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Wartime violence and authoritarian repression against civilians take various forms. Past research has explored the causes and consequences of violence, but no previous work simultaneously assessed the long-term effects of different types of violence on political identities. This paper contends that indiscriminate attacks can reinforce ingroup identity, whereas the role of civilian agency in selective violence may have a detrimental impact. Equipped with original data capturing municipality-level exposure to both selective and indiscriminate violence during the Spanish civil war (1936–1939) in Biscay (Basque Country), this study examines its legacy on voting behavior (1983–2015). Results indicate that fascist airstrikes increased Basque nationalism while selective violence diminished the popularity of Basque parties. Individual and community-level evidence suggests that airstrikes fostered the intergenerational transmission of political attitudes. Violence can boost national identities, but it can also erode them: it depends on the type. [ABSTRACT FROM AUTHOR]

Since the outbreak of the COVID-19 pandemic, the gender dimension of its more visible socio-economic impacts has been the topic of study by several researchers. The current paper takes this further by focusing on the invisible chores done in the families at home. This paper studies how people's behavior towards housework changed during and after the confinement period in Spain. We analyze whether people did more housework during the lockdown period than before it, the way this housework was distributed between women and men, and whether this has changed since the end of lockdown. The empirical analyses point to a new trend in the housework gender gap: differences between men and women have narrowed since the lockdown, although women continue to bear most of the responsibility. [ABSTRACT FROM AUTHOR]

Background and objectives: Systemic lupus erythematosus (SLE) is an autoimmune condition that can highly impact patients' quality of life (QoL). However, there is a lack of knowledge about SLE, affecting the general population and health care professionals (HCPs) alike. This lack of knowledge has negative implications for patients and the healthcare system, worsening prognosis, negatively impacting QoL, and increasing healthcare utilization. The aim of this paper is to draw attention, according to the perspective of the participants of this study, to the lack of awareness of SLE and its consequences in Spain, and to suggest improvements. Patients and methods: This qualitative, descriptive, observational, multicenter, and cross-sectional study included 40 patients with moderate or severe SLE, recruited during their routine visits in six university hospitals in Spain. The study also included 11 caregivers and 9 HCPs. All participants were individually interviewed. Data from the interviews were coded and analyzed thematically by two anthropologists following a phenomenological perspective. Results: Our study identified a lack of disease awareness among primary care physicians, emergency medicine doctors, and other specialists treating SLE symptomatology. This led to diagnostic delays, which had a clinical and emotional impact on patients. Furthermore, symptom awareness was found to be context dependent. Differences in symptom awareness between HCPs and patients led to a mismatch between the severity evaluation made by doctors and patients. Some HCPs did not consider the limitations of the current severity evaluation of SLE, and therefore attributed symptoms potentially caused by SLE to the unfavorable socioeconomic conditions patients lived in. Finally, a lack of social awareness among friends, family members, and romantic partners led to lower social support, increased isolation, and negative physical and emotional impact for patients. Gender differences in the provision of support were identified. Conclusion: This study highlights the need to increase SLE awareness among patients, HCPs, and the broader public in order to improve patient QoL. Being aware of the clinical and emotional impact of such lack of awareness, as well as the role played by context on the patient experience of SLE, is a crucial step towards achieving this goal. [ABSTRACT FROM AUTHOR]

Local government officials are accountable to citizens, who increasingly demand more transparency given the amount of taxes they pay. This paper analyses the relationship between municipal tax revenues and transparency in Spain. Based on a sample of 141 Spanish municipalities with more than 15,000 inhabitants and applying least squares regression and instrumental variable analysis based on two-stage least squares regression, we find that the most transparent municipalities collected more global taxes. Furthermore, more municipal financing through transfers from other levels of government leads to lower taxes on construction and capital gains generated by real estate transfers. [ABSTRACT FROM AUTHOR]

The football rivalry between Real Madrid CF and FC Barcelona is one of the most popular at club level globally. In Spain, where it is known as El Clásico (the Classic), it has an unrivalled status in the sports media industry. Its significance relies in part to the historical tension between Catalonia, the region of which Barcelona is the main centre, and Madrid, the capital of Spain. The exaltation of confrontation and partisanship is the central feature of highly popular radio programmes devoted to El Clásico. This study aimed to observe how the media discourse articulated by these programmes was affected by the fact that, during the Covid-19 pandemic, matches were played in empty venues. Through the comparisons of broadcasts of two games, one from 2017 and from 2020, the paper shows that the sensationalistic style is toned down, and a less polarised and partisan sports journalism is possible. [ABSTRACT FROM AUTHOR]

Platform capitalism is a growing reality with a widening social and economic impact. The rapid expansion of Short-Term Rental (STR) platforms has led to new challenges for policy regulation. The main objective of this paper is to shed some light on current conflicts surrounding the regulation of STR. The body of literature on this topic mainly focuses on the increasing substitution of sharing economy by commercial hosts. By contrast, we explain that the ideological notion of host hinders the understanding of the supply-side structure. A critical approach (as critique of ideology and ideological categories) should entail a class perspective based on rent theory and engage with critical works on platform capitalism. In this article, we propose an innovative analytical approach to STR supply-side supported by rent theory, which focuses on the relationship of agents with land and technology ownership and specialised management services, as these are forms of rent appropriation. From this point of view, these supply-side agents are not hosts, but class factions with common and competing economic interests in rent appropriation. Therefore, they can employ a variety of strategies to influence the political regulation of STRs. Based on in-depth interviews with landlords, individual managers, and corporate agencies in Andalusia (Southern Spain), we show the conflicting internal structure behind the ideological notion of host and even professionalisation. [ABSTRACT FROM AUTHOR]

Padel has become one of the most popular racket sports in the world, capturing the interest of researchers and thus increasing the number of manuscripts that revolve around this sport. This article describes the state of development of the science of padel and locates the most relevant journals, authors, institutions, countries and keywords on the subject. The set of publications related to padel was retrieved from the main collection of the Web of Science. The state of development of padel in science was verified. Journals, authors, institutions, countries and keywords in the topic were analysed with the VOSviewer software. A total of 116 publications were analysed, finding that the publications on padel were in a phase of exponential growth. Sánchez-Alcaraz, Courel-Ibañez, Muñoz-Marín, Ramón-Llin and Sánchez-Pay were the most prominent authors, with the University of Murcia and Spain being the main institution and country on the subject. The science of padel is growing exponentially, with Spain being the driving force behind the topic of study, with new countries joining in recent years. This study provides relevant information on the state-of-the-art padel, and it will help researchers to establish new relationships and find more relevant authors and articles. [ABSTRACT FROM AUTHOR]

In 2018, the Ethiopian government banned intercountry adoptions due to detected irregularities. This paper draws from the experiences of Spanish adoptive families, providing evidence of these irregularities and other abuses substantiated by adoptive families during their "search for origins" or reconnection with their children's birth families. We argue that these searches and contacts within the adoptive triad represent informal reparative initiatives among Spanish adoptive families. [ABSTRACT FROM AUTHOR]

In the ever-evolving landscape of qualitative social science research, innovative methodologies are crucial for capturing the complexities of human behavior and societal dynamics. Bricolage, a versatile approach derived from Claude Lévi-Strauss’s structuralist inquiry, has flourished within post-structuralism, post-modernism, critical theories, feminism, and cultural studies. Despite its growing recognition, challenges persist in comprehending and applying bricolage due to its interdisciplinary and eclectic nature. More established research methodologies face limitations in adapting to contemporary realities, whereas bricolage offers a pliable and adaptive lens. This paper explores bricolage’s conceptual underpinnings and real-world application, aiming to underline the importance of embracing innovative research methodologies. By presenting bricolage as a potent tool for generating knowledge, this study seeks to inspire researchers to explore its rich potential in understanding the multifaceted landscapes of human experience. [ABSTRACT FROM AUTHOR]

This study examines the way in which two major Spanish newspapers, El País and El Diario Vasco, framed the 11 March 2004 (11-M) Madrid train bombings through peace journalism or war journalism, based on Peace Studies theorist Johan Galtung's classification. An analysis of the news articles in the immediate aftermath of the bombings finds both frames present. The incumbent Spanish government initially tried to use the news media as a vehicle to present a premature interpretation that the Basque separatist group ETA perpetrated the attacks, even trying to pass a United Nations resolution. However, some journalistic coverage of the events in the week after the 11-M attacks portrayed the Spanish people's sentiments regarding Spain's support of the US in the Iraq war, Spaniards' engagement with their democracy, including massive street protests, and parallels between the Iraqi people's suffering and the Spanish train bombing victims. Other journalistic coverage focused on the perspectives of high-level Spanish government officials, emphasized the importance of prevailing in 'the war on terror', and provided an 'us–them' orientation. [ABSTRACT FROM AUTHOR]

Assessment is a key element in the teaching–learning process in physical education (PE). In 2020, the Association Internationale des Écoles Supérieures d'Éducation Physique (AIESEP) published a position statement on PE assessment, in which it reviews the current state of the field and establishes the current yet forward-looking main lines of research on this topic. The most widely used approach, which this article reviews in depth, is assessment for learning (AfL). In Spain, the most widespread approach employed in PE throughout primary and secondary education in the last 25 years has been formative and shared assessment, which clearly aligns with the AIESEP position statement. The objective of this study was to gain an understanding of the main contributions of the formative and shared assessment model in PE and PE teacher education (PETE). Four databases (ERIC, SCOPUS, WOS and DIALNET) were explored, and 51 documents were selected on which an inductive thematic analysis was conducted. The evidence obtained at different educational levels and contexts seems to show a positive influence of formative and shared assessment on learning outcomes, which has favoured the expansion of the model, especially in PETE. Research on the transfer of PETE to educational practice has indicated that adequate continuing professional development seems necessary to help teachers integrate formative and shared assessment in their PE classroom. In conclusion, this model can provide an answer to some of the current questions being raised at an international level about PE assessment, especially in relation to students' involvement in the assessment process and its role in PETE. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the efficacy of a graphic organizer for improving the expository text comprehension of adolescent Spanish–English bilingual students with learning disabilities. Students were two females and one male. Using a multiple baseline single case design, researchers taught students to create a funnel map graphic organizer for 10 descriptive text passages. Students' performance was assessed on their ability to correctly create the funnel map (criterion variable) and to comprehend expository passages during baseline, intervention, and maintenance phases. Each participant learned to create an accurate funnel map within four sessions. Text comprehension scores began to increase within three sessions. Results showed the positive effect of using the funnel map for improving comprehension of expository texts. Individual Tau effect sizes (.81–.92) and overall Tau-U effect sizes (.86) and a Between Case-Standardized Mean Difference (BC-SMD) of 1.87 showed the intervention to be highly effective. [ABSTRACT FROM AUTHOR]

Descriptive fit indices that do not require a formal statistical basis and do not specifically depend on a given estimation criterion are useful as auxiliary devices for judging the appropriateness of unrestricted or exploratory factor analytical (UFA) solutions, when the problem is to decide the most appropriate number of common factors. While overall indices of this type are well known in UFA applications, especially those intended for item analysis, difference indices are much more scarce. Recently, Raykov and collaborators proposed a family of effect-size-type descriptive difference indices that are promising for UFA applications. As a starting point, we considered the simplest measure of this family, which (a) can be viewed as absolute and (b) from which only tentative cutoffs and reference values have been provided so far. In this situation, this article has three aims. The first is to propose a relative version of Raykov's effect-size measure, intended to be used as a complement of the original measure, in which the increase in explained common variance is related to the overall prior estimated amount of common factor variance. The second is to establish reference values for both indices in item-analysis scenarios using simulation. And the third aim (instrumental) is to implement the proposal in both R language and a well-known non-commercial factor analysis program. The functioning and usefulness of the proposal is illustrated using an existing empirical dataset. [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]

This note illustrates some of the new roles that armed forces are taking on in developed countries, highlighting the structure, capabilities, and missions developed by the Spanish Military Emergency Unit (UME). The note describes some of these new roles assumed by UME, such as its response to the COVID-19 pandemic, and shows, using official temporal and georeferenced data, the growing use of the military to support civilian authorities in response to natural disasters, man-made disasters, and other emergencies alike. In addition, we also analyze public opinion survey data to argue that this is helping to improve society's perception of the armed forces even in a country like Spain where, due to its recent history, a significant part of its population is reluctant to the military. In short, the military is taking on more emergency roles as needs arise and these new roles can help to improve its perception by citizens. [ABSTRACT FROM AUTHOR]

Circular start-ups (CSUs) are gaining popularity to radically rethink the linear resource flows of global production systems and adopt ambitious approaches towards a circular economy from inception. For CSUs, the institutional environment is particularly relevant; this is because the complex nature of sustainability challenges requires a deep engagement with institutions to drive transitions from linear to circular practices. This article analyses how and why institutional factors influence CSUs in the highly entrepreneurial region of Catalonia in Spain. Based on a multiple case study, our findings demonstrate that CSUs are affected by informal institutions through founder motivations, their ability to create opportunities and social values. Formal institutions influence CSUs regarding the previous experience of founders, accessible ecosystem actors and supportive laws and regulations. These findings are important for effective policymaking to develop adequate support mechanisms and understand the particular challenges and opportunities CSUs face compared to traditional start-ups. [ABSTRACT FROM AUTHOR]

Background: Next-generation sequencing liquid biopsy (NGS-LB) for colorectal cancer (CRC) detection and surveillance remains an expensive technology as economies of scale have not yet been realized. Nevertheless, the cost of sequencing has decreased while sensitivity has increased, raising the question of whether cost-effectiveness (CE) has already been achieved from the perspective of European healthcare systems. Objectives: This health economic (HE) modeling study explores the CE of NGS-LB for CRC based on direct treatment costs compared to standard care without liquid biopsy in Spain, France, and Germany. Methods: A structured literature search was used to collect evidence from 2009 to 2020 on the stage-dependent quality of life (quality-adjusted life-years, QALY), efficacy, and total direct treatment costs (TDC) of NGS-LB. A decision-analytic Markov model was developed. Over the remaining lifetime, cumulative life expectancy (LE), TDC, and QALYs were calculated for 60-year-old men and women in CRC stage III with different assumed effects of NGS-LB of 1% or 3% on improved survival and reduced stage progression, respectively. Results: The use of NGS-LB increases LE by 0.19 years in Spanish men (France: 0.19 years, Germany: 0.13 years) and by 0.21 years in Spanish women (France: 0.21 years, Germany: 0.14 years), respectively. The 3% discounted cost per QALY gained was 35,571.95 € for Spanish men (France: 31,705.15 €, Germany: 37,537.68 €) and 35,435.71 € for Spanish women (France: 31,295.57 €, Germany: 38,137.08 €) in the scenario with 3% improved survival and reduced disease progression. Compared to the other two countries, Germany has by far the highest TDC, which can amount to >80k euros in the last treatment year. Conclusion: In this explorative HE modeling study, NGS-LB achieves generally accepted CE levels in CRC treatment from the health system perspective in three major European economies under assumptions of small improvements in cancer recurrence and survival. Confirmation of these findings through clinical trials is encouraged. Plain language summary: Is it worthwhile to use next generation liquid biopsy for cancer recurrence detection on patients with colorectal cancer? Colon cancer is common. Worldwide, almost one million people die from it every year. Next Generation Sequencing Liquid Biopsy is a very sensitive technology for detecting cancer cells and their genetic information in the blood. Therefore, it is a good way to detect cancer and to detect early recurrence of a previously treated tumor. This test procedure is not yet used very often. Therefore, it is still expensive. Furthermore, there are still no studies that have demonstrated that and how liquid biopsy can aid doctors and patients after initial treatment. The research team of this study has developed an analytical model to investigate what performance liquid biopsy should have to demonstrate an affordable patient benefit in terms of quality of life, survival and cost per additional quality-adjusted life year gained. To do this, they studied the existing medical literature and many cost studies on colorectal cancer for the countries of Spain, France and Germany to feed their model. Then, they made different assumptions about the performance of liquid biopsy and did calculations. In the process, they also particularly examined the significance of specific influencing factors such as costs or disease progression in so-called sensitivity analyses. As a result, the authors found that there are large differences in treatment costs for colorectal cancer between the three countries Spain, France and Germany. Furthermore, even small improvements in the progression of cancer and the survival of cancer patients lead to the economic efficiency of liquid biopsy for the health care system. However, these are still thought experiments, so the research team of this study says that there should be further clinical trials to assess the impact of liquid biopsy on cancer progression and patient survival by using this technology. By this, one could confirm or contradict the authors' educated assumptions and possibly pave a new way towards medical progress for people with colorectal cancer. [ABSTRACT FROM AUTHOR]

Purpose: Adolescents are particularly vulnerable to suicide attempts, which is a major risk factor for completed suicide in this age group. However, most research on suicide prevention interventions comes from high-income countries with predominantly white participants and English protocols. This study examines interventions that have been tested in Latin America and Spain. Methods: A systematic review was conducted to include interventions aimed at reducing suicide ideation, attempts, and increasing knowledge about it in these regions. Results: Sixteen articles were selected, and Dialectical Behaviour Therapy, Problem Solving Therapy, and Trauma-Focused Cognitive Behavioural Therapy were found to be more effective than standard treatments or wait-list conditions in reducing the outcomes. Discussion: This review highlights the need for more research on preventive interventions in Latin America and Spain. While all interventions evaluated were effective, further research and replication studies are necessary to strengthen the evidence base for these interventions. [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 objective of universal health care systems is to achieve equality in the use of health services at the same level of care need. This study evaluates the relationship of socioeconomic position with the frequency of doctor visits in subjects with and without chronic diseases in Germany and Spain. The dependent variables included number of consultations and if a medical consultation occurred. The socioeconomic factors were income and education. The magnitude of the relationship between socioeconomic position and medical consultation frequency was estimated by calculating the percentage ratio using binomial regression and by calculating the difference in consultations by analysis of the covariance, in the case of number of visits. Statistically significant findings according to education were not observed. The percentage ratio in the medical consultations among those with lower and higher income was 1.03 (95% confidence interval [CI] 1.01-2.88) in Germany and 1.11 (95% CI 1.03-1.20) in Spain among subjects with any of the studied chronic conditions. Also, in Germany the difference in the average number of consultations comparing lower income subjects with higher was 3.98 (95% CI 2.40-5.57) in those with chronic conditions. In both countries, there were no differences in the frequency of doctor visits according to education. However, a pro-inequality trend exists in favor of subjects with lower income. [ABSTRACT FROM AUTHOR]

The gender gap in political/ideological self-positioning literature usually considers that Spain is stagnant within traditional parameters, where women are more right-wing than men. However, an analysis of more than 87,000 opinion polls collected by the CIS over a period of almost 40 years shows that Spain is moving toward the modern gender gap, although following a particular path conditioned by its own history of the 20th century. These findings disagree with the conclusions reached by Inglehart and Norris about Spanish women in their study about the development of modern gender gap. Our research investigates the impact of cohort and period effects on the population aged over 64, whose political identity, in accordance with the theories of political socialization, was formed in a context alien to the modernization process, largely coinciding with the Franco dictatorship in Spain. [ABSTRACT FROM AUTHOR]

In the current context in which tourism is beginning to recover, this study examines the worldwide trend of tourists traveling to destinations with a low impact of the COVID-19 pandemic in a country such as Spain, which is highly dependent on tourism activity. By employing the SEM methodology and an extended theory of planned behavior (TPB), which includes the cognitive and affective dimensions of perceived risk about the pandemic and past behavior, the results show the positive effect that past behavior and the core variables of the TPB have on the behavioral intentions of Spanish tourists, despite the negative impact that their cognitive risk perception has on these core variables. The study's findings have useful practical implications for tourism authorities and stakeholders in Spain and other countries that are also highly dependent on tourism. [ABSTRACT FROM AUTHOR]

This study evaluates the changes in the expenditure–price elasticities of foreign tourists in the summer periods of 2019, 2020, and 2021. We first develop a theoretical characterization that combines microeconomic, loss aversion, price inequality and precautionary savings theories. Next, exploiting microdata for more than 34,000 foreign tourists visiting Spain, we estimate OLS and quantile regressions to empirically examine the expenditure elasticities with respect to the prices of transport services, leisure activities and bars and restaurants at the destination (17 regions). We find that (i) the expenditure–price elasticity of transportation (leisure activities) increases (decreases) during the pandemic, whereas that of bars and restaurants remains unchanged, (ii) foreign tourists are comparatively less expenditure–price elastic at high expenditure levels in transportation and bars and restaurants, and (iii) expenditure–price elasticities are highly heterogeneous depending on the origin country. Managerial and theoretical implications of the findings for firms' pricing strategies are discussed. [ABSTRACT FROM AUTHOR]

The situation of oppression and discrimination of Roma people is a fact that can be observed in many research studies. This is in conjunction with segregation and unequal educational conditions for Roma students, which do not seem to improve despite economic investment and specific intervention programmes. We understand that these situations are ever-present and structural in our society and that they segregate and exclude and become cultural, social and educational barriers for Roma students to successfully continue their academic careers until they reach university. The aim of this study was to understand the views of Roma students at a university in the south of Spain regarding the factors that had enabled them to overcome the initial difficulties they had faced during primary and secondary education, and which had acted as protective factors against educational exclusion. We have included quantitative data through the use of questionnaires, and qualitative data through the use of interviews. The results suggest that these factors are diverse, intersecting and are not mutually exclusive. Family and teacher support and the presence of a non-segregated environment, as well as personal motivation and self-awareness, are key factors. A relevant finding has been the flexibility of cultural reference models that have allowed them to navigate the exclusionary structures of the school. [ABSTRACT FROM AUTHOR]

Background: Multimorbidity, the coexistence of multiple chronic conditions in an individual, is a complex phenomenon that is highly prevalent in primary care settings, particularly in older individuals. This systematic review summarises the current evidence on multimorbidity patterns identified in primary care electronic health record (EHR) data. Methods: Three databases were searched from inception to April 2022 to identify studies that derived original multimorbidity patterns from primary care EHR data. The quality of the included studies was assessed using a modified version of the Newcastle-Ottawa Quality Assessment Scale. Results: Sixteen studies were included in this systematic review, none of which was of low quality. Most studies were conducted in Spain, and only one study was conducted outside of Europe. The prevalence of multimorbidity (i.e. two or more conditions) ranged from 14.0% to 93.9%. The most common stratification variable in disease clustering models was sex, followed by age and calendar year. Despite significant heterogeneity in clustering methods and disease classification tools, consistent patterns of multimorbidity emerged. Mental health and cardiovascular patterns were identified in all studies, often in combination with diseases of other organ systems (e.g. neurological, endocrine). Discussion: These findings emphasise the frequent coexistence of physical and mental health conditions in primary care, and provide useful information for the development of targeted preventive and management strategies. Future research should explore mechanisms underlying multimorbidity patterns, prioritise methodological harmonisation to facilitate the comparability of findings, and promote the use of EHR data globally to enhance our understanding of multimorbidity in more diverse populations. [ABSTRACT FROM AUTHOR]

Introduction: Educators require focused training to foster the development of intercultural competence in nurses. Training programs for educators need to be based on a comprehensive profile with a focus on intercultural learning. This study aims to define and validate a profile of the Intercultural Nursing Educator (INE). Method: The Delphi method was used with an iterative, multi-stage process to transform opinions into group consensus. A total of 46 European, African, and American experts from the nursing and intercultural field participated. Inclusion criteria required English at a level of B2, expertise in the field of intercultural competence, experience in teaching intercultural competence in the nursing context, and publications focused on intercultural topics. Results: The INE profile was developed and all 126 competencies were validated. Discussion and conclusion: The profile is freely available on the project website and provides the basis for curricula, training programs and assessment of the required competences. [ABSTRACT FROM AUTHOR]

Purpose: This article focuses on the evaluation of youth empowerment projects from the perspective of the educators themselves. Method: HEBE Rubric (collects quantitative and qualitative data) was applied to 20 youth projects. The selection of projects was based on intentional sampling. Results: The results show that the projects focus on some youth empowerment dimensions to the detriment of others. The most important dimensions are responsibility and self-sufficiency. There is also evidence of more work from the individual perspective of empowerment than from the community perspective, and from a perspective that is more internal to the project than in relation to the context. Discussion: Important educational work is carried out in the projects analyzed, according to the educators themselves. It would be interesting to reinforce the educational work carried out by these projects with activities and strategies that facilitate contact, openness, and educational work with the community. [ABSTRACT FROM AUTHOR]

In the present study, we investigate the convergence of research and development (R&D) expenditure, a relevant factor in competitiveness, across Spanish regions through a club convergence analysis for the period 2000 to 2017. The results show large regional disparities in R&D expenditure in Spain. We have identified four clusters, plus a divergent region: the Basque Country. The results are similar for the two perspectives considered: percentage of GDP and per capita. We discuss these results taking into account the effects of the Great Recession and compare the outcomes with those for a club convergence of regional GDP per capita. Finally, we carry out an ordered logit model to analyse the factors behind the clusters, with human capital and economic openness being significant. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is currently the most prevalent malignancy among women. Psychological resilience is an important factor that diminishes the stress-related emotional and psychosocial disturbances triggered when receiving the diagnosis. Furthermore, resilience appears to be associated with cortisol, the hormonal end-product of the hypothalamic-pituitary-adrenal axis; however, further studies are needed due to the mixed results reported. Thus, we aim to examine the predictive role of social support and cortisol in resilience among breast cancer patients. Methods: A total of 132 women with primary breast cancer completed the Medical Outcomes Study-Social Support Survey (MOS-SSS) and the Resilience Scale (RS-14) and provided four salivary samples for the estimation of participants' total daily cortisol production, for which the formula of the area under the curve with respect to the ground (AUCg) was applied. Moderation analyses were performed to study the influence of social support and AUCg on psychological resilience levels. Results: The regression analyses showed a direct significant effect for the emotional support subscale of MOS-SSS on resilience and the interaction between emotional support and AUCg was also found to be statistically significant. Specifically, the conditional effect of emotional support on resilience was found to be significant at middle (M = 3.08; p <.05) and low levels (M =.59; p <.001) of AUCg. Conclusions: Our results suggest that newly diagnosed breast cancer women with middle and low diurnal cortisol profiles may benefit more from emotional support based-interventions while women with high diurnal cortisol may need more individualized therapies. [ABSTRACT FROM AUTHOR]

Background: Poor sleep quality is prevalent in older people and impairs their quality of life. Various studies show an association between sleep disorders and altered levels of inflammatory cytokines. The cytokine IL-1β has been shown to display both somnogenic and insomnia-promoting effects in experimental animals. Objectives: to evaluate the relationship between insomnia and salivary IL-1β concentration and the role of associated factors such as the symptoms of depression, use of hypnotics, intake of caffeinated beverages, smoking, and alcohol use in older individuals. An analytical, cross-sectional, observational research was carried out with a population of community-dwelling individuals over 60 years of age in Valencia (Spain). Sleep quality was measured with the Athens insomnia scale (AIS) and depressive symptoms with Geriatric Depression Scale (GDS). Results: 287 individuals participated in the study (mean age 74.08 years (76.7% women). 41.5% of the participants had insomnia, 36.9% took drugs for sleep problems, and 32.4% had relevant depressive symptoms. There was a significant inverse correlation between the IL-1β and total AIS score (rho = −0.302, p < 0.001), the sleep difficulty subdomain (rho = −0.259, p < 0.001), and the daytime sleepiness subdomain (rho = −0.322, p < 0.001). No significant correlation was observed between GDS and salivary IL-1β concentration. The IL-1β concentration was significantly lower in individuals taking drugs for sleeping compared with those not taking those drugs (1.11 ± 0.09 and 1.48 ± 0.08, respectively; p = 0.001). Regarding the AIS score, there was no significant difference in marital status, smoking, or the number of cups of tea or cola drinks, but there was a significant association with alcohol intake (p = 0.019) and in the number of daily intakes of coffee (p = 0.030). The receiver operating characteristic (ROC) curve analysis of IL-1β for diagnosis of moderate-severe insomnia showed an area under the curve (AUC) value of 0.78 (95% confidence interval 0.71–0.85). At the cut-off of 0.83 pg/µL of Il-1β, it had a sensitivity of 70.3% and a specificity of 69.8%. [ABSTRACT FROM AUTHOR]

Do violence during a civil war and its aftermath leave a mark on political behaviour? In this article I study how violence perpetrated by the left and repression by the right during and after the Spanish Civil War shaped vote choice and turnout in 1977, in the first legislative election after a 40 year dictatorship. I argue that the effect of repression travels over time when actions are perpetrated by clearly identifiable antagonistic actors. By using a dataset that captures the intensity and the type of violence, results indicate that repression perpetrated by the Francoist dictatorship during and after the conflict had a positive and significant effect on left-wing support in 1977. Results are consistent across different indicators, such as religious violence, distance to mass graves or sanctions to teachers, confirming that violence triggered greater support for the political left. In contrast, results show no relationship between repression and turnout. [ABSTRACT FROM AUTHOR]