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Anxiety, depression, and stress are common and expected reactions to the coronavirus disease (COVID-19) pandemic. The objective of this study is to analyze psychological distress in a sample of Spanish population, identifying the predictive nature of the information received, the preventive measures taken, level of concern, beliefs, and knowledge about the infection. A cross-sectional observational study was conducted on a sample of 4615 participants. Data were collected through a self-prepared questionnaire and the general health questionnaire (GHQ-12). Bivariate analyses and logistic regressions were performed. Of the total participants, 71.98% presented psychological distress. The study population actively sought information about coronavirus, expressed a high level of concern and knowledge, and the most frequent preventive behavior was hand washing. As predictive factors, the degree of concern for COVID-19 was identified (odds ratio (OR) = 1.244, 95% confidence interval (CI) = [1.179, 1.312]), the number of hours spent consulting information on COVID-19 (OR = 1.038, 95% CI = [1.009, 1.068]), or the need for psychological support (OR = 1.135, 95% CI = [1.094, 1.177]), among others. These results could help design more effective strategies towards a psycho-emotional approach for the population when in similar health crisis situations. There is a need for interventions aimed at the psychological well-being of the population that meet the needs of their reality., Competing Interests: The authors declare no conflicts of interest.

Background: In times of pandemic, case management and tracking people with contact can be differential elements for controlling the spread. The objective of this review was to evaluate the digital tools used to track contacts of people infected with SARS-CoV-2., Methods: A systematic exploratory review was conducted in the electronic databases Pubmed, Scopus and Web of Science on May 29, 2020 through the descriptors: coronavirus, digital surveillance and contact tracing. A total of 11 studies were finally selected., Results: The results showed that some countries are implementing digital tools for contact tracking through mobile apps that allow user data to be shared via the device's GPS and/or Bluetooth. The terms on the privacy and confidentiality of the population data are, in some cases, questionable., Conclusions: The use of digital surveillance tools to track contacts of people infected with an infectious disease, such as SARS-CoV-2, can be key to reducing the number of people infected and reducing the spread of the virus.

Professional and academic legislation relating to nursing skills reflects conceptual and professional developments. In this sense, conceptual and methodological analyses are required to describe the concept of nursing competencies, the individual or group self-perception of competencies, to identify training needs, and to specify the nursing professional profile within the health organization. A sequential mixed methodology was proposed combining qualitative and quantitative approaches. The qualitative methodology involves the Focus Group and the Delphi technique. The quantitative methodology involves surveying and analyzing self-perception (descriptive and analytical in relation to personal and professional variables and levels of excellence). The methodology was piloted among primary care nurses. Competencies were analyzed and distributed across the training program. The combination of qualitative and quantitative methods showed that obtaining a deep insight into the nurses' competencies would be a good process. This proposal is applicable as an approach to global nursing competencies or to a particular specialty.

Mortality rates among pluripathological patients are significantly higher in the hospital setting, with advanced age and dependence on certain vital functions the main clinical aspects. Other features involved in the care, such as the loss of autonomy and social problems, have important ethical implications. The aim of this article is to analyze the health problems and the functional and social situation of chronic patients after hospital admission in order to determine their care needs and the ethical implications these might have. For this, a cross-sectional descriptive study is being carried out with a sample of 111 chronic pluripathological patients admitted to the internal medicine service and discharged later. Overall, 96.6% of the patients in the sample were dependent, 91.7% had social problems or were at social risk and 36.9% had cognitive impairment. Among dependent patients, 59.4% had social problems ( p = 0.029), 19.2% lived alone ( p = 0.13), and in 73.3% of cases the housing was inadequate ( p = 0.47). Among those with cognitive impairment, 79.5% of patients had social problems ( p = 0.001), and 10.3% lived alone ( p = 0.038). The results of the study confirm the presence of dependence and social problems at hospital discharge in a high proportion of chronic patients. Planning their care can lead to ethical conflicts related to the use of information technologies, which are destined to promote the patients' autonomy, and to the social problems associated with the illness.

Measures to prevent and contain the COVID-19 health crisis include population confinement, with the consequent isolation and interruption of their usual activities. The aim of the study is to analyse psychological distress during the COVID-19 pandemic. For this, a cross-sectional observational study with a sample of 4180 people over the age of 18 during quarantine was developed. Variables considered were sociodemographic variables, physical symptoms, health conditions, COVID-19 contact history and psychological adjustment. The data were collected through a self-developed questionnaire and the General Health Questionnaire (GHQ-12). Bivariate analyses were performed, including Chi-Squared test and Student's T-test. Predictive ability was calculated through logistic regression. Results obtained showed a high level of psychological distress (72.0%), with a higher percentage in women and people of lower middle age. Statistically significant differences were found in the variable working situation (χ² = 63.139, p ≤ 0.001, V = 0.123) and living with children under the age of 16 (χ² = 7.393, p = 0.007, V = 0.042). The predictive variables with the highest weight were sex (OR = 1.952, 95% IC = (1.667, 2.286)), presence of symptoms (OR = 1.130, 95% CI = (1.074, 1.190)), and having had close contact with an individual with confirmed COVID-19 (OR = 1.241, 95% CI = (1.026, 1.500)). These results could enrich prevention interventions in public health and, in particular, in mental health in similar pandemic situations., Competing Interests: The authors declare no conflict of interest.

The high incidence of vascular ulcers and the difficulties encountered in their healing process require the understanding of their multiple etiologies to develop effective strategies focused on providing different treatment options. This work provides a description of the principles of the physics of fluid dynamics related to vascular ulcers. The morphological characteristics of the cardiovascular system promote blood flow. The contraction force of the left ventricle is enhanced by its ability to reduce its radius of curvature and by increasing the thickness of the ventricular wall (Laplace's Law). Arterial flow must overcome vascular resistance (Ohm's equation). The elastic nature of the artery and the ability to reduce its diameter as flow rate progresses facilitate blood conduction at high speed up to arteriolar level, and this can be determined by the second equation of continuity. As it is a viscous fluid, we must discuss laminar flow, calculated by the Reynolds number, which favors proper conduction while aiming at the correct net filtration pressure. Any endothelial harmful process that affects the muscle wall of the vessel increases the flow speed, causing a decrease in capillary hydrostatic pressure, thus reducing the exchange of nutrients at the interstitial level. With regard to the return system, the flow direction is anti-gravity and requires endogenous aid to establish the Starling's equilibrium. Knowledge on the physics of vascular fluid dynamics makes it easier to understand the processes of formation of these ulcers so as to choosing the optimal healing and prevention techniques for these chronic wounds., Competing Interests: The authors declare no conflict of interest.

Background: The new coronavirus disease is an infectious disease caused by the SARS-Cov-2 virus, considered by the World Health Organization (WHO) an international public health emergency that may have negative consequences during breastfeeding. The objective of this work is to investigate the action plan on breastfeeding in postpartum women with SARS-CoV-2 and her newborn., Methods: A literature search has been conducted through the Medline, Web of Science, Scopus, BVS, and Cuiden databases. The methodological quality of the articles has been assessed using the "Grading of Recommendations Assessment, Development and Evaluation" (GRADE). This study has not been registered in PROSPERO., Results: A total of 14 documents have been found, of which 9 are observational empirical studies. Most of the studies were conducted in China, Italy, the USA, and Australia. A total of 114 mothers infected with coronavirus with their respective newborns have been assessed. The analyzed investigations state that it is best for the newborn to be breastfed; given that mother's milk samples were analyzed, detecting the presence of antibodies of the coronavirus in them, being a protective factor against infection., Conclusions: Breastfeeding in postpartum women with SARS-CoV-2 is highly recommended for the newborn, if the health of the mother and newborn allow it. When direct breastfeeding is favoured, the appropriate respiratory hygiene measures always have to be considered. Whether the mother's health does not permit direct breastfeeding, her breast milk should be previously extracted and kept unpasteurized. To secure the newborn feeding, milk banks are also an appropriate option.

Preanalytical errors account for up to 70% of the total potentially detectable errors in the laboratory. The main problems detected are related with procedures associated with Primary Care nursing practices that are directly involved in the preanalytical phase. The objective of this study is to carry out a transcultural adaptation and piloting of the "Regarding Blood-Sampling Practices at Primary Health Care Centres" questionnaire as regards blood sampling in Primary Care. For this, a cross-sectional descriptive study has been developed within the Primary Care area of the Andalusian Public Health System. The venous blood sampling questionnaire was translated into and adapted to Spanish by qualified professionals and expert translators. The questionnaires were then delivered to all staff nurses from the health districts involved. The total sample consisted of 224 primary care nursing professionals. The factors that showed statistically significant relationships were identification and sample collection, management with information search, storage and labelling of samples, and reporting of errors. A lack of global relationship between factors makes it impossible to find a global quality factor in the sampling process. The process of translation, adaptation, and piloting of the questionnaire from its original version to the Spanish one has proven to be understandable by professionals in its entirety and to offer data similar to the original version.

Sleep problems in university students are important and have implications for health, quality of life, and academic performance. Using an ex post facto design, a total sample of 855 students (55.7% women) participated in the study. Sleep assessment was conducted using the Pittsburgh Sleep Quality Index, the Nightmare Frequency Scale, the Nightmare Proneness Scale, and the Composite Morningness Scale. Women show a higher risk [OR = 2.61] of presenting poor sleep quality (> 5 points on the PSQI) compared with men ( p < 0.001). Similarly, women reported a greater frequency of nightmares ( p < 0.001, d = 0.60), greater propensity for nightmares ( p < 0.001, d = 0.70) and a higher score on Item-5h of the PSQI regarding nightmares ( p < 0.001, d = 0.59). Women, compared with men, show higher risk [OR = 2.84] for a sleep disorder related to nightmares ( p = 0.012). Women need more time to reach a state of alertness after getting up ( p = 0.022), and there was an interaction between sex and the alertness factor when evaluating the subjective quality of sleep ( p = 0.030). Women show worse sleep quality and a higher frequency and propensity for suffering nightmares. When considering the relationship between sleep quality and academic performance, it is observed that students with poor sleep quality obtain lower academic scores (M = 7.21, SD = 0.805) than those with good sleep quality (M = 7.32, SD = 0.685), an effect that reaches significance ( t = 2.116, p = 0.035). Regarding the relationship between the categorized chronotype and academic performance, students with a morning chronotype achieve better academic results (M = 7.41, SD = 0.89) than their evening counterparts (M = 7.15, SD = 0.76), although these differences have a small effect size ( d = 0.31).

Umbilical cord milking (UCM) could be an alternative in cases where delayed umbilical cord clamping cannot be performed, therefore our objective was to evaluate the effects of UCM in newborns <37 weeks' gestation. In this systematic review and meta-analysis, we searched MEDLINE, EMBASE, CINAHL, the Cochrane Database of Clinical Trials, the clinicaltrails.gov database for randomized UCM clinical trials with no language restrictions, which we then compared with other strategies. The sample included 2083 preterm infants. The results of our meta-analysis suggest that UCM in premature infants can reduce the risk of transfusion (relative risk (RR)= 0.78 [95% confidence interval (CI),0.67-0.90]) and increase hemoglobin(pooled weighted mean difference (PWMD)= 0.89 g/L[95%CI 0.55-1.22]) and mean blood pressure (PWMD=1.92 mmHg [95% CI 0.55-3.25]). Conversely, UCM seems to increase the risk of respiratory distress syndrome (RR = 1.54 [95% CI 1.03-2.29]), compared to the control groups. In infants born at <33 weeks, UCM was associated with a reduced risk of transfusion (RR= 0.81 [95%CI 0.66-0.99]), as well as higher quantities of hemoglobin (PWMD= 0.91 g/L[95%CI 0.50-1.32]). UCM reduces the risk of transfusion in preterm infants, and increases initial hemoglobin, hematocrit, and mean blood pressure levels with respect to controls., Competing Interests: The authors declare no conflict of interest.

In order to discover family conceptions and their difficulties with regard to healthy eating habits during the school day, a qualitative study framed in the phenomenological, exploratory, and explanatory perspective has been carried out to detect and describe the aspects and interrelationships that shape the study phenomenon. The researchers performed triangulation techniques and information analysis support with the Atlas-ti programme. As participants, the students' parents belonging to public secondary education high schools in Huelva, and the capital and its province were included. The participants were intentionally chosen based on established selection and segmentation criteria. Four main categories were obtained from the triangulated analysis. Healthy breakfast, school snack, school cafeteria, and promotion of healthy food measures. Other subcategories were established within them. Families are well aware of the composition of a healthy breakfast, although this is often not translated into practice. Lack of time, comfort and market influence are the main challenges they encounter for their children to acquire healthy habits. The maintenance of healthy habits, their responsibility and control on behalf of the family, and promoting fruit consumption and healthy products from the part of the centre and its cafeteria were highlighted as improvement proposals.

The European Higher Education Area was implemented more than a decade ago with the aim of improving internationally the competitiveness of European university education putting the spotlight on skills and competence development (and not only on knowledge acquisition). This work intends to analyze the impact of competence-based teaching methodologies on university students, as well as to contribute to the study of the individual personality traits differences regarding this impact. For this, a descriptive, quantitative, cross-sectional study was conducted with a non-randomised sample of university students. The sample was composed of a total of 499 students of the University of Huelva (350 from the Health Sciences degree, and 149 form other degrees), who completed a questionnaire on professional skills and teaching methods developed ad hoc for this research, as well as the brief version of the Spanish adaptation of the NEO Five-Factor Inventory. The results show that Health Sciences students feel more satisfied with the most participative and active methodologies, and they consider these better contribute to their future professional competence development. On the other hand, in relation to the big 5 personality traits studied, links have been found between competence development perception and personal preferences and the dimensions of extraversion, agreeableness, conscientiousness and openness to experience. This last factor, openness to experience, appears when analyzing the main differences among both groups, being Health Sciences students more intellectually curious, showing more openness and diversity of interests, in addition to being more creative, innovative, and flexible.

The role of nursing students as future health promoters of healthy behaviors is influenced by their attitude towards smoking. A cross-sectional study using a self-administered survey was performed to analyze smoking prevalence among undergraduate the nursing students who attend nursing faculties in 2 European countries (Spain and Portugal) during academic period 2015 to 2016. A total of 1469 subjects were surveyed (response rate of 79.8%). An 80% of the students were female with a mean age of 21.9 (4.8) years. The overall prevalence of tobacco use was 18.9%, with an average percentage of 16.2% in Portugal and 18.3% in Spain. Statistical significance was observed in relation to smoke and previous studies (16.4% vs 27.1%; P < .001). Only 1.1% of the students reported using electronic cigarette. 15.8% of smokers started smoking while at university with statistical gender and previous studies differences (P < .001). Fagerström and Richmond test showed low nicotine dependence (2.8 ± 2) and moderate motivation to stop smoking (4.9 ± 3), respectively. Smoking prevalence among nursing students was slightly higher than the general European population. For that reason, measures to reduce tobacco use have to be focused on students and university policies on tobacco control should be a challenge in the future.

In the new work environment, self-employment as a formula and entrepreneurship as an attitude have gained prominence as a means to foster a more competitive economy and increase employment opportunities. Having an entrepreneurial attitude, in addition to being positive on a work level, can also have positive effects on the health of the entrepreneur. The objective of this study is to analyze the relationship between an entrepreneurial attitude and its influence on the general health of Spanish self-employed workers who possess these skills, compared to those who lack them. A cross-sectional descriptive study was carried out through random sampling of 1148 self-employed professionals throughout Spain from 21 different economic sectors. The results show the existence of a negative relationship between entrepreneurial attitude and age, that is to say, an entrepreneurial attitude decreases with age. With the sex variable, women show less entrepreneurial attitude and with mental health, decreased mental health was shown in those with a greater entrepreneurial attitude. On the other hand, there is a positive linearity between a positive attitude and the social function of the state of health.

Over the past few decades, overweight and obesity have become a growing health problem of particular concern for women of reproductive age as obesity in pregnancy has been associated with increased risk of obstetric and neonatal complications. The objective of this study is to describe the incidence of obstetric and perinatal complications in relation to maternal body mass index (BMI) at the time prior to delivery within the Spanish Health System. For this purpose, a cross-sectional observational study was conducted aimed at women who have been mothers between 2013 and 2018 in Spain. Data were collected through an online survey of 42 items that was distributed through lactation associations and postpartum support groups. A total of 5871 women answered the survey, with a mean age of 33.9 years (SD = 4.26 years). In the data analysis, crude odds ratios (OR) and adjusted odds ratios (AOR) were calculated through a multivariate analysis. A linear relationship was observed between the highest BMI figures and the highest risk of cephalopelvic disproportion (AOR of 1.79 for obesity type III (95% CI: 1.06-3.02)), preeclampsia (AOR of 6.86 for obesity type III (3.01-15.40)), labor induction (AOR of 1.78 for obesity type III (95% CI: 1.16-2.74)), emergency C-section (AOR of 2.92 for obesity type III (95% CI: 1.68-5.08)), morbidity composite in childbirth (AOR of 3.64 for obesity type III (95% CI: 2.13-6.24)), and macrosomia (AOR of 6.06 for obesity type III (95% CI: 3.17-11.60)), as compared with women with normoweight. Women with a higher BMI are more likely to develop complications during childbirth and macrosomia.

The development of healthy eating habits in adolescence is perceived as an effective strategy to avoid health problems in adulthood. The involvement of educational centres' governing boards, as well as the Educational State and Regional Administrations', may be necessary to create healthy food environments during the school day. The objective of this study is to identify the relationship between students' eating habits during the school day and sociodemographic, family and physical activity variables, as well as the existence of a school cafeteria. For this, a cross-sectional study in a stratified random sample of 8068 students of Public Secondary Education High Schools of Andalusia (Spain) has been carried out. The results show that students who are 14 years old or older are more likely to skip breakfast at home (odds ratio (OR): 1.81, 95% confidence interval (CI): 1.55-2.12) than those under this age. Students whose mothers do not have a university education are more likely to consume incomplete breakfasts (OR: 1.83, 95% CI: 1.26-2.65). Snacks with sweets (OR: 1.93, 95% CI: 1.67-2.23), candy in general (OR: 2.75, 95% CI: 2.38-3.19), and bagged crisps (OR: 3.06, 95% CI: 2.65-3.54) were more likely to be consumed in schools with a cafeteria. The factors that significantly influence the eating habits of secondary students in Andalusia include age, sex, parental level of education, physical activity and the existence of a cafeteria.

When studying sexual desire during pregnancy, most research focuses on the pregnant woman's sexual desire and almost never takes into account her sexual partner. The novelty of this study is that sexual desire during pregnancy is studied from the point of view of the pregnant woman and from that of her male partner. The goal of this study is to see how sexual desire behaves during pregnancy in both partners. For this, a descriptive, longitudinal, and multistage study was designed. Methodologically, in the first stage, the different study variables were described through a single-variate analysis. In the second stage, one variable was related to others by means of a bivariate analysis. Finally, in the third stage, a multivariate analysis was done, composed of binary logistic regression models and latent growth curves. The results confirm that pregnancy influences the sexual desire of both partners, and that sexual desire behaves differently in women than in men during pregnancy. Men have higher levels of sexual desire throughout pregnancy as compared to women. The first trimester of pregnancy is the period when women have less sexual desire., Competing Interests: The authors declare no conflicts of interest.

Clinical practice guides recommend delayed clamping of the umbilical cord. If this is not possible, some authors suggest milking as an alternative. The objective of this study was to determine the variability in professional practice in the management of umbilical cord clamping and milking and to identify factors or circumstances associated with the different methods. An observational cross-sectional study done on 1,045 obstetrics professionals in Spain in 2018. A self-designed questionnaire was administered online. The main variables studied were type of clamping and use of milking. Crude odds ratios (OR) and adjusted odds ratios (ORa) were estimated using binary logistic regression. 92.2% (964) performed delayed clamping. 69.3% (724) clamped the cord when it stopped beating. 83.8% (876) had heard of milking, and 55.9% (584) had never performed it. Professionals over 50 were less likely to perform delayed clamping, with an ORa of 0.24 (95% CI: 0.11-0.52), while midwives were more likely to perform delayed clamping than obstetricians, with an ORa of 14.05 (95% CI: 8.41-23.49). There is clinical variability in the management of umbilical cord clamping and the use of milking in normal births. Part of this variability can be attributed to professional and work environment factors.

The increase in the demand for care has not led to a proportional growth in the number of primary care nurses. This imbalance is related to the decrease in the quality of care and patient safety, and also to the impact on the health of the professional group. The objective of this study is to identify relationships between overload, illness of the nurse, professional exhaustion, quality and safety in the services; and differentiate study methods and instruments for measuring the phenomena. For this, a comprehensive and structured review of the literature following the scoping review model is performed. The studies on which this review is based allow us to recognize that the scope of this phenomenon is global. The review includes 45 studies that show that there is a high pressure of care for Primary Care nursing, who suffer many alterations of their health due to burnout syndrome and that this situation contributes to the impairment of the quality of care and patient safety. However, for future lines, new evidence is needed to determine the degree of relationship between the high pressure suffered by Primary Care nursing and the attainment of health goals for professionals and patients.

Background: Sedoanalgesia secondary iatrogenic withdrawal syndrome (IWS) in paediatric intensive units is frequent and its assessment is complex. Therapies are heterogeneous, and there is currently no gold standard method for diagnosis. In addition, the assessment scales validated in children are scarce. This paper aims to identify and describe both the paediatric diagnostic and assessment tools for the IWS and the treatments for the IWS in critically ill paediatric patients., Methods: A systematic review was conducted according to the PRISMA guidelines. This review included descriptive and observational studies published since 2000 that analyzed paediatric scales for the evaluation of the iatrogenic withdrawal syndrome and its treatments. The eligibility criteria included neonates, newborns, infants, pre-schoolers, and adolescents, up to age 18, who were admitted to the paediatric intensive care units with continuous infusion of hypnotics and/or opioid analgesics, and who presented signs or symptoms of deprivation related to withdrawal and prolonged infusion of sedoanalgesia., Results: Three assessment scales were identified: Withdrawal Assessment Tool-1, Sophia Observation Withdrawal Symptoms, and Opioid and Benzodiazepine Withdrawal Score. Dexmedetomidine, methadone and clonidine were revealed as options for the treatment and prevention of the iatrogenic withdrawal syndrome. Finally, the use of phenobarbital suppressed symptoms of deprivation that are resistant to other drugs., Conclusions: The reviewed scales facilitate the assessment of the iatrogenic withdrawal syndrome and have a high diagnostic quality. However, its clinical use is very rare. The treatments identified in this review prevent and effectively treat this syndrome. The use of validated iatrogenic withdrawal syndrome assessment scales in paediatrics clinical practice facilitates assessment, have a high diagnostic quality, and should be encouraged, also ensuring nurses' training in their usage.

Aim: To analyze catharsis techniques used with professionals assisting victims of emergencies and disasters., Methods: Systematic review carried out in seven bibliographic databases: MEDLINE-Pubmed, Web of Science, Cochrane Library, CINAHL, Scopus, PsycINFO, and other secondary sources, for articles published between 2008 and 2017, with the terms "catharsis", "emergencies", "debriefing" y "post-traumatic stress". Publication and selection biases were taken into account., Results: Five reviews met the study inclusion criteria. Distress and traumatic experiences following an emergency or disaster are very common among health professionals, with adverse repercussions at the physical, psychological and cognitive levels. Some authors find that debriefing offers an opportunity for emotional release and toreduce the impact of stress on the lives of emergency responders, acting as a support network where they can reconstruct their experiences, express their thoughts and feelings, and reduce the impact on their lives. For other authors, however, this technique is not always effective for all professionals and may lead to negative consequences., Conclusions: Debriefing is a common intervention that promotes catharsis. However, there is considerable controversy over its implementation and effectiveness. This study identified a diversity of catharsis techniques applied to staff responding to emergencies and disasters., (Copyright belongs to the Associació Catalana de Salut Laboral.)

Mental health problems have been identified by the World Health Organization as a global development priority. Negative attitudes toward mental health patients have been documented in multiple health professionals. The aim of this study was to determine the level of stigma and associated factors toward people with mental health problems among students doing their degree in nursing. An explanatory sequential mixed-methods approach. A cross-sectional descriptive observational study was carried out on a sample of 359 students doing their degree in nursing. Students had to be enrolled in any of the four years of study of the degree at the time the questionnaire was done. We explored the perception and experience of students doing their degree in nursing regarding the level of stigma, through in-depth interviews ( n = 30). The mean overall Mental Health Stigma Scale (MHSS) score was 30.7 points (SD = 4.52); 29.5% ( n = 106) scored low for stigma, 49.9% ( n = 179) showed moderate stigma, and 20.6% ( n = 74) scored high. The multivariate analysis showed that 4th-year students had an OR of 0.41 (CI95%: 0.20-0.84) for high/moderate stigma and that 3rd-year students had an OR of 0.49 for high/moderate stigma compared with 1st-year students. We also observed that students with family members with mental health problems had an OR of 2.05 (CI95%: 1.19-3.56) for high/moderate stigma compared with students who did not have family members with mental health problems. The following categories emerged: fear and lack of knowledge, breaking the silence, and integration into society. The levels of mental health stigma in our sample of nursing students were moderate. Stigma levels were lower in 3rd- and 4th-year students (i.e., after having received training in mental health), and in students with family members with mental health problems.

Breast cancer is the most common malignant tumour in women around the world. The objective of this study was to quantify the number of non-haematological adverse reactions associated with chemotherapy, as well as to assess the effect of the sense of coherence, optimism-pessimism and the quality of the doctor-patient relationship on the quality of life of breast cancer patients. To this end, a cross-sectional descriptive study was conducted involving 110 breast cancer patients who were treated with docetaxel, epirubicin, and cyclophosphamide during the period 2012-2014. The difference in the quality of life in patients who have five or fewer toxicities compared to those with more than six is highlighted. This difference is not as important when comparing patients with 6 to 10 toxicities and those with more than 10. The multivariate model used in this study corroborates the direct implication of the sense of coherence on the quality of life and adds the number of adverse reactions as a new construct. This has virtually the same impact on the quality of life of these patients, but in reverse. In conclusion, to improve the quality of life of breast cancer patients it would be necessary to have an impact on the number of adverse reactions involved in chemotherapeutic treatment, as well as on psychological interventions, with the sense of coherence as a possible starting point., Competing Interests: The authors declare no conflict of interest.

Background: Decision aid tools (DAT) have been widely used in chronic diseases, but there are few studies on their usefulness in emergency departments. The objective of this study was to analyse the applicability of DAT in emergency services., Methods: An exploratory review was conducted. Between January 1, 2012 and August 1, 2019, searches of randomised and controlled clinical trials, systematic reviews and other secondary studies where DAT are used to assist patients of any age in emergency services were conducted. The databases used were: Pubmed, Embase, Web Of Science, Cuiden, Patient Decision Aids Research Group IPDAS Collaboration, Cochrane, Centres for Reviews and Dissemination, National Guideline Clearinghouse, Guidelines International Network. Two reviewers analysed and selected the studies., Results: Twelve studies of moderate-low quality were included. The patients in the intervention group (IG) were more aware of their illness (M=3.6 vs 3 correct answers and M=4.2 vs 3.6), and more involved in the decisions (score in OPTION: 26.6 vs 7 and 18.3 vs 7). The conflict was reduced in the IG regarding those imaging tests in the TBI (traumatic brain injury; M=14.8 vs 19.2). In the IG, admittance to perform effort tests was reduced in low-risk chest pain (58% vs 77%; CI95%=6%-31%, 37% vs 52%; p<0.001). When DAT were used in children with diarrhoea or vomiting, in 80% of the cases the decision was to use oral rehydration against 61% in the control group (CG, p=0.001)., Conclusions: DAT in emergency services improve patient's knowledge about the disease and their participation in care. More studies are needed to develop DAT in emergency services.

Objectives: The objective of this review was to describe cardiovascular risk (CVR) assessment methods and to identify evidence-based practice recommendations when dealing with population at risk of developing cardiovascular diseases., Review Methods and Data Sources: A literature review following the Arksey and O'Malley scoping review methodology was conducted. By using appropriate key terms, literature searches were conducted in PubMed, SciELO, Cochrane Library, Dialnet, ENFISPO, Medigraphic, ScienceDirect, Cuiden, and Lilacs databases. A complementary search on websites related to the area of interest was conducted. Articles published in English or Spanish in peer-review journals between 2010 and 2017. Critical appraisal for methodological quality was conducted. Data was extracted using ad-hoc tables and qualitatively synthesized., Results: After eliminating duplicates, 55325 records remained, and 1432 records were selected for screening. Out of these, 88 full-text articles were selected for eligibility criteria, and finally, 67 studies were selected for this review, and 25 studies were selected for evidence synthesis. In total, 23 CVR assessment tools have been identified, pioneered by the Framingham study. Qualitative findings were grouped into four thematic areas: assessment tools and scores, CVR indicators, comparative models, and evidence-based recommendations., Conclusions: It is necessary to adapt the instruments to the epidemiological reality of the population. The most appropriate way to estimate CVR is to choose the assessment tool that best suits individual conditions, accompanied by a comprehensive assessment of the patient. More research is required to determine a single, adequate, and reliable tool., (Copyright © 2018 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Aim: To describe the nature of care received by patients measured through the Caring Behaviours Inventory., Background: Professional nursing practice combines two dimensions of caring: instrumental care and expressive care. Instrumental care focuses on physical health needs, in terms of efficiency and employs interventions based on evidence. Expressive care is patient-centred and based on the interpersonal relationship. It requires caring attitudes that include respect, kindness, sensitivity and patience. The Caring Behaviours Inventory is a tool designed to assess the care expressed through the behaviours nurses perform, contextualised within the Jean Watson's Theory of Human Caring., Methods: A systematic review following PRISMA recommendations. Scopus, PubMed and CINAHL databases were consulted using the keywords "Caring Behaviours Inventory" AND "Nursing". The Joanna Briggs Institute tool was used for the quality appraisal. A conceptual analysis and a thematic synthesis were performed for data extraction., Results: 11 articles were selected. Three categories were identified: nature of caring, congruence between perceived care by patients and nurses, and factors associated with the expression of care., Discussion: An emphasis on care of an instrumental nature was identified. The perception of patients differs from that of nurses, patients perceive a lower level of expressive caring than the one nurses believe to deliver. Caring behaviours are affected by the working environment, nurses' emotional intelligence and coping skills, and socio-demographic characteristics., Conclusion: This paper described the findings of previous research regarding the nature of care that is transmitted and received in clinical practice. Results highlight an emphasis on the instrumental aspect of the nursing care according to the patients' perception., Relevance to Clinical Practice: Findings summarised in this review could contribute to a better understanding of the nursing care. Results reported in this paper could also help to improve the quality of care delivered by nurses as well as patient-centeredness., (© 2019 John Wiley & Sons Ltd.)

Aim: The study aims to analyse the efficacy of massage therapy and kinesitherapy applied by parents of premature infants admitted to hospital., Background: Premature newborns suffer early somatic deprivation that has adverse effects on their growth and development and that also has a negative impact on the emotional state of their parents. Massage therapy and kinesitherapy is beneficial in alleviating somatic deficit and facilitates the bond between parents and newborns., Design: A quasi-experimental community intervention trial will be conducted in a neonatology unit., Methods: This study will compare the benefits of a 15-min massage protocol applied by parents with the usual medical and nursing care given by neonatal units for premature babies. The evaluation of neuromotor development will take place through the Spanish Premie-Neuro scale. The determination of weight, size, and head circumference will be based on the unit's usual procedures., Discussion: If the implementation of a massage therapy and kinesitherapy protocol is effective in promoting the growth and development of hospitalized premature infants, the results of this study could give an impetus for the inclusion of somatic stimulation in the usual nursing care given for preterm infants., Impact: Prematurity and its associated morbidity pose a major global public health problem. Somatic and kinaesthetic stimulation has beneficial effects on anthropometric and neuromotor development in preterm infants. The results will have a positive impact on premature neonates and their families, both during the hospitalization, and a positive socio-economic effect throughout their lives (education, work, disability)., Trial Registration: NCT03704012., (© 2019 John Wiley & Sons Ltd.)

Objective: To examine the chronic care models of the different Spanish health services and to discuss the ethical questions derived from implementing some of their components., Method: Narrative review of care strategies and programmes for chronic patients in the different Autonomous Communities, searching in official health departments' web pages, using the terms "Programmes", "Strategies", "Chronic patients", and "Chronicity"., Results: 15 programmes were found. Most of them include all components of the chronic care model, "decision-making support" being under-represented. The main conflicts in the autonomy of patients arise from the use of big data to stratify the population and from telemonitoring. The stratification of population does not consider the social factors that accompany the disease., Conclusions: Chronic care strategies should consider the autonomy and privacy of patients in the use of clinical data and telemonitoring. In order to be equitable, they would have to provide an integrated health care system, incorporating measures to reduce the inequalities due to the social determinants that accompany the disease., (Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: A low proportion of individuals repeatedly exposed to the hepatitis C virus (HCV) remain uninfected. This condition could have a genetic basis but it is not known whether or not it is mainly driven by a high-penetrance common allele., Objective: To explore whether low susceptibility to HCV infection is mainly driven by a high-penetrance common allele., Methods: In this genome-wide association study (GWAS), a total of 804 HCV-seropositive individuals and 27 high-risk HCV-seronegative (HRSN) subjects were included. Plink and Magma software were used to carry out single nucleotide polymorphism (SNP)-based and gene-based association analyses respectively., Results: No SNP nor any gene was associated with low susceptibility to HCV infection after multiple testing correction. However, SNPs previously associated with this trait and allocated within the LDLR gene, rs5925 and rs688, were also associated with this condition in our study under a dominant model (24 out of 27 [88.9%] rs5925-C carriers in the HRSN group vs 560 of 804 [69.6%] rs5925-C carriers in the HCV-seropositive group, P = 0.031, odds ratio [OR] = 3.48; 95% confidence interval [CI] = 1.04-11.58; and 24 out of 27 [88.9%] rs688-T carriers in the HRSN group vs 556 of 804 [69.1%] rs688-T carriers in the HCV-seropositive group, P = 0.028, OR = 3.57, 95% CI = 1.65-11.96)., Conclusions: Low susceptibility to HCV infection does not seem to be mainly driven by a high-penetrant common allele. By contrast, it seems a multifactorial trait where genes such as LDLR could be involved., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: We analyzed state anxiety and trait anxiety in a population of nurses specialising in gynecology and obstetrics (nurse midwives) and a group of generalist nurses., Methods: Cross-sectional descriptive study using the State-Trait Anxiety Inventory questionnaire (STAI), administered to a group of non-specialist nurses (n=96) and nurse midwives (n=63) who practice in the Madrid Health Service of Spain., Results: State anxiety was similar in generalist nurses and in midwives (5,01±1,62 and 5,17±1,75, respectively). Levels of trait anxiety were lower in nurse midwives (3,46±1,58) than in the non-specialist group (4,36±2,84), with the latter presenting higher levels of habitual anxiety as a personality trait (p=0,013)., Conclusion: Nurse midwives may adapt better to the stress derived from their work than generalist nurses. This could be attributed to the greater training and safety that specialties provide for the development of nursing care functions., (Copyright belongs to the Associació Catalana de Salut Laboral.)

Ethnic inequalities are often associated with social determinants of health. This study seeks to identify the latest scientific evidence on inequalities in the health of people of African descent in the Americas. For this, a systematic review of the literature on health and people of African descent in the Americas was carried out in the LILACS, PubMed, MEDLINE, and IBECS databases. Institutional and academic repositories were also consulted. Evidence was obtained on the presence and persistence of health inequalities in the population of African descent in the Americas from the identification of five types of quantitative and qualitative evidence: (1) ethnic/racial concept and variables; (2) relations with other social determinants; (3) health risks; (4) barriers and inequalities in health services; and, (5) morbi-mortality from chronic diseases. Studies with qualitative methods revealed invisibility, stereotypes, and rejection or exclusion as main factors of inequality. This review evidenced the existence of health inequalities, its interconnection with other adverse social determinants and risk factors, and its generation and perpetuation by discrimination, marginalization, and social disadvantage. These conditions make people of African descent a priority population group for action on equity, as demanded by the 2030 Agenda for Sustainable Development.

Background: Pregnant women and newborns are at increased risk of complications from seasonal flu. Vaccination is effective and safe but there is low adherence in pregnant women. Objective: to identify the reasons that lead pregnant women not to be vaccinated against seasonal influenza., Methods: Scoping Review in which we used as search terms. DeCS "Pregnant Women", "Vaccines against Influenza". MeSH "Pregnant Women", "Influenza Vaccines", united by AND. Databases: Medline, VHL, Scielo, CUIDEN. The PRISMA model and the Joanna Briggs Institute tool were used to sort the search and synthesize the results. Motives were identified in each study and ordered according to frequency of appearance., Results: 16 studies were found that identify 15 reasons for not being vaccinated. The most frequent were: Concern about side effects and / or vaccine safety and lack of information / recommendation from health professionals., Conclusions: The decision of not to be vaccinated seems to be multifactorial. In some cases, health professionals can play a fundamental role in adherence. These results could be useful for future research.

Parity is associated with the incidence of problems in pregnancy, delivery and the puerperium. The influence of parity in the postpartum period has been poorly studied and the results are incongruous. The objective of this study was to identify the association between parity and the existence of distinct discomfort and problems during the postpartum period. Cross-sectional study with puerperal women in Spain. Data was collected on demographic and obstetric variables and maternal manifestations of discomfort and problems during the postpartum period. An ad hoc online questionnaire was used. Crude odds ratios (ORs) and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were estimated by conditional logistic regression. 1503 primiparous and 1487 multiparous participated in the study. 53.4% (803) of the primiparous women affirmed to have feelings of sadness, as opposed to 36.2% (539) of multiparous women (aOR: 1.60; 95% CI: 1.35-1.89). 48.3% (726) of primiparous had lactation problems vs 24.7% (367) of multiparous (aOR: 2.46; 95% CI: 2.05-2.94). 37.2% (559) of primiparous reported anxiety, while the percentage in multiparous was 25.7% (382) (aOR: 1.34; 95% CI: 1.12-1.61). 22.2% (333) of primiparous had depressive symptoms, and 11.6% (172) of multiparous (aOR: 1.65; CI 95%: 1.31-2.06). Faecal incontinence was more present in primiparous than in multiparous, 6.5% (97) and 3.3% (49) respectively (aOR: 1.60; 95% CI: 1.07-2.38). Parity is associated with the presence of certain problems in the postpartum period. Thus, primiparous are more likely to have lactation problems, depressive symptoms, anxiety, sadness, and faecal incontinence.

Objective: The literature points to the possibility of carrying out an intervention, from primary prevention to rehabilitation after a cardiac event, towards decreasing the incidence of such cardiac events and facilitating the return to daily life. The objective was to determine the effect of a cardiac rehabilitation intervention over perceived selfefficacy for patients who have suffered a cardiac event., Methods: A community clinical trial, open, controlled, and randomised, was designed, and performed in primary care. To determine the sample size, the research team used the General Self-Efficacy Scale by Baessler and Schwarzer. The mean difference between groups considered of clinical relevance was of at least 6 points in the aforementioned General Self-Efficacy Scale. A precision of 95% and a test power of 80% were accepted. The result proposed a sample of 44 subjects in each group. Over 12 months, all subjects of legal age (N = 104), both sexes, that had concluded phase II in the cardiac rehabilitation unit of the university Hospital Puerta del Mar (Cadiz) were offered to participate in the study. The patients were informed about the study development, asking for their participation and providing them with a written informed consent. The subjects were randomly assigned to the intervention or control group through blind allocation (in a sealed envelope to the researcher), on a pre-set 2:1 ratio (two patients assigned to the intervention group to one assigned to the control group). A non-response or rejection to participate in the study record was made for the non-response analysis., Results: A total of 89 subjects were included in the statistical analysis (response rate of 85.57%), with an average age of 63.01 years (SD: 8.75). The main dependent variable was the scores difference between groups, comparing means before and after the intervention, through the General Self-Efficacy Scale by Baessler & Schwarner. A mean difference of 6.0972 points was obtained between the intervention and the control groups (p<0.0053; 95% CI -4.1950 to -10.29), as a result of a 3.3750 mean points increase (standard deviation: 7.01) in the intervention group and a 3.3750 mean points decrease (standard deviation: 7.19) in the control group. In relation to the possible changes to be detected through the Hamilton anxiety scale and the Beck's depression inventory, after finishing the intervention, an estimate and contrast of population means was made between groups for the scores difference in the Hamilton scale, determined on the final visit, with no significant differences found (t-student 0.1211; p <0.9 43). Similarly, no significant differences were found between the groups for the means obtained in the variable "Beck's depression inventory scores difference" (t-student -0.1281; p<0.8987)., Conclusions: The inclusion in cardiac rehabilitation programmes carried out in primary care improves the general perceived self-efficacy of patients who have suffered cardiac events., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

This integrative literature review has been carried out with the aim of analyzing the scientific literature aimed at identifying and describing existing rehabilitation treatments/therapies for neonatal brachial plexus palsy (NBPP). NBPP is a frequent consequence of difficult birthing, and it impairs the function of the brachial plexus in newborns. This is why knowledge on rehabilitation strategies deserves special attention. The data collection was carried out in January 2019, in the EBSCOhost and BVS (Biblioteca Virtual em Saúde) platforms, in the CINAHL Complete, MEDLINE Complete, LILACS and PubMed databases. Thirteen articles were included in this integrative literature review, based on a literature search spanning title, abstract and full text, and considering the inclusion criteria. Two main treatments/therapies for NBPP rehabilitation were identified: conservative treatment and surgical treatment. Conservative treatment includes teamwork done by physiatrists, physiotherapists and occupational therapists. These professionals use rehabilitation techniques and resources in a complementary way, such as electrostimulation, botulinum toxin injection, immobilizing splints, and constraint induced movement therapy of the non-injured limb. Professionals and family members work jointly. Surgical treatment includes primary surgeries, indicated for children who do not present any type of spontaneous rehabilitation in the first three months of life; and secondary surgeries, recommended in children who after primary surgery have some limitation of injured limb function, or in children who have had some spontaneous recovery, yet still have significant functional deficits. Treatment options for NBPP are defined by clinical evaluation/type of injury, but regardless of the type of injury, it is unanimous that conservative treatment is always started as early as possible. It should be noted that there was no evidence in the literature of other types of rehabilitation and techniques used in clinical practice, such as preventive positioning of contractures and deformities, hydrotherapy/aquatic therapy, among others, so we consider there is a need for further studies at this level in this area.

Introduction: Shared decision making involves both patients and health care professionals working together to choose a certain diagnostic or therapeutic option. To facilitate these decisions, the shared decision-support tools (SDSTs) have been developed to assist in the communication with patients during the hospital process. They have been frequently used in the choice of treatment for chronic diseases. However, in emergency departments, this model has not been as widely implemented. For that reason, this article aims to examine, through a systematic review, the effects of SDSTs on patients' hospital care in emergency departments., Methods: The principal databases and repositories were consulted to obtain documents that compared the use of SDSTs with standard care., Results: The main results revealed that the SDSTs helped to significantly improve patients' knowledge of their disease and satisfaction with the care they received, also reducing decision-making conflicts., Discussion: Nevertheless, its implementation is limited by the belief that patients prefer physicians to decide for them and the pressures due to the limited time available. The development of SDSTs is relevant in urgent care pathways in which treatment has a high level of evidence and a complex risk-benefit balance., (Copyright © 2019 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.)

The complex process of gestation involves significant biological, psychological, and social changes for both women and men looking toward the same direction. The aim of this study was to analyze changes occurring in affective health between the members of a couple during pregnancy. For this, a cross sectional descriptive study using Sternberg's questionnaire based on his Triangular Theory of Love (intimacy, passion, and commitment) was implemented. A total of 180 couples participated in the study. Data were collected four times during pregnancy: at the beginning, during the first trimester, the second trimester, and during the third trimester. The level of intimacy was higher at the beginning of pregnancy (123.93 ± 9.67), the same as the level of passion (119 ± 9.83). The commitment score in women was, in general, higher than in men. The commitment score in men increased at the beginning of the third trimester (124.31 ± 7.72). Statistically significant differences between the sexes were found for the level of commitment at the beginning of the pregnancy ( p = 0.001) and at the third trimester ( p = 0.008), these scores being higher for women than for men. No significant differences between men and women were found for the remaining components of the triangle. During pregnancy, no significant changes were found regarding overall affection throughout the entire period.

Potentially inappropriate medications are associated with polypharmacy and polypathology. Some interventions such as pharmacotherapy reviews have been designed to reduce the prescribing of inappropriate medications. The objective of this study is to evaluate how effective a decision-making support tool is for determining medication appropriateness in patients with one or more chronic diseases (hypertension, dyslipidaemia, and/or diabetes) and polypharmacy in the primary care setting. For this, a quasi-experimental study (randomised, controlled and multicentre) has been developed. The study compares an intervention group, which assesses medication appropriateness by applying a decision support tool, with a control group that follows the usual clinical practice. The intervention included a decision support tool in paper format, where participants were informed about polypharmacy, inappropriate medications, associated problems and available alternatives, as well as shared decision-making. This is an informative guide aimed at helping patients with decision-making by providing them with information about the secondary risks associated with inappropriate medications in their treatment, according to the Beers and START/STOPP criteria. The outcome measure was the proportion of medication appropriateness. The proportion of patients who confirmed medication appropriateness after six months of follow-up is greater in the intervention group (32.5%) than in the control group (27.9%) p = 0.008. The probability of medication appropriateness, which was calculated by the proportion of drugs withdrawn or replaced according to the STOPP/Beers criteria and those initiated according to the START criteria, was 2.8 times higher in the intervention group than in the control group (OR = 2.8; 95% CI 1.3-6.1) p = 0.008. In patients with good adherence to the treatment, the percentage of appropriateness was 62.1% in the shared decision-making group versus 37.9% in the control group ( p = 0.005). The use of a decision-making support tool in patients with potentially inappropriate medications increases the percentage of medication appropriateness when compared to the usual clinical practice.

Due to the relation between lipids and Hepatitis C virus (HCV) life-cycle, we aimed to explore the existence of single nucleotide polymorphisms (SNPs) associated with low susceptibility to HCV-infection within lipid metabolism genes. This was a case-control study in three phases: (I) allelic frequencies of 9 SNPs within 6 genes were compared in 404 HCV-infected patients and 801 population controls; (II) results were validated in 602 HCV-infected individuals and 1352 controls; (III) results were confirmed in 30 HCV-exposed uninfected (EU) individuals. In phase I, only the LDLRAP1-rs4075184-A allele was differentially distributed in patients and controls (358 of 808 alleles [44.3%] and 807 of 1602 alleles [50.3%], respectively) (p = 0.004). In phase II, the A allele frequency was 547 of 1204 alleles (45.4%) in patients and 1326 of 2704 alleles (49.0%) in controls (p = 0.037). This frequency in EU was 36 of 60 alleles (60%), which was higher than that observed in patients from phase I (p = 0.018) and phase II (p = 0.027). The LDLRAP1-mRNA expression was lower in AA carriers than in non-AA carriers (median [Q1-Q3]: 0.85 [0.17-1.75] relative-units [ru] versus 1.71 [1.00-2.73] ru; p = 0.041). Our results suggest that LDLRAP1-rs4075184-A allele is associated with lower susceptibility to HCV-infection and with reduced expression of LDLRAP1-mRNA.

Cardiac rehabilitation is cost-effective and should be considered a part of the care system provided to patients who have suffered a myocardial infarction or another heart disease. The main variable to study was the scoring, prior to and after the intervention in the General Scale of Self-Efficacy by Baessler & Schwarzer. A clinical community trial that was open controlled and randomised was used. All adult subjects of both sexes who had completed a cardiac rehabilitation program for 12 months at the reference hospital were selected and offered to participate. The psychometric variables registered were the Salamanca screening questionnaire, the Hamilton Anxiety Rating Scale, and the Beck Depression Inventory. Eighty-nine subjects accepted to participate in the study (93.89% response rate), with an average age of 63.01 years (SD 8.75). Once the study was concluded, the main outcome was a difference in means of 6.09 points in the General Scale of Self-Efficacy ( p < 0.0053, 96% confidence interval-4.1950-10.29), showing that the group exposed to the intervention reached a higher score in the above-mentioned scale. However, there were no significant differences ( t -student 0.1211; p = 0.943) after the estimation and contrast of population means for score differences between the groups regarding the Hamilton scale. Similarly, there were no significant differences between the groups regarding the means obtained in the variable score difference in the Beck Depression Inventory ( t -student -0.1281; p = 0.8987). The results showed an increase in those scores related to general self-efficacy among the population that completed the intervention program, as compared to the control group.

The objective of the present study is to assess the model's impact on patients and their families in terms of outcomes and the efficiency results for the health system in Tenerife, Canary Islands, selecting a period of eight years from the time interval 2002-2018. The employed indicators were collected on a monthly basis. They referred to home care and its impact on clinical outcomes and on the use of resources. The comparison between the indicators' tendencies with and without the liaison nurse model was done with the F-test by Snedecor. All these tests are bilateral, with a level of significance of p < 0.05. In those areas with community liaison nurse (CLN), improvements have been found in indicators that describe: (1) the management of the clinical status of patients, (2) the efficiency of the use of resources, and (3) the quality and compliance with the process that also includes home visits and social risk detection and management. It can be said that in the basic areas of primary health care where the work of the CLN develops there are improvements in the management of the patients' clinical condition as well as in the quality and efficiency of care.

In Spain, the average waiting time for a specialist consultation is 58 days. A determinant factor that contributes to this situation is the poor communication between primary care and specialised care, which is mainly due to the waiting days for a consultation, number of avoided/avoidable face-to-face referrals, and waiting days for the resolution of the process. DETELPROG is a referral system in which the family physician requests a scheduled outpatient internal medicine consultation, integrated into the usual consultations agenda of both physicians, the family, and the outpatient clinic physician, in order to have a telephone consultation. A randomized controlled clinical trial has been carried out to assess the effectiveness of DELTELPROG. In a sample of 255 patients, the experimental group was referred via a scheduled telephone call, and those in the control group, by face-to-face hospital consultation area. The results showed statistically significant differences between both groups of 27 days (95% confidence interval (CI): 20-33) regarding specialised consultation, 47 days (95% CI: 17-74) as for the resolution of the process, and 91.7% for avoided face-to-face consultations. The DETELPROG resulted as a low coverage system (53%), which makes it a complementary referral model. It is necessary to make an in-depth analysis of the causes that have led to this technologically low coverage.

Although identified by the World Health Organization (WHO) as a global health priority, maternal mental health does not receive much attention even in the health systems of developed countries. With pregnancy monitoring protocols placing priority on the physical health of the mother, there is a paucity of literature documenting the traumatising effects of the birth process. To address this knowledge gap, this qualitative descriptive study aimed to investigate women perceptions of living a traumatic childbirth experience and the factors related to it. Qualitative data, collected via semi-structured interviews with 32 participants recruited from parent support groups and social media in Spain, were analyzed through a six-phase inductive thematic analysis. Data analysis revealed five major themes-"Birth Plan Compliance", "Obstetric Problems", "Mother-Infant Bond", "Emotional Wounds" and "Perinatal Experiences"-and 13 subthemes. The majority of responses mentioned feelings of being un/misinformed by healthcare personnel, being disrespected and objectified, lack of support, and various problems during childbirth and postpartum. Fear, loneliness, traumatic stress, and depression were recurrent themes in participants' responses. As the actions of healthcare personnel can substantially impact a birth experience, the study findings strongly suggest the need for proper policies, procedures, training, and support to minimise negative consequences of childbirth.

Clinical practice guidelines recommend the active management of the third stage of labour, but it is currently unknown what practices professionals actually perform. Therefore, the aim of this study was to determine the variability of professional practices in the management of the third stage of labour and to identify any associated professional and work environment factors. A nationwide cross-sectional study was performed with 1054 obstetrics professionals between September and November 2018 in Spain. A self-designed questionnaire was administered online. The crude odds ratios (OR) and adjusted odds ratios (ORa) were estimated using binary logistic regression. The main outcome measures were included in the clinical management of the third stage of labour and they were: type of management, drugs, doses, routes of administration, and waiting times used. The results showed that 75.3% (783) of the professionals used uterotonic agents for delivery. Oxytocin was the most commonly administered drug. Professionals who attend home births were less likely to use uterotonics (ORa: 0.23; 95% confidence interval (CI): 0.12-0.47), while those who completed their training after 2007 (ORa: 1.57 (95% CI: 1.13-2.18) and worked in a hospital that attended >4000 births per year (ORa: 7.95 CI: 4.02-15.72) were more likely to use them. Statistically significant differences were also observed between midwives and gynaecologists as for the clinical management of this stage of labour ( p < 0.005). These findings could suggest that there is clinical variability among obstetrics professionals regarding the management of delivery. Part of this variability can be attributed to professional and work environment factors.

It is unknown whether the digital application of automated ICD-9-CM codes recorded in the medical history are useful for a first screening in the detection of polypathological patients. In this study, the objective was to identify the degree of intra- and inter-observer concordance in the identification of in-patient polypathological patients between the standard clinical identification method and a new automatic method, using the basic minimum data set of ICD-9-CM codes in the digital medical history. For this, a cross-sectional multicenter study with 1518 administratively discharged patients from Andalusian hospitals during the period of 2013-2014 has been carried out. For the concordance between the clinical definition of a polypathological patient and the polypathological patient classification according to ICD-9-CM coding, a 0.661 kappa was obtained (95% confidence interval (CI); 0.622-0.701) with p < 0.0001. The intraclass correlation coefficient between both methods for the number of polypathological patient categories was 0.745 (95% CI; 0.721-0.768; p < 0.0001). The values of sensitivity, specificity, positive-, and negative predictive values of the automated detection using ICD-9-CM coding were 78%, 88%, 78%, and 88%, respectively. As conclusion, the automatic identification of polypathological patients by detecting ICD-9-CM codes is useful as a screening method for in-hospital patients.

Purpose: The aim of this study was to analyze the efficacy of massage therapy and kinesitherapy on the anthropometric development of hospitalized preterm infants applied by parents., Design and Methods: A prospective quasi-experimental study was designed. Hospitalized preterm infants received a daily 15-minute session of massage therapy and kinesitherapy. The control group received regular medical and nursing care., Results: The massage therapy and kinesitherapy protocol significantly improved the anthropometric parameters studied: weight (895.7 ± 547.9 vs 541.8 ± 536.2; p < 0.001) size (5.5 ± 4.3 vs. 3.0 ± 3.1; p < 0.001) and head circumference (4.2 ± 3.2 vs 2.4 ± 2.6; p < 0.001)., Conclusions: The implementation of a massage therapy and kinesitherapy protocol is beneficial for the anthropometric development of hospitalized preterm infants., Practice Implications: An easy to administer and cost-effective intervention such as massage therapy and kinesitherapy can improve the anthropometric development of preterm infants and reduce growth-related morbidity in the short, medium, and long term., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: To analyse the differences in perceived burden between family caregivers who are users of patient associations and those who are not; to assess the relationship between burden, resilience, and empathy levels., Method: Retrospective ex post facto study of two groups, one of them quasi control. The sample was composed of 155 informal caregivers (28 men and 155 women); 109 of them were users of patient relatives' associations and 46 were not. Both descriptive and bivariate comparative analyses were carried out., Results: Caregivers who were members of patient associations showed lower burden and empathy levels than those who were not. This highlighted that the higher their level of perceived burden, the lower their level of resilience., Conclusions: Belonging to carers' associations results in a lower level of perceived burden and a lower risk of developing compassion fatigue syndrome., (Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

The prevalence, relationships and outcomes of sarcopenia and frailty in polypathological patients remain unknown. We performed a multicenter prospective observational study in six hospitals in order to assess prevalence, clinical features, outcome and associated risk factors of sarcopenia and frailty in a hospital-based population of polypathological patients. The cohort was recruited by performing prevalence surveys every 14 days during the inclusion period (March 2012-June 2016). Sarcopenia was assessed by means of EWGSOP criteria and frailty by means of Fried's criteria. Skeletal muscle mass was measured by tetrapolar bioimpedanciometry. All patients were followed for 12 months. Factors associated with sarcopenia, frailty and mortality were analyzed by multivariate logistic regression, and Kaplan-Meier curves. A total of 444 patients (77.3 ± 8.4 years, 55% males) were included. Sarcopenia was present in 97 patients (21.8%), this being moderate in 54 (12.2%), and severe in 43 (9.6%); frailty was present in 278 patients (62.6%), and 140 (31.6%) were pre-frail; combined sarcopenia and frailty were present in the same patient in 80 (18%) patients. Factors independently associated to the presence of both, sarcopenia and frailty were female gender, older age, different chronic conditions, poor functional status, low body mass index, asthenia and depressive disorders, and low leucocytes and lymphocytes count. Mortality in the 12-months follow-up period was 40%. Patients with sarcopenia, frailty or both survived significantly less than those without these conditions. Sarcopenia and frailty are frequent and interrelated conditions in polypathological patients, shadowing their survival. Their early recognition and management could improve health-related outcomes in this population.

(1) Background: To evaluate women's satisfaction with the care received during childbirth undergoing labour and how this changes over time. (2) Methods: An observational, multicentre and longitudinal study in two public hospitals of Spain with a convenience sample of 248 women during the post-partum period. Satisfaction was evaluated using the Intrapartal-Specific Quality from the Patient's Perspective questionnaire. Socio-demographic and clinical variables were considered. A bivariate analysis evaluated the relationship between satisfaction and the recorded variables to compare the hypotheses, and also to know if there were any significant differences between the scores obtained at the various evaluated time points (three days, 15 days, one year postpartum). The multivariate analysis by binary logistic regression helped complete the study about the variables related to the level of satisfaction; (3) Results: The mean scores for satisfaction at each time point were high, and they lowered with time. The bivariate analysis showed an association between satisfaction and the following variables: 'mother's place of birth', 'level of education', 'type of labour onset', 'type of birth' and 'type of perineal trauma'. For the multivariate analysis, women who gave birth vaginally, began labour spontaneously and had an epidural were more satisfied than those who did not; (4) Conclusions: Women seemed to obtain good levels of satisfaction with the care they received. Even so, based on continuously improved quality, we proposed some improvement measures, particularly regarding the physical environment and the information offered to patients. It is important to know at what time experience while giving birth should be evaluated as scores can lower with time as part of its normal evolution.