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Introduction: Sexual violence victimization in the context of intimate partner among young women has been less addressed than other types of dating violence. Methods: The aim was to describe the prevalence of intimate partner sexual violence victimization among heterosexual female university students in Spain and to explore the presence of polyvictimization. A cross-sectional study was conducted involving female university students (n = 1064) from 10 degrees at a public university in northern Spain in 2018. Five types of intimate partner violence victimization were analyzed (coercion, detachment, humiliation, sexual violence, and physical violence). Results: Of the female university students, 20.8% experienced intimate partner sexual violence victimization. Among victims of intimate partner sexual violence, sexual debut before the age of 16, having had three or more partners, having interrupted that violent relationship, and having a family history of intimate partner violence were more frequent. Victimization of intimate partner sexual violence was significantly associated with other forms of intimate partner violence, especially coercion and detachment. Conclusions: Intimate partner sexual violence victimization is frequent among female university students and usually does not appear on its own. Rather, it occurs in the context of other types of intimate partner violence, especially psychological violence. Policy Implications: At the beginning of adulthood, many young women attend university and many of them are suffering IPSV, making this an appropriate environment to address this important problem through various actions such as: information campaigns to improve the recognition of abusive behavior or the creation of care offices as a nearby resource for university women who are victims of violence. [ABSTRACT FROM AUTHOR]

Simple Summary: Breast cancer and type 2 diabetes mellitus are highly prevalent and closely related diseases. Type 2 diabetes increases the risk of breast cancer. Our retrospective matched cohort study involving 318 women with type 2 diabetes assessed the evolution of cardiometabolic parameters and diabetic complications in women with (n = 106) and without subsequent breast cancer (n = 212). Over a 7-year follow-up period, women with breast cancer had worse glycemic control but not higher rates of diabetic complications compared to women without breast cancer. During breast cancer (BC), cardiometabolic disorders can worsen prognosis, particularly in women with type 2 diabetes mellitus (T2DM). This study aimed to determine the impact of BC diagnosis on cardiometabolic parameters and the incidence of complication in women over 50 years of age (90% aged ≥ 65 years) with pre-existing T2DM. Using primary care registries from Asturias (Spain), a total of 106 women diagnosed with T2DM followed by BC were selected and matched with women with T2DM (n = 212) in a cohort study. Indicators of cardiometabolic health and microvascular complications associated with T2DM were collected. Women were monitored from two years prior to five years after BC diagnosis. Conditional logistic regressions were used to compare the adjusted odds of staying below each indicator's threshold. During follow-up, women with T2DM+BC had a higher risk of fasting blood glucose ≥126 mg/dL (adjusted odds ratio [aOR] = 1.83; 95% confidence interval [CI95%]: 1.01–3.32) and glycosylated hemoglobin (Hb1Ac) ≥ 48 mmol/mol or 6.5% (aOR: 2.44; IC95%: 1.21–4.91). There was no difference between the groups regarding the incidence of microvascular complications. BC incidence negatively impacted the glycemic control of Spanish women with pre-existing T2DM measured by basal blood glucose and HbA1c, but not cardiometabolic health indicators or T2DM complications. [ABSTRACT FROM AUTHOR]

Aim. The aim was to explore the association between nursing professional values (NPV) and mental health among registered nurses (RN) in Spain. Background. Nursing is a profession rooted in strong professional values, which guide and shape clinical practice and occupational behaviors. NPV should serve as a source of support in situations of great uncertainty. Methods. A cross‐sectional study was conducted during the remission phase of the second wave of the COVID‐19 pandemic (December 2020‐January 2021) among a sample of Spanish RN (n = 420). NPV were assessed using the Nursing Professional Values Scale (NPVS‐R), comprising 26 items grouped into five factors: caring, activism, trust, professionalism, and justice. Perceived stress, anxiety, and depression were measured by the Perceived Stress Scale (PSS‐14) and the Hospital Anxiety and Depression Scale (HADS). Adjusted linear regressions were used to estimate b coefficients for the associations between NPV scores and the three mental health indicators. Results. The fully‐adjusted analysis, including sociodemographic and occupational variables, revealed that higher activism scores were associated with higher scores of stress (b coefficient: 0.46; 95% confidence interval: 0.03–0.88; p value: 0.035), anxiety (0.24; 0.05–0.43; 0.014), and depression (0.19; 0.01–0.36; 0.035). No other NPV was associated with mental health. Conclusion. Organizational policies and programs should be established to protect the most activist RNs and to mitigate the potential detrimental effect of activism on mental health at times and/or circumstances of high workloads and personal stress. [ABSTRACT FROM AUTHOR]

Background: The reproductive health of Roma women has been poorly studied. It is important to determine the follow-up care received by Roma women from pregnancy to the first postpartum visit, together with neonatal outcomes, to improve prenatal care and maternal–child outcomes. Objective: The aim of this study was to examine differences in prenatal care and maternal–infant outcomes between Roma and non-Roma women. Methods: A retrospective longitudinal study was conducted in 122 pregnant women (28 Roma and 94 non-Roma women) recruited from seven primary care centers in three districts of Asturias (Spain). Sociodemographic variables, prenatal control, birth characteristics, feeding, and neonatal outcomes (gestational age, weight, and APGAR [appearance, pulse, grimace, activity, and respiration]) were collected from the electronic medical records. Prenatal care was assessed using three indices: the Kessner index, the Modified Adequacy of Prenatal Care Utilization Spanish Index, and an ad hoc index that considered adherence to the recommendations for pregnant women in Spain. Results: Compared with non-Roma women, advanced maternal age (≥35 years) and primigravida were less common among Roma women. Roma women visited the dentist less often, smoked more, and underwent group B streptococcus screening less frequently. No differences were found in the number of prenatal visits between Roma and non-Roma women. Consequently, there were no differences between the Kessner index and the Modified Adequacy of Prenatal Care Utilization Spanish Index. Using the ad hoc index, the non-Roma women more frequently had adequate prenatal visits. There were no differences in birth characteristics, type of feeding, and neonatal outcomes. Discussion: Overall, prenatal care was slightly worse in Roma women; however, this did not imply worse neonatal health outcomes. Both study groups had similar birth characteristics and immediate puerperium, including feeding. [ABSTRACT FROM AUTHOR]

Delayed discharge for non-clinical reasons (bed-blocking) is characteristic of pathologies associated with ageing, loss of functional capacity and dependence such as stroke. The aims of this study were to describe the costs and characteristics of cases of patients with stroke and delayed discharge for non-clinical reasons (bed-blocking) compared with cases of bed-blocking (BB) for other reasons and to assess the relationship between the length of total stay (LOS) with patient characteristics and the context of care. A descriptive cross-sectional study was conducted at a high complexity public hospital in Northern Spain (2007–2015). 443 stroke patients presented with BB. Delayed discharge increased LOS by approximately one week. The median age was 79.7 years, significantly higher than in cases of BB for other reasons. Patients with stroke and BB are usually older patients, however, when younger patients are affected, their length of stay is longer in relation to the sudden onset of the problem and the lack of adequate functional recovery resources or residential facilities for intermediate care. [ABSTRACT FROM AUTHOR]

Background. Delayed discharge for non-clinical reasons also affects patients in need of palliative care. Moreover, the number of people dying in hospitals has been increasing in recent years. Our aim was to describe characteristics of patients who died during prolonged stay, in comparison with the rest of patients with delayed discharge, in terms of length of hospital stay, patient characteristics and the context of care. Methods. A descriptive cross-sectional study at a high complexity public hospital in Northern Spain (2007-2015) was conducted. To compare the differential characteristics of the groups of patients died during delayed discharge with the rest, Student's T test and Pearson's chi-square test (χ2) were used. Results. A total of 198 patients died (6.57% of the total), with a mean total stay of 27.45 days and a prolonged stay of 10.69 days. Mean age 77.27 years. These were highly complex cases, 77.79% resided in the urban area, were admitted urgently (95.45%), to internal medicine or oncology wards, and the most common diagnosis was pneumonia. In people with terminal illness, clinicians can better identify when therapeutic possibilities are exhausted and acute hospitalization is not an adequate resource for their needs. Living in an urban area with the availability of palliative care hospital beds is related to the decision to die in hospital. [ABSTRACT FROM AUTHOR]

Purpose: To explore the effect of type 2 diabetes mellitus (T2DM) on the risk of death among women with breast cancer (BC). Methods: A survival analysis was conducted among a cohort of women diagnosed with BC between 2006 and 2012 in Spain (n = 4,493). Biopsy or surgery confirmed BC cases were identified through the state population-based cancer registry with information on patients' characteristics and vital status. Physician-diagnosed T2DM was confirmed based on primary health care clinical history. Cox regression analyses were used to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (CI) for all-cause death. Analyses were adjusted for age, hospital size, several clinical characteristics (including BC stage and histology, among others) and treatment modalities. Results: Among the 4,493 BC women, 388 (8.6%) had coexisting T2DM. Overall, 1,299 (28.9%) BC women died during the completion of the follow-up and 785 (17.5%) did so during the first five years after BC diagnosis, resulting in a five-year survival rate of 82.5%. The death rate was higher in women with T2DM (43.8% died during whole period and 26.0% during the first five years) when compared with women without T2DM (27.5% and 16.7%, respectively). Accordingly, all-cause mortality was higher in women with T2DM (aHR: 1.22; 95% CI 1.03–1.44), especially if T2DM was diagnosed before BC (aHR:1.24; 95% CI 1.03–1.50) and in women with BC diagnosed before 50 years (aHR: 2.38; 95% CI 1.04–5.48). Conclusions: T2DM was associated with higher all-cause mortality among Spanish women with BC, particularly when the T2DM diagnosis was prior to the BC. [ABSTRACT FROM AUTHOR]

Background: A validated questionnaire to measure the contributions of nursing students to clinical settings could potentially assist in the improved management of students in healthcare institutions. Aim: To develop and test the psychometric properties of the questionnaire 'Nursing Student Contributions to Clinical Settings' (CEEEC, Spanish acronym for 'Contribuciones de los Estudiantes de Enfermería a los Entornos Clínicos'). Design: Instrument design and psychometric testing. Participants/settings: A multicentre study involving 1,098 nursing professionals from three universities and five hospitals of Spain, between January 2019 and March 2020. Methods: The study was carried out in two phases. Phase 1 involved the questionnaire design by experts (n = 28), which required a review of the available literature, cognitive interviews and Delphi rounds, and a preliminary validity study, which included a pilot test with responses from a sample of nurses (n = 143). Phase 2 involved a formal validation with a wider sample of nurses (n = 927), including factor analysis and a study of convergent validity with the Practice Environment Scale‐Nursing Work Index and Health Sciences‐Evidence Based Practice. Results: Experts selected 42 items on student contributions. After cognitive interviews, three items were eliminated and seven failed to reach the minimum content validity index (78%). Based on the remaining 32 items, the discrimination index of each item was calculated, and those with <0.3, eight items were sequentially eliminated. The resulting questionnaire contained 24 items grouped into a single factor, which explained 41% of the variance. The internal consistency was excellent (Cronbach's alpha: 0.94), and the convergent validity was confirmed. Conclusions: A 24‐item questionnaire was designed and validated to measure the contributions of nursing students to clinical practice settings. Impact: Most hospitals are also teaching centres where nursing students undergo clinical practice. The application of this test will provide insight into the nursing professionals' perception of the students' role. [ABSTRACT FROM AUTHOR]

Aims and objectives: To obtain feedback regarding the comprehension and acceptability of an information leaflet on breast cancer screening among women. Background: Women usually receive a leaflet inviting them to participate in breast cancer screening programmes for early detection of breast cancer. These leaflets include relevant information about mammograms to aid with decision‐making. It is important to know how the target population perceives these leaflets, as this may influence the attitude towards breast cancer screening. Design: A mixed‐methods study (concurrent triangulation design). Methods: Participants were 41 women aged between 40–60 years in the north of Spain. The leaflet included information about breast cancer, mammograms, benefits/risks of screening, and the breast cancer mortality and survival rates in relation to screening. Three written methods were used to assess the leaflet: a readability assessment (Flesch Index) and two comprehension assessments (Cloze and multiple‐choice questions). In addition, 26 semi‐structured interviews were conducted to explore the women's opinions regarding comprehension, acceptability and the contribution of the leaflet as a decision aid. The COREQ checklist was used to guarantee the quality and rigour of the qualitative study. Results: Overall, women found the leaflet fairly easy to read and most understood the content. Some women found the information on mortality alarming, difficult to understand and a cause for rejection. The leaflet was viewed as a decision aid, although further information was requested on mammograms, the need for complementary tests and the risks and symptoms of breast cancer. Conclusion: The leaflet was accepted by women and, overall, easy to understand. The participation of the target population enabled the content and format of the leaflet to be adjusted to their needs. Relevance for clinical practice: Nurses can contribute towards improving the breast cancer screening leaflets, considering women's perceptions surrounding screening. [ABSTRACT FROM AUTHOR]

Background: Social determinants of health explain most health inequities. Intermediate determinants dictate differences in the exposure and vulnerability of people based on social stratification. Vulnerable women (lower education level, older age, uninsured, etc.) have lower adherence to recommended Pap smear screening guidelines. However, a gap remains concerning the effect of social determinants on human papillomavirus (HPV) infection. Objectives: The aim of this study was to analyze the association between the level of knowledge about HPV infection and HPV vaccines with education level and residential setting among a sample of Spanish women. Methods: A cross-sectional study at six primary care centers (Cantabria, Spain) was performed. All women >21 years consecutively attended by midwives for routine follow-up were invited to participate during the study period (2015–2016) until a convenience sample was recruited. Participants completed an anonymous questionnaire addressing sociodemographic variables (age, education level, and residential setting) and the level of knowledge regarding HPV infection, including general knowledge about infection and knowledge about the HPV vaccine. Associations between education level (primary, secondary, and university) and residential setting (urban, semiurban, and rural) with the level of knowledge of HPV infection and HPV vaccine were calculated using adjusted logistic regressions. Dose–response associations were estimated based on p -trend. Results: Compared to university women, a lower education level was associated with limited or no knowledge of either HPV infection or the HPV vaccine. Women living in rural areas poorly identified "promiscuity" as a risk factor of HPV infection and "the use of condoms" as a protective factor. Moreover, living in rural areas was associated with limited or no knowledge of HPV infection and HPV vaccine. There were significant dose–response trends; those who were more educated and living in more urban areas had more knowledge about either HPV infection or the vaccine. Discussion: In our sample, the level of knowledge of HPV infection and HPV vaccine was high. However, vulnerable women, defined by a lower education level and living in rural areas, presented a greater lack of knowledge regarding HPV infection and the HPV vaccine. [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: The development of professional values in nursing is directly related to quality and ethical clinical practise and may also increase practitioner and patients' satisfaction. Some factors, such as work setting or work experience, can influence the importance granted to the professional values of nursing. Objectives: To compare in primary care nurses and hospital care nurses the importance granted to professional values and to contrast this perception as a function of professional experience. Research design, participants and research context: Descriptive cross-sectional study. Participants were 380 nursing professionals from the public health system (primary care and hospital care). Three dimensions were analysed: ethics, professional expertise and professional mastery. Data were collected from January to June 2015. Ethical considerations: We obtained permission from the Ethics Committee and participants' informed consent. Findings: Hospital care professionals attached more importance to all the values analysed, regardless of their work experience. Ethical values, such as confidentiality and respect for the person, were considered to be very important in both systems. Values related to professional expertise obtained lower scores, especially in primary care. In general, professionals with more than 20 years' experience granted less importance to the values. Conclusion: The professional setting influenced the importance assigned to professional nursing values, and clear differences were observed between primary and hospital care. The domain of ethics was considered the most important. It is necessary to reflect on the significance attributed to professional values, especially in more expert nursing staff. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to review the published literature on the health of the Roma population in Spain, particularly that which describes health interventions and outcomes. Design: A scoping review of published articles/reports on Roma population health was carried out in Spain for publications between 2002 and 2014. Articles in Spanish or English were identified from Pubmed, Scopus, Science Direct, Web of Science, Scielo, IBECS, MEDES, Dialnet, Index Foundation, a database of theses and Google Scholar. After an initial assessment of the article title and summary, genetic studies, editorials, reviews and grey literature with incomplete data were excluded. Two independent researchers followed a protocol to analyze the selected papers in terms of general information, methodology, themes, and results or conclusions. Results: Forty studies were selected for inclusion, primarily located through PubMed and Google Scholar. Most of the papers were scientific articles, published after 2007 in Spanish scientific journals (70.0%) followed by institutional reports (20.0%). The main language was Spanish (84.2%). The studies were carried out mainly by public institutions (35.0%) or universities (22.5%). Most (67.5%) followed a descriptive design and nearly half (47.5%) were concerned only with the Roma population. The main thematic areas were: child health (25%), infectious diseases (25%), health and social education context (20%), perceived health and lifestyle (15%), sexual and reproductive health (7,5%) and health services use (7,5%). We found seven intervention studies related to health, educational environment, or social services. Conclusions: There are few publications related to the health of the Roma community in Spain and even fewer related to health interventions and outcomes. Those that are available have focused on areas such as child health or infectious disease outbreaks. It is important to promote health interventions in Roma communities and longitudinal studies that include a comprehensive vision and account for the social determinants of health. [ABSTRACT FROM AUTHOR]

A cross-sectional study of pre-university and university students of both genders was carried out in Spain (N= 4,919) to determine the levels of tolerance of partner violence per gender and the perception of abuse. Of the students, 26.3% were in a situation of unperceived abuse, especially the males (29.6%), but the level of tolerance of abusive behavior was significantly lower in females. The group of youths who did not perceive themselves as abused had higher levels of tolerance. In contrast, non-abused students presented low tolerance of violent behavior. Tolerance of dating violence is more strongly determined by gender than by the perception of abuse in young people. [ABSTRACT FROM AUTHOR]

To describe the contribution of nursing students to clinical settings based on the perceptions of nurse preceptors and to examine whether certain characteristics of nurses' professional activity are associated with a positive perception of nursing students. Most clinical agencies receive many nursing students each year, who acquire clinical competencies under the guidance of a registered nurse preceptor. However, there is limited evidence of the contributions made by nursing students during clinical placements. A multi-center cross-sectional study was carried out between June and December 2019. A convenience sample of Registered Nurses (n = 927) was recruited from four public hospitals in Spain. The Nursing Student Contributions to Clinical Settings' questionnaire was used. In addition, sociodemographic, work and teaching activity variables were collected. Multivariable logistic regression was used to determine the variables associated with positive student contributions. The nursing student contributions were deemed favorable by 70.7% of the nurse preceptors, mainly because the nursing students are future professionals who know the center, support the development of the nurses' teaching role and constitute a link between the health center and the university. Certain professional characteristics of the Registered Nurses were significantly associated with a positive perception of the contributions of nursing students: having daily coffee breaks (Odds ratio: 2.60; 95% Confidence interval:1.27–5.32), high levels of professional satisfaction (Odds ratio: 2.13; 95% Confidence interval:1.21–3.75) and work in medical-surgical units (Odds ratio: 1.62; 95% Confidence interval: 1.08–2.41). In contrast, nurses with greater work experience (≥ 30 years) (Odds ratio: 0.48; 95% Confidence interval: 0.27–0.85) and who worked at units where 10 or more students perform clinical practice (Odds ratio: 0.57; 95% Confidence interval: 0.36–0.90) were associated with a lower probability of positive perceptions. In Spain, the contributions made by nursing students to clinical settings are favorable, both for the nursing profession and for healthcare institutions. Their contributions are influenced by the professional characteristics of the Registered Nurses, as well as the environment and the teaching activity within the units. [ABSTRACT FROM AUTHOR]

Background: Anxiety experienced by women during their participation in breast cancer screening programs can condition their adherence to the program. The aim was to determine whether a brief nursing intervention could reduce anxiety before screening mammography. Method: A randomized controlled trial carried out with 436 Spanish women aged between 50-69 years, who attended a population breast cancer screening program. The experimental group received an ad-hoc tailored intervention, which consisted of offering information about the screening program and the mammography exam, as well as of providing personal emotional support. Anxiety was assessed using the State-Trait Anxiety Inventory (STAI). Fear of screening outcome and fear of breast cancer were also assessed. Results: Women of the experimental group had 60% less probability of having a high anxiety state (OR = 0.40; 95%: CI [0.25, 0.65]), after adjusting for sociodemographic and clinical variables. Regarding trait anxiety, no differences were observed between groups. The stratified analysis showed that this positive impact was greater in women who did not fear the screening outcome (OR = 0.24; 95% CI [0.11, 0.52]) or breast cancer (OR = 0.07; 95% CI [0.01, 0.41]). Conclusions: A protocolized nursing intervention reduced the probability of being anxious when undergoing a screening mammography. [ABSTRACT FROM AUTHOR]

To adapt the 'Nursing Student Contributions to Clinical Settings' scale (CEEEC, Spanish acronym), designed for specialized care and to evaluate the validity and reliability of a measure in the primary health care setting. Additionally, a description of the contributions of nursing students to primary health care in Spain is presented, based on the perception of preceptor nurses. A multicenter cross-sectional study was conducted in Spain, involving a committee of nursing experts who participated in a Delphi panel (n = 5) and cognitive interviews (n = 5) and a sample of nursing preceptors (n = 300) from 57 primary health care centers (2019–2020). The CEEEC was reviewed by experts for the conceptual semantic adequacy of the 24 items for its application in primary health care. Nurse preceptors' responses to the CEEEC scale were used to study the validity and reliability of the measure, including factor analysis, convergent validity with the Health Sciences-Evidence Based Practice scale and a matched test-retest over a three-week interval. According to the consensus of experts, the CEEEC scale is valid for primary health care with minimal modifications (change " patient " to " user "). Based on the analysis of responses to the scale, the corrected item-total correlations of the 24 items were ≥ 0.40 and were grouped into a single factor, explaining 46.3% of the variance. The Cronbach's alpha value was 0.95. Regarding convergent validity, there was a positive correlation between the CEEEC scale and the score of the Health Sciences-Evidence Based Practice scale (Pearson's coefficient= 0.33; p < 0.001). The overall intraclass correlation coefficient was 0.91. Finally, the mean CEEEC score was 61.9 points (range 0–96). The two most positive contributions were 'Nursing students enable nursing professionals to perform their teaching role' and 'Nursing students become future professionals who know the healthcare facility'. The CEEEC scale provides a valid and reliable measure of nursing students' contributions to primary health care. Nursing students' contributions to Spanish primary health care were positive, especially towards the nursing profession and healthcare organizations. [ABSTRACT FROM AUTHOR]

Objective: Breast cancer screening (BCS) leaflets are important for outreach and dissemination of BCS programs. Knowing how women perceive these leaflets is relevant to better understand their attitude towards BCS. The objective of this paper was to explore women's reactions regarding BCS leaflet., Methods: A simple descriptive qualitative design was performed involving women aged between forty and sixty years of age in Asturias (Spain). Twenty-six semi-structured interviews were conducted with women of different socioeconomic profiles in 2018. Thematic analysis was carried out., Results: Reading the leaflet elicited positive emotions such as peace of mind, well-being or gratitude, in addition to fear or anxiety. The women expressed various beliefs about breast cancer (highly prevalent and high survival rates), about BCS (a program aimed at prevention, a normative activity among their peers) and about the relevant role of health services and the media. Ambivalent attitudes towards BCS were detected, related to emotions., Conclusions: The emotional response after reading the brochure is ambivalent, although most of the women express positive emotions. Women compare the information with previous beliefs, especially regarding breast cancer (BC) and BCS. It is important to understand how certain emotions (especially negative ones) are closely related to the attitude towards BCS., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Background: Traditional gender roles (GRs) have a considerable influence on relationships among couples. These can lead to negative health effects in women; however, their impact on intimate partner violence (IPV) has been less explored, especially among younger women., Objective: To explore the association between traditional GRs and several indicators of IPV on a sample of Spanish female university students involved in heterosexual dating relationships., Methods: A cross-sectional study involving female university students (n = 1,005) pursuing ten degrees (four Health Science degrees and six Social Sciences degrees). Data were collected using two validated scales: 1) the Questionnaire on the Gender Determinants of Contraception (COGANT), used to examine four traditional GRs (submissive, blind, and passive attitudes of female students, and male dominance), and 2) the Dating Violence Questionnaire-R (DVQ-R) scale, used to measure five types of IPV-behaviors (coercion, detachment, humiliation, sexual violence, and physical violence), perceived fear, entrapment, and abuse. Logistic and linear regressions were conducted to study the association between GR and a series of IPV indicators in dating relationships., Results: Traditional GRs were highly prevalent (57.0% submissive, 52.0% blind attitude, 75.7% passive, and 31.7% identified their boyfriend as being dominant). Up to 66.3% experienced some type of violent behavior. All GRs were significantly associated with IPV indicators. A submissive attitude in female students was the GR that was most strongly associated to total IPV-behavior (adjusted odd ratio [OR] = 3.18; 95% confidence interval [CI]: 2.29-4.42), followed by male dominance (OR = 2.79: 95% CI:1.71: 4.54). Both GRs were also highly associated with perceived fear, entrapment, and abuse., Conclusions: A high presence of traditional GRs was found in the relationships held by female university students, which was significantly associated with IPV indicators. Universities must adopt policies for gender equality and raise awareness on dating violence., Competing Interests: The authors have declared that no competing interests exist.

Background: Delayed discharge for non-clinical reasons is related to a failure to plan for discharge and a lack of availability of intermediate care resources as an alternative to acute hospitalisation. The literature concerning the relationship with pneumonia is scarce. At present, the coronavirus pandemic is a new cause of complicated pneumonias that can further affect the functionality of the most fragile patients., Objective: The aim of this study was to understand what characteristics are typical of patients affected by pneumonia, compared with other cases of delayed discharge., Methods: A cross-sectional study was conducted. All cases of delayed discharge were studied at the hospitalisation units of a general university hospital in Northern Spain from 2007 to 2015. In order to compare the differential characteristics of the groups of patients with pneumonia with the total Student's T-test and Pearson's chi-square test (χ²) were used., Results: 170 patients were identified with a diagnosis of pneumonia and delayed discharge for non-clinical reasons during the study period. These cases accumulated a total of 4790 days of total stay, of which 1294 days corresponded to the prolonged stay. The mean age of the patients was 80.23 years. The mean DRG weight was 2.28 [SD 0.579], and 14.12% of patients with pneumonia and delayed discharge died. So, patients with pneumonia were older (P = .001), less complex (P = .001) and suffered greater deaths compared with the remaining patients (P = .001)., Conclusions: The sum of these factors has to do with comorbidities and complications associated with ageing and the characteristics of conditions such as aspiration pneumonia., (© 2021 The Authors. International Journal of Clinical Practice published by John Wiley & Sons Ltd.)

Delayed discharge for non-clinical reasons shares common characteristics with hip procedures. We sought to quantify the length of stay and related costs of hip procedures and compare these with other cases of delayed discharge. A cross-sectional study was conducted at a public hospital in Spain (2007-2015) including 306 patients with 6945 days of total stay and 2178 days of prolonged stay. The mean appropriate stay was 15.58 days, and the mean prolonged stay was 7.12 days. The cost of a prolonged stay was €641,002.09. The opportunity cost according to the value of the hospital complexity unit was €922,997.82. The mean diagnostic-related groups' weight was 3.40. Up to 85.29% of patients resided in an urban area near the hospital ( p = 0.001), and 83.33% were referred to a long-stay facility for functional recovery ( p = 0.001). The proportion of patients with hip procedures and delayed discharge was lower than previous reports; however, their length of stay was longer. The cost of prolonged stay could account for 21.17% of the total. Compared with the remaining cases of delayed discharge, the appropriate stay was shorter in hip procedures, with a profile of older women living in an urban area close to the hospital and referred to a long-stay center for functional recovery.

Nurses can be overwhelmed by the growing need for documentation derived from the implantation of electronic health records. The objective was to describe the evolution of nursing workload since the implementation of the EHR. We performed a longitudinal study of global workload indicators over a 5-year period at a referral hospital in Spain since introduction of the EHR (2014). Clinical activity records of each nurse were monitored using audit logs of their accesses to EHRs. During the study period, the number of EHR sessions, the number of EHR sessions in which a nursing order was changed, and the time needed to complete each session significantly increased. The number of mouse clicks and keystrokes and the time required to complete each nursing order decreased. Documentation of the following nursing tasks increased: administration of medication, peripheral vascular catheters, urinary catheters, pressure ulcers, nursing assessment forms, and pre-surgical verification. In conclusion, since the implementation of the EHR, an increase in the workload of nursing professionals-estimated through indirect indicators-has been observed due to greater documentation., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To explore the association between immigrant status and performance of pap-smear and mammography, and to study the potential effect of social integration on that association., Method: Secondary analysis of the National Health Survey of Spain 2012. Individual data from 8944 women aged 18-75 were analyzed. Dependent variables were the performance of pap-smear tests and mammographies according to the guidelines of the state of residence. The level of integration in Spain was estimated through perceived social support (Duke-UNC scale) and the number of years living in Spain. Logistic regressions were used in order to obtain odds ratios (OR) and their 95% confidence intervals (95%CI), adjusted for confounders (sociodemographic and health-status)., Results: Compared to natives, immigrant women were more likely to not adhere to cervical cancer screening (OR: 1.31; 95%CI: 1.06-1.63) or breast cancer screening (OR:=3.13; 95%CI: 2.14-4.58). Additional adjustment by social support and length of residence in Spain attenuated the association, consequently losing statistical significance (OR: 1.08, 95%CI: .77-1.52 for pap-smear; OR: 1.62, 95%CI: .97-2.74 for mammographies)., Conclusions: The probability of participating in the screening programs for gynecological cancer was lower if women were born abroad. Perceived social support and time living in Spain of immigrant women explained to a large extent the differences between immigrants and natives., (Copyright © 2019 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Clinical practices are key environments for skill acquisition during the education of nursing students, where it is important to encourage reflective learning. This study sought to explore the experience of final year nursing students during their clinical placement in emergency and intensive care units and to identify whether differences exist between female and male students. Using qualitative methodology, a documentary analysis of 28 reflective learning journals was carried out at a public university in Northern Spain. Four themes were identified: "an intense emotional experience", "the importance of attitudes over and above techniques", "identifying with nurses who dominate their environment and are close to the patient in complex and dehumanized units" and "how to improve care in critically ill patients and how to support their families". The female students displayed a more emotional and reflective experience, with a strong focus on patient care, whereas male students identified more with individual aspects of learning and the organization and quality of the units. Both male and female students experienced intense emotions, improved their learning in complex environments and acquired attitudes linked to the humanization of care. However, the experience of these clinical rotations was different between female and male students.

Objective: Providing care for people with chronic diseases is a challenge requiring institutional programs and strategies, thus it necessary to evaluate the impact of the same on the social determinants of health (SDH). The aims were: 1) to describe the impact of the structural determinants of the Health Strategy for the Population with Chronic Diseases (EAPEC) in Asturias and 2) to propose actions for improvement regarding social stratification factors., Methods: Qualitative study of six strategic programs of the Chronic Disease Strategy: Health Observatory, Social and Healthcare Coordination, School for Patients Program, Caregivers Program, Mental Health Services Continuity, and Quality and Safety in Healthcare. A screening tool was used, validated for evaluation of the health impact on the structural determinants (socioeconomic and political context and social stratification factors) of the SDH. A personal semi-structured interview was carried out with the manager of each program in 2016, and a final report was produced that included the impacts found and proposals for improvement., Results: All programs had a positive impact on social values (social justice, equity) and the state of wellbeing (social and educational policies). In terms of social stratification, the principal positive effects included age and functional diversity. Regarding the factors linked to geographic location, gender, origin/ethnicity, and social class the principal effects were negative., Conclusions: This strategy aimed at people with chronic diseases has positive effects. However, paying attention to social stratification factors during implementation of the same is a priority.

Objective: To explore university health science students' intimate partner violence tolerance and sexist attitudes and to examine their trend throughout the academic years., Methods: Cross-sectional study of students of both sexes of the degrees of medicine, nursing, and psychology from three selected Spanish universities (n = 1,322). Data were collected anonymously using two validated scales: the Dating Violence Questionnaire (DVQ-R) and the Gender Role Attitudes Scale (GRAS). Logistic regressions were used to compare tolerance toward violence and sexist attitudes across the degrees. The evolution of these variables throughout different academic courses was assessed., Results: Of the sample, 62.8% were tolerant towards intimate partner violence. The percentage of tolerant students was significantly higher in Psychology (75.9%) than in Nursing (57.7%) and Medicine Degrees (60.3%). A higher percentage of sexist students was also found in psychology students (80.8%) than in nursing (62.2%) and medicine students (62.7%). Compared to the first-year students, female medicine students of the last courses were less tolerant to intimate partner violence (p-trend <0.001), and male medicine students had less sexist attitudes (p-trend = 0.002)., Conclusions: Tolerance of intimate partner violence and sexist attitudes were very high, especially among psychology students. These indicators were significantly better among medicine students of higher courses, suggesting a positive effect of medical training. Intimate partner violence in the university education of the future health professionals should be addressed. ., (Copyright © 2019 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Current studies on bed-blocking or delayed discharge for non-medical reasons report important variations depending on the country or setting under study. Research on this subject is clearly important as the current system reveals major inefficiencies. Although there is some agreement on the patient-related factors that contribute to the phenomenon, such as older age or a lack of functional ability, there is greater variability regarding environmental or organizational factors. This study sought to quantify the number of cases and days inappropriately spent in hospital and identify patient characteristics and healthcare service use associated with the total length of stay. All cases of delayed discharge were studied at the hospitalization units of a general university hospital in Northern Spain between 2007 and 2015. According to regression estimates, the following characteristics were related to a longer stay: higher complexity through (Diagnosis-Related Group) DRG weight, a diagnosis that implied a lack of functional ability, surgical treatment, having to wait for a destination upon final discharge or return home. After an initial increase, a reduction in delayed discharge was observed, which was maintained for the duration of the study period. Multi-component interventions related with discharge planning can favor a reduced inefficiency with fewer unnecessary stays.

It is essential to develop a comprehensive approach to institutionally promoted interventions to assess their impact on health from the perspective of the social determinants of health and equity. Simple, adapted tools must be developed to carry out these assessments. The aim of this paper is to present two tools to assess the impact of programmes and community-based interventions on the social determinants of health. The first tool is intended to assess health programmes through interviews and analysis of information provided by the assessment team. The second tool, by means of online assessments of community-based interventions, also enables a report on inequality issues that includes recommendations for improvement. In addition to reducing health-related social inequities, the implementation of these tools can also help to improve the efficiency of public health interventions., (Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Aim: To explore the association between gender-role attitudes and the recognition of abuse among adolescents and young adults during dating relationships., Design: Cross-correlation study., Location: 57 schools of secondary education, vocational education and university in five provinces of Spain (Huelva, Seville, A Coruña, Pontevedra and Asturias)., Participants: 4,337 students aged between 15 and 26 years (40.6% males and 59.4% female) who had a dating relationship that lasted more than a month., Main Measurements: The Gender Role Attitudes Scale was used, which consists of 20 indicators of egalitarian or sexism attitudes at the family, social and occupational level. The students also reported whether they suffered from recognized abuse (RA), unperceived abuse (UPA), or not abused (NA)., Results: In the whole sample, 68.6% declared themselves NA, 26.4% were under a situation of UPA, and 5.0% were RA. The RA group was more frequent among the females (6.3%), ≥18 years (6.4%) and university students (6.9%). UPA was more common in males (30.2%). The most sexist attitudes were found in the occupational dimension and especially in men and adolescents (15-17 years). Less sexist attitudes were associated with a lower probability of experiencing UPA (odds ratio=.71; P-trend<.001)., Conclusions: Sexism seems to hinder the recognition of abuse. Achieving gender equity in adolescence and youth is imperative. Public health efforts should focus on men, as they constitute the group with more sexist attitudes and with higher prevalence of UPA., (Copyright © 2017 Elsevier España, S.L.U. All rights reserved.)