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Background: The incidence of coagulation of continuous renal replacement therapy circuits remains high. To the best of our knowledge, no scholar has published a protocol to avoid management errors when different types of citrates coexist in the same Intensive Care Unit. Aim: To assess the safety and efficacy of the unification of two protocols with different concentrations of citrate solution. Study Desing: A prospective, quasi‐experimental study was carried out in the intensive care unit of a tertiary referral hospital (in Barcelona, Spain), over 3 years. Consecutive adult patients requiring continuous renal replacement therapy with citrate were included. The sample was divided into two groups, a control group (concentrated citrate) and an intervention group (diluted citrate). The decision to initiate anticoagulation with diluted (18 mmol/L) or concentrated (136 mmol/L) citrate was made based on the machine available and the decision of the doctor responsible for the patient. It was not possible to randomize the sample. Both protocols were matched with a starting citrate dose of 3.5 mmol/L, and a dialysis solution was used. Post‐filter replacement was not used, and the citrate solution was the only fluid administered pre‐filter. Results: The analysis included 59 circuits in the concentrated citrate group and 40 circuits in the diluted citrate group. An increased need for electrolyte replacement was observed in the diluted group (p <.001). The concentrated citrate group had a longer filter life (p <.05), and there was a slight trend toward alkalosis. Conclusion: The diluted citrate group had a higher incidence of electrolyte replacement. The concentrated citrate group had longer circuit lifespan and a trend toward metabolic alkalosis, although this was not statistically significant. If these conclusions are considered, the protocol can be unified. Relevance to Clinical Practice: The present work aims to provide information on the differences in the use of regional anticoagulation with diluted or concentrated citrate. The objective is to pay special attention to aspects that can lead to complications. The unified protocol proposed in this paper could be extrapolated to any machine on the market that uses either of these two types of citrate concentration. [ABSTRACT FROM AUTHOR]

Background: Down syndrome (DS) is a neurodevelopmental disorder of genetic origin with a cognitive‐behavioural profile that distinguishes it from other syndromes. Within this profile, language difficulties are particularly marked, having been more studied in childhood than in adulthood. More generally, there is a paucity of research on the prosodic skills of individuals with DS, despite the relevance of this linguistic component for effective communication. Aims: This study aimed to analyse, for the first time, the prosodic profile of Spanish‐speaking teenagers and young adults with DS. We hypothesized that participants with DS would show significantly lower skills for the perception and production of prosodic functions and forms when compared to peers with intellectual disability (ID) of unknown origin. We also hypothesized that teenagers and young adults with DS would have better prosody perception than prosody production. Methods & Procedures: The final sample included in the study comprised 28 Spanish‐speaking teenagers and young adults with DS and 29 teenagers and young adults with other ID matched on chronological age and nonverbal cognition. Their prosodic skills were tested by means of the Profiling Elements of Prosody for Speech and Communication battery. This battery allows for the separate evaluation of the comprehension and expression of the communicative functions of prosody and the discrimination and production of the forms that carry out such functions. Outcomes & Results: In the prosody function tasks, which are the most adaptive tasks for the communicative process, we found, as expected, significantly lower scores on the turn‐end, chunking, and focus tasks in the group with DS. However, no significant between‐group differences were found for the affect tasks. Participants with DS also had significantly lower scores on the prosodic form tasks than participants with other ID. The results of the comparison between prosodic perception and production skills showed that a generalization about a better profile in comprehension versus production is not possible and that there is a dependence on the demands of the prosodic task undertaken. Conclusions & Implications: The findings contribute to the ongoing development of the language profile of teenagers and young adults with DS and imply the need to design prosodic intervention programs based on their specific profile. WHAT THIS PAPER ADDS: What is already known on the subject: Prosody is a fundamental element of language, and its mastery affects the effectiveness of communication. However, research on prosody in Down syndrome (DS) that offers a holistic view from a psycholinguistic approach is still scarce. To date, studies focused on providing a detailed profile of prosodic skills in individuals with DS have been mainly conducted with a few English‐speaking children. These studies have shown that the comprehension and production of prosody is severely impaired, especially when considering affect and focus production, as well as the perception and production of prosodic forms. During childhood, greater efficacy is found in prosody comprehension than in prosody expression. What this study adds: This is the first study analysing the prosodic profile of a large group of Spanish‐speaking teenagers and young adults with DS. Poorer performance in the perception and production of both prosodic functions and forms was observed in participants with DS compared to participants with intellectual disability of unknown origin matched on chronological age and nonverbal cognition. Unlike what has been previously found in children, teenagers and young adults with DS performed at the same level as the control group on the understanding and expression of affect through prosodic cues. Results also showed that a generalization about a better prosody profile in comprehension versus production is not possible. What are the clinical implications of this work?: This study provides new data on the prosodic skills of Spanish‐speaking teenagers and young adults with DS. Given the impact of prosody on effective communication and the pattern of difficulties found in this study, speech and language therapists working with individuals with DS should consider including prosodic skills in interventions not only in childhood but also in adolescence and adulthood. Therefore, the prosodic profile of strengths and weaknesses in individuals with DS found in this research has direct implications for clinical practice. [ABSTRACT FROM AUTHOR]

Serious games have proven to be a powerful tool in education to engage, motivate, and help students learn. However, the change in student knowledge after playing games is usually measured with traditional (paper) prequestionnaires–postquestionnaires. We propose a combination of game learning analytics and data mining techniques to predict knowledge change based on in‐game student interactions. We have tested this approach in a case study for which we have conducted preexperiments–postexperiments with 227 students playing a previously validated serious game on first aid techniques. We collected student interaction data while students played, using a game learning analytics infrastructure and the standard data format Experience API for Serious Games. After data collection, we developed and tested prediction models to determine whether knowledge, given as posttest results, can be accurately predicted. Additionally, we compared models both with and without pretest information to determine the importance of previous knowledge when predicting postgame knowledge. The high accuracy of the obtained prediction models suggests that serious games can be used not only to teach but also to measure knowledge acquisition after playing. This will simplify serious games application for educational settings and especially in the classroom easing teachers' evaluation tasks. Lay Description: What is currently known about the subject matter Serious games are a powerful tool to engage, motivate, and help students learn.Pre‐post experiments are commonly used to measure knowledge acquisition.Game learning analytics can be applied to interaction data from games. What this paper adds We present a two‐step approach combining game learning analytics and data mining to predict players' performance in serious games based on their interactions.The approach is tested in a case study with pre‐post experiments collecting interaction data with 227 students playing a serious game to determine if performance can be accurately predicted.The comparison of prediction models has helped to determine if pretest information is essential.The highly accurate prediction models obtained suggest that games can be used to teach and measure knowledge acquisition after playing. Implications of study findings for practitioners The approach aims to simplify the measurement of players' learning with serious games.It may be generalized at least to similar scenarios (e.g., games for procedural learning or game‐likesimulations) where similar interaction data are feasible.Game mechanics and educational design should define the interaction data to capture.Using an accepted standard tracking profile is a clear recommendation. [ABSTRACT FROM AUTHOR]

Introduction: Regular moderate‐to‐vigorous physical activity (MVPA) is associated with improved mental health, but the evidence for the effect of reducing sedentary behavior (SB) or increasing light PA (LPA) in older adults is lacking. Using isotemporal substitution (IS) models, the aim of this paper was to investigate the effect of substituting SB with LPA or MVPA on associations with mental health in older adults. Methods: Data from 1360 older adults (mean age 75.18 years) in four countries were utilized. PA and SB was measured using ActiGraph wGT3X‐BT + accelerometers worn for 7 days. Self‐rated mental health was measured using the Hospital and Anxiety Depression Scale (HADS). IS models estimated cross‐sectional associations when 30 minutes of one behavior was substituted with another. Models were adjusted for age, sex, marital status, and educational attainment. Results: Substituting 30 minutes of SB with LPA (β −.37; 95% CI −0.42, −0.32) or MVPA (β −.14; 95% CI −0.21, −0.07) and substituting LPA with MVPA (β −.11; 95% CI −0.18, −0.04) were associated with improvements in anxiety. However, substituting 30 minutes of SB with LPA (β.55; 95% CI 0.49, 0.62) was associated with increased depression. Conclusion: Replacing 30 minutes of SB with LPA or MVPA was associated with improved anxiety symptoms in older adults. Greater benefits were observed when shifting SB and LPA to MVPA. [ABSTRACT FROM AUTHOR]

Abstract: Rationale, aims and objectives: Self‐monitoring of blood glucose (SMBG) is recommended to monitor glycaemic levels. The recent development of real‐time continuous glucose monitoring (RT‐CGM) enables continuous display of glucose concentration alerting patients in the event of relevant glucose fluctuations, potentially avoiding hypoglycaemic events and reducing long‐term complications related to glycosylated haemoglobin (HbA1c) levels. This paper aims to evaluate the cost‐effectiveness of RT‐CGM compared to SMBG in patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) which should support decision‐making on public funding of RT‐CGM in Spain. Methods: We performed a systematic review and meta‐analyses on the effectiveness of RT‐CGM in the reduction of HbA1c levels and severe hypoglycaemic events. A cost‐effectiveness analysis was conducted using a Markov model which simulates the costs and health outcomes of individuals treated under these alternatives for a lifetime horizon from the perspective of the Spanish Health Service. The effectiveness measure was quality‐adjusted life years (QALYs). We ran extensive sensitivity analyses, including a probabilistic sensitivity analysis. Results: Real‐time continuous glucose monitoring provides a significant reduction of HbA1c for T1DM (13 studies; weighted mean difference (WMD) = −0.23%, 95% CI: −0.35, −0.11) and T2DM (5 studies; WMD = −0.48%, 95% CI: −0.79, −0.17). There were no statistically significant differences in the rate of severe hypoglycaemic events in T1DM (9 studies; OR = 1.16, 95% CI: 0.78, 1.72) or T2DM (no severe hypoglycaemic events were reported in any study). In the base case analysis, RT‐CGM led to higher QALYs and health care costs with an estimated incremental cost‐effectiveness ratio of €2 554 723 and €180 553 per QALY for T1DM and T2DM patients respectively. Sensitivity analyses revealed that the study results were robust. Conclusions: Real‐time continuous glucose monitoring is not a cost‐effective technology when compared to SMBG in Spain. [ABSTRACT FROM AUTHOR]

Abstract: Introduction and objective: The ODHIN trial found that training and support and financial reimbursement increased the proportion of patients that were screened and given advice for their heavy drinking in primary health care. However, the impact of these strategies on professional accuracy in delivering screening and brief advice is underresearched and is the focus of this paper. Method: From 120 primary health care units (24 in each jurisdiction: Catalonia, England, the Netherlands, Poland, and Sweden), 746 providers participated in the baseline and the 12‐week implementation periods. Accuracy was measured in 2 ways: correctness in completing and scoring the screening instrument, AUDIT‐C; the proportion of screen‐negative patients given advice, and the proportion of screen‐positive patients not given advice. Odds ratios of accuracy were calculated for type of profession and for intervention group: training and support, financial reimbursement, and internet‐based counselling. Results: Thirty‐two of 36 711 questionnaires were incorrectly completed, and 65 of 29 641 screen‐negative patients were falsely classified. At baseline, 27% of screen‐negative patients were given advice, and 22.5% screen‐positive patients were not given advice. These proportions halved during the 12‐week implementation period, unaffected by training. Financial reimbursement reduced the proportion of screen‐positive patients not given advice (OR = 0.56; 95% CI, 0.31‐0.99; P < .05). Conclusion: Although the use of AUDIT‐C as a screening tool was accurate, a considerable proportion of risky drinkers did not receive advice, which was reduced with financial incentives. [ABSTRACT FROM AUTHOR]

What is already known about this subject There is an association between adiposity levels and physical activity guidelines for adolescents., Achieving physical activity recommendations helps adolescents to prevent obesity status., What this study adds This paper presents an association between physical activity levels and obesity status., This paper supports physical activity recommendations to avoid children's obesity levels., This paper emphasizes vigorous physical activity for this matter., Background There is no information about physical activity (PA) recommendations to avoid children's obesity levels and how much of vigorous PA (VPA) is included into the '60 minutes of MVPA 5 days a week' recommendation for children. Objective The aim of this study was to examine the association between PA and adiposity in children and to examine whether the current PA guidelines are associated with a low risk of having excess of body fat in children, with special focus on sex differences, and PA intensity. Methods A sample of 439 Spanish children aged 8-10 years from the European Youth Heart Study participated in the study. The variables measured were anthropometric characteristics (height, weight, body mass index [ BMI], skin-folds and waist circumference) and PA was measured during 6 consecutive days using the GT1M accelerometer. Results Receiver operating characteristic analysis showed significant cut-off points associated with non-overweight: 45 min d−1 of VPA and 67 min d−1 of moderate-to-vigorous physical activity ( MVPA) (using BMI categories); and non-fat: 41 min d−1 of VPA and 67 min d−1 of MVPA (using percentage of body fat) and 38 min d−1 of VPA and 47 min d−1 of MVPA (using waist circumference categories) for boys. For girls, the optimal cut-offs of moderate-to-vigorous activity and MVPA associated with non-overweight were 24 and 57 min d−1, respectively ( BMI). Boys who did not meet 67 min in MVPA had an increased risk of being overweight + obese and overfat + obese (odds ratio [ OR] = 2.48, 95% confidence interval [ CI] = 1.36, 4.53, and OR = 2.56, 95% CI = 1.12, 5.82). Conclusions The findings support current PA recommendations (60 min d−1 of MVPA) to avoid excess of body fat in Spanish children. However, VPA appears to be an important component for the prevention of obesity, and our findings suggest that PA recommendations should specify the dose of VPA required for optimal health. Therefore, public health PA recommendations should incorporate specifically a greater dose of VPA into the total amount of MVPA in 8- to 10-year-old boys. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND This study describes the perceived impact of H1N1 influenza and the adoption of the recommended measures to address the pandemic in schools. METHODS A cross-sectional self-reported survey was conducted in 433 schools in Barcelona addressed to the school principal or the H1N1 influenza designated person. A descriptive analysis was performed, stratifying by educational level and type of school. A logistic regression analysis also was conducted. RESULTS Around 70% of the respondents reported that there had been H1N1 influenza cases among students, being this percentage significantly higher among those schools offering primary education (74.4%) (p < .05). The main measures (single-use paper towels, availability of sanitizer solutions and 15 minutes ventilation per day of enclosed spaces) were implemented in most of the centers. However, the correct adoption of the main measures took place in around 30% of the schools, being the percentage lower in those offering only secondary education (Odds ratio [OR]: 0.518; 95% confidence interval [CI]:0.272-0.986) and those located in medium (OR: 0.438, 95% CI: 0.234-0.811) or low socioeconomic status (SES) districts (OR: 0.321, 95% CI: 0.159-0.649). CONCLUSIONS Despite the climate of social alarm, the perceived impact of H1N1 influenza in most schools was moderate. In future potential threats, the educational level and the SES of the school should be considered, especially when measures requiring purchasing any product are recommended but not provided. [ABSTRACT FROM AUTHOR]

Background The aim of this study was to test the usefulness of the Cognitive and Language scales Bayley-III in the early assessment of cognitive and language functions in the context of an autism spectrum disorder (ASD) diagnosis. This paper focuses on the application of the Bayley-III and studies the predictive value of the test result in children with ASD with different levels of verbal ability. Method A sample of 135 children (121 boys, 14 girls) with a confirmed ASD diagnosis at age 4 years were assessed with the Bayley-III before 42 months of age ( m = 36.49, s = 4.46) and later with other rating scales of different psychological and psycholinguistic functions as part of a longitudinal study [ McCarthy Scales of Children's Abilities (MSCA) ( n = 48, 90% boys), Kaufman Assessment Battery for Children (K-ABC) ( n = 38, 87% boys) or Illinois Test of Psycholinguistic Abilities (ITPA) ( n = 44, 89% boys)]. Age assessment in months: MSCA ( m = 48.80, s = 3.33), K-ABC ( m = 51.80, s = 7.17) and ITPA ( m = 54.48, s = 3.34). Results Lower scores on the cognitive and language Bayley-III scales before 3.5 years of age predicted lower cognitive and oral language levels at 4 years of age. A significant correlation was found between the Cognitive Bayley-III Scale and the General Cognitive MSCA Scale, and with the Compound K-ABC Mental Processing. An association between the nonverbal cognitive level and oral language level acquired at 4 years of age was found. Conclusions The Bayley-III is a useful instrument in cognitive and language assessment of ASD. [ABSTRACT FROM AUTHOR]

Prenatal iron supplementation improves children's health and cognitive performance, but few studies explore behavioural development. This study assessed the effects of adjusting prenatal iron supplementation to maternal iron stores during early pregnancy on children's behavioural problems. Randomized controlled trial conducted in Tarragona (Spain) involving 230 nonanaemic pregnant women and their children after a 4‐year follow‐up. Based on haemoglobin (Hb) levels before gestational week (GW) 12, women receive different iron doses: those with Hb = 110–130 g/L were randomized to receive 80 or 40 mg/day and those with Hb > 130 g/L were randomized to receive 20 or 40 mg/day. Maternal iron stores at GW12 were classified using serum ferritin (SF) as low (SF < 15 µg/L), normal (SF = 15–65 µg/L), and normal‐high (SF > 65 µg/L). Children's behaviour was assessed by parents using the Child Behaviour Checklist for ages 1.5–5 years and the Behaviour Rating Inventory of Executive Function‐Preschool Version, and by teachers using the Teacher's Report Form for ages 1.5–5 years. Multivariable regression models were performed. Taking 80 mg/day of iron improved child behaviour when women had low iron stores but worsened it when mothers had normal–high iron stores, except for depressive and attention/hyperactivity problems. Taking 20 mg/day of iron improved behaviour only in those children whose mothers had SF > 65 µg/L in early pregnancy. Additionally, executive functioning improved at high doses of prenatal iron when maternal baseline SF < 15 µg/L. Adjusting prenatal iron supplementation to both maternal baseline Hb levels and iron stores reduces behavioural problems in 4‐year‐old children. Key messages: Prenatal iron supplementation succeeds in improving maternal haematological outcomes and cognitive performance of children, but few studies have focused on behavioural development.Prenatal iron supplementation adjusted to maternal iron stores reduces behavioural problems in 4‐year‐old children.Maternal iron stores early in pregnancy should be measured in addition to haemoglobin concentration.These findings contribute greatly to the advancement of public health by giving physicians the tools to prescribe the most appropriate dose of iron supplementation to contribute to better child development. [ABSTRACT FROM AUTHOR]

Purpose To examine the perception of registered nurses and nursing assistants regarding the use of physical restraints with residents of nursing homes located in four of the regions of Spain; and to evaluate the relationship of these perceptions to the staff respondents' level of training. Design Cross-sectional multicenter and correlational study. The research was conducted in 2013 in 19 Spanish nursing homes with 2,940 residential beds. A total of 785 nurses (170 registered nurses and 615 nursing assistants) participated in the study. Methods The Perception of Restraint Use Questionnaire (PRUQ), consisting of 17 of the most cited reasons for using these devices, was used, as was a questionnaire capturing the sociodemographic characteristics and educational or experience level of staff respondents. Findings Nurses reported the most important uses for restraints as prevention of falls and avoidance of medical device interference. As indicated by an average PRUQ score of 3.47, staff respondents supported restraint use, especially nursing assistants (3.59) as compared to registered nurses (3.00). With regard to training: 83.7% had participated in little, if any, training and only 29.2% had read three or more documents related to restraint use; 66.6% believed that their training was inadequate. No correlation was found between the results of the PRUQ and the respondents´ sociodemographic characteristics or participation in training activities. No differences were found among nurses by region. Conclusions In contrast to papers published in other countries, nurses in this study still consider it necessary to apply restraints in everyday practice. The education of nursing staff regarding restraint and knowledge of alternatives is needed; they should at least be aware of international standards of care regarding physical restraint use. Clinical Relevance Most of the staff perceived their training related to the use of these devices as insufficient. Nursing assistants considered the use of restraints more important than did the registered nurses. [ABSTRACT FROM AUTHOR]

Objectives Lipoatrophy is a long-term adverse effect of some antiretrovirals that affects quality of life, compromises adherence and may limit the clinical impact of HIV treatments. This paper explores the effect of tenofovir/emtricitabine ( TDF/ FTC) on the amount of limb fat in patients with virological suppression. Methods A randomized, prospective clinical trial was performed to compare continuation on a zidovudine/lamivudine ( ZDV/3TC)-based regimen with switching to a TDF/ FTC-based regimen in terms of the effect on limb fat mass as assessed by DEXA over a 72-week period. Results Eighty patients were included (39 in the TDF/ FTC arm and 41 in the ZDV/3 TC arm) and 73 completed the study (37 and 36, respectively). In the switch arm, limb fat increased by a median of 540 g from baseline ( P = 0.022), while in the ZDV/3TC arm it decreased by a median of 379 g ( P = 0.112; p between groups = 0.007). Subjects with baseline limb fat ≤ 7200 g, previous time on ZDV > 5 years or a body mass index > 25 kg/m2 experienced higher limb fat gains than other subjects, and these differences were statistically significant. Haemoglobin increased by a median of 1.0 g/d L in the TDF/ FTC arm ( P < 0.001) and remained unchanged in the ZDV/3TC arm (p between groups = 0.0002). There were no significant differences between groups in other secondary endpoints (body weight, total body and trunk fat content, total body bone mineral density, laboratory parameters, CD4 cell count and viral load). Conclusions Switching from a ZDV/3TC-based to a TDF/ FTC-based regimen led to a statistically significant improvement in limb fat, in contrast to the progressive loss of limb fat in subjects continuing ZDV/3TC. [ABSTRACT FROM AUTHOR]

Objectives This paper examines the awareness and use of nonoccupational HIV post-exposure prophylaxis ( nPEP) in Spain, and the factors that influence this awareness. Methods Between June 2009 and July 2010, a mobile unit offered free, rapid HIV tests in a number of Spanish cities. A total of 2545 people were passively recruited and tested, and answered a self-administered questionnaire containing sociodemographic, behavioural and nPEP-related questions. Bivariate and multivariate analyses were performed, stratifying by gender/sexual behaviour. Results Some 34% of the responders were men who have sex with men ( MSM), 30% were men who have sex exclusively with women ( MSW), and 35% were women. Approximately 26% were foreigners, 46% had a university degree, and 51% had previously taken an HIV test. Overall, 22% were aware of nPEP. Only 2% had ever used it; 70% of these after high-risk sexual intercourse. Awareness was higher among MSM (34%) than women (16%) and MSW (15%). Multivariate analysis showed a lack of nPEP awareness to be associated with being born in Latin America, while awareness increased with the number of previous HIV tests among women and MSW. In MSM, awareness was also associated with having a university degree, the degree of interaction with gay culture, number of partners, and use of the internet as the main way of meeting partners. Conclusions nPEP awareness in the studied population was unacceptably low. The promotion of its availability should be made a major objective of prevention programmes, as a complementary measure to condom use. [ABSTRACT FROM AUTHOR]

Aims To update the existing scientific evidence on the efficacy of local antimicrobials as adjuncts to subgingival debridement in the treatment of chronic periodontitis. Material and Methods Fifty-six papers were selected, reporting data from 52 different investigations. All the studies reported changes in probing pocket depth ( PPD) and clinical attachment level ( CAL) and most in plaque index (PlI) and/or bleeding on probing ( BOP). Meta-analyses were performed with the data retrieved from the studies fulfilling the inclusion criteria. Results The overall effect of the subgingival application of antimicrobials was statistically significant ( p = 0.000) for both changes in PPD and CAL with a weighted mean difference ( WMD) of −0.407 and −0.310 mm respectively. No significant differences occurred for changes in BOP and PlI. Subgingival application of tetracycline fibres, sustained released doxycycline and minocycline demonstrated a significant benefit in PPD reduction ( WMD between 0.5 and 0.7 mm). The rest of the tested outcomes demonstrated a high heterogeneity. The local application of chlorhexidine and metronidazole showed a minimal effect when compared with placebo ( WMD between 0.1 and 0.4 mm). Conclusions The scientific evidence supports the adjunctive use of local antimicrobials to debridement in deep or recurrent periodontal sites, mostly when using vehicles with proven sustained release of the antimicrobial. [ABSTRACT FROM AUTHOR]

Objectives: To describe prevalence and factors associated with unplanned pregnancies, and social and partner support during pregnancy among women from the Cohort of the Spanish HIV/AIDS Research Network (CoRIS). Methods: We included all women recruited in CoRIS from 2004 to 2019, aged 18–50 years at recruitment who were pregnant during 2020. We designed a questionnaire, organized into the following domains: sociodemographic characteristics, tobacco and alcohol consumption, pregnancy and reproductive health, and social and partner support. The information was gathered via telephone interviews conducted from June to December 2021. We calculated prevalence of unplanned pregnancies as well as odds ratios (ORs) of association and 95% confidence intervals (CIs) according to sociodemographic, clinical and reproductive characteristics. Results: Among 53 women who were pregnant during 2020, 38 (71.7%) answered the questionnaire. Median age at pregnancy was 36 years [interquartile range (IQR) 31–39], 27 (71.1%) women were born outside of Spain, mainly in sub‐Saharan Africa (39.5%) and 17 (44.7%) were employed. Thirty‐four (89.5%) women had been through previous pregnancies and 32 (84.2%) had experienced previous abortions/miscarriages. Seventeen (44.7%) women had shared with their clinician their desire to get pregnant. Thirty‐four (89.5%) pregnancies were natural and four used assisted reproductive techniques (in vitro fertilizations; one additionally used oocyte donation). Of 34 women with natural pregnancies, pregnancy was unplanned in 21 (61.8%) and 25 (73.5%) had information on how to become pregnant avoiding HIV transmission to the baby and partner. Women who did not seek advice from their physician about becoming pregnant had a significantly increased risk of unplanned pregnancy (OR = 71.25, 95% CI: 8.96–566.67). Overall, 14 (36.8%) women reported having low social support during pregnancy and 27 (71.0%) had good/very good support by their partner. Conclusions: Most pregnancies were natural and unplanned and very few women had talked with their clinician about their desire to become pregnant. A high proportion of women reported low social support during pregnancy. [ABSTRACT FROM AUTHOR]

Purpose: Smoking cessation interventions should be promoted in cancer centers to improve clinical outcomes among cancer patients and the quality of life of cancer‐free patients and survivors. The aim of the present study was to examine long‐term abstinence (1, 3, and 5 years) among smokers who received an intensive nurse‐led smoking cessation intervention. Design: A prospective follow‐up study was conducted in a smoking cessation clinic in Barcelona. Methods: The study included 479 smokers who received a nurse‐led smoking cessation intervention that included motivational interviewing, psychological support, behavioral change counseling, promotion of smoke‐free policies, and relapse‐prevention strategies, as well as pharmacotherapy if necessary, for 12 months. We calculated overall and sex‐specific 1‐, 3‐, and 5‐year abstinence probabilities (Kaplan–Meier curves) and adjusted hazard ratios (aHRs) of relapse with 95% confidence intervals (CIs) using Cox regression. Findings: The overall probability of abstinence at 1 and 5 years was 0.561 (95% CI: 0.516–0.606) and 0.364 (95% CI: 0.311–0.417), respectively. Females had a higher, but not significant, hazard ratio for relapse compared to males (aHR = 1.180; 95% CI: 0.905–1.538). Attending <5 visits was the most remarkable determinant of relapsing compared to attending 5–9 visits or ≥10 visits, both overall and by sex (p for trend: overall, p < 0.001; males, p = 0.007; and females, p < 0.001). Conclusions: Abstinence probability decreased over the 5‐year follow‐up but was relatively high. Males had higher abstinence rates than females in all follow‐up periods. Completeness of the intensive intervention was the main predictor of cessation. Clinical Relevance: Smoking cessation interventions should consider sex and incorporate strategies to increase adherence to obtain higher long‐term abstinence rates. [ABSTRACT FROM AUTHOR]

Objective This systematic review aimed to evaluate the scientific evidence on the efficacy of desensitizing mouthwashes for the treatment of dentin hypersensitivity ( DH) and root sensitivity ( RS). Material and methods A thorough search in MEDLINE, PubMed and Cochrane Plus Library was conducted up to February 2015. Randomized clinical trials, parallel, double-blinded and placebo-controlled, with a follow-up of at least 6 weeks, reporting changes on response to tactile stimuli, thermal/evaporative stimuli or patients' subjective assessment of the pain experienced during their daily life after the home use of desensitizing mouthwashes were considered for inclusion. Results The screening of titles and abstracts resulted in seven publications meeting the eligibility criteria. The desensitizing agents evaluated were potassium nitrate ( n = 5), aluminium lactate ( n = 1) and sodium fluoride ( n = 1). A meta-analysis for each of the hypersensitivity stimuli was performed. Results demonstrated statistically significant reduction in sensitivity scores favouring test group when DH was assessed by means of patients' self-reported pain experience ( SMD at 8 weeks = 0.77; 95% CI [0.23; 1.31]; P = 0.005). No significant effects were detected in response to tactile or thermal/evaporative stimuli. Meta-regression analysis demonstrated a tendency towards an increased effect favouring test group for the patients' subjective perception, whereas tactile and thermal/evaporative stimuli showed a slight tendency towards a reduction in the efficacy of the test mouthwash. Conclusions There exists a tendency towards a decrease in DH or RS scores with time in both treatment groups, with significant differences in favour of test group when sensitivity is evaluated in terms of patients' self-reported sensitivity symptoms. [ABSTRACT FROM AUTHOR]

Background and Objectives: First‐line treatment for trigeminal neuralgia (TN) is limited to carbamazepine and oxcarbazepine, and in refractory cases, alternatives are scarce. Lacosamide has been suggested as a valid option. In this study, we describe a series of patients who received oral lacosamide as treatment for TN after first‐line drug failure. Methods: In this retrospective descriptive cohort study, we included patients with refractory TN who attended a tertiary center between 2015 and 2021 and were prescribed oral lacosamide after first‐line treatment failure. The primary endpoints were pain relief and adverse effects. We secondarily analyzed clinical outcomes and compared responders versus nonresponders in the search for potential predictors of response. Results: Eighty‐six patients were included (mean age: 62 [SD 15.6] years; 54/86 [63%] female). The TN etiology was secondary in 16/86 (19%) patients. Concomitant continuous pain was present in 29/86 (34%) patients. The mean number of previous treatments was 2.7 [SD 1.5]. Pain relief was achieved in 57/86 (66%) cases, with 28/86 (33%) patients presenting adverse effects, all of which were mild. No statistically significant differences were observed between responders and nonresponders, but subtle clinical differences suggested potential predictors of response. Conclusion: Lacosamide may be an effective and relatively safe treatment for refractory pain in TN patients after first‐line treatment failure. [ABSTRACT FROM AUTHOR]

Background: The ABCDE bundle is a set of evidence‐based practices to systematically reduce the risks of sedation, delirium, and immobility in intensive care patients. Implementing the bundle improves clinical outcome. Aims and Objectives: To investigate the association between patient outcomes and compliance with bundle components ABC (analgosedation algorithms), D (delirium protocol), and E (early mobilization protocol). Design: A Spanish multicentre cohort study of adult patients receiving invasive mechanical ventilation (IMV) for ≥48 h until extubation. Methods: The primary outcome was pain level, cooperation to permit Medical Research Council Scale administration, patient days of delirium, and mobility. The secondary outcome was cumulative drug dosing by IMV days. Tertiary outcomes (ICU days, IMV days, bed rest days, ICU mortality, ICUAW) and independent variables (analgosedation, delirium, early mobilization protocols) were also studied. Results: Data were collected from 605 patients in 80 ICUs and 5214 patient days with IMV. Two‐thirds of the ICUs studied applied no protocols. Pain was not assessed on 83.6% of patient days. Patient cooperation made scale administration feasible on 20.7% of days. Delirium and immobility were found on 4.2% and 69.9% of days, respectively. Patients had shorter stays in ICUs with bundle protocols and fewer days of IMV in ICUs with delirium and mobilization bundle components (P = 0.006 and P = 0.03, respectively). Analgosedation protocols were associated with more opioid dosing (P = 0.02), and delirium and early mobilization protocols with more propofol (P = 0.001), dexmedetomidine (P = 0.001), and lower benzodiazepine dosing (P = 0.008). Conclusions: The implementation rate of ABCDE bundle components was very low in our Spanish setting, but when implemented, patients had a shorter ICU stay, more analgesia dosing, and lighter sedation. Relevance to clinical practice: Applying some but not all the bundle components, there is increased analgesia and light sedation drug use, decreased benzodiazepines, and increased patient cooperation and mobility, resulting in a shorter ICU stay and fewer days of IMV. [ABSTRACT FROM AUTHOR]

The present study investigates the precursors of representations of phonemes in 4.5‐month‐olds. The emergence of phonemes has been mainly studied within the framework of perceptual narrowing, that is, infants tuning to their native language and losing sensitivity to non‐native speech. One of the mechanisms behind this phenomenon is distributional learning. In this article, we tested the preference of 4.5‐month‐old infants using lists of pseudowords that resemble the vowel distribution of the native or a non‐native language. We found that infants prefer listening to the lists mirroring the native language. The results suggest that infants can extract vowel information from novel stimuli, and they can map it on pre‐existing knowledge on vowels that leads to a preference for the native lists. [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]

Aim: The aim of the study was to evaluate the psychological impact on nursing students at the end of period of confinement during the first wave of the COVID‐19 outbreak in Spain. Design: A cross‐sectional study reported in line with the STROBE guidelines. Methods: Nursing students were invited to complete an online questionnaire at the end of the 2019–2020 academic year using convenience sampling. The questionnaire collected data on sociodemographic factors, work, and life experiences in relation to COVID‐19, habits and lifestyle using the World Health Organization Five Well‐Being Index (WHO‐5) and the Generalized Anxiety disorder‐7 scale. Variables related to anxiety were analysed using multiple lineal regression analysis, Results: The prevalence of low psychological well‐being in the 203 students was 44.3% and of anxiety 55.7%. In the multivariate analysis the variables associated with anxiety were having worked in the pandemic, having had symptoms of COVID‐19 and having been afraid of getting infected. Conclusions: The levels of anxiety due to the COVID‐19 pandemic in nursing students have been high, and levels of psychological well‐being have been low. The fact of having worked during the pandemic, having had symptoms compatible with COVID‐19 or being afraid of getting infected are associated with the highest scores for anxiety. Relevance to clinical practice: This study gives more evidence on the psychological impact on nursing students during the first wave of the pandemic in Spain. This can be used to design anxiety management programmes for inclusion into teaching syllabuses. It also gives arguments for the setting up of psychological and emotional support services for these students and other healthcare professionals working during the pandemic. [ABSTRACT FROM AUTHOR]

Aims: Randomized controlled trials have demonstrated the efficacy of several dietary patterns plus physical activity to reduce diabetes onset in people with prediabetes. However, there is no evidence on the effect from the Mediterranean diet on the progression from prediabetes to diabetes. We aimed to evaluate the effect from high adherence to Mediterranean diet on the risk of diabetes in individuals with prediabetes. Methods: Prospective cohort study in Spanish Primary Care setting. A total of 1184 participants with prediabetes based on levels of fasting plasma glucose and/or glycated hemoglobin were followed up for a mean of 4.2 years. A total of 210 participants developed diabetes type 2 during the follow up. Hazard ratios of diabetes onset were estimated by Cox proportional regression models associated to high versus low/medium adherence to Mediterranean diet. Different propensity score methods were used to control for potential confounders. Results: Incidence rate of diabetes in participants with high versus low/medium adherence to Mediterranean diet was 2.9 versus 4.8 per 100 persons‐years. The hazard ratios adjusted for propensity score and by inverse probability weighting (IPW) had identical magnitude: 0.63 (95% confidence interval, 0.43–0.93). The hazard ratio in the adjusted model using propensity score matching 1:2 was 0.56 (95% confidence interval, 0.37–0.84). Conclusions: These propensity score analyses suggest that high adherence to Mediterranean diet reduces diabetes risk in people with prediabetes. [ABSTRACT FROM AUTHOR]

Introduction: Smokers are frequent users of healthcare services. Admissions to hospital can serve as a "teachable moment" for quitting smoking. Clinical guidelines recommend initiating smoking cessation services during hospitalization; however, in Southern European countries less than 5% of inpatients receive a brief intervention for smoking cessation. Objectives: The aims of this study were (i) to examine rates of smoking abstinence during and after hospitalization; (ii) to measure changes in smoking patterns among persons who continued smoking after discharge; and (iii) to identify predictors of abstinence during hospitalization and after discharge. Methods: A cohort study of a representative sample of current adult smokers hospitalized in two Spanish and two Portuguese hospitals. We surveyed smokers during hospitalization and recontacted them one month after discharge. We used a 25‐item ad hoc questionnaire regarding their smoking pattern, the smoking cessation intervention they have received during hospitalization, and hospital and sociodemographic characteristics. We performed a descriptive analysis using the chi‐square test and a multivariate logistic regression to characterize the participant, hospital, and smoking cessation intervention (5As model) characteristics associated with smoking abstinence. Results: Smoking patients from both countries presented high abstinence rates during hospitalization (Spain: 76.4%; Portugal: 70.2%); however, after discharge, their abstinence rates decreased to 55.3% and 46.8%, respectively. In Spain, smokers who tried to quit before hospital admission showed higher abstinence rates, and those who continued smoking reduced a mean of five cigarettes the number of cigarettes per day (p ≤ 0.001). In Portugal, abstinence rates were higher among women (p = 0.030), those not living with a smoker (p = 0.008), those admitted to medical‐surgical wards (p = 0.035), who consumed their first cigarette within 60 min after waking (p = 0.006), and those who were trying to quit before hospitalization (p = 0.043). Conclusions: Half of the smokers admitted into the Spanish hospitals are abstinent one month after discharge or have reduced their cigarettes per day. Nevertheless, success rates could be increased by implementing evidence‐based tobacco cessation programs at the organizational‐level, including post‐discharge active quitting smoking support. Clinical relevance: Three‐quarters of the inpatients who smoke remain abstinent during hospitalization and over half achieve to maintain their abstinence or at least reduce their consumption one month after discharge, proving that admission to hospitals is an excellent teachable moment to quit smoking. [ABSTRACT FROM AUTHOR]

Rationale aims and objectives: The available evidence on the use of heuristics and their relationship with diagnostic error in primary care is very limited. The aim of the study is to identify the use of unknown thought and specifically the possible use of Representativeness, Availability and overconfidence heuristics in the clinical practice of primary care physicians in cases of dyspnoea and to analyse their possible relationship with diagnostic error. Methods: A total of 371 patients consulting with new episodes of dyspnoea in Primary Care centres in Spain were registered. Based on specific operational definitions, the use of unconscious thinking and the use of heuristics during the diagnostic process were assessed. Subsequently, the association between their use and diagnostic error was analysed. Results: In 49.6% of cases, the confirmatory diagnosis coincided with the first diagnostic impression, suggesting the use of the representativeness heuristic in the diagnostic decision process. In 82.3% of the cases, the confirmatory diagnosis was among the three diagnostic hypotheses that were first identified by the general physicians, suggesting a possible use of the availability heuristic. In more than 50% of the cases, the physicians were overconfident in the certainty of their own diagnosis. Finally, a diagnostic error was identified in 9.9% of the recorded cases and no statistically significant correlation was found between the use of some unconscious thinking tools (such as the use of heuristics) and the diagnostic error. Conclusion: Unconscious thinking manifested through the acceptance of the first diagnostic impression and the use of heuristics is commonly used by primary care physicians in the clinical decision process in the face of new episodes of dyspnoea; however, its influence on diagnostic error is not significant. The proposed explicit and reproducible methodology may inspire further studies to confirm these results. [ABSTRACT FROM AUTHOR]

Purpose To assess the efficacy of petrolatum jelly for the prevention of diaper rash and to evaluate the relationship between the occurrence of diaper rash and certain treatments and type of nutrition. Design and Methods A randomized clinical trial was carried out with two parallel groups ( n = 213) at the neonatal care unit of Donostia University Hospital in San Sebastián, Guipuzcoa Province, Spain. Results There was a lower incidence of diaper rash in the experimental group with petrolatum jelly (17.1%) than the control group (22.2%), but the difference was not statistically significant ( p =.39). The use of antibiotics and oral 50% glucose as well as an increased number of stools are associated with a higher incidence of diaper rash, while breastfeeding and phototherapy are protective factors. Practice Implications Prevention is strengthened by a better understanding of the risk factors. [ABSTRACT FROM AUTHOR]

Purpose: To determine which nursing interventions are used in individuals with a digestive stoma and the relationships between nursing interventions used and sociodemographic and clinical variables. Methods: The present study is an observational, cross‐sectional, descriptive. Data from 102 individuals in the general surgery unit of a first‐level hospital (University Hospital Complex of Granada, Spain) were analyzed. Data on the use of nursing interventions and sociodemographic and clinical variables were collected. Univariate, bivariate, and multivariate data analyses were conducted. Findings: Interventions: Decision‐Making Support (5250) and Ostomy Care (0480) were the most prevalent interventions in the sample. The period of care (postoperative and follow‐up) was the most common significant variable (p < 0.05) among the interventions observed. Anxiety Reduction (5820), Nutritional Counseling (5246), Self‐Esteem Enhancement (5400), and Body Image Enhancement (5220) were also relevant findings. Conclusions: The present study contributes to determining which nursing interventions are used in individuals with a digestive stoma. Implications for nursing practice: This study could be useful in planning nursing interventions in individuals with a digestive stoma. [ABSTRACT FROM AUTHOR]

Background: The situation of the COVID‐19 global pandemic has generated an unprecedented state of emergency worldwide that has had a psychological impact on health care workers working in the ICU and this has created the need to implement different psychological strategies. Aim: This study explores (a) the prevalence of symptoms associated with generalized anxiety disorder (GAD), (b) the relationship between GAD symptoms and resilience skills, and (c) which of the resilience skills were associated with a probable GAD among the ICU professionals during the COVID‐19 pandemic. Study design Cross‐sectional survey design. Methods: We explored anxiety and resilience in 448 ICU health care workers using an online survey. Results: The participants showed high resilience levels and more than half of them presented symptoms consistent with a possible diagnosis of GAD. The GAD symptoms were more prevalent among women, nursing assistants, interns, staff who worked on rotation and health care workers who had to attend to more than 20 COVID patients. Significant negative correlations between resilience skills and GAD symptoms were found. The multiple regression analysis showed that resilience skills contribute to 14.4% of the variance for GAD symptoms. The binary logistic regression showed that the only skill that had a significant and negative predictive effect was "I usually take things in my stride" (OR = 0.774, 95% CI 0.67, 0.88; P =.000). This ability was the differentiating skill between professionals who equal or exceed the cut‐off point established for the diagnosis of a probable GAD regarding those who do not. Conclusion: ICU professionals developed symptoms consistent with a possible diagnosis of GAD due to their exposure to extremely stressful circumstances. However, resilience skills acted as a protective factor. Relevance to clinical practice: The importance of incorporating programmes that mitigate these psychological effects and to promote adaptive coping styles during pandemics has become a need after what ICU professionals have gone through. [ABSTRACT FROM AUTHOR]

In relative performance evaluation systems, appraisers may choose to adopt stricter or laxer evaluation criteria. When laxer (vs. stricter) criteria are used, higher absolute performance evaluations become easier (vs. harder) to achieve. Thus, each appraisee's absolute performance feedback and the mean of the distribution of absolute performance feedback are shifted upward (vs. downward). Yet, relative performance remains constant. When evaluation outcomes depend solely on relative performance, can the adoption of laxer (vs. stricter) criteria-leading to higher absolute performance feedback but no change in relative performance-influence appraisees' satisfaction with performance? Despite the ubiquity of such systems in organizations, research has not addressed this question. This article points to an important gap between practitioners' beliefs and research findings. We show that while most appraisers believe that higher absolute performance feedback will automatically result in more satisfaction with performance, the opposite may also happen. Specifically, we find that appraisees with a stronger (vs. weaker) chronic or contextual need to engage in social comparison are more satisfied with lower (vs. higher) absolute performance feedback. Overall, we demonstrate why and how feedback interventions in relative performance evaluation systems may backfire, and suggest a set of practical guidelines for maximizing appraisees' satisfaction with performance in such systems. © 2015 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore cross‐level mechanisms stimulating employees' innovative behavior in small firms, specifically emotional contagion between small business owners and their employees. Using data from three European countries and applying a multilevel approach, we tested how small business owners' work‐related affect—enthusiasm and comfort—relate to their employees' work‐related affect and innovative work behavior. The sample consisted of 85 small business owners and 711 employees from firms operating in the Netherlands, Poland, and Spain. Controlling for country, the results of multilevel modeling showed that small business owners' work‐related affect was positively related to their employees' work‐related affect. The hypothesized contagion of work‐related affect in small firms was, thus, supported. Employees' work‐related affect, in turn, was positively associated with their innovative behavior. Employees' work‐related affect mediated the relationship between small business owners' work‐related affect and employees' innovative behavior. The results also showed cross‐country differences in the strength of some of the relationships. The study is a step forward in understanding innovation in small firms, extending the insights gained from single‐level investigations. [ABSTRACT FROM AUTHOR]

Objective: Objective of this study is to explore the most prevalent pathologies of the population received in the Spanish coast and to know the nursing prehospital interventions required, as well as the treatments applied and their follow‐ups. Design and Measures: A descriptive and retrospective study. Sample: A total of 481 immigrants cared for by the Red Cross in the study period. Results: Dermatological pathologies were more frequent in men (32.1). In women, the most prevalent pathology was headache (19%). According to age, dermatological pathologies prevail in those over 18 years of age (31.9%) and in children, respiratory pathologies (42.9%). Relationships were found statistically significant between gender and type of disease and between specifying or not nursing interventions (p <.001). Age was also related to the type of diagnosis and the type of nursing interventions to be carried out (p <.001). Conclusion: In general, a good state of health was considered in the migrants, concluding that knowing the pathologies or activities to be carried out according to the sociodemographic variables would help improve the quality of the assistance. [ABSTRACT FROM AUTHOR]

Advances in the research of work performance have been due in large part to the conceptualization of performance as a multidimensional construct. Recently, Griffin, Neal, and Parker (2007), have identified three different dimensions of work role performance: proficiency, adaptivity, and proactivity. Social effectiveness constructs (i.e., political skill) have been receiving increased attention in research and there have been recent calls for further research in the area. This study compares the explanatory capacity of political skill, professional experience and intrinsic motivation in the prediction of engineers' proficiency, adaptivity, and proactivity. The relationships were tested with structural equations analysis of 180 supervisor-engineer dyad data. Results indicate that the three dimensions of individual work performance are significantly influenced by political skill and professional experience, but not by intrinsic motivation. The results also indicate that political skill is the strongest predictor. © 2014 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Background: Patients with alcohol use disorder (AUD) are likely to suffer disproportionate harms related to the COVID‐19 pandemic and related policy measures. While many surveys have been conducted, most are focused on drinking changes in the general population and validation with biological markers is lacking. Method: We performed a retrospective cohort study among patients with AUD attending a urine drug screening program. With mixed‐effects logistic regression models, we assessed the probability of screening positive for ethyl glucuronide according to patients' main clinical characteristics and time of analysis (either prior to or after a lockdown was implemented in Spain). Results: A total of 362 patients provided 2,040 urine samples (1,295 prior to lockdown, 745 during lockdown). The mean age of participants was 52.0 years (SD 12.6), and 69.2% were men. Of the 43% of patients tested for other drugs 22% screened positive. After adjusting for all covariates, the odds of screening positive for ethyl glucuronide during lockdown almost doubled (OR = 1.99, 95% CI 1.20 to 3.33, p = 0.008). Other significant covariates included testing positive for other drugs (OR = 10.79, 95% CI 4.60 to 26.97) and length of treatment (OR = 0.59, 95% CI 0.47 to 0.74). Conclusions: Our data support an association between the lockdown due to COVID‐19 and increased alcohol use in patients with AUD. Thus, addiction healthcare systems could face significant challenges ahead. In light of these findings, it is essential to evaluate prospectively how patients with AUD are affected by the pandemic and how health systems respond to their needs. [ABSTRACT FROM AUTHOR]

Background: The objective of this study is to assess the prevalence of visual impairment and visual care practices and its association with socioeconomic conditions in the infant population in Catalonia. Methods: The Catalan Institute of Statistics provided a random sample of 0 to 14‐year‐old non‐institutionalized children whose parents were interviewed in a continuous health survey from 2011 to 2015 in Catalonia. A multistage stratified and random sampling procedure considering age, sex, county and town was followed. All results have been weighted according to the sample design and are presented as the proportion of the condition with its 95% confidence limits. Chi‐square tests were performed to evaluate the association between categorical variables. To study the association of visual care with independent variables, a multiple logistic regression model was used. Results: In 0 to 14‐year‐old children, a 12.9% (95% confidence interval [CI] [11.8–13.9]) prevalence of correctable visual impairment was observed. The prevalence of non‐correctable visual impairment was 0.9% (95% CI [0.6–1.2]). Non‐correctable visual impairment was more prevalent in families with lower education levels, manual professions or unemployed. Of children without visual impairment, 13,5% (95% CI:12.3–14.6) visited a visual care professional in the last 12 months while this proportion was 67.4% (95% CI [63.3–71.5]) among those with correctable visual impairment. When parents have a university degree or non‐manual professions, a higher level of visual care was observed. In children with correctable visual impairment, visual reviews were more frequent when parents are employed in a non‐manual profession. Conclusions: For the first time, indicators related to visual impairment in children in Catalonia have been recorded. There is an association between lower socioeconomic status and having non‐correctable visual impairment, and conversely, having correctable visual impairment was significantly associated with employed parents. More visual care is associated with higher socioeconomic status. [ABSTRACT FROM AUTHOR]

Introduction: Evidence of an association between periodontitis and MetS (metabolic syndrome) remains controversial. The objective of this study is to evaluate the association between periodontitis and MetS in a cross‐sectional population survey. Material and Methods: WORALTH (Workers' ORAL healTH) Study is a cross‐sectional survey, conducted on a representative sample of the Spanish employed population, including 5154 participants. An oral examination following the World Health Organization (WHO) criteria evaluated the periodontal status using the Community Periodontal Index (CPI) and Clinical Attachment Levels (CAL). Logistic regression analysis with adjustment for potential confounders was used to evaluate the association between periodontitis and MetS, and its individual components. Results: Participants presenting a CPI = 4 were more likely to have MetS than subjects with CPI < 4 [odds ratio, OR = 1.41; 95% confidence interval (CI) 1.10–1.81; p < 0.001]. High blood pressure was the component with stronger association with periodontal status (OR = 1.94 for CAL ≥6 mm; 95% CI 1.49–2.53; p < 0.001). After stratifying for sex, the association was higher in women (OR = 2.20 for CPI = 4; 95% CI 1.31–3.62; p < 0.001). Non‐metabolically healthy subjects, obese or not, presented a worse periodontal condition. Conclusion: Severe periodontitis (CPI = 4) was associated with MetS in a representative sample of the Spanish employed population. This association seems to be independent of body mass index and other potential confounders. [ABSTRACT FROM AUTHOR]

The article offers information on COVID-19 in patients with hematological malignancies. Topics icnlude the patients with cancer have a higher susceptibility to infections due to their immunosuppression state caused by the malignancy itself or by antineoplastic treatments, and the infections has caused by community respiratory viruses had been associated with poor outcome in patients with hematological malignancies.

Background: Heavy drinking (HD) and binge drinking (BD) exhibit marked differences in their relationships with contextual‐level factors imbedded in geographical areas of residence. The objective is to identify sociodemographic factors, both at the individual and at the contextual level, associated with these 2 main hazardous consumption patterns. Methods: Cross‐sectional study using data from the 2011 to 2012 National Health Survey in Spain. The sample included 21,007 individuals ≥15 years of age. HD was defined as an alcohol intake of ≥40 g/d in men and ≥24 g/d in women. BD was defined as the consumption in the previous month of ≥6 alcoholic drinks (men) or ≥5 drinks (women) within 4 to 6 hours. Individual‐level variables included sociodemographic factors, urban/rural residence, smoking, and perceived social support. Contextual‐level variables covered percentage of population with no schooling, unemployment rate, and hospitality industry‐related economic activity, all at the census tract level. We analyzed data using multilevel logistic regression and calculated areas under the curve (AUC). Results: Being male, smoking, high‐income, and low perceived social support were associated with both hazardous drinking patterns. Younger individuals were at higher risk for BD but at lower risk for HD. BD was more common among rural than urban dwellers (odds ratios [OR] = 1.35; 95% CI: 1.05 to 1.72), whereas HD was less likely in participants residing in areas with high unemployment rates (OR = 0.62; 95% CI: 0.41 to 0.93). HD was more likely in census tracts with higher levels of hospitality industry activity (OR = 1.74; 95% CI: 1.20 to 2.54). The AUC increased substantially for both HD and BD when the census tract variable was entered in the respective models (reaching 89.5 and 93.3%, respectively). Conclusions: Except for age, both drinking patterns have similar associations with individual‐level variables but disparate links to contextual‐level indicators. In both cases, accounting for area of residence substantially increased the ability to discriminate between high‐risk drinkers from nonhazardous alcohol consumers. [ABSTRACT FROM AUTHOR]

Background and Aims: Guidelines recommend the 5As model of brief intervention for providing smoking cessation support in clinical settings. This study assessed patient and hospital characteristics associated with self‐reported receipt of the 5As (ask, advise, assess, assist and arrange). Design Multi‐center cross‐sectional study. Setting and participants: Adult inpatients (n = 1047) were randomly selected from 13 hospitals in the Barcelona province of Spain in 2014–2015. Measurements We explored participants' receipt of the 5As through a questionnaire. Given the progressiveness of the 5As, we recoded the fulfillment of the intervention as: A0: no intervention; A1: ask; A2: ask and advise; A3: A2 and assess; A4: A3 and assist; and A5: A4 and arrange a follow‐up. We explored patient (e.g. age, sex, comorbidities) and hospital (e.g. type of hospital, unit) characteristics. We adjusted multi‐level robust Poisson regression models to estimate the adjusted prevalence ratios (aPR) of the association between the recoded 5As intervention received. Findings A total of 60.4% (n = 624) of patients had been asked (A1) about their smoking status. Among smokers, 46.5% (n = 90) were advised (A2), 26.6% (n = 48) assessed (A3) and 4.6% (n = 10) received all the components of the 5As (A5). Middle‐aged smokers [aPR = 3.63; 95% confidence interval (CI) = 1.69–7.79] with a respiratory disease (aPR = 2.19; 95% CI = 1.11–4.34) were most likely to have been asked, advised and assessed (A3). The cessation intervention was most frequently performed by physicians. Conclusions: In the Barcelona province of Spain, it appears that fewer than half of hospitalized patients who smoke were advised to quit and few received the full 'five As' brief intervention for smoking cessation. [ABSTRACT FROM AUTHOR]

Introduction: Nurses play an important part in the education of patients with HF. To prepare patients with HF for self‐care maintenance behaviours, nurses must have knowledge of basic self‐care maintenance principles. Aim study: The aim of this study was to determine the degree of knowledge of primary care (PC) nurses on the principles of self‐management of HF and variables associated with this. Methodology: This is an observational, cross‐sectional descriptive study, carried out in 2014, in the city of Barcelona (Catalonia). Nurses' Knowledge of Heart Failure Education Principles questionnaire (NKHFEP) was used to assess the principles of HF self‐care education. Instrument items assess knowledge of nurses on 5 themes: diet, liquids/weight, worsening signs or symptoms, medication and exercise. Factors related to adequate knowledge were evaluated. Results: Of 216 PC nurses, who completed the questionnaire, the average score was 15.6 (SD: 2.2). Only 36 (16.7%) obtained an adequate level of knowledge and defined as a score ≥ 18 points. In multivariate logistic regression, nurse factors associated with an adequate knowledge of principles of self‐care of HF were having achieved a PhD degree (OR: 36.4, 95% CI: 2.8–468.2, p = 0.006) and previous specific training in HF (OR: 19.8, 95% CI: 1.4–279.3, p = 0.026). Conclusions: The degree of knowledge of PC nurses in the principles of self‐care in HF was higher among nurses who had completed the doctorate and in nurses who had received specific training in HF. [ABSTRACT FROM AUTHOR]

The time‐loss definition of injury is commonly adopted in epidemiological groin‐injury studies in football, with a significant risk of underestimating the impact of these injuries. This study investigated the extent of groin problems, beyond the time‐loss approach, over a full Spanish football season. Players from 17 amateur male teams were followed over 39 consecutive weeks. Groin‐injury time loss and self‐reported groin pain, irrespective of time loss, were combined to calculate the average weekly prevalence of all groin problems with or without time loss. A subscale measuring hip‐ and groin‐related sporting function from the Copenhagen Hip and Groin Outcome Score questionnaire (HAGOS, Sport/Rec) was registered every 4 weeks. In total, 407 players participated in the study. The average (range) weekly prevalence of all groin problems was 11.7% (7.2%‐20.8%); 1.3% with time loss (0.0%‐3.2%) and 10.4% without time loss (6.3%‐17.6%). Players with groin problems reported lower scores (mean difference) on the HAGOS, Sport/Rec subscale compared with players without (−19.5 [95% CI: −20.7 to −18.4]), while there was no difference between players reporting groin problems with and without time loss (4.0 [95% CI: −1.1 to 9.1]). The traditional time‐loss measure only captured 10% of all groin problems. Hip‐ and groin‐related sporting function was not different between players reporting groin problems with or without time loss, suggesting the reason for continuing to play is not only related to the severity of symptoms. These findings question the judicious use of the time‐loss approach in overuse conditions, such as groin pain in footballers. [ABSTRACT FROM AUTHOR]

Background: Heart failure (HF) causes high rates of hospital admissions. It is known that disease progression impacts the health‐related quality of life (HRQoL) of both patients and caregivers, yet to date, this finding is based on cross‐sectional studies with limited samples. Objectives: The study aim is to analyze the relationship between HF patients' use of hospital services (a proxy for disease progression) and the HRQoL of their family caregivers. Methods: This work is a multicenter nested case‐control study on a population of patients admitted to hospitals in southern Spain due to heart failure. The sample comprised 530 patient‐caregiver dyads. Hospital admission data were retrospectively collected for the 5 years prior to inclusion in the study. Bivariate analyses and multivariate logistic regression were used to determine associations between patient deterioration and caregivers' quality of life. Results: Patients' use of hospital services was associated with worsened quality of life for family caregivers, with an overall OR of 1.48 (95% CI: 1.23‐1.79). A positive correlation was found between patients' perceptions of their physical health and the perceived mental health of caregivers (r = 0.127, p = 0.004) and between the perceived mental health of both (r = 0.291; p <0.0001). Conclusions: Greater use of hospital services by patients with HF is an independent predictor of deterioration of family caregivers' HRQoL. The physical and mental components of patients' and their family caregivers' HRQoL interact and influence each other. Additional factors, such as the nature and intensity of care provided, also determine the worsening of a family caregiver's HRQoL. Clinical Relevance: These results can be used to identify family caregivers of people with heart failure at risk of suffering a deterioration in their health‐related quality of life. Increased use of hospital services is an independent predictor of the deterioration of the family caregivers' health‐related quality of life. Since clinical nurses are the main provider who gives support and education to family caregivers, they should be alert to this situation and individualize interventions to prevent this deterioration. [ABSTRACT FROM AUTHOR]

Aim: To compare Spanish nursing students' and registered nurses' perception of professional values from the perspective of gender and professional experience. Background: Nursing has traditionally been a female profession; however, the analysis of professional nursing values from a gender perspective has received little attention. The integration of professional values typically begins during academic life and is, thereafter, reinforced during professional activities. Methods: A descriptive cross‐sectional study was conducted with 159 students (97.4% females) and 386 registered nurses (86.8% females) from primary healthcare centres, hospitals and management positions within the public health system. The validated Spanish adaptation of the Nurses Professional Values Scale was used. This instrument measures three dimensions: ethics, commitment and professional mastery. Descriptive statistics were used to analyse the data, together with bivariate analysis using the chi‐squared test. Results: Females granted more importance to professional values. Important gender differences among students were detected. Ethical values were considered to be the most important for both students and nurses, followed by professional mastery and commitment. The importance given to values progressively decreased in the groups under study: students, less‐experienced nurses and expert nurses (in decreasing order). Conclusions: Significant gender differences exist with regard to professional nursing values. The values related to professional commitment and mastery should be integrated and promoted during academic education and specifically focus on male students' perceptions. As professional experience increases, the importance attributed to professional values decreases. Implications for Nursing Policy: Professional nursing values should be promoted among universities, health services and professional organizations, encouraging their dissemination, implementation and evaluation. [ABSTRACT FROM AUTHOR]

BACKGROUND: This study examined the combined influence of gender variables (specifically gender stereotypes, sexism, and genderism/transphobia) as well as racism/xenophobia and attitudes toward bullying roles on gender‐bashing. METHODS: A trans‐cultural sample of 2410 Spanish and Portuguese students participated in the study (mean age = 15.13). Structural equation modeling and multiple group analyses were used to examine the relationships among variables. RESULTS: The model revealed a good fit with the data for the whole sample. Results showed that instrumentality, hostile sexism, genderism/transphobia, racism/xenophobia, and positive attitudes toward the bully were positively correlated with gender‐bashing. An inverse pattern was also observed: expressiveness, benevolent sexism, and positive attitudes toward the defender were negatively correlated with gender‐bashing. Overall, the eight variables explained 48% of the variance of gender‐bashing. Structural relationships among the assessed constructs were equivalent for girls and boys, and for Spain and Portugal. CONCLUSIONS: These results reveal the need to implement inclusive educational policies to improve school health, which promote expressiveness, egalitarian attitudes, and sexual and cultural diversity. [ABSTRACT FROM AUTHOR]

Background/aim: Cocaine consumption may result in irreversible structural changes in the brain. The long‐term effects of cocaine are related to a wide range of deteriorated cognitive functions. This study aimed to examine the fine motor control and hand‐function in cocaine users compared to healthy controls. Methods: An observational study was conducted. Sociodemographic variables, substance consumption, the Purdue Pegboard and the Jebsen–Taylor Hand‐function Test were evaluated bilaterally in 35 participants who were cocaine users and in 35 healthy participants. Differences between sides (dominant and non‐dominant hands) and groups were analysed with analysis of variance (ANOVA). Results: The ANOVA revealed significant differences between groups (P < 0.001) and between sides (dominant and non‐dominant hands) (P = 0.005) for the one‐hand pin placement subtest of the Purdue Pegboard Test. Also, ANOVA tests showed significant differences between sides, but not groups, for the simulated feeding (P < 0.001) and stacking checkers (P < 0.001) Jebsen–Taylor subtests. Cocaine user participants exhibited significantly lower scores in bilateral pin placement and required more time for the Jebsen–Taylor subtests compared to healthy participants. Conclusions: Cocaine user participants display deficits of fine motor control and some aspects of manual dexterity when compared to healthy controls. These findings show the convenience of incorporating functional rehabilitation by occupational therapists as a key component within the treatment of cocaine users. This study therefore opens a new field of practice for occupational therapy based on the assessment and treatment of motor deficits in the hand and the upper limb of people who consume cocaine. [ABSTRACT FROM AUTHOR]

BACKGROUND: Based on Mayer and Salovey's model of emotional intelligence, this study examined whether perceived stress mediates the interplay of emotional intelligence and life satisfaction for girls and boys during early and middle adolescence. METHODS: Using multigroup structural equation modeling with questionnaire data from a sample of Spanish adolescent students (N = 800; MAgeT1 = 14.02, MAgeT2 = 15.00, SD = 1.21) in 2 waves (T1 = March 2015; T2 = December 2015). RESULTS: Results of multigroup structural equation modeling indicated no group differences between boys and girls in early adolescence (7th and 8th grade) and middle adolescence (9th and 10th grade), as stress function as mediator between emotional intelligence and life satisfaction for all groups. However, latent mean comparison indicated that girls not only perceive and understand emotions better than boys, but they also perceive higher amounts of stress at an older age. CONCLUSION: Results indicate the potential risk of perceived stress that might drop the protective effect of emotional intelligence on life satisfaction. These findings have implications for future research and educational practice considering combined prevention programs for adolescent's health and well‐being. [ABSTRACT FROM AUTHOR]

Background and aims: The World Health Organization's (WHO's) proposed International Classification of Diseases, 11th edition (ICD‐11) includes several major revisions to substance use disorder (SUD) diagnoses. It is essential to ensure the consistency of within‐subject diagnostic findings throughout countries, languages and cultures. To date, agreement analyses between different SUD diagnostic systems have largely been based in high‐income countries and clinical samples rather than general population samples. We aimed to evaluate the prevalence of, and concordance between diagnoses using the ICD‐11, The WHO's ICD 10th edition (ICD‐10) and the Diagnostic and Statistical Manual of Mental Disorders, 4th and 5th editions (DSM‐IV, DSM‐5); the prevalence of disaggregated ICD‐10 and ICD‐11 symptoms; and variation in clinical features across diagnostic groups. Design Cross‐sectional household surveys. Setting: Representative surveys of the general population in 10 countries (Argentina, Australia, Brazil, Colombia, Iraq, Northern Ireland, Poland, Portugal, Romania and Spain) of the World Mental Health Survey Initiative. Participants: Questions about SUDs were asked of 12 182 regular alcohol users and 1788 cannabis users. Measurements Each survey used the World Mental Health Survey Initiative version of the WHO Composite International Diagnostic Interview version 3.0 (WMH‐CIDI). Findings Among regular alcohol users, prevalence (95% confidence interval) of life‐time ICD‐11 alcohol harmful use and dependence were 21.6% (20.5–22.6%) and 7.0% (6.4–7.7%), respectively. Among cannabis users, 9.3% (7.4–11.1%) met criteria for ICD‐11 harmful use and 3.2% (2.3–4.0%) for dependence. For both substances, all comparisons of ICD‐11 with ICD‐10 and DSM‐IV showed excellent concordance (all κ ≥ 0.9). Concordance between ICD‐11 and DSM‐5 ranged from good (for SUD and comparisons of dependence and severe SUD) to poor (for comparisons of harmful use and mild SUD). Very low endorsement rates were observed for new ICD‐11 feature for harmful use ('harm to others'). Minimal variation in clinical features was observed across diagnostic systems. Conclusions: The World Health Organization's proposed International Classification of Diseases, 11th edition (ICD‐11) classifications for substance use disorder diagnoses are highly consistent with the ICD 10th edition and the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM‐IV). Concordance between ICD‐11 and the DSM 5th edition (DSM‐5) varies, due largely to low levels of agreement for the ICD harmful use and DSM‐5 mild use disorder. Diagnostic validity of self‐reported 'harm to others' is questionable. [ABSTRACT FROM AUTHOR]

PURPOSE: To estimate the prevalence of Grieving, risk for Complicated Grieving, and Complicated Grieving in the primary care setting. METHODS: Retrospective epidemiological study, analyzing data from electronic health records (EHR). FINDINGS: A total of 84% of the 9,063 records had diagnostic labels without defining characteristics, related factors, or risk factors. A larger frequency of complicated grieving was found in deceased mourners. CONCLUSIONS: The grieving epidemiology opens new chances for the research using data from EHR. PRACTICE IMPLICATIONS: The adequacy of the records is essential to develop a profile of the patient at risk of complications after the loss. This research is an important step to build an epidemiological basis for nursing diagnosis of grieving in the primary health care setting. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To assess the cost‐effectiveness of alternative smoking cessation scenarios from the perspective of the Spanish National Health Service (NHS). Design: We used the European study on Quantifying Utility of Investment in Protection from Tobacco model (EQUIPTMOD), a Markov‐based state transition economic model, to estimate the return on investment (ROI) of: (a) the current provision of smoking cessation services (brief physician advice and printed self‐helped material + smoking ban and tobacco duty at current levels); and (b) four alternative scenarios to complement the current provision: coverage of proactive telephone calls; nicotine replacement therapy (mono and combo) [prescription nicotine replacement therapy (Rx NRT)]; varenicline (standard duration); or bupropion. A rate of 3% was used to discount life‐time costs and benefits. Setting: Spain. Participants: Adult smoking population (16+ years). Measurements: Health‐care costs associated with treatment of smoking attributable diseases (lung cancer, coronary heart disease, chronic obstructive pulmonary infection and stroke); intervention costs; quality‐adjusted life years (QALYs). Costs and outcomes were summarized using various ROI estimates. Findings: The cost of implementing the current provision of smoking cessation services is approximately €61 million in the current year. This translates to 18 quitters per 1000 smokers and a life‐time benefit–cost ratio of 5, compared with no such provision. All alternative scenarios were dominant (cost‐saving: less expensive to run and generated more QALYs) from the life‐time perspective, compared with the current provision. The life‐time benefit–cost ratios were: 1.87 (proactive telephone calls); 1.17 (Rx NRT); 2.40 (varenicline‐standard duration); and bupropion (2.18). The results remained robust in the sensitivity analysis. Conclusions: According to the EQUIPTMOD modelling tool it would be cost‐effective for the Spanish authorities to expand the reach of existing GP brief interventions for smoking cessation, provide pro‐active telephone support, and reimburse smoking cessation medication to smokers trying to stop. Such policies would more than pay for themselves in the long run. [ABSTRACT FROM AUTHOR]

ABSTRACT The A(H1N1)pdm09 influenza virus reached pandemic level in Spain in 2009, prompting a national vaccination campaign. To avoid transmission to patients, healthcare professionals' vaccination against pandemic influenza is crucial. The main objective of this study was to analyze factors associated with the failure by healthcare professionals to accept the pandemic vaccination in 2009. A cross-sectional survey was conducted of healthcare professionals in seven of Spain's autonomous regions. A questionnaire was used to collect information about personal and professional details, the respondents' flu vaccination status in the 2008-2009 and 2009-2010 seasons (seasonal and pandemic vaccines), and their knowledge and attitudes. A total of 1,661 professionals completed the survey. In the 2009-2010 season, 38.2% had both the seasonal and the pandemic vaccine, 22.1% had had only the seasonal, and 4.7% only the pandemic vaccine. The strongest predictor of not receiving the pandemic vaccine was not having had seasonal vaccinations in that year or the previous year. Those who had not received the pandemic vaccine were more often female; nurses; under 45; denied contact with at-risk groups; and had negative beliefs about the vaccine effectiveness and little concern for getting the disease, being infected at work, or passing it on to patients. It would be prudent to direct preventive campaigns not only at individuals at risk of catching flu but also at health professionals with a negative view of flu vaccine, with a particular focus on nurses, who have a key role in recommending flu vaccine. [ABSTRACT FROM AUTHOR]

Objectives The objective of this study was to seek correlates of immune protection in HIV infection. We sought to elucidate the association between the presence of human leucocyte antigen ( HLA) alleles, as well as killer immunoglobulin receptor ( KIR) genotypes, and the susceptibility to HIV infection in a Spanish cohort of HIV-exposed seronegative ( HESN) individuals. Methods A total of 152 individuals were evaluated: 29 HESN individuals in stable heterosexual relationships with an HIV-infected partner admitting high-risk sexual intercourse for at least 12 months prior to inclusion in the study, 61 HIV-infected patients and 62 healthy controls. HLA class I and II alleles and KIR genotypes were assessed in genomic DNA from all individuals in the study by polymerase chain reaction−sequence-specific oligonucleotide ( PCR- SSO) using bead array technology. Results HESN individuals showed a higher prevalence of HLA-A3 (62%) and HLA-B44 (83%) supertypes compared with HIV-infected individuals (42% and 66%, respectively). Regarding specific HLA alleles, HESN individuals had a higher prevalence of HLA-A*33:01, DRB1*04 and DQB1*03:02 alleles (14%, 34% and 31%, respectively) and a lower prevalence of the HLA-A*02:01 allele (27%) than HIV-infected patients (3%, 15%, 11% and 52%, respectively; P < 0.05). Interestingly, in a multivariate analysis, only the presence of DQB1*03:02 and the absence of A*02:01 alleles were independently associated with HESN status [odds ratio ( OR) 3.4 (95% confidence interval ( CI) 1.1-10.5) and 0.4 (95% CI: 0.1-0.9), respectively; P < 0.05]. No KIR genotype was associated with susceptibility to HIV infection. Conclusions Our data showed that the presence of the HLA class II allele DQB1*03:02 was a correlate of immune protection against HIV infection, while the presence of the HLA class I allele A*02:01 was associated with being infected with HIV. [ABSTRACT FROM AUTHOR]