos de salmonel·losi, i es continua detectant la presència de la bacteria en algunes explotacions avícoles. Per això, es continua buscant noves alternatives en la lluita contra la bacteria, com pot ser l'ocupació d'additius en el pinso, un bon maneig a nivell de camp o l'ús de bacteriòfags. Els bacteriòfags o fags són virus ubics en l'ambient i es troben àmpliament distribuïts en la naturalesa. Són microorganismes que ataquen específicament a les bacteries, alterant-les fins a destruir-les. Estes característiques fan dels bacteriòfags una ferramenta molt prometedora per a l'eliminació de Salmonella en explotacions avícoles com a mesura complementària a la neteja i desinfecció i com una ferramenta més de control per a incloure en les bones pràctiques d'higiene. En este context, en esta tesi doctoral hem centrat els nostres estudis a conèixer la diversitat fàgica en les explotacions avícoles i estudiar l'aplicació de la teràpia fágica per al control de Salmonella com a mesura complementària a la neteja i desinfecció. Per a això, es van realitzar tres experiments durant el període de gener de 2017 i desembre de 2019, en els que es van aïllar y multiplicar bacteriòfags de diferents mostres procedents de granges avícoles. L'objectiu del primer experiment va ser avaluar la prevalença de bacteriòfags enfront de Salmonella en granges comercials de gallines ponedores i pollastres. Els resultants de este estudi indiquen que les granges avícoles podrien representar una important font enfront de bacteriòfags de Salmonella. A més, s'ha observat una estreta relació entre la prevalença de bacteriòfags enfront de Salmonella i la prevalença de serotips de Salmonella en les granges avícoles, la qual cosa suggereix que els bacteriòfags coexisteixen amb el seu serotip. L'objectiu del segon experiment va ser avaluar l'efecte dels bacteriòfags contra Salmonella Infantis i Salmonella Enteritidis en les superfícies de les granges, i avaluar l'aplicació del procediment dels bacteriòfags com a desinfectant contra Salmonella en les condicions de camp. La concentració de Salmonella Infantis i Salmonella Enteritidis va disminuir 4,55 log10 UFC/mL i 3,85 log10 UFC/mL, respectivament, després de dos aplicacions consecutives de bacteriòfags. La major reducció de S. Infantis i S. Enteritidis es va obtindre el 5º dia després de la primera aplicació. Estos resultats manifesten que els bacteriòfags són una ferramenta prometedora per a utilitzar en combinació amb els procediments de neteja i desinfecció. Finalment, l'objectiu del tercer experiment va ser avaluar l'aplicació experimental dels autòfags per al control de S. Enteritidis en una granja de gallines ponedores. Este estudi posa en evidència que els autofagos es podrien emprar com a mesura complementària en la neteja i desinfecció de les instal·lacions amb una gran eficàcia i per a reduir els recomptes de Salmonella en animals infectats. A més, el fet de que l'autòfag eliminarà la Salmonella del medi ambient, encara amb els animals en l'interior de la nau, podria evitar la recontaminació horitzontal entre animals infectats i no infectats. Els resultats més rellevants que s'han obtingut d'esta tesi doctoral és que el sector avícola disposa d'una ferramenta prometedora, econòmica i ecològica capaç de reduir significativament la prevalença de Salmonella quan les mesures actuals no són capaços d'eliminar-la de les granges avícoles. / Agradecer al Centro de Calidad Avícola y Alimentación Animal de la Comunidad Valenciana (CECAV) por su apoyo para realizar este proyecto. En especial, al comité técnico de Asociación Avícola Valenciana (ASAV) por la iniciativa de este proyecto y a los miembros de la Junta Directiva de CECAV por la financiación. / Sevilla Navarro, S. (2020). Selection and assessment of bacteriophages against salmonella spp. in the poultry industry [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/149561 / TESIS

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Meeting patient expectations in relation to pain management is an essential component of palliative and end-of-life care. However, previous research has demonstrated that pain is highly prevalent, especially during the four months prior to death. Poorly controlled pain contributes to cognitive failure, depression and an inability to complete daily activities. Unfortunately, pain and symptom management are often inadequate for patients placed in hospice care. The purpose of this study is to evaluate the perspectives of hospice nurses on complementary and alternative therapies to determine if there is an educational need in order to aide in the management of chronic pain in older adults. A survey was developed in order to determine the nursing perceptions of complementary and alternative therapies. A total of 24 participants were recruited. The survey targeted 28 complementary and alternative therapies most commonly used as defined by National Institute for Complementary and Alternative Medicines (NCCAM). Each therapy was ranked on several aspects including perceptions, personal experience, and present knowledge and training. After completing the survey it was found that all participants were either eager or open to use some complementary and alternative therapies in their workplace, in spite of having an educational barrier on how to implement them, and wanted these therapies to become available to patients, families, and staff.

Fibromyalgia is a chronic widespread pain disorder that can also cause fatigue, depression, sleep disturbances, and cognitive symptoms. Because the etiology of fibromyalgia is unknown, it is difficult to treat. Research shows that medication alone is insufficient to treat the symptoms of fibromyalgia and that complementary therapies are required to fully manage this disorder. The purpose of this research was to determine what complementary therapies patients with fibromyalgia were currently using. The sample for the survey was taken from fibromyalgia support groups throughout the state of Florida. A total of 15 people diagnosed with fibromyalgia participated in the survey. The most commonly used complementary therapies included diet and relaxation techniques. The therapies that were rarely or never used were hypnotherapy, Tai Chi, and Chi (Qi) Gong. These findings provide evidence to support client education concerning the use of complementary therapies for individuals with fibromyalgia. Research with larger samples is recommended to provide further evidence of the effectiveness of complementary therapies for this patient population.

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According to the American Cancer Society (2009) it is estimated that there will be 1.5 million new cases of cancer in the United States in 2009. Pain is a common symptom experienced by cancer patients throughout various stages of the disease process, as well as while undergoing cancer treatment. Research has found that between 30 and 45% of cancer patients report pain upon diagnosis or at some stage throughout the course of the disease, while 75% of patients with advanced cancer report suffering from pain. The pain experienced by cancer patients is often under treated. Unrelieved pain has negative effects on almost every aspect of an individual's life resulting in needless suffering, decreased quality of life, immunosuppression, and additional burdens on family caregivers. The under treatment of pain in cancer patients could be due in part to the fact that cancer pain is not always completely relieved by analgesic medications. Research is beginning to support the integration of complementary, nonpharmacologic, interventions for pain relief along with a traditional analgesic regimen in order to provide optimal management of pain in cancer patients. The purpose of this integrative review of literature is to examine the use and effectiveness of complementary therapies for the management of pain in cancer patients. Findings indicate that the majority of complementary therapies are effective in improving the pain experience among cancer patients. Recommendations for nursing practice, research, and education will be provided.

Yes / Mothers' responsiveness to hunger and fullness cues has been implicated in the development of infant over-weight, and baby led weaning (BLW) is argued to be one way to protect against overfeeding. Whilst studies have examined maternal perceptions of hunger, fullness and adequate intake to some degree in traditional weaning (TW) contexts, less is known about this in BLW. This study therefore aimed to understand and compare maternal perceptions of cues and intake in BLW and TW. Eleven mothers of infants (7–24m) participated in semi-structured interviews based on discussions of short videos featuring participants feeding their infants. Interviews were read and transcribed in full. Data were selected for coding which addressed mothers' perceptions of infant hunger, fullness and sufficient consumption and subsequently subjected to template analysis. A sample of data was coded to produce an initial template which was applied to all interviews and revised in an iterative process to produce a final template for interpreting findings. Mothers in the study were adept at recognising fullness cues and gauging feeding state. Both groups perceived similar hunger cues although TW mothers reported a wider range of fullness cues. Both groups used numerous strategies for judging the adequacy of their babies’ intake. These included the use of infant cues, however perceived adequacy of intake was also influenced by factors such as infant tiredness and maternal worries about over and under-eating. Findings have implications for the development of responsive feeding interventions while also highlighting the utility of video elicited interviews for understanding feeding interactions. / This work was supported by a White Rose Doctoral Training Partnership Economic and Social Research Council PhD studentship (UK) to Janet McNally.

Purpose: Parental decisions to vaccinate their children may be impacted by the advice of health care providers practicing complementary and alternative medicine (CAM). Available literature suggests an association between vaccine delay or refusal and CAM use, decreased vaccination status of naturopathic patients, and increased vaccine hesitancy among naturopathic students. Some naturopathic physicians state that their approach towards discussions about childhood vaccinations may support families in choosing partial vaccination over complete refusal, ultimately contributing to an overall increase in vaccinations. Methods: Using a modified Health Belief Model as a theoretical framework, this online survey of naturopathic physicians assessed childhood vaccine-related perceptions and practices. The survey instrument was developed through an iterative process using surveys from previous research, adapted by expert opinion and input from focus group participants. Results: Surveys were completed between October and November 2014 by 145 naturopathic physicians (response rate 28.7%) licensed and practicing in Vermont or Oregon State. The vast majority of respondents (93%) discuss childhood vaccines with their patients, and discussions may include numerous topics focused on assessing individualized risk factors and providing information to parents. Most (70%) assist parents in creating a customized vaccine schedule for their children, which may delay the start of vaccination until a later age, give select vaccines only, and/or spread out the vaccine schedule (as compared to the CDC-ACIP recommended schedule). Vaccine-specific safety concerns are highly prevalent (67%), vary by vaccine, and include concerns regarding vaccine schedule, necessity, risk for potential adverse effects, and safety of vaccine ingredients. The majority of respondents use a variety of approaches intended to reduce adverse effects of vaccination (91%) and to make childhood vaccination safer and more effective (93%). Finally, most respondents are in agreement with each other on key vaccination beliefs underscoring both concerns and the importance of childhood vaccinations. Conclusions: Results highlight an individualized approach towards childhood vaccinations by naturopathic physicians, often including a customized schedule and in-depth conversations with parents. The impact of this approach on parental vaccine choice and public health remains unknown. Results may promote further understanding of the various therapeutic recommendations and safety concerns regarding childhood vaccinations held by naturopathic physicians and can potentially foster more effective communication among all healthcare providers on this important public health issue.

BACKGROUND: Randomized controlled trials show acupuncture and acupressure support anesthesia management by decreasing anxiety, opioid requirements and treating post-operative nausea and vomiting. Acupuncture and acupressure have demonstrated clinical usefulness and received governmental support (NIH, PPACA, WHO, U.S. Military), but have not yet diffused into mainstream anesthesia practice. This study examined US anesthesia providers' perceptions of acupuncture and acupressure. METHODS: Ninety-six anesthesiology departments stratified by geographic region (Northeast, South, West, and Midwest) and institution type (university medical centers, community hospitals, children’s hospitals, and VA hospitals) were selected for participation in an anonymous, online survey. The target sample was 1,728 providers of which N = 292 (54% anesthesiologists, 44% CRNAs, 2% AAs) responded yielding an overall 17% response rate. RESULTS: Spearman’s correlation coefficient revealed a statistically significant correlation between acupuncture and geographic region, with the West having the highest predisposition toward acupuncture use (rs = 0.159, p = 0.007). Females are more likely to use acupuncture than men (rs = -.188, p = 0.002). Age yielded a moderate effect size with providers between the ages of 31-50 years old experiencing the best outcomes administering acupuncture (rs = 0.65, 95% CI = 2.79, 3.06). A strong effect size exists between acupuncture and country of pre-anesthesia training (rs = 1.00, 95% CI = 1.08, 1.16). Some providers have used acupuncture (27%) and acupressure (18%) with positive outcomes, however the majority of providers have not used these modalities, but would consider using them (54%, SD = 1.44 acupuncture; 60%, SD = 1.32 acupressure). Seventy-six percent of respondents would like acupuncture education and 74% would like acupressure education (SD = 0.43, SD = 0.44, respectively). Lack of scientific evidence (79%, SD = 0.73) and unavailability of credentialed providers (71%, SD = 0.92) were the primary barriers. CONCLUSIONS: While most U.S. anesthesia providers have not used these modalities, they still report a favorable perception of acupuncture/acupressure’s role as part of an anesthetic and the majority of providers express an interest in receiving education. This study adds to the body of acupuncture and acupressure research by providing insight into anesthesia providers’ perceptions of these alternative medicine modalities.