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Objetivo Diseñar y validar un procedimiento enfermero de cribado de la neuropatía periférica diabética en atención primaria. Método El estudio se llevó a cabo en tres fases. 1) Construcción de un banco de ítems para conformar el procedimiento con una puntuación de salida que describiera la situación clínica del paciente. 2) Prueba y reducción del procedimiento tentativo inicial sobre una muestra de 50 pacientes usuarios de consultas enfermeras comunitarias, eliminando los componentes con baja fiabilidad inter-intra enfermeras. 3) Validación de la versión del procedimiento obtenida en el paso anterior sobre una muestra de 106 pacientes. Cálculo de validez y fiabilidad eliminando componentes con baja validez de criterio respecto a los resultados de la electromiografía diagnóstica utilizada como patrón de referencia. Se estimaron puntos de corte para el empleo del procedimiento como herramienta de cribado, valores predictivos, rendimiento, consistencia interna y fiabilidad inter-intra enfermera. Resultados El procedimiento tentativo inicial constó de 12 componentes que fueron reducidos a 10. En el proceso de validación de esta segunda versión el procedimiento se simplificó nuevamente, quedando conformado por 6 componentes, con un punto de corte de 2,5 en su escala de salida, punto en el que alcanza valores adecuados de sensibilidad y predictivos negativos para emplearlo como instrumento de cribado. Para este punto de corte la fiabilidad inter-intra enfermeras, la validez de criterio y la validez predictiva alcanzaron valores aceptables. Conclusiones NeuDiaCan como procedimiento de cribado enfermero de la neuropatía periférica diabética en atención primaria resulta válido, fiable y de fácil empleo. Objective To design and validate a nursing screening procedure for diabetic peripheral neuropathy in primary care. Methods The study was carried out in three phases. 1) Construction of an item bank to form the procedure with an exit score describing the patient's clinical situation. 2) Test and reduction of the initial tentative procedure on a sample of 50 patients using community nurse consultations, eliminating the components with low inter-intra nurse reliability. 3) Validation of the version of the procedure obtained in the previous step on a sample of 106 patients. Calculation of validity and reliability by eliminating components with low criterion validity with respect to the results of the diagnostic electromyography used as a reference standard. Cut-off points were estimated for the use of the procedure as a screening tool, predictive values, performance, internal consistency and inter-nurse reliability. Results The initial tentative procedure consisted of 12 components that were reduced to 10. In the process of validation of this second version the procedure was simplified again, eventually comprising 6 components, with a cut-off point of 2.5 in its output scale, the point at which it reaches adequate values of sensitivity and negative predictors to be used as a screening instrument. For this cut-off point the inter-intra nurse reliability, criterion validity and predictive validity reached acceptable values. Conclusions NeuDiaCan as a nursing screening procedure for diabetic peripheral neuropathy in primary care is valid, reliable and easy to use. Sin financiación No data JCR 2020 0.226 SJR (2020) Q3, 11/17 Fundamentals and Skills No data IDR 2020 UEC

Objective: The aim of this study was to evaluate the effects of a manual therapy using fascial therapy on joint bleeding, joint pain and joint function in patients with hemophilic ankle arthropathy. Setting: Hemophilia patient associations. Design: Randomized, controlled trial, multicenter and intention-to-treat analysis. Participants: A total of 65 patients with hemophilic ankle arthropathy. Intervention: The experimental group ( n = 33) received one fascial therapy session per week for three weeks. The control group ( n = 32) received no treatment. Outcome measure: The primary outcome was frequency of joint bleeding measured using self-reporting. Secondary outcomes were joint pain (under load-bearing and non-load-bearing conditions) measured using the visual analog scale; joint condition was measured using the Hemophilia Joint Health Score. Outcomes were measured at baseline, posttreatment and after five months of follow-up. Results: Improvements in the frequency joint bleeding at T0, T1 and T2 were significantly higher in the experimental group (T0: mean (SD) = 1.56 (1.30); T1: mean (SD) = 0.00 (0.00); T2: mean (SD) = 0.27 (0.57)) compared to the control group (T0: mean (SD) = 1.70 (1.78); T1: mean (SD) = 0.05 (0.21); T2: mean (SD) = 0.58 (0.85)). Mean improvement of joint state after the study period was 1.74 points (±1.66) for patients in the experimental group, while the control group exhibited a joint deterioration with 0.43 points (±0.85). Ankle joint pain under load-bearing and non-load-bearing conditions improved in the experimental group with −1.72 (±1.86) and −0.50 (±1.39) points, respectively. Conclusion: The study showed that fascial therapy is favorable for patients with hemophilic ankle arthropathy.

To analyze whether there is an association between conformity to male and female gender norms and the Edinburgh Postnatal Depression Scale (EPDS) score as an indicator of depression during pregnancy, a cross-sectional study was made to a sample of 200 pregnant women being seen at any of the public primary care centers in Segovia (Spain) for the prenatal care. A score of 13 points or higher on the Spanish version of the EPDS is considered to be an indicator of antenatal depression. The Conformity to Feminine Norms Inventory (CFNI-84) and the Conformity to Masculine Norms Inventory (CMNI-94) were used to determine the degree of conformity to gender norms. Descriptive and inferential statistics, as well as multivariate analysis, were carried out. Logistic regression analysis showed the Nice in Relationships Subscale score to be associated with a decreased risk of depression (OR = 0.88; 95%CI 0.79–0.98; p = 0.029). In addition, the CMNI total score, as well as the Self-Reliance subscale, were associated with an increased risk of depression (OR = 1.04; 95%CI 1.01–1.07; p = 0.022; OR = 1.30; 95%CI 1.08–1.55; p = 0.004, respectively). An association between conformity to male gender norms and nonconformity to some female gender norms in pregnant women and a score on the EPDS indicating depression during pregnancy was found. Particularly, an increase in the CMNI total score was associated to increased risk of suffering depression in the pregnant women studied. Castile and León Health Authority (SACyL) - GRS 1287/B/16 2.500 JCR (2019) Q3, 78/155 Psychiatry 1.176 SJR (2019) Q1, 30/185 Obstetrics and Gynecology, 112/545 Psychiatry and Mental Health No data IDR 2019 UEM

Background Benefits of breastfeeding on the health of children, mothers and society are well known. However, breastfeeding rates vary according to the population examined. Chinese-born women migrated to high-income countries have shown low breastfeeding rates. Nevertheless, studies comparing breastfeeding rates of Chinese-born immigrants and natives are scarce. The aims of this study were therefore: 1) to compare the rate of exclusive breastfeeding at hospital discharge after giving birth between Chinese-born women resident in Spain and native Spanish women, 2) to assess the influence of the biological, socioeconomic, work-related and cultural factors on exclusive breastfeeding in women of Chinese origin. Methods A cross-sectional descriptive study with between group comparisons. This study included 73 postpartum women (33 Chinese-born and 40 native Spanish women). The association between exclusive breastfeeding and the country of origin was assessed by binary logistic regression. Results Native Spanish women showed a greater prevalence of exclusive breastfeeding (80%) compared to Chinese born immigrant women (36.4%) (adjusted for socioeconomic status, parental level of education, age, cesareans and birth weight) (OR = 0.21; 95% CI 0.05–0.91; p = 0.037). However, in other models that considered both work and cultural influences, no differences were observed. Discussion The classic biological and socioeconomic variables (educational and socioeconomic levels) do not seem to explain the lower rates of exclusive breastfeeding among Chinese immigrant women. This paradigm of inequity appears to be based on both the work conditions as well as cultural characteristics of Chinese born women in Spain, such as their overall attitude towards breastfeeding. Los beneficios de la lactancia materna en la salud de los niños, las madres y la sociedad son ampliamente conocidos. Sin embargo, las tasas de lactancia materna varían según la población estudiada. Las mujeres de origen chino que han inmigrado a países desarrollados muestran tasas muy bajas de lactancia materna. Los objetivos de la investigación son comparar las tasas de lactancia materna exclusiva tras el parto, al alta del hospital, entre mujeres de origen chino y de origen español, y evaluar la influencia de variables biológicas, socioeconómicas, relacionadas con el trabajo y culturales sobre las tasas de lactancia materna. Estudio descriptivo transversal con comparación entre grupos. Se incluyó a 73 puérperas (33 de origen chino y 40 españolas). La asociación entre lactancia materna y país de origen se evaluó utilizando regresión logística. Resultados: Las mujeres españolas mostraron una mayor prevalencia de lactancia materna exclusiva (80%) en comparación con las mujeres de origen chino (36,4%), ajustando por nivel socioeconómico, nivel educativo de los padres, edad de la madre, parto por cesárea y peso al nacer). Sin embargo, al construir otros modelos de regresión logística en los que se incluyó variables relacionadas con el trabajo de la madre, o la actitud respecto a la lactancia materna, las diferencias pasaban a ser no significativas. Discusión: Las variables clásicas biológicas y socioeconómicas no explican la diferencia en las tasas de lactancia materna entre mujeres de origen chino y españolas. Sin embargo, parece que esas diferencias están relacionadas con las condiciones laborales de las mujeres chinas (trabajan más mujeres, por cuenta propia, incorporándose antes al mundo laboral tras el parto...) y con aspectos culturales (actitud menos positiva hacia la lactancia materna). Sin financiación 2.239 JCR (2019) Q2, 33/82 Obstetrics & Gynecology 1.275 SJR (2019) Q1, 19/185 Obstetrics and Gynecology No data IDR 2019 UEM

Background Nursing is an art and science based on knowledge of professional caring. As such, the examination of how students perceive care may improve the way this concept is taught and learnt in nursing. Objectives To examine and describe the perception of caring among Spanish nursing students. Methods A cross-sectional design.From an initial population of 500 students, 321 volunteers participated in this study by completing the Caring Dimensions Inventory (CDI-25) during April 2014. Parametric tests were used to perform descriptive analyses of the dimensions of caring and the predominant factor; additionally, inferential (bivariate) analyses were performed of the dimensions of caring and of the predominant factor according to each of the independent variables. A logistic multinomial regression of the predominant psychosocial factor was calculated using the professional-technical factor as a reference, with adjustments for each of the covariates. Results The two dimensions most identified by students in relation to caring were: Providing privacy for a patient (D23) and Listening to a patient (D13) whereas the least identified were: Putting the needs of a patient before your own (D19) and Sharing your personal problems with a patient (D16). Overall, students identified caring mostly with the Psychosocial Factor (F1) (psychosocial aspects of care). Students in their first year identified caring more with the professional-technical factor, whereas those in their third and fourth year did so with the psychosocial factor. Conclusions The perception of caring among nursing students is a dynamic phenomenon that is modified throughout the nurse education process. The academic year, previous work experience in healthcare and the type of access to the university influence students' perceptions of caring. Sin financiación 2.490 JCR (2019) Q1, 7/121 Nursing, 9/41 Education, Scientific Disciplines 1.178 SJR (2019) Q1, 7/150 Nursing (miscellaneous), 129/1401 Education No data IDR 2019 UEM

Background: Nurses who practice limitation of therapeutic effort become fully involved in emotionally charged situations, which can affect them significantly on an emotional and professional level. Objectives: To describe the experience of intensive care nurses practicing limitation of therapeutic effort. Method: A qualitative, phenomenological study was performed within the intensive care units of the Madrid Hospitals Health Service. Purposeful and snowball sampling methods were used, and data collection methods included semi-structured and unstructured interviews, researcher field notes, and participants’ personal letters. The Giorgi proposal for data analysis was used on the data. Ethical considerations: This study was approved by the Ethical Research Committee of the relevant hospital and by the Ethics Committee of the Rey Juan Carlos University and was guided by the ethical principles of voluntary enrollment, anonymity, privacy, and confidentiality. Results: In total, 22 nurses participated and 3 themes were identified regarding the nurses’ experiences when faced with limitation of therapeutic effort: (a) experiencing relief, (b) accepting the medical decision, and (c) implementing limitation of therapeutic effort. Conclusion: Nurses felt that, although they were burdened with the responsibility of implementing limitation of therapeutic effort, they were being left out of the final decision-making process regarding the same.

Nursing clinics in rheumatology (NCRs) are organisational care models that provide care centred within the scope of a nurse’s abilities. To analyse the impact of NCR in the rheumatology services, national multicenter observational prospective cohort studied 1-year follow-up, comparing patients attending rheumatology services with and without NCR. NCR was defined by the presence of: (1) office itself; (2) at least one dedicated nurse; and (3) its own appointment schedule. Variables included were (baseline, 6 and 12 months): (a) test to evaluate clinical activity of the disease, research and training, infrastructure of unit and resources of NCR and (b) tests to evaluate socio-demographics, work productivity (WPAI), use of services and treatments and quality of life. A total of 393 rheumatoid arthritis and ankylosing spondylitis patients were included: 181 NCR and 212 not NCR, corresponding to 39 units, 21 with NCR and 18 without NCR (age 53 + 11.8 vs 56 + 13.5 years). Statistically significant differences were found in patients attended in sites without NCR, at some of the visits (baseline, 6 or 12 months), for the following parameters: higher CRP level (5.9 mg/l ± 8.3 vs 4.8 mg/l ± 7.8; p < 0.005), global disease evaluation by the patient (3.6 ± 2.3 vs 3.1 ± 2.4), physician (2.9 ± 2.1 vs 2.3 ± 2.1; p < 0.05), use of primary care consultations (2.7 ± 5.4 vs 1.4 ± 2.3; p < 0.001) and worse work productivity. The presence of NCR in the rheumatology services contributes to improve some clinical outcomes, a lower frequency of primary care consultations and better work productivity of patients with rheumatic diseases. Sin financiación 1.824 JCR (2016) Q3, 21/30 Rheumatology UEM

There is a great concern whether Physical Therapy students upon completion of their educational program are ready and equipped with the requisite skills to construct and implement a successful patient intervention with culturally diverse groups. The purpose of this study is to describe the professional and personal physical therapist development of Physical Therapy students after participating in Solidarity Activities in Collaboration with a Prisoner reinsertion program as a service-learning course. A qualitative approach was used. A convenience sample of twenty physical therapy students doing service learning and one teaching professor were included. Student diaries were analyzed. Semi-structured interviews were done to explore five students&rsquo, and the professor&rsquo, s judgements. Internal and external observations and filling out structure field-notes were also used as data triangulation in order to build the conceptual model. The main findings include that the application of knowledge and practice of skills in different environments are the most important skills attained with this service learning. Five key themes emerged from the data analysis, namely: application of knowledge, adaptation to different environments, improving communication with patients, assisting people and providing treatment with self-confidence. A recommendation is that Physical Therapy programs include workplace practice in different environments to enhance the development of professionalism among students.

Background Hemophilic arthropathy is characterized by loss of function and range motion. Fascial therapy mobilizes the connective tissue, intervening in the state of the injured fascial complex. Objectives The aim of this study is to assess the safety and effectiveness of a fascial therapy treatment in patients with hemophilic ankle arthropathy. Design Randomized clinical trial. Methods Sixty-five adult patients with hemophilia from 18 to 65 years of age were recruited. The intervention through fascial therapy lasted 3 consecutive weeks with a weekly session of 45 min each. The dependent variables were frequency of bleeding (selfregistration), ankle range of motion (goniometer) and lower limb functionality (6-Minute Walking Test). Three assess were made: baseline, posttreatment and after follow-up period. ANOVA of repeated measures was performed to compare both groups at the three assess time points. Bonferroni correction has been applied to control the error rate of the significance level. Results Improvements were found (p < 0.001) in terms of a reduced frequency of ankle hemarthrosis. Significant differences were found in the experimental group following intervention (p < 0.001), and when comparing baseline and follow-up assessments (p < 0.05) in all variables. The frequency of hemarthrosis (p = 0.04) and functionality (p = 0.01) improved in patients who received manual therapy as compared to the control group. Conclusions Fascial therapy achieves improvements in terms of frequency of hemarthrosis in patients with hemophilic ankle arthropathy. Ankle functionality improved in patients treated with manual therapy. This technique can improve ankle range of motion. Sin financiación 2.520 JCR (2020) Q2, 27/68 Rehabilitation 0.870 SJR (2020) Q1, 44/210 Physical Therapy, Sports Therapy and Rehabilitation No data IDR 2019 UEM

Aims and objectives: To analyse link between empathy and emotional intelligence as a predictor of nurses' attitudes towards communication while comparing the contribution of emotional aspects and attitudinal elements on potential behaviour. Background: Nurses' attitudes towards communication, empathy and emotional intelligence are key skills for nurses involved in patient care. There are currently no studies analysing this link, and its investigation is needed because attitudes may influence communication behaviours. Design: Correlational study. Method: To attain this goal, self-reported instruments (attitudes towards communication of nurses, trait emotional intelligence (Trait Emotional Meta-Mood Scale) and Jefferson Scale of Nursing Empathy (Jefferson Scale Nursing Empathy) were collected from 460 nurses between September 2015-February 2016. Two different analytical methodologies were used: traditional regression models and fuzzy-set qualitative comparative analysis models. Results: The results of the regression model suggest that cognitive dimensions of attitude are a significant and positive predictor of the behavioural dimension. The perspective-taking dimension of empathy and the emotional-clarity dimension of emotional intelligence were significant positive predictors of the dimensions of attitudes towards communication, except for the affective dimension (for which the association was negative). The results of the fuzzy-set qualitative comparative analysis models confirm that the combination of high levels of cognitive dimension of attitudes, perspective-taking and emotional clarity explained high levels of the behavioural dimension of attitude. Conclusions: Empathy and emotional intelligence are predictors of nurses' attitudes towards communication, and the cognitive dimension of attitude is a good predictor of the behavioural dimension of attitudes towards communication of nurses in both regression models and fuzzy-set qualitative comparative analysis. In general, the fuzzy-set qualitative comparative analysis models appear to be better predictors than the regression models are. Relevance to clinical practice: To evaluate current practices, establish intervention strategies and evaluate their effectiveness. The evaluation of these variables and their relationships are important in creating a satisfied and sustainable workforce and improving quality of care and patient health. Sin financiación 1.757 JCR (2018) Q1, 28/120 Nursing 0.768 SJR (2018) Q1, 18/152 Nursing (miscellaneous); Q2, 836/2844 Medicine (miscellaneous) No data IDR 2018 UEV

This study aimed to explore the reflective dialogues and processes that take place between preceptors and their nursing students and to examine how preceptors make use of their expert knowledge in order to enhance students' experiential learning during clinical placements. Two 30-h courses on reflective teaching were conducted. The study sample included 15 preceptors and 27 undergraduate nursing students. Data were collected during the course and during clinical placements at two X hospitals. Data collection included non-participatory observation and informal conversations with preceptors, in-depth interviews and focus groups. Preceptors used a series of strategies to promote experiential learning; these included creating links with practice, the use of examples, allowing students to adopt professional roles and enhancing autonomy. The value of preceptors is their wealth of professional experience, which is key during the learning process of nursing students. Preceptors must learn to master the art of questioning and stimulating reflective dialogues, in order to stimulate students' critical thinking and encourage them to resolve common problems that arise during practice. Students demand a more active role in their own learning processes. Sin financiación 1.665 JCR (2018) Q1, 29/118 Nursing 0.810 SJR (2018) Q1, 17/152 Nursing (miscellaneous), 218/1400 Education; Q2, 782/2844 Medicine (miscellaneous) No data IDR 2018 UEM

Background Patient communication is a key skill for nurses involved in clinical care. Its measurement is a complex phenomenon that can be addressed through attitude evaluation. Objectives To develop and psychometrically test a measure of nurses' attitudes towards communication with patients (ACO), to study the relationship between these dimensions, and to analyse nursing attitudes. Design To develop and psychometrically test the ACO questionnaire. Settings All hospitals in the province of Valencia were invited by e-mail to distribute the ACO instrument. Ten hospitals took part in the study. Participants The study population was composed of a convenience sample of 400 hospital nurses on general or special services. The inclusion criteria were nurses at the selected centres who had previously provided an informed consent to participate. Methods A literature review and expert consultation (N = 10) was used to develop the content of the questionnaire. The 62-item version of the instrument was applied to a convenience sample of 400 nurses between May 2015 and March 2016. Factor structure was evaluated with exploratory and confirmatory factor analysis (EFA, CFA), and reliability was evaluated with Cronbach's alpha, composite reliability (CR), and average variance extracted (AVE). Results The final instrument (ACO), composed of 25 items grouped into three attitude dimensions (cognitive, affective and behavioural), had good psychometric properties. In the study sample, nurses had a favourable attitude towards communication. The cognitive and affective dimensions of the ACO should be able to predict the behaviour dimension. Conclusion The ACO is useful for evaluating current clinical practices, identifying educational needs and assessing the effectiveness of communication training or other interventions intended to improve communication. Sin financiación 2.442 JCR (2018) Q1, 9/118 Nursing, 10/41 Education, Scientific Disciplines 1.041 SJR (2018) Q1, 7/152 Nursing (miscellaneous), 134/1400 Education No data IDR 2018 UEV

Background: Cervical and thoracic spinal manipulative therapy has shown positive impact for relief of pain and improve function in non-specific mechanical neck pain. Several attempts have been made to compare their effectiveness although previous studies lacked a control group, assessed acute neck pain or combined thrust and non-thrust techniques. Aim: To compare the immediate effects of cervical and thoracic spinal thrust manipulations on mechanosensitivity of upper limb nerve trunks and grip strength in patients with chronic non-specific mechanical neck pain. Design: Randomized, single-blinded, controlled clinical trial. Setting: Private physiotherapy clinical consultancy. Population: Eighty-eight subjects (32.09±6.05 years; 72.7% females) suffering neck pain (grades I or II) of at least 12 weeks of duration. Methods: Participants were distributed into three groups: 1) cervical group (N.=28); 2) thoracic group (N.=30); and 3) control group (N.=30). One treatment session consisting of applying a high-velocity low-amplitude spinal thrust technique over the lower cervical spine (C7) or the upper thoracic spine (T3) was performed, while the control group received a sham-manual contact. Measurements were taken at baseline and after intervention of the pressure pain threshold over the median, ulnar and radial nerves. Secondary measures included assessing free-pain grip strength with a hydraulic dynamometer. Results: No statistically significant differences were observed when comparing between-groups in any of the outcome measures (P>0.05). Those who received thrust techniques, regardless of the manipulated area, reported an immediate increase in mechanosensitivity over the radial (both sides) and left ulnar nerve trunks (P