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Objectives: To explore the rate of NUPs and associated factors in the PED of the 'Hospital Universitario y Politécnico La Fe' in Valencia (Spain) using Andersen's Behavioural Model. Methods: We conducted a descriptive cross‐sectional study using Andersen's Behavioural Model in parents visiting the PED with their children at the 'Hospital Universitario y Politécnico La Fe' in Valencia (Spain). Results: The study involved a total of 530 participants, of whom 419 (79%) had made an NUP. The predisposing factors identified were: (I) paediatric patients brought in by their fathers (OR = 0.460; p = 0.005), (II) lower educational attainment (OR = 3.841; p = 0.000), (III) first‐time parenthood (OR = 2.335; p = 0.000) and (IV) higher parental stress (OR = 1.974; p = 0.023). The enabling factors included: (I) responsibility for a significant part of the childcare shared with others (OR = 0.348; p = 0.041) and (II) the perception that PEDs provide better care than primary care (PC) services (OR = 1.628; p = 0.005). The need factors were: (I) existing chronic illness in the child seeking care (OR = 0.343; p = 0.000) and (II) the perceived severity of the urgency (OR = 0.440; p = 0.031). Conclusions: The NUP rates found in this study are similar to those found internationally. In accordance with Andersen's Behavioural Model, we identify predisposing, enabling and need factors to explain the multifactorial nature of NUPs in PEDs. Implications for Practice: Identifying the factors associated with NUPs enables interventions to be targeted at those groups most likely to engage in NUPs, thereby optimising the functioning of the PED and improving the well‐being of children and families. These interventions should focus on improving parental health literacy, providing education on making appropriate decisions about accessing health services and recognising severe symptoms in children, as well as improving access to high‐quality PC services. Providing support to parents during the transition to parenthood would also be beneficial. Reporting Method: This paper adheres to the STROBE initiative guidelines. Contribution from patients or members of the public: Participants, who voluntarily agreed to take part, contributed to the study by completing a paper‐based questionnaire containing all the study variables as prepared by the research team. [ABSTRACT FROM AUTHOR]

Research has drawn attention to the stigma and high rates of victimization among people with intellectual disabilities (ID) and an overlap between bias and non-bias victimization. However, studies of bias events or hate crime involving persons with ID are scarce. Using a self-report measure, we analyze lifetime bias victimization in a sample of 260 adults diagnosed with ID (age M = 41.7, SD = 12.0; 59.2% men), of whom 92 experienced bias victimization (age M = 41.2, SD = 11.9; 54.3% men), and compare the number of different types of victimization and the poly-victimization status between bias and non-bias victims. We also examine the following features: the victim, offender(s), victim–offender relationship, and location. Results show that bias victims experience a higher number of different types of victimization than non-bias victims (M = 7.74 and 4.96, respectively; p <.001, r rb=.37, ξ =.42) and are four times more likely to be poly-victims than non-bias victims (odds ratio [ OR ] = 4.37; 95% CI, p <.001). Most of the victims experienced a number of bias victimization episodes (89.1%; n = 82), and more than a quarter were injured (27.2%, n = 25) as a result of the victimization. All the bias victimizations by strangers were carried out in public places, as were most of the bias victimizations by acquaintances. Schoolmates and work colleagues perpetrated attacks at school and in the workplace, respectively. More than half of the victims, 63% (n = 58), spoke of the experience with someone, but only one reported it to the authorities. The paper provides a valuable descriptive and bivariate analysis of bias victimization of people with ID. The findings will help to understand bias violence against this population, highlighting the need for targeted and effective interventions. [ABSTRACT FROM AUTHOR]

Background: This study aimed to analyze the relationship between socioeconomic status (SES), poverty rate, and the prevalence of overweight/obesity or obesity in children and adolescents aged 2–14. Methods: Parents or guardians reported the weight and height of participants, used to calculate body mass index (BMI) and BMI z-scores according to the International Obesity Task Force standards. Participants were categorized into "overweight/obesity" and "no overweight/obesity" and further into "obesity" and "no obesity". The rate of poverty rate was determined using data from the National Statistics Institute of Spain, defining it as the percentage of people with income below 60% of the national median. SES was based on the head of household's occupation and categorized into low, medium, and high levels. Results: Adjusted multilevel models showed participants with medium or high SES had lower odds of overweight/obesity compared to those with low SES (medium SES: odds ratio [OR]: 0.63, 95% confidence interval [CI]: 0.54–0.73; high SES: OR: 0.59, 95% CI: 0.49–0.70). Participants in the high-poverty group had higher odds of having overweight/obesity (OR: 1.40, 95% CI: 1.13–1.74) compared to the low-poverty group. Conclusions: The study highlights significant socioeconomic disparities in childhood overweight/obesity, emphasizing the potential impact of SES and poverty on health outcomes in Spanish children and adolescents. [ABSTRACT FROM AUTHOR]

Background: One of the main drawbacks of tunneled central venous catheters (CVCs) is catheter-related bloodstream infections (CRBSIs). Antibiotic lock therapy (ALT) can be combined with systemic antibiotics to achieve catheter salvage. Our objectives are to describe cases of CRBSI and our experience with ALT in a pediatric oncology–hematology ward. Methods: a retrospective descriptive study of pediatric CRBSI cases in a Spanish oncology–hematology unit from 2007 to 2017 was conducted. We collected demographic, clinical, and microbiological data from all patients. Results: fifty-eight CRBSIs were diagnosed in thirty-nine patients; 72.9% of these patients were male, with a median age of 42.1 months. The main underlying diseases were leukemia/lymphoma (51.7%) and solid tumors (32.7%). Thirty-five (60.3%) CRBSIs were caused by Gram-positive cocci, of which 70.6% were coagulase-negative Staphylococci, and sixteen (27.6%) were caused by Gram-negative bacilli. We treated 41/58 (71%) cases with ALT. A total of 12/17 (71%) CVCs that were not treated with adjunctive ALT were removed, compared with 13/41 (32%) that were treated with ALT (relative risk (RR), 0.449; confidence interval (CI), 95%: 0.259–0.778, p = 0.004). Major reasons to remove the CVC in the CRBSI-ALT group were local insertion/pocket site infection (23%), persistent symptoms (23%), and infectious' relapses (15%). Conclusions: ALT was shown to be an effective approach to keeping the CVC in place, with no added adverse effects. [ABSTRACT FROM AUTHOR]

Suicidal behavior has become an important public health problem, correlating with stress and emotional deficits in recent research. This study examined the relationship between perceived stress and suicidal behavior risk, testing the mediating roles of cognitive emotion regulation and impulsivity, and the moderating role of problematic alcohol use in stress-suicidal behavior association in a sample of 121 Spanish adolescents surveyed online. Results showed positive and significant associations between perceived stress and suicidal behavior risk, as well a mediation role of adaptive cognitive emotion regulation strategies and a moderation role of problematic alcohol use between perceived stress and suicidal behavior risk, supporting stress as an influential factor in suicidal behavior. Our findings emphasize adaptive emotional regulation strategies in stressful situations, as well as the importance of promoting responsible alcohol consumption to decrease suicide risk in adolescents. Additionally, they contribute to effective educational suicide prevention programs for young people. [ABSTRACT FROM AUTHOR]

The Mar Menor, Europe's largest saltwater lagoon in the Mediterranean basin (Murcia, southeastern Spain), is an ecosystem facing severe pollution, anoxia events, and marine biodiversity loss. This exploratory study examines the association between residential proximity to the Mar Menor and childhood cancer incidence in Murcia from 2000 to 2018. In our case–control study of 594 cancer cases and 3564 controls, matched by birth year and sex, participants were categorized by proximity to the lagoon (G1 ≥ 20 km, G2 = 10–20 km, G3 = 2–10 km, G4 = ≤ 2 km). Odds ratios (ORs) and 95% confidence intervals (95%CI) were adjusted for sociodemographic and environmental covariates. Analysis of distance as a continuous variable indicated a decrease both in all types of cancer and lymphoid acute leukemia risk with greater distance (OR = 0.99; 95% CI 0.98–0.99), while as a categorical variable, it revealed a non-linear pattern. Specifically, the risk did not increase for those living within 2 km of the lagoon (OR = 0.87; 95% CI 0.52–1.37), whereas increased risks were observed in the 2–20 km range within Campo de Cartagena (G2; OR = 1.32; 95% CI 1.01–1.73 and G3; OR = 1.43; 95% CI 1.00–2.02). This suggests modulating factors near the lagoon may counterbalance risks from broader environmental contamination. These findings highlight the complexity of environmental health dynamics and the importance of detailed research to guide public health strategies and urban planning for environmental and child health protection. [ABSTRACT FROM AUTHOR]

(1) Background: To analyze the prevalence of physical activity (PA) according to the presence of overweight or obesity and other sociodemographic factors in the Spanish adult population. (2) Methods: Cross-sectional study using the European Health Interview Surveys for Spain from 2014 and 2020. (3) Results: In overweight and obese people, the percentage of those who reported not performing any type of PA remained constant between 2014 and 2020, while a statistically significant increase was observed in the percentage of people who walked for 10 min a day and exercised at least 2 days a week. The probability of being obese with respect to normal weight was higher in individuals who reported not engaging in PA during leisure time (OR 1.42; 95% CI 1.31–1.53), those who did not walk 10 min a day at least 2 days a week (OR 1.25; 95% CI 1.15–1.35), and those who did not exercise at least 2 days a week (OR 1.42; 95% CI 1.32–1.53). The probability of being overweight was higher in individuals who reported not performing PA during leisure time (OR 1.07; 95% CI 1.02–1.15) and in those who did not exercise at least 2 days per week (OR 1.15; 95% CI 1.09–1.22). (4) Conclusions: Small increases in PA have been observed in both overweight and obese individuals from 2014 to 2020. [ABSTRACT FROM AUTHOR]

Simple Summary: A 90-day mortality predictive model for curative gastric cancer resection based on the Spanish EURECCA Esophagogastric Cancer database was externally validated using the GASTRODATA registry. The externally validated model showed a modestly worse performance compared to the original model, nevertheless maintaining its discriminating ability in clinical practice. Background: Radical gastrectomy remains the main treatment for gastric cancer, despite its high mortality. A clinical predictive model of 90-day mortality (90DM) risk after gastric cancer surgery based on the Spanish EURECCA registry database was developed using a matching learning algorithm. We performed an external validation of this model based on data from an international multicenter cohort of patients. Methods: A cohort of patients from the European GASTRODATA database was selected. Demographic, clinical, and treatment variables in the original and validation cohorts were compared. The performance of the model was evaluated using the area under the curve (AUC) for a random forest model. Results: The validation cohort included 2546 patients from 24 European hospitals. The advanced clinical T- and N-category, neoadjuvant therapy, open procedures, total gastrectomy rates, and mean volume of the centers were significantly higher in the validation cohort. The 90DM rate was also higher in the validation cohort (5.6%) vs. the original cohort (3.7%). The AUC in the validation model was 0.716. Conclusion: The externally validated model for predicting the 90DM risk in gastric cancer patients undergoing gastrectomy with curative intent continues to be as useful as the original model in clinical practice. [ABSTRACT FROM AUTHOR]

This study explored the association between parental employment status and education level and the prevalence of sensory reactivity (SR) in population-based sample of school-aged children. SR was assessed in 495 children using the parent-reported Short Sensory Profile (SSP) questionnaire. Children with SR were identified based on probable or definitive differences in total SSP and subscales. Association between parental employment and education level were explored using multiple Poisson regression models with robust variance, adjusted for potential confounders. The main findings showed that a mother's unemployment status was associated with higher prevalence of SR for the taste/smell sensitivity subscale (PR = 1.66, 95%CI: 1.08–2.56), and the low energy/weak (PR = 2.18, 95%CI: 1.31–3.49) subscale. A lower education level of a father was also associated with a higher prevalence of sensory problems on the tactile sensitivity subscale (PRprimary education = 2.68, 95%CI: 1.27–5.61; PRsecondary education = 1.96, 95%CI: 1.004–3.66) and the low energy/weak subscale (PRsecondary education = 1.95, 95%CI: 1.02–3.73). This study underscores the impact of parental employment and education on SR in school-aged children, offering insights for interventions and support systems aimed at improving their sensory functioning and overall well-being. [ABSTRACT FROM AUTHOR]

Introduction: Teledermatology is the practice of dermatology through communication technologies. The aim of this study is to analyze its implementation in a Spanish health area during its first two years. Methods: Cross-sectional descriptive study. It included interconsultations between dermatologists and family physicians in the Salamanca Health Area (Spain) after the implementation of the non-face-to-face modality over a period of two consecutive years. A total of 25,424 consultations were performed (20,912 face-to-face and 4,512 non-face-to-face); 1000 were selected by random sampling, half of each modality. Main measures: referral rate, response time and resolution time, type of pathology, diagnostic concordance, and quality of consultation. Results: The annual referral rate was 42.9/1000 inhabitants (35.3 face-to-face and 7.6 non-face- to-face). The rate of face-to-face referrals was higher in urban areas (37.1) and the rate of non- face-to-face referrals in rural areas (10.4). The response time for non-face-to-face consultations was 2.4 ± 12.7 days and 56 ± 34.8 days for face-to-face consultations (p < 0.001). The resolution rate for non-face-to-face consultations was 44%. Diagnostic concordance, assessed by the kappa index, was 0.527 for face-to-face consultations and 0.564 for non-face-to-face consultations. Greater compliance with the quality criteria in the non-attendance consultations. Conclusions: Teledermatology appears to be an efficient tool in the resolution of dermatological problems, with a rapid, effective, and higher quality response for attention to skin pathologies. Registry: ClinicalTrials.gov Identifier: NCT05625295. Registered on 21 November 2022 (https://clinicaltrials.gov/ct2/show/ NCT05625295). [ABSTRACT FROM AUTHOR]

Aim: The study explores the experiences of women with low‐risk pregnancies and no complications who planned a home birth. Design: A cross‐sectional study was conducted using an online questionnaire. Methods: The questionnaire included socio‐demographic, obstetric and perinatal variables. Birth satisfaction was evaluated via the Spanish version of the childbirth experience questionnaire. The study group comprised home‐birthing women in Catalonia, Spain. Data were collected from 1 January 2019 to 31 December 2021. Statistical analysis was performed using SPSS. Results: A total of 236 women responded. They reported generally positive experiences, with professional support and involvement being the most highly rated dimensions. Better childbirth experiences were associated with labour lasting less than 12 h, no perineal injuries, no intrapartum transfers to hospital, euthocic delivery and the presence of a midwife. Conclusions: Women's positive home birth experiences were linked to active participation and midwife support. Multiparous women felt safer. Medical interventions, especially transfers to hospitals, reduced satisfaction, highlighting the need for improved care during home births. Implications for the Profession and Patient Care: Home births should be included among the birthplace options offered by public health services, given the extremely positive feedback reported by women who gave birth at home. Impact: Home birth is not an option offered under Catalonia's public health system only as a private service. The experience of home‐birthing women is unknown. This study shows a very positive birth experience due to greater participation and midwife support. The results help stakeholders assess home birth's public health inclusion and understand valued factors, supporting home‐birthing women. Reporting Method: The study followed the STROBE checklist guidelines for cross‐sectional studies. Public Contribution: Women who planned a home birth participated in the pilot test to validate the instrument, and their contributions were collected by the lead researcher. The questionnaire gathered the participants' email addresses, and a commitment was made to disseminate the study's results through this means. [ABSTRACT FROM AUTHOR]

Background: Women report a heightened concern of (breast) cancer, relative to other chronic conditions. This experimental study investigated whether such heightened concern may be a function of availability bias. Methods: participants (N = 750; 100% female) were randomly assigned to one of two experimental conditions: in the recall condition, they were asked to name the health condition they feared most; in the recognition condition, they picked the disease they feared most out of a list of chronic conditions. Results: The probability of selecting cancer as the most frightening disease varied as a function of experimental condition χ2 (10) = 112.13, p < 0.001. Participants in the recall condition were almost twice as likely to select cancer as the most frightening disease (N = 240, 59.10%) as those in the recognition condition (N = 121, 35.20%), who most frequently selected neurological diseases as the most threatening. The majority of participants believed that cancer was the disease receiving the most media attention (86.27%) (prior to the COVID-19 pandemic), and the one accounting for the highest number of deaths among Spanish females (63.50%). Conclusions: altogether, these results provide experimental evidence that availability bias may partly account for misperceptions and a heightened fear of cancer, which may narrow the scope of women's information-seeking and health-preventive behaviors. [ABSTRACT FROM AUTHOR]

The use of electronic cigarettes (ECs) is a major problem globally. Susceptibility and curiosity are important factors that develop prior to the onset of substance use, such as ECs, and are therefore considered as predictors. Both factors are used to obtain an extended index of susceptibility (ESIe-c), which allows the identification of adolescents who are at risk of starting to use these devices. The aim of this study was to determine the prevalence of EC consumption and to assess the association of possible predictors with susceptibility to use and experimentation with ECs among adolescents. A cross-sectional study was carried out in 377 adolescents (53.0% female). Participants were compared according to their experimentation with ECs. A total of 45.9% had already used electronic cigarettes, and 20.8% were current users. Among those who had not tried electronic cigarettes, 43.3% had a medium-high susceptibility to EC initiation. Consumption among close friends, receiving offers of consumption and alcohol consumption were associated with initiation. There was an inverse association between a medium susceptibility index electronic cigarette score and the consumption of cigarettes and positive affect; on the other hand, the lack of premeditation was associated with a higher susceptibility index score. Intrapersonal factors and social factors seem to influence the ESIe-c and onset of EC use, respectively. The main conclusion in this study is that susceptibility is influenced by intrapersonal factors such as affectivity and impulsivity through the lack of premeditation, and by social factors such as EC consumption by best friends. [ABSTRACT FROM AUTHOR]

Background: The Nursing Care Continuity Report (NCCR) is a tool for evaluating the quality of nursing care during hospital admission. Aim: To explore the role of the NCCR in predicting longer length of stay (LOS) in older adults (≥65 years) admitted to a tertiary hospital and determine possible clinical differences at discharge between patients who had a short LOS (≤7 days) and a prolonged LOS (>7 days). Research Design and Setting: A retrospective cohort study was conducted including all patients with a completed NCCR admitted to the hospital between 2015 and 2019. Sociodemographic data, risk of pressure injuries, level of dependence, presence and intensity of pain, and presence and type of pressure injury were the variables registered in the NCCR. Results: A total of 41,354 patients were included in this study, with a mean age of 78 years, of whom 47% were female. At admission, 21% of patients were at potential risk of developing pressure ulcers. Age, admission to the internal or respiratory medicine unit, and having at least medium risk of developing pressure ulcers were the predictors of prolonged LOS using a random sample of 950 patients. At discharge, patients with prolonged LOS presented higher risk of pressure ulcers and a higher level of dependency and were more likely to present hospital‐acquired pressure ulcers. Conclusions: Older adults from the internal or respiratory medicine unit who exhibited higher risk of pressure ulcers were related to a prolonged LOS, a higher level of dependency, and hospital‐acquired ulcers at hospital discharge. Relevance to Clinical Practice: Identifying clinical data that have a greater relationship with LOS could be a useful tool for nursing management and for the implementation of strategies to prevent adverse events during hospitalisation. No Patient or Public Contribution: No direct patient contact was made during the data collection. [ABSTRACT FROM AUTHOR]

Fundamental movement skills (FMS), considered as building blocks of movement, have received growing interest due to their significant impact on both present and future health. FMS are categorized into locomotor, object control and stability skills. While there has been extensive research on assessing the proficiency and reliability of locomotor and object control skills, stability skills have received comparatively less attention. For this reason, this study aimed to assess the test–retest, intrarater and interrater reliability of five stability skills included in the Alfamov app. The performance of eighty-four healthy primary school children (60.8% girls), aged 6 to 12 years (mean ± standard deviation of 8.7 ± 1.8 years), in five stability skills was evaluated and scored by four raters, including two experts and two novices. The Alfamov tool, integrating various process-oriented tests, was used for the assessment. Reliability analyses were conducted through the computation of the intraclass correlation coefficient (ICC) along with the corresponding 95% confidence intervals. Good-to-excellent intrarater reliability, excellent interrater reliability and moderate-to-good reliability in the test–retest were achieved. The results proved that Alfamov is a robust test for evaluating stability skills and can be suitable for use by different professionals with less experience in assessing children's motor competence. [ABSTRACT FROM AUTHOR]

Objective: To evaluate therapeutic footwear expectations and usability of individuals with diabetes and foot complications. Design: A prospective multicenter study was conducted on participants with a high risk of developing a diabetic foot ulcer. Setting: Participants were enrolled in 11 different specialized diabetic foot units in Spain between March 2022 and June 2023. Subjects: Patients with diabetes at moderate to high risk of foot ulceration receiving first therapeutic footwear prescription. Interventions: All the patients included in the research were prescribed with their first pair of therapeutic footwear. Main measures: Primary outcome measures were MOS-pre and MOS-post questionnaires evaluating use and usability of prescribed therapeutic footwear. Secondary outcome measures aimed to evaluate footwear clinical efficacy as ulceration rate and self-reported perceived walking distance per day. Results: The use of therapeutic footwear exceeded the patient's pre-provision prediction of their anticipated use in 94% of people (n = 126). Based on the visual analogic satisfaction scale, the median satisfaction of daily wearing their therapeutic footwear was 7 points, Interquartile Range (IQR) [5–8.25]. During the follow-up period, 39 participants (29.1%) experienced diabetic foot ulcer. Perceived walking distance participants reported an improvement in their perceived walking ability during various daily life activities. Conclusions: Diabetes patients at moderate to high risk of diabetic foot ulcer improved their perception of walking ability after therapeutic footwear prescription. Adherence to the therapeutic footwear prescription resulted in less ulcerations. [ABSTRACT FROM AUTHOR]

The Chronic Disease Self-Management Program (CDSMP) focuses on a health promotion perspective with a salutogenic approach, reinforcing the pillars of self-efficacy. The aim of this study was to assess the impact of the CDSMP on Self-perceived Health (SPH) in disadvantaged areas of Asturias, España. The study included vulnerable adults with experience of chronic diseases for over six months, along with their caregivers. The intervention consisted of a six-session workshop led by two trained peers. SPH was evaluated by administering the initial item of the SF-12 questionnaire at both baseline and six months post-intervention. To evaluate the variable "Change in SPH" [improvement; remained well; worsening/no improvement (reference category)], global and disaggregated by sex multivariate multinomial logistic regression models were applied. There were 332 participants (mean = 60.5 years; 33.6% were at risk of social vulnerability; 66.8% had low incomes). Among the participants, 22.9% reported an improvement in their SPH, without statistically significant sex-based differences, while 38.9% remained in good health. The global model showed age was linked to decreased "improvement" probability (RRRa = 0.96), and the "remaining well" likelihood drops with social risk (RRRa = 0.42). In men, the probability of "remaining well" decreased by having secondary/higher education (RRRa = 0.25) and increased by cohabitation (RRRa = 5.11). Women at social risk were less likely to report "remaining well" (RRRa = 0.36). In conclusion, six months after the intervention, 22.9% of the participants had improved SPH. Age consistently decreased the improvement in the different models. [ABSTRACT FROM AUTHOR]

Background. Nurses are one of the largest and costliest groups in healthcare organizations; therefore, it is important to comprehend their scope of practice. Aim. To contribute to the improvement of nursing resource management in medical-surgical and Intensive Care Units by identifying factors that influence the scope of nursing practice. The hypothesis was that the activities carried out by nurses in medical-surgical units and intensive care units are influenced by individual and job-related factors, with job characteristics having an additive and moderating effect on individual characteristics. Materials and Methods. Cross-sectional correlational design to test the relationship between the individual and job characteristics on the nursing scope of practice measured by the Actual Scope of Nursing Practice (ASCOP) questionnaire. The sample consisted of 270 nurses. Linear mixed effects models analysis (LME) was used with the aleatory effect of the intensive care unit (ICU). Results. Belonging to the ICU decreased the scope of practice of nurses. We found a statistically significant effect of psychological demand, practice environment, role ambiguity, and growth need strength on the scope of nursing practice. The models explained a variance up to 24%. Conclusions. Although the survey results revealed the existence of broader scope of practice levels in Spanish hospital units than in the original Canadian study, the use of scope of nursing practice remains suboptimal. Higher levels on the psychological demand, the practice environment and in the individual growth need strength were related with a broader scope of practice. Otherwise, role ambiguity negatively affected the scope of practice. Implications for Nursing Management. This article provides an analysis of the impact of individual and job-related characteristics on the nursing scope of practice. It serves as a valuable resource for both managers and nurses, offering insights to improve nurses' working conditions and obtain more efficient workforces. [ABSTRACT FROM AUTHOR]

This document analyzes a survey conducted in three geographical areas in Spain, focusing on centers for individuals with cerebral palsy (CP). The study aims to determine the adherence rate to recommended physical activity guidelines, assess if there is a decline in interest in physical activity over time, identify the stage at which this decline occurs, and explore potential mechanisms, tools, or strategies to sustain long-term engagement in regular physical activity for this population. The 36-item questionnaire comprises multiple-choice, open-ended, and Likert scale-type questions. Data were collected on physical activity frequency and duration, daily living activities, and demographics. Statistical analysis identified patterns and relationships between variables. Findings reveal that only a 17.6% meets the World Health Organization (WHO) recommendations regarding regular physical activity (RPA), decreasing in frequency or number of days a week, (3.7 d/w to 2.9 d/w; p < 0.01) and duration (50.5 min/d to 45.2 min/d; p < 0.001) with age, especially for those with higher Gross Motor Function Classification System (GMFCS) mobility levels. Obesity slightly correlates with session duration (ρ = −0.207; p < 0.05), not mobility limitations. Gender has no significant impact on mobility, communication, or physical activity, while age affects variables such as body mass index (BMI) and engagement (p < 0.01). A substantial proportion follows regular physical activities based on health professionals' advice, with interest decreasing with age. To improve adherence, focusing on sports-oriented goals, group sessions, and games is recommended. These findings emphasize the importance of personalized programs, particularly for older individuals and those with greater mobility limitations. [ABSTRACT FROM AUTHOR]

Aim: To psychometrically assess the Spanish version of the Self‐Care of Chronic Illness Inventory (SC‐CII‐Sp) in community‐dwelling older adults with chronic multimorbidity. Design: A methodological study. Method: A total of 1260 older adults participated in the study between May 2020 and February 2022. The data were analysed using SPSS Statistics® 26 and AMOS® 24. The items' content validity index and the Fleiss' kappa were calculated to assess the SC‐CII‐Sp's content validity. Convergent validity was assessed by calculating the Pearson correlation coefficient between the participants' scores on the SC‐CII‐Sp and their scores on the Spanish Chronic Disease Self‐Efficacy scale (SCD‐SE). Construct validity was tested by performing a confirmatory factor analysis (CFA). The SC‐CII‐Sp's reliability was tested by computing the Cronbach's alpha. Results: The SC‐CII‐Sp showed good content and convergent validity. The CFA showed that the SC‐CII‐Sp has three sub‐scales. The 8‐item Self‐Care Maintenance sub‐scale has good internal consistency and is comprised of two dimensions: illness‐related and health‐promoting behaviour. The Self‐Care Monitoring sub‐scale had excellent internal consistency and its five loaded items belonged to a single dimension. The 6‐item Self‐Care Management sub‐scale has adequate internal consistency and two dimensions: autonomous and consulting behaviour. Conclusion: The Spanish version of SC‐CII is a valid and reliable instrument to be used in the assessment of self‐care behaviours amongst Spanish‐speaking, community‐dwelling older adults with chronic multimorbidity. Implications for the Profession: Nurses need valid and reliable tools to assess self‐care behaviours in Spanish‐speaking community‐dwelling older adults with chronic multimorbidity. This study provides a 19‐item tool that allows for the comprehensive evaluation of self‐care behaviours in healthy and ill states. Impact: Using the SC‐CII‐Sp in clinical or research settings could help nurses to examine the effects of different interventions on self‐care behaviours amongst Spanish‐speaking, community‐dwelling older adults with chronic multimorbidity. Patient or Public Contribution: None to be reported. [ABSTRACT FROM AUTHOR]

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Aims Obesity levels have increased worldwide with serious public health concerns. However, weight status is related to socioeconomic status (SES), which may also influence health-related lifestyles. Here, we study the association between SES and obesity mediated by diet and physical activity. Methods and results Using cross-sectional data from 2006, 2011, 2014, and 2017 Spanish health surveys (the final sample consisted of 61 768 adults aged between 18 and 64 years), we conducted a latent class analysis to estimate health-related lifestyle clusters (based on dietary patterns and physical activity) and mediation analyses to evaluate the association of SES and obesity through the clustering of health-related lifestyles. In both men and women, SES was inversely related to obesity (P<0.001) and positively related to healthier lifestyle classes (P< 0.001). Obesity was inversely related to healthier lifestyle classes (P<0.001). A small--although significant--proportion mediated by the clustering of lifestyles was found as follows: 4.9%, 95% CI (6.6%, 3.2%) in men and 2.3%, 95% CI (3.4%, 1.3%) in women for educational attainment, 5.3%, 95% CI (7.2%, 3.6%) in men and 2.0%, 95% CI (2.9%, 1.1%) in women for occupational social class, and 4.9%, 95% CI (6.5%, 3.1%) and 1.9%, 95% CI (2.9%, 1.1%) combining the above two SES indicators. Conclusions SES is related to obesity through clustering health-related lifestyles, with greater emphasis on men. However, the complex relationship between SES and weight status also suggests other indicators that contribute to the social gradient of obesity. [ABSTRACT FROM AUTHOR]

The objective of this longitudinal study carried out with the same participants, with two repeated measurements, the first taken in March 2020 (M1) and the second measurement in March 2021 (M2), is to investigate the impact of the COVID-19 pandemic throughout one year on the levels of Affect, Psychological Well-being, Depression and Mental and Physical Health, as well as to learn about the evolution of those levels from M1 to M2. Comparison of the mean scores of the variables analyzed between the two measurements (M1 and M2) show significant differences in the following scales: Positive Affect (PANAS), with lower scores at M2; Total Depression (BDI-II) and the two Cognitive-Affective and Somatic-Motivational factors, with higher scores at M2; the physical and mental health scales (SF-36) of Physical Functioning, Role Physical, Vitality, Social Functioning, Role Emotional, and Mental Health, and the two Physical and Mental Health components, with lower scores at M2 in all of them; and the Purpose in Life (PWB) scale, with a lower score at M2. We can conclude that the one-year pandemic situation has affected all the variables analyzed in this work, showing a decrease in positive affect, an increase in the score of the depression inventory, worse physical and mental health, and less psychological well-being. Throughout the pandemic year, the results show that age has a moderation effect on the Somatic-Motivational factor and on the Total Depression, Physical Functioning, Vitality, and Role Emotional scales. Gender shows no moderation effect on any of the four variables analyzed. [ABSTRACT FROM AUTHOR]

Simple Summary: Metastatic colorectal cancer is common and complicated to treat. The first choice of treatment is guided by the genetics of the patients (RAS mutation status) and the location of their primary tumor. However, real-world information on what treatments are actually being used and the survival benefits of these patient-guided treatments in Spain is lacking, so we aimed to determine this. We found that, in general, treatment choice was guided by primary tumor location and mutation status, with mutation status being the more influential characteristic. In addition, non-mutated RAS or left-sided tumors were predictive of longer survival times. We hope the results of this study may serve as a useful benchmark for future studies and assist practicing oncologists in selecting appropriate treatments for their patients. The retrospective, observational RWD-ACROSS study analyzed disease characteristics, systemic treatment, and survival in patients with metastatic colorectal cancer (mCRC) in Spain. In total, 2002 patients were enrolled (mean age 65.3 years; 62.7% male). Overall median overall survival (OS) was 26.72 months, and was longer in patients with left-sided tumors (28.85 vs. 21.04 months (right-sided tumors); p < 0.0001) and in patients receiving first-line anti-epidermal growth factor receptor (EGFR) treatment (31.21 vs. 26.75 (anti-vascular endothelial growth factor (VEGF) treatment) and 24.45 months (chemotherapy); p = 0.002). Overall median progression-free survival (PFS) was 10.72 months and was longer in patients with left-sided tumors (11.24 vs. 9.31 months (right-sided tumors); p < 0.0001), and in patients receiving either first-line anti-EGFR or anti-VEGF (12.13 and 12.00 vs. 8.98 months (chemotherapy); p < 0.001). PFS was longer with anti-VEGF treatment in patients with right-sided tumors and wild-type RAS (11.24 vs. 8.78 (anti-EGFR) and 7.83 months (chemotherapy); p = 0.025). Both anti-EGFR and anti-VEGF produced longer PFS in patients with left-sided tumors and wild-type RAS than chemotherapy alone (12.39 and 13.14 vs. 9.83 months; p = 0.011). In patients with left-sided tumors and mutant RAS, anti-VEGF produced a longer PFS than chemotherapy alone (12.36 vs. 9.34 months; p = 0.001). In Spain, wild-type RAS or left-sided mCRC tumors are predictive of longer survival times. [ABSTRACT FROM AUTHOR]

Aim: To describe transitions in smoking status and their determining factors among nursing students between baseline (2015–2016) and follow‐up (2018–2019). Design: Observational prospective longitudinal study of 4381 nursing students in Catalonia (Spain). Methods: We examined transitions in smoking status from: (i) current smokers to recent quitters, (ii) never smokers to new smokers and (iii) former smokers to quitters who relapsed. We fitted logistic regression models to assess the predictors of quitting smoking. Results: The proportion of current smokers decreased from 29.7% at baseline to 23.6% at follow‐up, with a cumulative incidence rate of quitting of 28.3% during follow‐up. Nondaily smokers were more likely to quit than daily smokers. Of those who were never smokers at baseline, 4.6% were smokers at follow‐up, and 23.2% of former smokers at baseline had relapsed at follow‐up. Conclusions: Nondaily smokers were more likely to have quit smoking at follow‐up among this cohort of nursing students. The early implementation of a comprehensive tobacco control program that includes tobacco‐free campus policies, tobacco prevention interventions and cessation support during college years may decrease tobacco use among nursing students. Impact: Nursing students' tobacco use is concerning, as they are the future workforce of nurses who have a key role in tobacco product use prevention and cessation. During college years, nursing students have a greater likelihood of experimenting with several smoking status changes as well as to consolidate smoking behaviors. This is the first longitudinal study to highlight the factors associated with quitting smoking among a cohort of Spanish nursing students. Being a nondaily smoker at baseline predicted quitting at follow‐up. Our findings support the early implementation of a comprehensive tobacco control program that includes tobacco‐free campus policies, tobacco prevention interventions and tobacco cessation support during college years to decrease tobacco product use prevalence among nursing students. Reporting Method: We have adhered to STROBE guidelines. No Patient or Public Contribution. This observational study has not been registered. [ABSTRACT FROM AUTHOR]

A randomized pilot study was conducted involving 69 third-year nursing students (ClinicalTrials.gov ID: NCT05270252). Students were randomly assigned to the CG (n = 34) or the intervention group (n = 35), using computer-generated randomization. The CG completed the third-year nursing, and the intervention group received in addition the Learning & Care educational intervention. The aim of this study was to determine the effectiveness, feasibility, and acceptability of the Learning & Care for students to acquire the knowledge, skills, and attitudes necessary to care for survivors and their families. The intervention group significantly improved in knowledge (p =.004; −1.15, 95% confidence interval [CI] [−1.94, −0.37]), skills (p ≤.0001; −13.51, 95% CI [−15.19, −11.83]), and attitudes (p =.006; −5.61, 95% CI [−8.81, −2.42]). The students' satisfaction was found to be high (93.75%). Offering a family nursing approach improves students' competence to care for long-term cancer survivors and their families. [ABSTRACT FROM AUTHOR]

Aims and objectives: The aim of this study was to assess the effect of the FreeStyle Libre device implantation in adult type 1 diabetics in a Health Area of Castilla La Mancha (Spain) during the COVID‐19 pandemic. Background: FreeStyle Libre is a so‐called mHealth device that supports health care. During COVID‐1 confinement, diabetic patients could have improved their glycaemic monitoring thanks to these devices, although health care in these patients may have been limited due to confinement. Methods: A 12‐month longitudinal study in which a total of 206 type I diabetics participated, belonging to a single health area. Sociodemographic and analytical data and the Self Care Inventory Revised questionnaire (SCI‐R) were collected. STROBE checklist was followed. Results: The analysis showed differences related to the use of the sensor. After the study period, patients obtained better levels of basal glucose, glycosylated haemoglobin, creatinine, cholesterol, triglycerides and LDL. In addition, a significant increase in the total score of the SCI‐R questionnaire was observed after the use of the monitor (MD −7.77; 95% CI −10.43, −8.29). The same occurred with different SCI‐R items such as diet (MD ‐2.995; 95% CI −3.24, −2.57), glucose determination (MD −3.21; 95% CI −3.52, −2.91), medication administration (MD −2.58; 95% CI −2.53, −1.96) and hypoglycaemic episodes (MD −1.07; 95% CI −1.21, −0.93). In the analysis by groups, worse values of glycosylated haemoglobin and adherence to treatment (p <.05) were observed in overweight/obese subjects versus those with normal weight after one year of study. Conclusion: The use of flash monitoring is related to better adherence to most of the recommended habits in diabetes. Nevertheless, there seems to be no relationship with an improvement in physical exercise and preventive aspects of diabetes. A good nursing intervention to support physical exercise and the use of mHealth devices could improve the control of diabetic patients. Relevance to clinical practice: The use of this mHealth device has shown positive results and reduced complications. Despite less contact with healthcare facilities due to the pandemic, type 1 diabetic patients have improved their blood results and adherence after using the device for one year. Nursing staff should focus on promoting physical activity and routine disease care in type 1 diabetics. [ABSTRACT FROM AUTHOR]

Type 1 diabetes (T1D) is a chronic disease that is usually diagnosed in childhood, underscoring the importance of early disease control for overall wellbeing. Our aim was to design an explanatory model of subjective emotional wellbeing in children and adolescents with T1D. A longitudinal study was conducted at the Reina Sofia University Hospital in Cordoba (Spain). A total of 151 patients (mean age = 14.50, SD = 2.67; 41.1% girls) participated at T1, while 97 participated at T2 (mean age = 14.93, SD = 2.56; 39.2% girls). Participants completed a self-report questionnaire. Descriptive, reliability, correlation, path, and mediation analyses were performed. The explanatory model showed excellent fit indices [χ2 (10) = 8.62, p = 0.57, RMSEA = 0.00, 95% [0.00, 0.10], CFI = 1.00, GFI = 0.98, AGFI = 0.93, and TLI = 1.01]. The results showed significant and positive relationships between family social support and subjective emotional wellbeing and improved self-care skills. Self-efficacy presented a mediating role between family social support and subjective emotional wellbeing. Given that self-efficacy is a self-regulatory mechanism and a determinant of health, it is argued that future psychoeducational interventions could aim to improve self-efficacy to manage chronic diseases, to achieve greater emotional wellbeing in children and adolescents with T1D. [ABSTRACT FROM AUTHOR]

Objective: To identify the flow charts and discriminators of the Manchester Triage System that are most likely to identify the onset of delirium in older people. Background: Delirium is an underdiagnosed geriatric syndrome, and up to 80% of all cases of delirium go undetected in emergency departments. Patient triage seeks to manage clinical risk with a view to safely and appropriately managing patient flows. Design: A case–control study was performed according to the STROBE checklist. Setting: The emergency department of a secondary hospital. Participants: Older adults aged ≥65 years and admitted from 1 January to 31 December 2020. Methods: Older patients were identified from the emergency department research database. Cases were defined as patients diagnosed with delirium (n = 128), excluding cases of delirium due to alcohol or substance abuse. Controls were randomised from the remaining patients (n = 128). Results: A total of 29.35% of the subjects admitted to the emergency department were older adults with an incidence of delirium of 0.7%. The flow charts with the highest probability of delirium were 'unwell adult' [OR = 3.04 (95%CI:1.82–5.1)] and 'behaving strangely' [OR = 16.06 (95%CI:3.72–69.29)], and the discriminators were 'rapid onset' [OR = 3.3 (95%CI:1.85–5.88)] and 'new neurological deficit less than 24 h old' [OR = 4.76 (95%%CI:1.01–22.5). The area under the curve for 'unwell adult' in the presence of dementia, previous stroke and fall in the previous 30 days was 0.73 (95%CI: 0.67–0.79), and that for 'behaving strangely' in the presence of diabetes was 0.75 (95%CI: 0.69–0.81). Conclusions: Knowing which flow charts, discriminators and risk factors are most likely to predict delirium allows the identification of the older population at risk for triage screening in emergency departments. Relevance to clinical practice: Risk factors such as diabetes, dementia, previous stroke and recent fall among 'unwell adult' or 'behaving strangely' triaged older persons should be assessed for the probable presence of delirium. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Teen dating violence (TDV) refers to a wide range of partner-directed harmful behaviors among adolescents. Since it was first documented in the 1980s, there is a growing interest in TDV due to its potentially devastating mid- and long-term consequences. Aiming at the early detection of TDV onset with prevention purposes, research has focused on the detection of typologies of perpetrators and/or victims as well as on identifying risk and protective factors for its occurrence. Research with Spanish adolescents, however, is very limited. To fill this gap, we recruited a total of 2,319 adolescents from different regions in Spain, out of which, 1,079 reported having had a romantic partner during the last year. These filled out measures of TDV (perpetration and victimization), school aggression, hostile and benevolent sexism, empathy, assertiveness, psychological inflexibility (general measures), and psychological inflexibility with prejudice thoughts. A cluster analysis revealed that adolescents could be divided into two clusters as a function of their TDV profile: Cluster 1, including close to 76% of the sample (boys and girls), presented low TDV perpetration and victimization; Cluster 2, including 24% of the sample (boys and girls), presented higher TDV perpetration and victimization. Regression analyses revealed that, as compared to those in Cluster 1, adolescents in Cluster 2 were more likely to be older boys who scored high in benevolent sexism, overt and relational school aggression, and personal distress, and low in behavior regulation skills, perspective taking, and practical personal ability. We discuss the implications of these findings for the design of evidence-based TDV prevention campaigns. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to determine whether cardiorespiratory fitness (CRF) decreases the association between insulin resistance and sugar-sweetened beverage (SSB) consumption in a population-based sample of Spanish schoolchildren. Methods: This is a cross-sectional study including 430 schoolchildren (51.4% girls), aged 8–12 years, from 10 schools in Cuenca (Spain). Blood samples were drawn to measure fasting insulin levels. Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) was also assessed. Data on SSB consumption were gathered using the Children's Eating Habits Questionnaire, which was completed by parents. The CRF level was determined by the 20 m Shuttle Run test and a curvilinear allometric model. Results: Our conditional regression estimates showed that CRF moderated the association of SSB consumption on insulin levels or HOMA-IR. In children who had levels of CRF < 34.4 ml/kg/min ml/kg/min (for insulin levels) or < 33.6 ml/kg/min (for HOMA-IR), the association between SSB consumption and fasting insulin levels or HOMA-IR raised. Among children with CRF levels between 34.4 and 52.1 ml/kg/min (for insulin levels) or 33.6–55.4 ml/kg/min (for HOMA-IR), the association of SSB consumption on insulin level or HOMA-IR neither increased nor decreased. Among children with CRF levels > 52.1 ml/kg/min (for insulin levels) or > 55.4 ml/kg/min (for HOMA-IR), the association of SSB consumption on fasting insulin levels or HOMA-IR decreased. Conclusions: Our results showed that certain levels of CRF moderate the association between SSB consumption and insulin resistance in a population-based sample of Spanish schoolchildren. [ABSTRACT FROM AUTHOR]

As future employers, nurse managers are in a key position to assess the correspondence between the competence of graduating nursing students and work life demands. The aim of the present study was to assess the competence of graduating nursing students from the perspective of managers, and analyze the factors linked to it. Among European managers in six countries, a cross-sectional survey design with a convenience sample was applied. Data were collected using the Nurse Competence Scale. The study was reported using the STROBE guidelines. Managers (n =538, 65.8%) assessed the level of competence of graduating nursing students as good, but there were statistically significant differences between countries. In a multivariable analysis, managers who had a Doctoral/Master’s degree and were dissatisfied with the nursing program in their country assessed the level of competence as lower. Overall, graduating nursing students seem to meet the competence demands of current work life rather well. Further research is needed to confirm the connection between the managers’ competence assessment and their individual background factors. [ABSTRACT FROM AUTHOR]

Background: Stickler syndrome (SS) is a connective tissue disorder of fibrillary collagen with very variable clinical manifestations, including premature osteoarthritis and osteopenia. This musculoskeletal alteration may affect gait maturity or produce strength difficulties. Objective: Our aim was to describe the musculoskeletal characteristics, bone stiffness, gait kinematics, and kinetics of SS patients. Methods: This is a cross-sectional study of children and youngsters with SS recruited by telephone calls through the Spanish SS Association. All participants underwent an analysis of musculoskeletal characteristics, including a 3D gait analysis. Results: The sample included 26 SS patients, mainly boys (65.4%) with a median age of 11 (IQR 5–14). The manual muscle testing was normal in 88.5% of patients. The median distance covered in the 6-min walking test was 560.1 ± 113.4 m. Bone stiffness index scores were 70.9 ± 19.7 for children under 10 years and 88.3 ± 17.5 for children older than 10 years. The gait indicators GPS and GDI were: 7.4 ± 1.9 and 95.3 ± 9.7, respectively, for the left side and 6.8 ± 2.0 and 97.7 ± 9.5 for the right side, respectively. Conclusions: In our series of patients with SS, we found muscle-articular involvement does not have a high impact on strength or gait problems. More work is needed to understand the effect of SS on the musculoskeletal system. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the safety, feasibility, and preliminary effectiveness of implementing supervised exercise programming into the clinical care of individuals with advanced cancer. Design: Single group implementation feasibility study using a pre–posttest design. Setting: Exercise Oncology Unit of the Spanish Cancer Association (a cancer-specific community facility outside the hospital setting). Participants: Adult individuals with advanced cancer profile involving advanced local cancer or distant metastases. Intervention: A 12-week, twice-weekly, supervised, clinic-based multi-component exercise program. Main Measure: Paired t -tests were used to assess pre–post changes and analyses of covariance were used to compare effects based on selected participant characteristics. Results: Eighty-four individuals with advanced cancer completed the baseline assessment, with six participants withdrawing prior to the start of the program. Of the 78 participants, 17 dropped out, thus, a total of 61 completed the final assessment. Mean adherence was 82.5%. No serious adverse events occurred. Exercise significantly improved VO2max by 5.2 mL·kg·min (p < 0.001), chest strength (p < 0.001), leg strength (p < 0.001), lean body mass (p = 0.003), skeletal muscle mass (p < 0.002), % body fat (p = 0.02), quality of life by 5.3 points (p = 0.009), fatigue by 3.2 points (p = 0.012), and physical activity by 1680 METs/week (p < 0.001). Conclusions: Our clinically supervised and tailored exercise program involving moderate to vigorous intensity exercise was found to be feasible, safe, and effective for individuals with advanced cancer. Implications for Cancer Survivors: With proper screening and supervision, individuals with advanced cancer can benefit from tailored exercise oncology support as part of an overall therapeutic care plan. [ABSTRACT FROM AUTHOR]

This research evaluates the prevalence of inadequate folate status in early pregnancy, the pattern of prenatal folic acid (FA) supplementation and associated factors in Spanish pregnant women from the ECLIPSES study, which included 791 participants prior gestational week 12. A cross-sectional evaluation of erythrocyte folate levels was performed at recruitment and used to calculate the prevalence of folate deficiency (erythrocyte folate < 340 nmol/l) and insufficiency (erythrocyte folate < 906 nmol/l). Sociodemographic and lifestyle data as well as information on prenatal FA supplementation were recorded. Descriptive and multivariate statistical analyses were performed. The prevalence of folate deficiency and insufficiency were 9·6 % and 86·5 %, respectively. Most of women used prenatal FA supplements, but only 6·3 % did so as recommended. Supplementation with FA during the periconceptional period abolished folate deficiency and reduced folate insufficiency. Prenatal FA supplementation with ≥1000 µg/d in periconceptional time and pregnancy planning increased erythrocyte folate levels. The main risk factor for folate insufficiency in early pregnancy was getting prenatal FA supplementation out of the periconceptional time (OR 3·32, 95 % CI 1·02, 15·36), while for folate deficiency they were young age (OR 2·02, 95 % CI 1·05, 3·99), and smoking (OR 2·39, 95 % CI 1·30, 4·37). In addition, social and ethnic differences according to folate status were also identified. As conclusion, periconceptional FA use is crucial for achieving optimal folate levels in early pregnancy. Pregnancy planning should focus on young women, smokers, those with low consumption of folate-rich foods, low socio-economic status or from ethnic minorities. [ABSTRACT FROM AUTHOR]

Cyberbullying is an extremely damaging form of interpersonal violence. Little is yet known about cyberbullying behaviors in the child and youth population during the COVID-19 pandemic and what effect this reduction in face-to-face social interactions has had on an increase in socialization via the Internet and cyberbullying. The present study is a cross-sectional descriptive study conducted in young people between the ages of 12 and 27 years attending two secondary schools in southern Spain (N = 733) to examine differences regarding sociodemographic characteristics, academic performance, and digital device use (independent variables) in the experiences of cybervictimization, cyberperpetration, and adverse psychological effects (dependent variables). Logistic regression models were constructed for each of the dependent variables including the independent variables mentioned above. More than 50 percent of the sample were victims of cyberbullying. Females and the LGBTIQ+ Community were at greater risk of being cybervictims and suffer adverse psychological effects. A total of 22.8 percent of the students reported having been victims and 26.5 percent perpetrators of cyberbullying for the first time during the COVID-19 pandemic, but no other major differences were observed. These findings point out that cyberbullying must be prioritized in public policy as part of an overall strategy for combating violence in childhood and adolescence, as well as gender-based and discriminatory violence. [ABSTRACT FROM AUTHOR]

Background: Perceived discrimination is associated with worse mental health. Few studies have assessed whether perceived discrimination (i) is associated with the risk of psychotic disorders and (ii) contributes to an increased risk among minority ethnic groups relative to the ethnic majority. Methods: We used data from the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions Work Package 2, a population-based case−control study of incident psychotic disorders in 17 catchment sites across six countries. We calculated odds ratios (OR) and 95% confidence intervals (95% CI) for the associations between perceived discrimination and psychosis using mixed-effects logistic regression models. We used stratified and mediation analyses to explore differences for minority ethnic groups. Results: Reporting any perceived experience of major discrimination (e.g. unfair treatment by police, not getting hired) was higher in cases than controls (41.8% v. 34.2%). Pervasive experiences of discrimination (≥3 types) were also higher in cases than controls (11.3% v. 5.5%). In fully adjusted models, the odds of psychosis were 1.20 (95% CI 0.91–1.59) for any discrimination and 1.79 (95% CI 1.19–1.59) for pervasive discrimination compared with no discrimination. In stratified analyses, the magnitude of association for pervasive experiences of discrimination appeared stronger for minority ethnic groups (OR = 1.73, 95% CI 1.12–2.68) than the ethnic majority (OR = 1.42, 95% CI 0.65–3.10). In exploratory mediation analysis, pervasive discrimination minimally explained excess risk among minority ethnic groups (5.1%). Conclusions: Pervasive experiences of discrimination are associated with slightly increased odds of psychotic disorders and may minimally help explain excess risk for minority ethnic groups. [ABSTRACT FROM AUTHOR]

Background: Psychosis rates are higher among some migrant groups. We hypothesized that psychosis in migrants is associated with cumulative social disadvantage during different phases of migration. Methods: We used data from the EUropean Network of National Schizophrenia Networks studying Gene-Environment Interactions (EU-GEI) case–control study. We defined a set of three indicators of social disadvantage for each phase: pre-migration, migration and post-migration. We examined whether social disadvantage in the pre- and post-migration phases, migration adversities, and mismatch between achievements and expectations differed between first-generation migrants with first-episode psychosis and healthy first-generation migrants, and tested whether this accounted for differences in odds of psychosis in multivariable logistic regression models. Results: In total, 249 cases and 219 controls were assessed. Pre-migration (OR 1.61, 95% CI 1.06–2.44, p = 0.027) and post-migration social disadvantages (OR 1.89, 95% CI 1.02–3.51, p = 0.044), along with expectations/achievements mismatch (OR 1.14, 95% CI 1.03–1.26, p = 0.014) were all significantly associated with psychosis. Migration adversities (OR 1.18, 95% CI 0.672–2.06, p = 0.568) were not significantly related to the outcome. Finally, we found a dose–response effect between the number of adversities across all phases and odds of psychosis (⩾6: OR 14.09, 95% CI 2.06–96.47, p = 0.007). Conclusions: The cumulative effect of social disadvantages before, during and after migration was associated with increased odds of psychosis in migrants, independently of ethnicity or length of stay in the country of arrival. Public health initiatives that address the social disadvantages that many migrants face during the whole migration process and post-migration psychological support may reduce the excess of psychosis in migrants. [ABSTRACT FROM AUTHOR]

This study had two aims: (1) to identify the levels of physical activity, screen time and sleep time of adolescents according to the sex of the participant and the day of the week; (2) to find out the relationships between physical activity, screen time and sleep time according to the sex of the participant and the day of the week. The study design was non-experimental, descriptive-correlational and cross-sectional. The sample consisted of 694 adolescents in Compulsory Secondary Education from Soria (Spain). Four by One-Day Physical Activity Questionnaires were used to measure levels of physical activity, screen time and sleep time. Levene's test and Student's t-test were used to calculate the difference between the means of the variables. Pearson's test was used to calculate bivariate correlations between variables. Results showed higher levels of screen time in males (136.93 min/day ± 81.548). Screen time, sleep time and moderate–vigorous physical activity are higher during the weekend. Positive relationships were found between screen time and light physical activity (rmales = 0.274; p ≤ 0.01; rfemales = 0.065; p > 0.05). The correlations between moderate–vigorous physical activity and screen time were negative (rmales = −0.282; p ≤ 0.01; rfemales = −0.187; p ≤ 0.05). The relationship between screen time and sleep time was negative in males (r = −0.135; p ≤ 0.05). In conclusion, the levels of physical activity, screen time and sleep time vary according to the sex of the participants and the day of the week. [ABSTRACT FROM AUTHOR]

The present article aimed to test a predictive model based on children's perception of autonomy support exercised by their physical education teachers in establishing a state of high motivational quality, which in turn leads to greater intention and physical activity. Participants were 502 elementary school students aged 9 to 11 years (52.59% males (9.47 ± 0.53 years old) and 47.41% females (9.54 ± 0.53 years old)), who completed a self-reported questionnaire of perceived autonomy support from physical education teachers, self-determination, intention to be physically active, and physical activity. Results showed that perceived autonomy support was positively related to autonomous motivation, which in turn was associated with intention and physical activity. In addition, the model did not present variations with respect to gender and confirmed the indirect effects of autonomous motivation on intention and practice of physical activity. Finally, we conclude on the importance of an adequate perception of autonomy support in students by their teachers for the establishment of an appropriate motivational state that could promote greater intention and physical activity. Thus, the motivational state acquired in physical education classes can be translated into intention and practice of physical activity in different contexts of students' daily lives. [ABSTRACT FROM AUTHOR]

Purpose: This study analyses the evolution of attitudes of nursing students towards mental health, paying particular attention to the influence of social desirability. Design and Methods: Prospective longitudinal repeated‐measures study in a sample of nursing students who completed the Community Attitudes toward Mental Illness scale and The Social Desirability Scale. Findings: After their training, and after adjusting for social desirability, students of female gender recognized attitudes that foster humanistic values than their male counterparts. However, attitudes of restrictiveness and authoritarianism continued to be manifested significantly when the students themselves had mental health problems (MHPs), had had previous training, or were older. Practice Implications: University courses should continue to foster attitudes of acceptance and destigmatization of people with MHPs, through responses that value authenticity. [ABSTRACT FROM AUTHOR]

Purpose: To assess the association between a multi-dimensional Macronutrient Quality Index (MQI) and the risk of cardiovascular disease (CVD) in a Mediterranean cohort. Methods: Prospective analyses among 18,418 participants (mean age 36 years, 60.8% women) of the Seguimiento Universidad de Navarra (SUN) cohort. Dietary intake information was obtained through a validated semi-quantitative food-frequency questionnaire (FFQ). The MQI (expressing high-quality macronutrient intake) was calculated based on three previously reported quality indices: the Carbohydrate Quality Index (CQI), the Fat Quality Index (FQI), and the Healthy Plate Protein source Quality Index (HPPQI). Adherence to the Mediterranean diet (MedDiet) and Provegetarian Diet was evaluated using the Trichopoulou index and the score proposed by Martínez-González, respectively. CVD was defined as new-onset stroke, myocardial infarction, or CVD death. Results: After a median follow-up time of 14 years (211,744 person-years), 171 cases of CVD were identified. A significant inverse association was found between the MQI and CVD risk with multivariable-adjusted HR for the highest vs. the lowest quartile of 0.60 (95% IC, 0.38–0.96; Ptrend = 0.024). Conclusion: In this Mediterranean cohort, we found a significant inverse relationship between a multidimensional MQI (expressing high-quality macronutrient intake) and a lower risk of CVD. [ABSTRACT FROM AUTHOR]

Aim: To establish groups of people with chronic non‐cancer pain according to the impairment caused by pain and to identify factors associated with the group with a higher level of impairment. Background: Knowing the profiles of people who suffer from chronic non‐cancer pain could make it possible to direct their treatment and to detect associated risks. Design: A cross‐sectional study. Methods: A sample of 395 people with chronic non‐cancer pain was collected in Pain Units and Primary Healthcare Centres in southern Spain (January to March 2020). A cluster analysis was performed to divide the population into groups and a binary logistic regression model was established to determine factors associated with the group with a higher level of impairment. Results: Two groups were identified: lower level of impairment due to pain, characterized by being 45–65 years old, not medicated with opioids or anxiolytics, employed and with a mild level of impact on daily life; and higher level of impairment characterized by being older than 65 years old, medicated with opioids and anxiolytics, retired or on medical leave and with a severe impact on daily life. In addition, among women, being widowed, single or a smoker are risk factors for belonging to the group with a higher level of impairment; being smokers or consuming alcohol three or less times a week would be risk factors in men. Conclusions: Age, chronic non‐cancer pain impact on daily life, work situation and the consumption of opioid drugs and/or anxiolytics are factors that appear to influence the level of impairment due to chronic pain. Impact These findings could help detect impairment due to pain in its early stages, determining the specific needs of each person. [ABSTRACT FROM AUTHOR]

Aim: We aim to describe the relationship between job satisfaction and compare levels of resilience among out‐of‐hospital emergency medical service professionals. Background: The study of the impact of the working environment on health professionals has raised great interest. Job‐related variables and resilience can be a protective factor against stressful and demanding events at work. Methods: A cross‐sectional survey comprising sociodemographic and job‐related variables was conducted among 406 workers (doctors, nurses, psychologists, and ambulance technicians) from the out‐of‐hospital emergency medical system in Spain. Resilience was self‐reported using the Connor‐Davidson Resilience Scale. Results: Nursing professionals were less resilient compared with ambulance technicians (score difference 1.709, p =.008). As age increased, resilience was lower (r = −.118). Professionals with higher resilience scores were more satisfied in their work (OR = 1.06, 95% CI: 1.02–1.11), and professionals with higher psychological strength, gained from working with other colleagues, also showed greater job satisfaction (OR = 5.47, 95% CI: 2.55–11.73). Conclusion: There was a positive association between resilience, job satisfaction and collaborative work. Professionals with greater psychological strength, gained from working with other colleagues, also showed higher levels of job satisfaction. Implications for Nursing Management: Managers can use these results to influence the work environment to enhance job satisfaction and hence improve the resilience of the out‐of‐hospital emergency health care professionals. [ABSTRACT FROM AUTHOR]

Nowadays pulmonary diseases are an increasingly important cause of morbidity and mortality. Diaphragmatic breathing is a controlled-breathing technique that aims to optimize thoracoabdominal movements. The aim of this study was to apply a respiratory and musculoskeletal physiotherapy program in institutionalized older adults and to assess the effects on their pulmonary function tests and oxygen saturation. A randomized double-blind clinical trial was conducted with thirty institutionalized older adults, randomly assigned to a control group (CG), who conducted musculoskeletal exercises; or an experimental group (EG) who, in addition, carried out diaphragmatic breathing, administered for eight weeks, three times/week. Outcomes were pulmonary function variables (forced vital capacity, FVC; forced expired volume at 1 s, FEV1; the FEV1/FVC ratio) and oxygen saturation (SpO2) before and after treatment. Normality of the distributions was tested with Saphiro-Wilk and the pre-post improvement was assessed with a two-sample Mann-Whitney test. Significance level was corrected for multiple comparisons using Benjamini-Hochberg correction (p < 0.04). There was a clinically significant improvement of FVC and FEV1 for the EG. Moreover, the EG showed a statistically significant increase of SpO2 (p = 0.028) after treatment when compared to CG. A physiotherapy program combining breathing and musculoskeletal exercises, improved respiratory parameters in institutionalized older adults. [ABSTRACT FROM AUTHOR]

The objective of this research was to analyze the relationship between social support and resilience with prosocial behavior before and during the confinement caused by COVID-19. Materials and Methods: The participants were divided into a confined group (228 women and 84 men) and an unconfined group (153 women and 105 men), all of whom were university students. Instruments were applied to measure the variables proposed. Results: Social support predicted 24.4% of the variance in prosocial behavior among women and 12% among men in the confined group; no evidence of this relationship was found in the unconfined groups. Resilience predicted 7% of the variance in prosocial behavior among confined women, 8.4% among confined men, 8.8% among unconfined women, and 5.1% in unconfined men. Discussion and Conclusion: The results show the importance of social support and resilience in prosocial behaviors, which are key elements for the proper functioning of society, especially in the face of a crisis such as COVID-19. [ABSTRACT FROM AUTHOR]

This study examines the prevalence and characteristics of sexual victimization experiences suffered by people with intellectual disabilities (ID). The sample consisted of 260 adults with an ID diagnosis (154 men and 106 women), ranging in age from 20 to 71 years (M = 41.69, SD = 12.05). The results showed that 35% of the sample had been sexually victimized at some point in their life. Being a woman, being declared legally incapable, and having comorbid mental health diagnoses were the most relevant characteristics of sexual victims with ID. Fondling was the most reported victimization, and rape showed the greatest gender differences, with a higher risk for women with ID of being raped compared to their male counterparts (odds ratio = 4.28, p <.05). The offender was generally a known male adult, and the percentage of incidents reported to the authorities was very low (7.4%). The psychological consequences of abuse were general distress, anxiety, and depressive symptomatology. Intervention and prevention programs targeting this population, as well as the training of professionals and caregivers, are essential to deal with sexual victimization and to protect and ensure the quality of life of people with ID. [ABSTRACT FROM AUTHOR]

Objective: To analyze the impact of the foot health and health behavior and the characteristics of outdoor footwear among minority ethnic groups. Design and measures: A cross‐sectional study design using the Foot Health Status Questionnaire: foot pain, foot function, shoe, general foot health, general health, physical activity, social capacity, and vigor. Outcomes included the self‐reported type of outdoor footwear and clinical characteristics by sex were collected in 2019–2020. Sample: A total of 78 Roma participants self‐identified as members of this ethnic minority and 72 participants non‐Roma were assessed (n = 150). Results: The lower score values was recorded in the footwear and general foot health domains in Roma population. General population obtained higher scores in general health domains. The most common outdoor footwear types were running shoes and walking shoes in non‐Roma population, versus flip flops and slippers in Roma population. Clinical characteristics did not show any statistically significant differences (p <.05). Conclusion: Roma people wear flip flops and slippers and non‐Roma people running shoes and walking shoes. These findings reveal cultural differences that make it easier for the Roma population to experience a greater burden of foot health problems. General foot health and foot pain dimensions show statistically significant differences among ethnicity. [ABSTRACT FROM AUTHOR]