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Aims: This study outlines a protocol aimed at identifying and mapping health promotion practices in need of development from the perspectives of key sectors responsible for it at the local level and from an intersectoral perspective across four Spanish regions., Design: A complementary multi-method study combining survey methods and qualitative interviews will be adopted., Methods: Purposive snowball sampling will be employed to select potentially rich informants from city councils, primary care centres, primary and secondary schools, and public health and civil society organizations in 12 municipalities sensitive to local health. Data on the degree of execution of health promotion activities, the level of intersectorality in their implementation, and their origins will be collected using PromoACTIVA questionnaires, an intersectoral typology model and an interview protocol. A parallel mixed analysis encompassing descriptive statistics and a 'framework analysis' will be performed., Discussion: This study is expected to yield thorough and reliable insights into health promotion practices and omissions at the local level by focusing on key stakeholders, both individually and collaboratively. This information can enhance health promotion planning and improve its effectiveness, efficiency and contextual relevance. The development and testing of a methodology for the integration and interpretation of these data will ensure sustainable capacity building., Impact: Managers and practitioners interested in health promotion planning in the researched settings can benefit from a comprehensive map of the current state of their practices and insights into the starting points of collaboration. In addition, planners from other local settings will gain access to tools and methodologies to replicate and expand these maps to their own contexts., Stakeholder Engagement: Engaging key stakeholders with experience working in or with primary care centres, public health organizations, primary and secondary schools, civil society organizations, and city councils was vital to ensure the study's relevance and feasibility., (© 2024 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Introduction: Effective implementation of strategies to promote health and prevent noncommunicable illnesses requires a profound understanding of the interaction between the individual and society. This study brings to health research the consideration of psychosocial factors that influence the maintenance and change of health behaviors and conduct. From a primary care perspective, it is crucial to propose a biopsychosocial approach for the development of health promotion and self-care programs that embrace personal aptitudes as a relevant individual aspect., Objectives: To explore experiences related to personal aptitudes and personality traits that influence health behaviors and conduct, taking into account the social determinants of health, through a thematic analysis based on the capability-opportunity-motivation and behavior (COM-B) system., Methods and Analysis: This qualitative research is carried out from a descriptive phenomenological perspective, based on 17 focus groups in which 156 people participated. Inductive and deductive analysis techniques were used following Lincoln and Guba's criteria of methodological rigor. In addition to 7 different triangulations of analysts, 6 main categories were identified based on the COM-B system: psychological capacity, physical capacity, physical opportunity, social opportunity, reflective motivation, and automatic motivation. The importance of considering these factors to promote healthy behaviors was stressed., Discussion: This study examined how personal experiences related personal aptitudes and personality traits influence health behaviors and conduct in Spain. It was found that personality traits such as health literacy, self-efficacy, activation, and self-determination can influence the adoption of healthy behaviors. Likewise, the need for control, overthinking, and ambivalence made it impossible. Furthermore, social determinants of health and interpersonal relationships also play an important role., Trial Registration: ClinicalTrials.gov, NCT04386135. Registered on April 30, 2020., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Young-Silva, Berenguera, Juvinyà-Canal, Martí-Lluch, Arroyo-Uriarte, Tamayo-Morales, Marcilla-Toribio, Elizondo-Alzola, Méndez-López, Chela-Àlvarez and Motrico.)

Background: Informal caregivers are essential figures that deal with the effects of dependence in the elderly. However, they suffer from poorer health-related quality of life, particularly regarding mental health. Social support is crucial, but this was suspended or dramatically reduced during the Covid-19 pandemic. Salutogenesis theory explores the contributing factors for the promotion and maintenance of health. Considering all these, we offered caregivers the opportunity to join a participatory project aimed at creating communication spaces where they could share experiences, think together about potential solutions, and explore which salutogenic actions they used in their daily basis and how they had changed during Covid-19 restrictions., Methods: We used a qualitative methodology with a socio-constructivist and phenomenological approach and purposive sampling. We organized two focus groups consisting of online semi-structured discussions with seven participants in total. Conversations were videotaped and transcribed and we conducted content thematic analyses using the NVivo software., Results: Caregiving in our setting are primarily women with high levels of education that do not always feel comfortable with this load because it interferes with their personal and professional lives. The pandemic increased caregivers feelings of loneliness, resignation, and burden, directly affecting their mental health. Furthermore, the disappearance of prevention programs and the difficulties to access healthcare services produced negative consequences on the already fragile elderly and their family caregivers., Conclusion: The pandemic and its restrictions exacerbated the problematics affecting informal caregivers. Although these people are aware of their situation and have valued knowledge of how to improve their health, they cannot always put it into practice. We call policymakers to reframe interventions aimed at caregivers by introducing the voice of the community in the planning and to rethink the management of vulnerable people and their carers in other potential health crises., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Mas-Casadesús, de la Torre-Pérez, Reig-Garcia, Mas-Casadesús, Berenguera and Juvinyà-Canal.)

Introduction: Maintaining or acquiring healthier health-oriented behaviours and promoting physical and mental health amongst the Spanish population is a significant challenge for Primary Health Care. Although the role of personal aptitudes (characteristics of each individual) in influencing health behaviours is not yet clear, these factors, in conjunction with social determinants such as gender and social class, can create axes of social inequity that affect individuals' opportunities to engage in health-oriented behaviours. Additionally, lack of access to health-related resources and opportunities can further exacerbate the issue for individuals with healthy personal aptitudes. Therefore, it is crucial to investigate the relationship between personal aptitudes and health behaviours, as well as their impact on health equity., Objectives: This paper outlines the development, design and rationale of a descriptive qualitative study that explores in a novel way the views and experiences on the relationship between personal aptitudes (activation, health literacy and personality traits) and their perception of health, health-oriented behaviours, quality of life and current health status., Method and Analysis: This qualitative research is carried out from a phenomenological perspective. Participants will be between 35 and 74 years of age, will be recruited in Primary Health Care Centres throughout Spain from a more extensive study called DESVELA Cohort. Theoretical sampling will be carried out. Data will be collected through video and audio recording of 16 focus groups in total, which are planned to be held in 8 different Autonomous Communities, and finally transcribed for a triangulated thematic analysis supported by the Atlas-ti program., Discussion: We consider it essential to understand the interaction between health-related behaviours as predictors of lifestyles in the population, so this study will delve into a subset of issues related to personality traits, activation and health literacy. Clinical trial registration : ClinicalTrials.gov, identifier NCT04386135., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Young-Silva, Berenguera, Jacques-Aviñó, Gil-Girbau, Arroyo-Uriarte, Chela-Alvarez, Ripoll, Martí-Lluch, Ramos, Elizondo-Alzola, Garcia-Martinez, Méndez-López, Tamayo-Morales, Martínez-Andrés, Motrico, Gómez-Gómez, Fernández-Alvarez, Juvinyà-Canal and the DESVELA Cohort investigators.)

Background: Pain is a considerable health concern that interferes with hemodialysis treatment outcomes and can lead to a patient developing anxiety and depression., Aims: To examine the perception of pain in patients on chronic hemodialysis therapy, and to analyze the relationship between their pain, anxiety, depression, and sociodemographic data., Method: The research was conducted using a quantitative, observational, cross-sectional design. The study recruited 138 patients from multicentered hemodialysis units. A battery of questionnaires, including the visual analog scale (VaS) as pain intensity scale, the Hospital Anxiety and Depression Scale (HADS), and an ad hoc sociodemographic data questionnaire, were given to patients to answer during their hemodialysis sessions. A linear regression analysis was conducted to obtain the results., Results: The mean of pain to all participants was generally low, as per AVS scale (0-10) it was 3.6 (stanard deviation [SD] = 3.07). Women manifested lower levels of pain than men (p = .015). One in five participants in both sexes suffered from clinical anxiety and one in six participants in both sexes suffered from clinical depression. Women scored higher on both the anxiety (4.8 versus 4.2) and depression scale (6.8 versus 6.5). Those participants who manifested clinical anxiety were younger compared with those who did not (aged 56.8 versus 66.8 years). Finally, older patients (aged 68.5 years) manifested higher levels of depression., Conclusions: The level of pain perceived by patients undergoing chronic hemodialysis therapy was generally low, especially in women. The study also demonstrated a positive association between levels of pain and anxiety and depression., Competing Interests: Declaration of Competing Interest The authors declare that the research was conducted in the absence of any commercialor financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Positive mental health (PMH) and mental illness are distinct, yet interrelated, constructs. However, this relationship has yet to be adequately established. We aimed to evaluate the level of PMH and its relationship with sociodemographic and clinical determinants as well as to explore the relationship between PMH and the positive constructs of recovery, subjective wellbeing (SWB), insight and functioning in patients with psychotic disorder. A multicenter, descriptive, cross-sectional and correlational study with a sample of 347 patients with psychotic disorder was conducted. The following assessment instruments were used: Positive Mental Health Questionnaire, Maryland Assessment of Recovery in Serious Mental Illness scale, Insight Scale, Personal Wellbeing Index-Adult version (PWI-A), Overall Life Satisfaction (OLS) and Global Assessment of Functioning scale. The mean global level of PMH was 116.16 (range of 39-156, SD = 19.39). Significant differences were found in PMH in relation to sociodemographic (sex, civil status and employment situation) and clinical variables (family history of mental disorders, number of prescribed antipsychotics, treatment with anxiolytics, treatment with antidepressants and suicide attempts). PMH was significantly and positively correlated with recovery ( r = 0.760), SWB (PWI-A: r = 0.728 and OLS: r = 0.602) and functioning ( r = 0.243), and negatively with insight ( r = -0.335). These results can lead to a major change in mental health care. If actions are taken to increase PMH, then recovery, SWB and functioning will also increase. At the same time, interventions should be carried out to boost insight, since increasing PMH could decrease insight, all resulting in better quality of life for patients with psychotic disorder., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Broncano-Bolzoni, González-Carrasco, Juvinyà-Canal and Lluch-Canut.)

Purpose: The exchange of information between different healthcare settings through a nursing discharge plan is essential for safe care. However, the factors contributing to achieving the most efficient exchange have not been well studied. This study aimed to evaluate and explore the perceptions of a nursing discharge plan from the perspective of nurses in different healthcare settings., Methods: A mixed methods approach comprising a specifically designed ad hoc questionnaire (n = 437) and a focus group session (n = 8)., Findings: Overall, 66.1% out of 437 nurses, and especially those working in nursing homes, were satisfied with the nursing discharge plan. Lack of time to complete the report and poor information about both nursing diagnoses and patients' social assessment were identified as problem areas. Some proposals emerged from the focus group: providing sufficient time for its completion, giving the nursing discharge plan a more flexible structure permitting more open-ended responses, requiring more information to be provided about the social and psychological situation of the patients, training nurses to use standardized language to avoid possible misinterpretations, and getting nurses from the different health care settings to work together in designing continuity of care plans. Elderly and low-income patients are found to need greater attention when filling out nursing discharge plans., Conclusions: The study has revealed key aspects that need to be improved and some recommendations in implementing the nursing discharge plan in our health area. These include that there should be more time provided to complete the NDP, and also specific details regarding the format, structure, content of the information that is communicated, and the prioritization of the patient profile., (© 2022. The Author(s).)

Nurses’ lifestyle habits play a key role in promoting healthy lifestyles; although, they may not always be entirely healthy and can be influenced by working conditions. This paper aims to analyze the influence of doing shift work on nurses’ lifestyle habits. Participants (n = 219) were recruited from 27 primary health care centres in Spain. Data were collected on socio-demographic characteristics, working conditions and lifestyle behaviour, assessed by use of an adhoc questionnaire including validated measures. Descriptive analysis and logistic regression models were performed. A total of 95% of the nurses reported having an adequate diet; 45.2% did not engage in any type of physical activity; and 85.8% did not smoke, especially women. A total of 60.3% did shift work, especially the younger ones (80.8%; p < 0.001), these nurses being the ones with the worst food habits (81.8%). In contrast, nurses who did shift work, exercised more days a week (69.5%; p < 0.001). The dietary habits of the nurses were adequate. Low tobacco consumption and low adherence to physical activity were observed, especially among women. Shift work harmed eating habits and obesity rates, but was a protective factor in terms of adherence to physical exercise.

Objective: Breast-feeding rates are unsatisfactory in Lebanon. Social media groups could play an important role in promoting breast-feeding in normal conditions and post crisis. The aim of this study is to identify breast-feeding challenges, facilitators and assets and to describe how community assets via social media could build community resilience to pandemic's and disaster's effects., Design: A two-phase qualitative content analysis was performed on posts and comments collected from a Facebook breast-feeding support group. Data were categorised into themes, categories and subcategories., Setting: Posts and comments retrieved from a Facebook breast-feeding support group in Lebanon during the month of August 2020., Participants: Group members: mothers who breastfed, breast-feeding mothers and group admins that are lactation consultants., Results: In phase one, breast-feeding 'Challenges' identified were lack of support from peers and family, lack of supportive policies, lack of knowledge and maternal stress related to political instability, COVID-19 and economic crisis. 'Assets and facilitators' included community support and donations. In phase two, analysis revealed how assets were being used on social media platform to build community resilience post crisis, through access to social support in challenging times, community engagement, material resources and transformative potential., Conclusion: Challenges faced during breast-feeding were diminished due to the support and assets received on a Facebook breast-feeding support group, and social media has been shown to be an important community asset implicated in empowering women to breastfeed and to build community resilience in moments of crisis.

Maintaining therapeutic levels of anticoagulation is essential to avoid health complications in people who take vitamin K antagonists. This study aimed to analyze the influence of people's characteristics and the presence of changes in their lives in the control of therapeutic levels of anticoagulation. A longitudinal multicenter study with a 1-year follow-up of a cohort of 199 people receiving anticoagulant therapy was performed. The effect of biological, clinical, social, lifestyle, and changes in life on the international normalized ratio (INR) was analyzed. During the follow-up, 46.7% of participants presented good INR control. At baseline, a diagnosis of atrial fibrillation ( P  = .00), the lack of comorbidities ( P  = .03), absence of depression ( P  = .04), and not following a pharmacological treatment with hypoglycemia drugs ( P  = .01) were associated with good INR control. During the follow-up, the variable of making changes to the usual diet was associated with poor INR control ( P  = .05). In the binary multiple regression model, factors associated with poor control were taking hypoglycemia drugs ( P  = .02) and the presence of depression ( P  = .04), and only the diagnosis of atrial fibrillation was associated with good control ( P  = .03). People with a diagnosis of atrial fibrillation had good INR control. Having comorbidities, suffering depression, taking hypoglycemia drugs, and making changes to the diet have a negative effect on INR control.

Background: Fibromyalgia is a chronic and complex disease whose management by patients requires a high level of commitment. Patient empowerment therefore represents an important milestone in chronic disease treatment and control. We explored the impact of a peer social support network from the perspective of women with fibromyalgia., Methods: A generic qualitative design was proposed for the study, for which women who had been diagnosed with fibromyalgia were purposefully selected. Six semi-structured interviews were conducted, and the collected data were thematically analysed., Results: Three key themes emerged regarding the peer social support network: (1) empowerment (facilitating acceptance of the diagnosis and acting as a source of information); (2) effects on well-being and quality of life (attenuated the stigma, improved physical well-being, provided emotional support and was a socialization medium); and (3), valuable aspects (transmitted feelings of being understood and listened to and increased personal feelings of satisfaction)., Conclusions: A peer social support network for women with fibromyalgia exerts positive effects on their physical, mental, and social well-being and empowers them to better manage their disease. Healthcare for women with fibromyalgia should include strategies that connect them through peer social support networks.

Chronic diseases are treated and cared for in different healthcare settings. Continuity of care and the case management model facilitate the integration of processes and care levels. However, there is little evidence regarding the satisfaction of nurses with this model. The purpose of this study was to examine nurses' satisfaction with continuity of care and the case management model. A cross-sectional study was conducted. An ad hoc questionnaire was administrated to 437 Spanish nurses from the three health care settings that responded. This included items on socio-demographics, employment relationship, and satisfaction with continuity of care and case management. Descriptive analysis and linear regression models were performed. In total, 96.1% of the nurses expressed a high level of satisfaction with continuity of care and 80.7% with the case management model. Nurses in a primary care setting reported the greatest satisfaction with the case management model ( B = 0.146, 95% CI = 0.139-0.694, p = 0.003). The nurses' higher perception of patient satisfaction was associated with greater satisfaction with continuity of care ( B = 0.466, 95% CI = -0.367-0.533, p < 0.000). Nurses identified the case management model as an optimal facilitator of continuity of care. While satisfaction with continuity is high, strategies are needed to improve it in primary care centers and aged care homes.

Objective: To describe the professional training health professionals receive in community health engagement in Spain., Method: The identification and descriptive analysis of trainings developed between 2013-2018 offered by public universities, public administrations and the teaching units for the specialization of family and community health doctors and nurses., Results: Twenty eight trainings were included in the descriptive analysis. Most of them had been organized during 2018 in eight Autonomous Communities. Two of them were organized at a national level. Most trainings were attendance based and have been developed by teaching units in charge of training doctors and nurses specializing in family and community health, with an average duration of 10-25hours and no enrolment costs., Conclusion: There is a lack of training in community health engagement in the majority of autonomous communities in Spain which shows that it is scarce and not yet fully integrated in the training of health professionals. The trainings that have been analyzed are mainly part of wider specialization programs for doctors and nurses specializing in family and community health, and even so this training is not standardized and included in the specialization programs of all the Spanish regions. To develop a comprehensive health approach it is key to include community health engagement as part of the trainings professionals receive during their University degree, and to extend it to other health professions. The institutions responsible for the training of health professionals should include community health engagement as part of the different training itineraries of professionals., (Copyright © 2019 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objectives: Taking care of people with dementia (PWD) has been associated with some degree of burden. The variability of the carer's burden can be partially explained by their personal characteristics. Antonovsky's model of health defined the resistance resources (RRs) as essential mechanisms to cope with stressors, and to shape the personal sense of coherence (SOC). This study identifies the RRs related with carer's SOC, and their implications in the perception of burden in family dementia carers. Methods: A sample of 308 participants from the 'SOC & DEM study' (154 carers and 154 PWD) was recruited from two memory clinics. Carer's personal characteristics of burden, SOC, self-efficacy, coping strategies, perceived social support, and depression were evaluated using standardized instruments. PWD's degree of dependence and behaviour and psychological symptoms of dementia (BPSD) were assessed too. A path analysis was used to test the relationship between caregiver burden and SOC including the personal RRs of the carers and clinical data of PWD. Results: The path model identified SOC as a major factor related to carer's burden perception ( r = -.327). Self-efficacy (r = .285), two coping strategies, 'use instrumental support' ( r = -.235) and 'behavioural disengagement' ( r = -.219), and social support perceived ( r  = .304) were the main carer's personal characteristics directly related with SOC. Caring experience ( r = -.281) was the main carer factor related with burden while dependence ( r = .156) and BPSD ( r = .157) were the dementia factors. Conclusion: The SOC has previously related with carer's burden. The results contributed to identify relevant and modifiable personal characteristics as RRs that could reduce this burden.

Background: Most elderly people wish to grow old at their own homes. The sociodemographic characteristics; home and neighbourhood conditions; and the social services support and networks are determinants in the possibility of "ageing in place". The present study aimed to explore the ageing in place phenomenon, as well as the enablers and barriers that interact in a healthy ageing from the perspective of the elderly connected to local entities., Methods: A generic qualitative design was proposed in the Health Region of Girona in Catalonia (Spain). Seventy-one elderly people were purposefully selected. Six focus groups were conducted, and data were thematically analysed., Results: Three key themes were generated: (1) Participants experienced ageing differently. The physical and mental health, the family environment and financial stability were key elements for life quality. (2) The perception of the elderly's role in the community depended on their age, health status and attitude towards life. (3) The participants identified several enablers and barriers to healthy ageing in place., Conclusions: The promotion of older people's autonomy and wellbeing, together with the creation of an active network of health and social services, may improve the possibility for elderly to age at home and avoid or delay institutionalisation.

The mental health of nurses working in long-term healthcare centers is affected by the care they provide to older people with major chronic diseases and comorbidity and this in turn affects the quality of that care. The aim of the study was to investigate dispositional optimism, burnout and self-reported health among nurses working in long-term healthcare centers. A descriptive, cross-sectional survey design was used. Survey questionnaires were distributed in 11 long-term health care centers ( n = 156) in Catalonia (Spain). The instruments used were LOT-R (dispositional optimism), MBI (burnout) and EuroQol EQ-5D (self-reported health). Bivariate analyses and multivariate linear regression models were used. Self-reported health correlated directly with dispositional optimism and inversely with emotional exhaustion and cynicism. Better perceived health was independently associated with greater dispositional optimism and social support, lower levels of emotional exhaustion level and the absence of burnout. Dispositional optimism in nurses is associated with a greater perception of health and low levels of emotional exhaustion.

Health literacy has been defined by the World Health Organization as the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health. Its importance in reducing inequalities makes health literacy a thematic area that should be addressed in the training of professionals in the fields of healthcare, Social Work and Education. The objective of this study was to define the health literacy levels of students from the Universities of Girona and Barcelona (Spain) and the Regional Institute of Social Work in Perpignan (France). A cross-sectional study was conducted among students of Nursing, Social Work, Primary Education and Special Education in the 2017-2018 academic year. Sociodemographic and academic variables were considered and the HLS-EU-Q16 questionnaire was used to study health literacy levels. In total, 219 students with an average age of 24.9 participated. Of these, 64.4% were studying Social Work, 23.7% Nursing, 5.9% Primary Education, and 5.9% Special Education. Of the total sample, 36.5% were classified as sufficient in health literacy. The total average score of the health literacy index was 11.1; 13.2 among Nursing students; 10.5 among Social Work students; 10.1 among Primary Education students, and 10.1 among Special Education students ( p < 0.001). Nursing students obtained the best results and healthcare was the highest rated subdomain, more than disease prevention and health promotion.

Satisfaction at work has been found to be a predictive factor of permanency. On the other hand, burnout has been associated with financial loss. The purpose of this study was to analyse the levels of satisfaction and burnout of professionals in a hospital emergency department and make a comparison with results from the same service during the economic recession in 2012. An analytical, cross-sectional and descriptive study was undertaken during two time periods into the levels of satisfaction and burnout of the professionals of an emergency department. Consequently, 146 replies were received. The percentage of professionals who considered their salary to be unsatisfactory in 2012 diminished in comparison with 2018 ( p = 0.034), while job stability was considered more satisfactory in 2018 ( p = 0.039) and the timetable in 2018 as more unsatisfactory ( p = 0.009). With regards to burnout, it was observed that in 2018 the score for depersonalisation had fallen ( p = 0.029) in comparison with 2012. An improvement in the level of satisfaction is observed in 2018, and more positive scores have also been found in the depersonalisation subscale in 2018. An inverse association was observed between depersonalisation in 2018 and overall satisfaction.

Background: Dementia care is associated with physical, emotional, and monetary impact on the informal carers providing unpaid care. Differences in the personal characteristics of caregivers may help explain the variations in the costs of dementia care., Objective: The aim of this study was to analyze the effect of caregivers' sense of coherence (SOC) on direct and indirect costs in dementia care., Methods: A cross-sectional study was conducted in community dwelling caregivers of patients with Alzheimer's disease. Data of healthcare services were obtained from clinical registries, and information was collected from caregivers regarding their use of social care resources and time spent caregiving. The transformation of all costs into Euros was made assigning a fixed cost of 10.29 € /h and 16.24 € /h for assisting in instrumental and basic activities of daily living, respectively. Caregivers' SOC was assessed using the Orientation to Life Questionnaire (OLQ-13). Adjusted regression models were developed, with different types of costs as dependent variables., Results: A sample of 147 caregivers was recruited. The mean OLQ-13 score was 73.3 points (SD = 11.6). The regression models showed a small association between caregivers' SOC and direct costs, mainly linked to the use of social care resources (r2 = 0.429; β= -15.6 € /month), and a greater association between SOC and indirect costs (r2 = 0.562; β= -222.3 € /month)., Conclusion: Increasing caregivers' SOC could reduce dementia care costs by decreasing the use of social care resources and caregiving time.

Aim: To examine the sense of coherence among registered nurses and its relationship with health and work engagement., Background: Sense of coherence is a global orientation to view life as structured, manageable and meaningful and have the capacity to cope with stressful situations. A high sense of coherence score indicates that an individual can understand, manage and attribute meaning to events in his or her life as well as in the work environment. Registered nurses face many workplace stressors that may be easier to manage with a strong sense of coherence; however, the effect of this score on their self-reported health status and work engagement remains unknown., Methods: In a cross-sectional study, 109 registered nurses working in a long-term care setting responded to a self-administered questionnaire. Social support, work-related family conflicts, sense of coherence, self-reported health status and work engagement variables were analysed using multiple linear regression models., Results: Nurses with a high sense of coherence score reported no work-related family conflicts (mean difference -6.91; 95% CI -10.65 to -3.18; p = .000), better health (r = .408) and greater work engagement (r = .223), compared to their peers with lower sense of coherence. The association between sense of coherence and self-reported health was confirmed by linear regression modelling (β = .276, p = .003)., Conclusions: Nurses with a higher sense of coherence had better health and greater work engagement. The work engagement variable showing the highest association with sense of coherence was dedication., Implications for Nursing Management: Implementing interventions that increase sense of coherence among nurses can increase commitment to their work, to the institution and to building more engaged teams., (© 2019 John Wiley & Sons Ltd.)

Background: Health Literacy (HL) is the knowledge and competence to access, understand, appraise, and apply health information for health judgment. We analyze for the first time HL level of Catalonia's population. Our objective was to assess HL of population in our area and to identify social determinants of HL in order to improve the strategies of the Healthcare Plan, aimed at establishing a person-centered system and reducing social inequalities in health., Methods: This was a cross-sectional study based on the Health Survey for Catalonia (ESCA, Enquesta de Salut de Catalunya), which included the 16 items of the European Health Literacy Survey Questionnaire (HLS-EU-Q16). The statements in the questionnaire cover three different health literacy domains: Health Care, Disease Prevention, and Health Promotion. HL was categorized in three levels: Sufficient, Problematic and Inadequate. Chi-square tests were performed to compare the percentages of subjects with adequate or inadequate HL across sociodemographic and health-related variables. Variables showing significant differences were included in a stepwise logistic regression to predict inadequate HL level., Results: The questionnaire was administered to 2433 subjects aged between 15 and 98 years old (mean of 45.9 years, SD 18.0). Overall, 2059 subjects (84.6%) showed sufficient HL, 250 (10.3%) inadequate HL, and 124 (5.1%) problematic HL, with no significant differences between men and women (p = 0.070). A logistic regression analysis showed that low health literacy is associated with a lower level of education (OR 2.08, CI 95% 1.32-3.28, p = 0.002), low socioeconomic status (OR 2.11, CI 95% 1.42-3.15, p <  0.001) and a physical limitation to perform everyday activities (OR 2.50, CI 95% 1.34-4.66, p = 0.004). We also found a more modest association with low physical activity, having a self-perceived chronic disorder and performing preventive activities., Conclusions: Catalonia has a high percentage of subjects with sufficient HL. Education level, socioeconomic status and physical limitations were the factors with the strongest contribution to inadequate or problematic health literacy. Although these results are likely to be country-specific, the factors identified will allow policymakers of areas with similar socioeconomic profiles to identify groups with high risk of problematic or inadequate HL, which is essential for a successful patient-centered model of care.

Aim: The aim was to study the level of satisfaction with an emergency department and to identify the factors associated with satisfaction., Design: This research consisted of a descriptive, cross-sectional study., Methods: The study population was composed of patients and companions who visited the emergency department during a three-month period. The patients were selected randomly from the register of visits to the emergency department during the period of study. Sociodemographic variables and variables related to the attention received were studied through questionnaires (response rate 33%)., Results: Older age was associated with greater satisfaction ( p  = 0.002), as was female sex ( p  = 0.013) and greater optimism ( p  < 0.001). Greater control of pain was a factor associated with satisfaction ( p  = 0.033), as was the perception of a shorter waiting time before the medical visit ( p  < 0.001).

Background: Active and Healthy Ageing (AHA) is the process of optimizing opportunities related to health, participation, and safety in order to improve quality of life. The approach most often used to measure AHA is Rowe and Kahn's Satisfactory Ageing model. Nonetheless, this model has limitations. One of the strategic objectives of the WHO Global Strategy and Action Plan (2016) is to improve Healthy Ageing measurement. Our objectives were to compare two models of assessing AHA and further compare the results by country and sociodemographic variables., Methods: This was a cross-sectional, observational analysis of a representative sample of the general population aged 50 years and older in Europe. The data analysed were obtained by the Study of Health, Ageing and Retirement in Europe (SHARE). The dependent variable was AHA and its dimensions, measured using the Rowe and Kahn AHA model (AHA-B) and the authors' model based on the WHO definition (AHA-BPS). A descriptive analysis and multivariate models of binary logistical regression were developed., Results: The sample consisted of 52,641 participants (mean age 65.24 years [SD = 10.18; Range = 50-104], 53.2% women). Healthy Ageing prevalence in the AHA-B model was 23.5% (95%CI = 23.1%-23.9%). In the AHA-BPS model, this prevalence was 38.9%. In both models, significant variations were observed between countries, and were distributed along a north-western to south-eastern gradient. The sociodemographic variables associated with the absence of AHA were advanced age, female sex, death of spouse, low educational level, lack of employment, and low financial status. Comparing the two models, the strength of association between absence of AHA and advanced age (85 years and older) was four times greater in the AHA-B model., Conclusions: Our results showing differences between these two models provide evidence that the AHA-BPS model does not penalize older age and is more likely to characterize AHA from a health promotion perspective., Competing Interests: The authors have declared that no competing interests exist.

Objective: To describe the demographic, health and socio-economic characteristics of the participants in the Study on Maturity and Satisfactory Ageing in Girona (MESGI50 study)., Methods: Population-based Study linked to the Survey of Health, Ageing, and Retirement in Europe (SHARE). The reference population was the inhabitants of the province of Girona (Spain) aged 50 and over. A probabilistic two-stage stratified cluster sampling according to the number of inhabitants and the degree of ageing of the population was used., Results: Twenty-eight municipalities were randomly selected according to their type (demographically aged or young), and then stratified by the population size. The response rate was 65% with a mean of 1.7 eligible individuals per household and a final sample of 2,065 households and 3,331 participants. The design effect was 1.27. 52.9% were women and the mean age was 66.9 years (SD=11.5). The self-rated health status, hand grip strength, restriction in daily life activities and depressive symptomatology increased with age and more markedly in women. There were differences in alcohol consumption and eating patterns depending on the area of residence., Conclusions: The demographic, health and socio-economic characteristics during the ageing process differ depending on age group, gender, and area of residence., (Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Immigrant women often experience health inequities, whether for reasons of gender, country of origin, or socioeconomic status. The view of immigrant women has always focussed on their needs, without taking into account their available assets. A salutogenic approach incorporating an assets analysis could provide a new perspective on the design of health promotion interventions to reduce health inequities. The study objective was to identify the assets of this group of women as a necessary first step in changing the paradigm used in such health promotion interventions., Methods: This qualitative study combined focus groups, in-depth interviews, and a photovoice session. The aim was to describe the assets of this group, based on Antonovsky's salutogenic approach and assets model. Qualitative results were interpreted with a phenomenological focus, identifying each individual's internal, community, and institutional assets., Results: The self awareness of skills was linked to a person's description of herself as being optimistic, having religious beliefs, and having motivations and objectives in life, for herself, her family or her children. Being motivated helped the women to persist in doing or learning things that could be useful in confronting difficult situations. Another selfawareness skill was feeling useful to others, whether this was due to religious beliefs about their role in life or to the importance of the mutual support of interpersonal relationships., Conclusions: High optimism, strong capacity for struggle and self-initiative, the importance of religious beliefs, social support, and concern for their children's future were described as assets of immigrant women. Identification of these assets allows us to develop more in-depth knowledge and better tools for health promotion programs and policies intended to reduce health inequities in this population of immigrant women.

Aims and Objectives: This study aimed to translate the community nursing version of the Developing Evidence-Based Practice questionnaire, adapt the Spanish translation to the primary care context in Spain, and evaluate its reliability and validity., Background: Instruments available in Spanish to date are not designed to rigorously evaluate barriers and incentives associated with evidence-based practice implementation in community health nursing., Design: Classical Test Theory approach., Methods: The 49-item Developing Evidence-Based Practice questionnaire was translated, back-translated and pilot-tested. Two items were added to assess respondents' ability to read and understand the English language. During the first six months of 2010, 513 nurses from 255 primary health care centres in Catalunya (Spain) voluntarily participated in the study. Internal consistency and test-retest reliability were evaluated. Internal structure was analysed by principal component analysis. A randomized, controlled, parallel-design study was carried out to test scores' sensitivity to change with two groups, intervention and control. The intervention consisted of eight hours of in-person training, provided by experts in evidence-based practice., Results: Of 513 nurses, 445 (86·7%) nurses responded to all 51 items. Factor analysis showed six components that explained 51% of the total variance. Internal consistency and test-retest reliability were satisfactory (Cronbach α and intraclass correlation coefficients >0·70). A total of 93 nurses participated in the sensitivity-to-change tests (42 in the intervention group, 51 controls). After the training session, overall score and the 'skills for evidence-based practice' component score showed a medium (Cohen d = 0·69) and large effect (Cohen d = 0·86), respectively., Conclusions: The Developing Evidence-Based Practice questionnaire adapted to community health nursing in the primary care setting in Spain has satisfactory psychometric properties., Relevance to Clinical Practice: The Developing Evidence-Based Practice questionnaire is a useful tool for planning and evaluating the implementation of evidence-based practice in community health nursing., (© 2016 John Wiley & Sons Ltd.)

Objectives: To identify areas of improvement in diabetic foot care as regards the availability of materials and specialties in primary and secondary care. To determine the model of care for surgical centres and hospitals caring for diabetic foot problems and their relation to amputations., Design: Cross-sectional study, Setting and Participants: Random sample of 36 basic health areas (BHA) and all hospital surgery centres in Catalonia (Spain)., Measurements: Information was collected by structured interview of managers of each centre on: availability of specialists, material off-loading and examination. The models were established according to the classification of Van Acker, and amputations from hospital discharge records., Results: An endocrinologist was available in 36.1% [confidence interval (CI) 95%:19.0-53.2] of the BHA and 11.1% [95% CI: 3.1-26.1] had a podiatrist,100% [95% CI: 90.3-100.0] had Doppler, 91.7% [95% CI:77.5-98.2] a monofilament, 5.6% [95% CI: 0.7-18.7] a quantitative tuning fork, 11.1% [95% CI:3,1-26, 1] material off-loading, and 8.3% [95% CI: 1.8 - 22.5] a specialist reference centre. A total of 85 surgical centres and hospitals dealt with these problems: 11(13.0%) excellent model, 29 (34.1%) intermediate and 45 (52.9%) basic/insufficient. Centres with a basic model/insufficient performed 12.5% of the amputation, intermediate models, 56.4%, and 31.1% in excellent models., Conclusions: The proportion of ABS with materials, specialists and/or specialist reference centres was low. The basic/insufficient model was the most common among surgical/hospital centres. Most amputations were performed in centres with excellent and intermediate model; nevertheless, a considerable percentage was performed in centres with basic/insufficient models., (Copyright © 2011 Elsevier España, S.L. All rights reserved.)

Objective: To evaluate the effectiveness of an intervention to increase the participation among young people in the Health Prevention and Promotion Activities Programme (PAPPS) and the register of their variables. To evaluate differences in registering based on age and sex., Design: randomized, controlled clinical trial., Setting: Palamós primary care centre., Participants: A total of 828 people between the ages of 25 and 40 assigned to a nurse with one of the PAPPS variables improperly completed: 415 in control group and 413 in intervention group., Intervention: letter to complete the PAPPS and phone call if the response after three weeks was less than 10%., Variables: age, sex, nationality, clinic attendance, number of variables of PAPPS variables properly completed and the correct registration of each one at the beginning and end of the period., Statistical Analysis: univariate and bivariate analysis, 95% confidence interval, RRR and NNT., Results: Heterogeneous groups as regards clinic attendance: 5 (1.2%) of control and 85 (20.6%) of intervention group, NNT=5 (95% CI, 4-7); and properly completed registration of PAPPS (P<.001): 5 (1.2%) of control and 73 (17.7%) of intervention, NNT=6 (95% CI, 5-8). At the end, there were differences with regard to age and sex in the number of variables completed and in the registration of cholesterol (P<.001), and only in regard to age in body mass index (P=.005)., Conclusions: The strategy significantly increased the number of people who completed the PAPPS and their registration. Sex and age influenced the completion., (Copyright © 2010 Elsevier España, S.L. All rights reserved.)

Canalizing veins is a habitual technique carried out by nurses. Inserting a catheter in a peripheral vein causes pain. The importance of fine quality in nursing treatment implicitly bears on a person's well-being. In daily practice, health professionals do not use any method to reduce pain when inserting a catheter. The authors observations led them to believe in the need to carry out a bibliographical review whose objective was to discover all the methods used to reduce pain caused by puncturing a peripheral vein. Six randomly assigned clinical tests and a meta-analysis evaluate the effectiveness of: The use of Valsalva, an analgesic cream which contains two local amino-amide anesthetics; lidocaine and prylocaine (EMLA) compared to another analgesic cream, Myolaxin; a meta-analysis of twenty studies evaluates the degree by which pain is diminished by one such method: an EMLA cream; an anti-inflammatory skin dressing (diclofenaco), a diclofenaco dressing versus an EMLA anesthetic dressing, 0.25 ml subcutaneous injection of 1% mepivaína, an amida type local anesthetic; and direct photography moments before puncture occurs to use the effects of a flash of light. All these methods studied proved effective in reducing pain. Creams and dressing prove to be unaggressive methods but require some time for application prior to puncture. Using a camera flash, subcutaneous injection of mepivacaine and the application of Valsalva can be effective alternatives to reduce pain when puncturing veins in patients who require emergency care.

Aim: This paper is a report of a study conducted to evaluate, from the patients' perspective, a Liaison and Continuity of Care Programme coordinating care provision between a hospital and primary care centres., Background: Promoting continuity of care between hospitals and primary care improves quality of care, patient satisfaction and decreases further hospitalizations. However, inadequate pain management is common after discharge., Method: A sample of patients from the Liaison and Continuity of Care Programme were included in a longitudinal study in 2007. We conducted standardized telephone interviews at 24 hours, 7 days, 1 and 3 months after discharge. Outcome measures included readmission, time between hospital discharge and readmission, information level at discharge, patient satisfaction, queries about care and information related to perceived state of health and pain., Results: Eighty-three adult patients (average age 69.3, 50.6% males) who needed continued care at discharge were followed. Ten participants died during follow-up, and seven required readmission. A total of 49.4% of patients stated that they had understood the information given at discharge very well or perfectly. At 24 hours after discharge, 30% already had doubts about their state of health and the management of their condition. In relation to perceived health, only 25.3% stated that this was good or very good. Prevalence of pain 24-hours after discharge was 58.3% in surgical patients and 17.1% in other patients., Conclusion: The preparation and education of patients and family members should be improved before discharge, and appropriate written information must be given, especially if a patient has pain or requires complex care.

Aims: To evaluate the possible relationships between a health policy decision, in relation to the diabetes education strategies and the metabolic control outcomes., Design: Longitudinal prospective cohort study., Participants: A random cohort sample of 276 type II diabetes mellitus subjects., Location: All primary care centres in three regions of Catalonia., Principal Measurements: Patients were classified as specialised (n=59) or non-specialised (n=217) groups, as regards whether having received previous diabetes education before the start of the study. HbA1c values were evaluated in all subjects at baseline and after 5 years after receiving only conventional education., Results: Baseline evaluation showed a better metabolic control in the specialised group (P=0.009). The final evaluation showed no significant differences in outcomes between the two groups (P=0.679). When baseline and outcomes values were compared, significant differences were observed in all subjects (P=0.001), the specialised group showed significantly poorer metabolic control (P<0.001), but in the group with previous conventional education no significant differences were observed (P=0.058)., Conclusions: Our results suggest that the withdrawal of higher levels of diabetes education may play a major role in poor metabolic control, and that conventional diabetes education does not improve outcomes. Health policy in Primary Care should consider improving the level of diabetes education.

Aims: To evaluate the implementation of a liaison nursing model that integrates primary care and hospital functions and to analyze the role of this model in situations of dependency., Method: We performed an analytical-observational study of demand for liaison in continuity of care during the first year after implementation of the model. Patients were classified into six categories. The degree dependency was established by means of the Barthel index and Virginia Henderson's needs., Results: A total of 515 cases of liaison were observed (women: 57.3%, age: 69.32 +/- 18.25). Origin: hospital (78.1%), primary care (21.9%); destination: hospital (6.8%), primary care (82.1%), other (11.1%). Most frequent patient profile: continuity of cures/techniques. Main altered needs: hygiene/skin (65.8%), movement (55.5%), dressing (47.4%) and elimination (26.2%). Degree of dependency: no dependency (15.2%), slight dependency (62.7%), moderate dependency (3.4%), high dependency (18%). The degree of dependency was lower in hospital demand than in primary care demand (p<0.001). Other services involved: social work (21.7%), Functional Interdisciplinary Social-Health Unit (10.3%), Administration (5%), Domiciliary Care Support Team Program (4.7%), Residential Physio-Rehabilitation Team (3.9%). ProdeP project (people over 65): 37.5% showed dependency (low dependency [14.5%], moderate [33%], high or complete dependency [52.5%])., Conclusions: TThe highest flow was from the hospital setting to primary care, with a lower degree of dependency but greater urgency in the provision of continuity of care. We observed a high percentage of dependency. The liaison nursing model facilitates provision of coordinated and comprehensive care, with a high component of situations of dependency.

The authors research the opinions of first year nursing students about why the nursing profession does not receive the same degree of consideration which similar academic professionals receive. At the same time, the authors studied to see if this lower professional consideration is due to the predominant presence of females in the nursing profession. To collect data, the authors ran a transversal, descriptive, qualitative study by means of nominal group and discussion group techniques. Among the main results, the authors highlight that Nursing is considered a socially unknown profession and receives little acknowledgment inside the new health care model; furthermore, the fact that the majority of nurses are female does bear an influence on the vision of the nursing field and this female predominance harms competitiveness in the profession since nurses must conciliate their family lives with their professional lives.