Search

Accessible summary: What is known on the subject?: AHDs in mental health are fundamental tools in advance care planning processes. It is an important method for involving mental healthcare users in clinical decisions and in providing effective healthcare based around user preferences.AHDs can be applied in situations in which the person may forfeit their legal capacity, according to the Convention on the Rights of Persons with Disabilities.However, the use of AHDs as described above is not yet a reality in Spain. What the paper adds to existing knowledge?: The present study surveys the knowledge and attitudes of mental healthcare providers towards AHDs in clinical practice.Although providers had a moderate–low level of knowledge about AHDs, they presented positive attitudes towards them. What are the implications for practice?: The use of AHDs in mental healthcare practice poses challenges to the Spanish mental healthcare system. Acquiring up‐to‐date data on the knowledge and attitudes of providers towards AHDs allows organizations to address aspects of their service that require reinforcement. This data could also be used by other countries just starting to use AHDs, as an initial step towards supporting the implementation of a multistage intervention process.More in‐depth training for providers would help improve their competence to implement or honour the statements set out in AHDs, the related legal and ethical issues, and liability issues related to their implementation.The Spanish mental healthcare system requires structural changes so that providers can embrace new ways of relating to users and to organize partnerships and a continuity of care centred on user preferences. Introduction: Advance healthcare directives (AHDs) in mental health offer important information regarding service users' preferences. However, whether AHDs are truly understood by providers is questionable. Aim: To survey the knowledge and attitudes of mental health professionals towards AHDs and examine any associations with sociodemographic and occupational variables. Method: We cross‐sectionally surveyed the knowledge and attitudes of 113 mental health professionals by using two validated questionnaires. Results: Participants showed very positive attitudes and high levels of knowledge about the conceptual definition and application of AHDs in clinical practice but their knowledge of the legalities, procedure and registration of AHDs was poor. Working in a community, having a career specializing in mental health or having personally signed an AHD was associated with enhanced knowledge about them. Moreover, female sex or employment as an auxiliary nursing‐care technician was associated with stronger positive attitudes. Discussion: Legal and structural changes will be needed to implement AHDs in Spain and to promote competence among healthcare providers in order to include AHDs in everyday practice. Implications for practice: The Spanish mental healthcare system requires legal and structural changes and must improve healthcare providers' competence in AHDs before they are implemented. [ABSTRACT FROM AUTHOR]

There is overwhelming consensus among policy makers, academics, and professionals about the need to support families in their childrearing tasks. Consequently, European countries have been encouraged to develop family support interventions aimed at guaranteeing children's rights, targeting particularly those children in situations of psychosocial risk. While a certain amount of evidence exists regarding how family support is generally delivered in certain European countries, with a particular focus on parenting initiatives, this paper aims to take existing evidence one step further by providing an updated review focusing on two core components of the Council of Europe's Recommendation on Positive Parenting: families at psychosocial risk as the target population, and family education and support initiatives as the delivery format. The scope of the study was therefore broad, in both geographical and conceptual terms. An online survey was conducted with experts from 19 European countries to gather information regarding how they perceive family education and support initiatives for families at psychosocial risk. Both quantitative and qualitative data were analysed by computing frequencies/percentages and by following a thematic synthesis method, respectively. The results revealed both similarities and disparities as regards provider profiles, intervention characteristics, and quality standards. Practical implications are discussed, such as the need to diversify initiatives for at‐risk families in accordance with the tenets of progressive universalism, the ongoing need for an evidence‐based, pluralistic approach to programmes, and the skills and qualifications required in the family support workforce. This study constitutes a first step towards building a common family support framework at a European level, which would encompass family support and parenting policies aimed at families at psychosocial risk. [ABSTRACT FROM AUTHOR]

Purpose: This paper studies the relationship between computed tomography (CT) scan on admission, according to Marshall’s tomographic classification, and quality-of-life (QoL) after 1 year in patients admitted to the Intensive Care Unit (ICU) with traumatic brain injury (TBI). Methods: This study used validated scales including the Glasgow Outcome Scale and the PAECC (Project for the Epidemiologic Analysis of Critical Care Patients) QoL questionnaire. Results: We enrolled 531 patients. After 1 year, 171 patients (32.2%) had died (missing data = 6.6%). Good recovery was seen in 22.7% of the patients, while 20% presented moderate disability. The PAECC score after 1 year was 9.43 ± 8.72 points (high deterioration). Patients with diffuse injury I had a mean of 5.08 points vs 7.82 in those with diffuse injury II, 11.76 in those with diffuse injury III and 19.29 in those with diffuse injury IV (p< 0.001). Multivariate analysis found that QoL after 1 year was associated with CT Marshall classification, depth of coma, age, length of stay, spinal injury and tracheostomy. Conclusions: Patients with TBI had a high mortality rate 1 year after admission, deterioration in QoL and significant impairment of functional status, although more than 40% were normal or self-sufficient. QoL after 1 year was strongly related to cranial CT findings on admission. [ABSTRACT FROM PUBLISHER]

Evidence on trends in prevalence of disease and disability can clarify whether countries are experiencing a compression or expansion of morbidity. An expansion of morbidity, as indicated by disease, has appeared in Europe and other developed regions. It is likely that better treatment, preventive measures, and increases in education levels have contributed to the declines in mortality and increments in life expectancy. This paper examines whether there has been an expansion of morbidity in Catalonia (Spain). It uses trends in mortality and morbidity and links these with survival to provide estimates of life expectancy with and without diseases and mobility limitations. We use a repeated cross-sectional health survey carried out in 1994 and 2011 for measures of morbidity, and information from the Spanish National Statistics Institute for mortality. Our findings show that at age 65 the percentage of life with disease increased from 52 to 70 % for men, and from 56 to 72 % for women; the expectation of life with mobility limitations increased from 24 to 30 % for men and from 40 to 47 % for women between 1994 and 2011. These changes were attributable to increases in the prevalence of diseases and moderate mobility limitation. Overall, we find an expansion of morbidity along the period. Increasing survival among people with diseases can lead to a higher prevalence of diseases in the older population. Higher prevalence of health problems can lead to greater pressure on the health care system and a growing burden of disease for individuals. [ABSTRACT FROM AUTHOR]

Summary: The study objective was the identification of social workers' ethic profiles in their professional interventions. To conduct this pilot study, we used data from a national survey (N = 1071) carried out in Spain. The information was collected through an online questionnaire. Findings: Results show that social workers face a variety of ethical dilemmas in their professional practice. Through exploratory factor analysis, it was revealed that the underlying structure of the questionnaire consisted of three categories: direct service to individuals and families, design and implementation of social welfare policy and programmes and relationships among professional colleagues. Through latent class analysis, four unique social workers' ethical profiles were identified: professionals with minimum incidence of experiencing ethical dilemmas, professionals with low incidence of experiencing ethical dilemmas, professionals with a notable incidence of experiencing ethical dilemmas and, finally, professionals with high incidence of experiencing ethical dilemmas. A third of the social workers in the sample showed a very low probability to be conflicted by ethical dilemmas. Applications: The pilot study is expected to serve as a catalyst for discussion of social workers' ethical conduct and professional practice, to promote professional ethics training and education and to support the development of professional guidelines. [ABSTRACT FROM AUTHOR]

The present study is aimed at exploring the role of loneliness in the healthcare professionals' mental health during the COVID‐19 outbreak in Spain. A total of 1,421 healthcare professionals who were in contact with at least one positive COVID‐19 patient participated in a cross‐sectional online survey from April to June 2020. Mental health was measured with the General Health Questionnaire‐12, and loneliness was assessed with the 3‐item UCLA Loneliness Scale. More than 80% of participants showed a certain prone to experience mental health problems, and 90% felt that they had not enough workplace protective measures to manage COVID‐19 patients. Presence of loneliness was positively related to higher mental health problems after controlling for other covariates. Other factors related to higher mental health problems were a higher COVID‐19 risk perception, being in quarantine, checking COVID‐19‐related news several times a day and having a lower training on managing infectious diseases. Neither living alone, nor supervisor social support, were related to healthcare professionals' mental health. Results suggest that the impact of COVID‐19 in terms of mental health in the healthcare professionals could be more related to subjective appraisals of social isolation rather than to be physically alone. There were also a variety of cognitive, behavioural and training‐related factors that were associated with the healthcare professionals' mental health, and that should be potentially managed in the mental healthcare interventions. [ABSTRACT FROM AUTHOR]

Aims: To determine the levels of job satisfaction and burnout syndrome and related factors among nurses in three Spanish regions. Background: The nursing profession involves high work stress due to emotional involvement, workload and available resources. Methods: Descriptive multicentric cross‐sectional study. Sociodemographic and migration data were collected and participants completed the Job Satisfaction Questionnaire S20/23 and Maslach Burnout Inventory. The data were analysed using descriptive statistical methods using the program SPSS. Results: The sample included 228 nurses (187 women and 41 men), with a mean age of 37.11 ± 10.87. Reported job satisfaction was medium to high. Overall, values were low in emotional fatigue and medium in depersonalization and personal fulfilment. In terms of migration, 21.59% of the participants had already moved to other Spanish regions or another country, while 18.58% had the intention of doing so. Conclusion: Nurses with a temporary contract showed a high burnout rate, and high levels of emotional fatigue, depersonalization and lack of personal fulfilment. Implications for Nursing Management: Strategies are needed to improve working and contractual conditions such as enhancing teamwork, management and leadership skills in nurses; achieving internal promotion; and having higher participation in decision‐making and a better balance of power between health institution managers and health professionals. [ABSTRACT FROM AUTHOR]

Aims: To discover the level of evidence‐based practice competency of Spanish nurses, to develop a scale of the EBP‐COQ‐Prof© and to analyse the influence of different variables on the level of competency. Background: The evidence‐based practice competency has previously been assessed using a wide variety of instruments, although these have methodological limitations and lack associated scales that allow for the interpretation of the score obtained. Method: Observational, cross‐sectional, national study. Using an online questionnaire, data were obtained between January and March 2020 from nurses working in the National Health System. An ANOVA was performed along with multiple regression analyses. The T‐score and percentiles were calculated to obtain the scale of the EBP‐COQ‐Prof©. Results: 2,942 nurses participated. The score for the evidence‐based practice competency was 130.29 (standard deviation 17.55). The multiple regression analysis showed a model comprised of 8 variables that explained 33% of the variance. Conclusions: The Spanish nurses have a moderate level of evidence‐based practice competency. The scale classifies the subjects into 3 levels: low, moderate and high competency. Implications for Nursing Management: The scale proposed for the EBP‐COQ‐Prof© could be utilized to facilitate the diagnosis of evidence‐based practice competency, and to monitor and plan individual and collective strategies to improve this competency. [ABSTRACT FROM AUTHOR]

Ageing well involves individuals continuing participating in personal, social and civic affairs even in older age. From this standpoint, limitations in individual's functioning (beyond the mere absence of disease) may drastically impact on how well people becoming older. This study aimed to identify functional status profiles in a nationally representative sample of older adults, using latent class analysis methods. Moreover, it intended to study the how identified classes would be related to health‐related outcomes later in life, as a way to provide some evidence on predictive validity. Data from a nationally representative sample of Spanish older adults (N = 2,118; 56.18% women; M = 71.50 years, SD = 7.76), were used. Profiles were identified according to a large set of functioning indicators from multiple domains using latent class analysis. Outcomes were studied over a 3‐year follow‐up, considering both the individual (quality of life, well‐being and mortality) and institutional level (health service utilisation). As a result, seven profiles were identified: normative profile (showed by most participants), limited cognitive functioning class, limited global functioning class, limited mental and mobility functioning class, poor self‐reported health class, limited sensory functioning class and limited objective functioning class. All the profiles with limitations across domains showed poor outcomes. Multidimensional limitations were related to the worst outcomes, especially when psychosomatic complaints and high feelings of loneliness were reported. To sum up, latent class analysis constitutes a suitable alternative to study population heterogeneity, providing relevant evidence to help making decision in public and community health. [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]

Background: Economic crises constitute a shock to societies with potentially harmful effects to the mental health status of the population, including depressive symptoms, and existing health inequalities. Methods: With recent data from the European Social Survey (2006-14), this study investigates how the economic recession in Europe starting in 2007 has affected health inequalities in 21 European nations. Depressive feelings were measured with the CES-D eight-item depression scale. We tested for measurement invariance across different socio-economic groups. Results: Overall, depressive feelings have decreased between 2006 and 2014 except for Cyprus and Spain. Inequalities between persons whose household income depends mainly on public benefits and those who do not have decreased, while the development of depressive feelings was less favorable among the precariously employed and the inactive than among the persons employed with an unlimited work contract. There are no robust effects of the crisis measure on health inequalities. Conclusion: Negative implications for mental health (in terms of depressive feelings) have been limited to some of the most strongly affected countries, while in the majority of Europe persons have felt less depressed over the course of the recession. Health inequalities have persisted in most countries during this time with little influence of the recession. Particular attention should be paid to the mental health of the inactive and the precariously employed. [ABSTRACT FROM AUTHOR]

Background: We aimed to determine the prevalence of consumption of oral contraceptives (OCs) among adolescents and young women living in Spain and to identify the factors associated with this consumption. Methods: We performed a cross-sectional study on the consumption of OCs by women aged 15-30 years residing in Spain. We used secondary individualized data from the 2006 (n = 2513) and 2012 (n = 1530) Spanish National Health Surveys. The dependent variable was the use of OCs in the previous 2 weeks. Independent variables included sociodemographic characteristics, comorbidity, lifestyle, and healthcare resource utilization. The prevalence of OC consumption was analysed by investigating the changes observed between 2006 and 2012. We used multivariate logistic regression to identify the independent factors associated with OC use in each year. Results: In 2006, 14.42 % of women reported using OCs; this percentage dropped to 10.21 % in 2012 (p <0 . 05). Multivariate analysis revealed an association between OC use and visits to the gynaecologist (AOR, 5.60 [95 % CI, 2.93-10.73] in 2006; and AOR, 3.55 [95 % CI, 1.30-9.73] in 2012), Pap smear tests (AOR, 1.8 [95 % CI, 1.23-2.87] in 2006; and AOR, 2.42 [95 % CI, 1.30-4.51] in 2012), and smoking in 2006 (AOR, 1.42 [95 % CI, 1.04-1.93]). Conclusions: There was a significant decrease in OC use from 2006 to 2012 among adolescents and young women living in Spain. In the present study, consumers of OCs were women who visited a gynaecologist more often and complied more with preventive measures such as Pap smear testing. Also, women who reported having used OCs were more likely to smoke than the rest of the study population, although the smoking habit is a risk factor for thrombotic events in women who take OCs. [ABSTRACT FROM AUTHOR]

Background: Obesity is increasing worldwide and weight-control strategies, including the consumption of plant food supplements (PFS), are proliferating. This article identifies the herbal ingredients in PFS consumed for weight control and by overweight/obese dieters in six European countries, and explores the relationship between their consumption and their self-reported BMI. Methods: Data used were a subset from the PlantLIBRA PFS Consumer Survey 2011-2012, a retrospective survey of 2359 PFS consumers. The survey used a bespoke frequency-of-PFS-usage questionnaire. Analyses were performed in two consumer subsamples of 1) respondents taking the products for "body weight reasons", and 2) "dieters for overweight/obesity", to identify the herbal ingredients consumed for these reasons. The relationship between the 5 most consumed herbal ingredients and self-reported BMI in groups 1 and 2 is explored by comparing BMI proportions of consumers vs. non-consumers (using Chi-squared test). Results: 252 PFS (8.8 %) were consumed for "body weight reasons" (by 240 PFS consumers); 112 PFS consumers (4.8 %) were "dieting for overweight/obesity". Spain is the country where consuming herbal ingredients for body weight control and dieting were most popular. Artichoke was the most consumed herbal ingredient. Considering only the 5 top products consumed by those who responded "body weight", when using the total survey sample, a greater proportion of BMI ≥ 25 was observed among consumers of PFS containing artichoke and green tea as compared to non-consumers (58.4 % vs. 49.1 % and 63.2 % vs. 49.7 % respectively). Considering only the 5 top products consumed by "dieters" and using only the "dieters" sample, a lower proportion of BMI ≥ 25 was observed among pineapple-containing PFS consumers (38.5 % vs. 81.5 %); however, when using the entire survey sample, a greater proportion of BMI ≥ 25 was observed among artichoke-containing PFS consumers (58.4 % vs. 49.1 %). Conclusions: A comparison of results among the scarce publications evaluating the use of weight-loss supplements at the population level is limited. Nevertheless every hint is important in finding out which are the self-treatment strategies used by overweight/obese individuals in European countries. Although limited by a small sample size, our study represents a first attempt at analysing such data in six EU countries. Our findings should encourage the conduction of further studies on this topic, long-term and large sample-sized studies, ideally conducted in the general population. [ABSTRACT FROM AUTHOR]

Background: Ethnobotanical academic research, particularly in European industrialised countries, has been, and is, mostly focused on folk uses of food and medicinal plants. Nevertheless, other uses, as may well be supposed, account for a significant portion of these folk uses. In the Catalan linguistic domain, a considerable amount of ethnobotanical work has been produced, but to date almost nothing has been published on these other plant uses. Methods: We basically used the method of semistructured interviews to collect data on names, knowledge and use of plants in the above-mentioned fields from 759 informants in three Catalonian (Alt Empordà, Montseny and Ripollès) and two Balearic (Formentera and Mallorca) areas. We identified the plants quoted by the informants and prepared herbarium vouchers. We analysed and compared the results obtained. Results: Information has been collected on 401 genera, 552 species, 81 subspecies and four varieties, belonging to 122 families, totalling 4137 use reports for popular non-food and non-medicinal uses (classified in 14 modalities), and designated with 1303 folk Catalan names. The informant consensus factor is 0.87, accounting for a consistent and robust dataset. Conclusion: Contrarily to what could be thought a priori, and irrespective of the fact that some uses are declining or changing, non-medicinal and non-food folk plant uses strongly persist in the territories considered, are highly considered by their practitioners, and may even imply some economic revenues. [ABSTRACT FROM AUTHOR]

Background: Many studies have explored personal values in nursing, but none has assessed whether the predictions made by the theory of intergenerational value change are true for the different generations of nursing professionals and students. This theory predicts a shift in those personal values held by younger generations towards ones focussed on self-expression. Research question: The purpose of the study was to identify intergenerational differences in personal values among nursing professionals and nursing students and to determine whether generational value profiles fit the predictions made by the theory. Research design: An exploratory comparative design with a cross-sectional survey method was used. Participants and research context: Participants were recruited from four public hospitals and 10 Primary Care Centres in medium-size cities in Spain. A sample of 589 nurses and 2295 nursing students participated in the study. An open survey method was used to collect data that were classified grouping reported values into categories following a method of value lexicon construction and analysed by contingency tables with Pearson’s χ2 and standardized residuals. Ethical considerations: Approval to conduct the study was obtained from the Deans of the nursing schools and the Directors of Nursing of the institutions. Anonymity was guaranteed, participation was voluntary and participants were informed of the purpose of the study. Findings: The results can be synthesized in two age-related trends in the reporting of values among three groups of participants. First, among younger nurses and students, some nursing core values (e.g. ethical and professional) decreased in importance, while other values centred on social relationships and personal well-being increased. Discussion and Conclusion: This study shows intergenerational change in personal values among both nursing students and young nursing professionals. Findings suggest the need to pay more attention to value training and professional socialization during the schooling period. [ABSTRACT FROM AUTHOR]

The purpose of the study was to examine received and expected knowledge of patients with knee/hip arthroplasty in seven European countries. The goal was to obtain information for developing empowering patient education. The data were collected (during 2009-2012) from patients (n = 943) with hip/knee arthroplasty prior to scheduled preoperative education and before discharge with the Received Knowledge of hospital patient scale (RKhp) and Expected Knowledge of hospital patient scale (EKhp). Patients’ knowledge expectations were high but the level of received knowledge did not correspond to expectations. The difference between received and expected knowledge was higher in Greece and Sweden compared with Finland (p < .0001, p < .0001), Spain (p < .0001, p = .001), and Lithuania (p = .005, p = .003), respectively. Patients’ knowledge expectations are important in tailoring patient education. To achieve high standards in the future, scientific research collaboration on empowering patient education is needed between European countries. [ABSTRACT FROM AUTHOR]

The article presents a study of the needs of paediatric patient organizations (PPOs) in Spain, aimed at identifying opportunities to enhance health services through information and communications technology (ICT). The study is part of the APTIC, a pilot online health community project for PPOs and families. Results showed that the major needs of PPOs are to provide accredited and managed information, improve personal support and assistance and the promotion of joint commitment to healthcare.

Background There are doubts on whether patients feel that they have sufficient information for actively participating in clinical decisions. Objective To describe the type of information that patients receive. To determine whether patients consider this information sufficient, and whether it contributes or not to improve clinical safety. To identify the barriers for patient participation in clinical decision making. Study Design Cross-sectional study with 764 patients and 327 physicians. Study Setting and participants Fourteen health centres belonging to three primary care districts and three hospitals in Spain. Principal Findings Just 35.1% (268) (95% CI 32.2, 39.1%) of patients preferred to have the last word in clinical decisions. Age (39 vs. 62%, P < 0.001) and severity of illness (38 vs. 46%, P = 0.002) increased the tendency to take a passive role. In 85.1% (650) (95% CI 83.3, 88.3%) of the cases, patients reported having received sufficient information. Lack of consultation time (29.6%, 95% CI 25.8, 32.5%) and patients' use of Internet or other sources (19.2%, 95% CI 16.4, 22.2%) were identified as new obstacles to doctor-patient communication by the patients. Only 19.6% (64) (95% CI 15.4, 24.2%) of doctors considered that they could intervene to involve patients in the decisions. Discussions and Conclusions The majority of patients prefer the decisions to be made by their doctor, especially those with more severe illnesses, and older patients. Patients are not normally informed about medication interactions, precautions and foreseeable complications. The information provided by general practitioners does not seem to contribute enough to the patient involvement in clinical safety. [ABSTRACT FROM AUTHOR]

Ageing population entails a growing international problem of osteoarthritis. Best practices for education of these patients are lacking. This study focused on empowering education in Northern ( Finland, Iceland, Lithuania and Sweden) and Southern Europe ( Cyprus, Greece and Spain). The aim was to analyse associations between expected knowledge and background factors. The data were collected from European arthroplasty patients with the Knowledge Expectations of hospital patients- scale, (KEhp- scale), including bio-physiological, functional, experiential, ethical, social and financial dimensions. Patients had essential bio-physiological and functional knowledge expectations. Women expected more than men, employed less than retired, unemployed or who worked at home. Generally, patients in Northern countries expected more than in Southern countries. However, highest expectations were found in Sweden and Greece, lowest in Spain and Cyprus. There are differences in knowledge expectations based on patients' backgrounds. Development of common standards in European patient education needs further research. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to examine, for female and male students separately, whether perceived quality of relationships with peers and parents and relations in school predict self-reported frequent drunkenness among Spanish adolescents. Methods: The Spanish data from the Health Behaviour in School-aged Children Study (HBSC) 2010 survey were used including 1177 female and 1126 male students aged between 15 and 16 years. Results: For both genders, students reporting low school satisfaction had increased odds of frequent drunkenness. Among females, low and medium levels of classmate support were associated with decreased odds of frequent drunkenness, whereas low perceived maternal knowledge as well as medium and low satisfaction with the family increased odds of being frequently drunk. The proportion of male students reporting medium satisfaction with friendships had significantly lower odds of frequent drunkenness compared with those with high level of satisfaction with friendships. Conclusion: We found different associations between perceived quality of social relations and frequent drunkenness among male and female students. Results showed that social relations seemed to better predictors of frequent drunkenness among female than male students and that other factors than social relations may contribute to explain excessive alcohol use among Spanish adolescents. [ABSTRACT FROM AUTHOR]

Background: The idea that knowledge flows through social networks is implicit in research on traditional knowledge, but researchers have paid scant attention to the role of social networks in shaping its distribution. We bridge those two bodies of research and investigate a) the structure of network of exchange of plant propagation material (germplasm) and b) the relation between a person's centrality in such network and his/her agroecological knowledge. Methods: We study 10 networks of germplasm exchange (n = 363) in mountain regions of the Iberian Peninsula. Data were collected through participant observation, semi-structured interviews, and a survey. Results: The networks display some structural characteristics (i.e., decentralization, presence of external actors) that could enhance the flow of knowledge and germplasm but also some characteristics that do not favor such flow (i.e., low density and fragmentation). We also find that a measure that captures the number of contacts of an individual in the germplasm exchange network is associated with the person's agroecological knowledge. Conclusion: Our findings highlight the importance of social relations in the construction of traditional knowledge. [ABSTRACT FROM AUTHOR]

Objective: To describe Spanish nurses' preparedness to care for hospitalised terminally ill patients and how this translates into care delivery. Methods: An exploratory, sequential mixed methods study with two stages. Stage I used unstructured observations of 22 hospital nurses over 235 hours to understand their daily reality, followed by semi-structured interviews with 21 nurses to elicit their perspectives. Stage 2 was a regional survey (65% response rate) concerned with hospital nurses' opinions of caring for terminally ill patients and their perceived competence. Results: The nurses felt competent to provide physical but not emotional care for terminally ill patients. They reported that care could be improved, particularly through providing more emotional care. This coincided with an observed focus on physical care. The nurses reported a lack of support in caring for terminally ill patients and wanted more education on emotional issues and dealing with their own feelings. Conclusion: There is a need for an integrative approach in Spain that combines an educational programme with a supportive environment, focusing on developing nurses' competence to deliver emotional care and deal with their own feelings. Promoting a supportive environment might enable nurses to change their behaviour when caring for terminally ill patients and deal with patients' emotional as well as physical needs. [ABSTRACT FROM AUTHOR]

Aims: To assess compliance with the 2010 nutritional objectives for the Spanish population in the Balearic Islands' adolescents. Methods: A cross-sectional nutrition survey was carried out in adolescents (n = 1,231). Dietary habits were assessed by means of 2 nonconsecutive 24-hour recalls and a semiquantitative food frequency questionnaire. Differences in the percentage of compliers with the 2010 nutritional objectives and differences in food consumption patterns between genders and high or low consumers of fat, saturated fatty acids (SFA), fiber, and fruits and vegetables were analyzed. Results: None of the nutritional objectives were achieved by the Balearic Islands' adolescents, and less than 25% of them met the dietary fiber, folate, iodine, total fat, SFA, polyunsaturated fatty acid (PUFA), total carbohydrate, and fruit and vegetable requirements. Gender differences were observed in terms of energy, nutrients, and food item consumption. Low fat/SFA and high fruit and vegetable/fiber consumers kept a diet in line with current food group pyramids and the traditional Mediterranean diet. Adolescents need to decrease their meat and increase pulse, fish, and fruit and vegetable consumption. Conclusions: The nutritional objectives for the Spanish population could be achieved through maintenance of the traditional Mediterranean diet in the Balearic Islands' adolescents. This dietary model could be used to develop food-based dietary guidelines relevant to this population. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]