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Abstract Background Demand for home care services has increased considerably, along with the growing complexity of cases and variability among resources and providers. Designing services that guarantee co-ordination and integration for providers and levels of care is of paramount importance. The aim of this study is to determine the effectiveness of a new case-management based, home care delivery model which has been implemented in Andalusia (Spain). Methods Quasi-experimental, controlled, non-randomised, multi-centre study on the population receiving home care services comparing the outcomes of the new model, which included nurse-led case management, versus the conventional one. Primary endpoints: functional status, satisfaction and use of healthcare resources. Secondary endpoints: recruitment and caregiver burden, mortality, institutionalisation, quality of life and family function. Analyses were performed at base-line, and at two, six and twelve months. A bivariate analysis was conducted with the Student's t-test, Mann-Whitney's U, and the chi squared test. Kaplan-Meier and log-rank tests were performed to compare survival and institutionalisation. A multivariate analysis was performed to pinpoint factors that impact on improvement of functional ability. Results Base-line differences in functional capacity – significantly lower in the intervention group (RR: 1.52 95%CI: 1.05–2.21; p = 0.0016) – disappeared at six months (RR: 1.31 95%CI: 0.87–1.98; p = 0.178). At six months, caregiver burden showed a slight reduction in the intervention group, whereas it increased notably in the control group (base-line Zarit Test: 57.06 95%CI: 54.77–59.34 vs. 60.50 95%CI: 53.63–67.37; p = 0.264), (Zarit Test at six months: 53.79 95%CI: 49.67–57.92 vs. 66.26 95%CI: 60.66–71.86 p = 0.002). Patients in the intervention group received more physiotherapy (7.92 CI95%: 5.22–10.62 vs. 3.24 95%CI: 1.37–5.310; p = 0.0001) and, on average, required fewer home care visits (9.40 95%CI: 7.89–10.92 vs.11.30 95%CI: 9.10–14.54). No differences were found in terms of frequency of visits to A&E or hospital re-admissions. Furthermore, patients in the control group perceived higher levels of satisfaction (16.88; 95%CI: 16.32–17.43; range: 0–21, vs. 14.65 95%CI: 13.61–15.68; p = 0,001). Conclusion A home care service model that includes nurse-led case management streamlines access to healthcare services and resources, while impacting positively on patients' functional ability and caregiver burden, with increased levels of satisfaction. Trial registration ISRCTN44054549

WHAT IS KNOWN ON THE SUBJECT?: Patients do not always receive enough information about their diagnosis and their perceived participation in decision-making about their treatment is low. Some participants reported feeling very uncertain when the physician invited them to choose between these options. Others users expressed their satisfaction with the trend away from paternalistic attitudes in the health system. There is a trend towards pharmacological prescription as a first approximation. This contrasts with the recommendations of scientific organizations based on evidence and cost-effectiveness studies on the offer of psychological interventions as the first option. The user groups pointed out that active coping, based on exposure to anxiety-generating situations, made a significant contribution to alleviating their anxiety disorders. However, some of those interviewed rejected this type of intervention. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Users diagnosed with anxiety disorders miss more information about the disorder and participation in its treatment. Opposite positions coexist in terms of participation in the choice of treatment. Pharmacological treatment is most commonly the first option offered. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This study is an example in itself of the involvement of users in the healthcare process, and therefore placing them at the centre of attention, as reflected in healthcare policies and clinical practice guidelines. It promotes the identification of needs that users diagnosed of anxiety disorders may have, with the aim of putting in place, from healthcare professionals and health services, the necessary supports adapted to these. Mental health nurses are well-positioned to offer support and guidance during the process of involvement and shared decision-making., Abstract: INTRODUCTION: An essential aspect of mental health treatment and recovery is the degree of involvement by health service users in the process., Aim/question: Explore the values, demands and preferences of persons diagnosed with anxiety disorders, their participation in the treatment provided, and the response of the health system in this regard., Methods: A qualitative study was conducted, with 51 participants. Nine focus groups and four in-depth interviews took place., Results: Three broad categories were identified: (1) diagnosis; (2) treatment options offered and shared decision-making; and (3) coping with the disorder. Sometimes patients do not receive enough information to cover their needs. A trend towards drug prescription as a first approach was observed, while active coping based on exposure to anxiogenic situations was indicated as the most effective option., Conclusion: Shared decision-making is a necessary aspect of treatment, and the therapeutic process should be adapted to match the service user's preferences, values and needs., Implications for the Practice: This research identifies the needs of patients diagnosed with anxiety disorders and promotes, therefore, from healthcare professionals and services, the provision of measures to meet these needs., (© 2024 The Author(s). Journal of Psychiatric and Mental Health Nursing published by John Wiley & Sons Ltd.)

Aim: To investigate the detection and initial management of first psychotic episodes, as well as established schizophrenia, within the primary care of the Andalusian Health System., Background: Delay in detecting and treating psychosis is associated with slower recovery, higher relapse risk, and poorer long-term outcomes. Often, psychotic episodes go unnoticed for years before a diagnosis is established. Primary care physicians are crucial for early recognition of psychosis and schizophrenia, especially in Spain, where primary care is the main entry point to healthcare services., Methods: Cross-sectional exploratory study. All active primary care physicians in the Malaga Guadalhorce Health District were invited to participate. Due to the COVID-19 pandemic, the survey was conducted online. The survey, adapted and validated for the local context, included 22 items and 5 sociodemographic questions covering early detection, treatment options, physical health monitoring, and management challenges. Descriptive and bivariate analyses summarized the data and explored correlations between key variables., Findings: The study included 142 primary care physicians (response rate 35.5%), with 28.9% men and 71.1% women, primarily from urban areas (83.1%). Most had completed residency training (86.6%), with 79.6% receiving psychiatric training. However, only 5.6% had participated in training sessions in the last 5 years, with all such sessions lasting less than 30 h. Physicians typically managed 0-10 patients with diagnosed schizophrenia and saw these patients 2 to 3 times annually. They often felt capable of managing these patients, especially with mental health consultancy support. Physical health monitoring was common, though some relied on mental health services to do this. Collaboration with mental health services was moderate, with high utility perceived for having a list of patients with severe mental disorders in their care panel., Conclusions: Family physicians are generally confident in managing psychosis and schizophrenia but lack recent specialized training. Mental health consultancy services are valued, but collaboration with these services needs improvement. Clear guidelines and enhanced training are essential to ensure comprehensive care, addressing both mental and physical health needs of these patients., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background/objectives: Patients with dementia present with feeding difficulties (FDs) since diagnosis, conditioning their progression. Early identification is vital for preventing deterioration due to nutritional problems. The Edinburgh Feeding Evaluation in Dementia Scale (EdFED) identifies the FDs of patients with dementia by studying their behaviours while eating or being fed. The aim of this study was to assess the responsiveness of the EdFED over time in older people with cognitive impairment and to compare its effectiveness in identifying malnutrition and risk with that of the gold standard Mini Nutritional Assessment (MNA) method., Methods: This was a multicentre, prospective, observational, longitudinal, analytic study with a follow-up period of 18 months (with patients participating in nursing homes and in the community). Sociodemographic and nutritional data (body mass index (BMI), MNA, forearm circumference (FC), calf circumference (CC), and a nutritional blood test) were collected; EdFED score was reported by nurses, nursing assistants, and family caregivers., Results: The total sample consisted of 359 individuals-60.7% residential participants and 39.3% community participants. In the last follow-up there were 149 remaining (41.5%). Malnutrition was more than 30%, and the risk was 40% at the three follow-ups. The results suggest that the EdFED scale is a useful tool for assessing feeding difficulties (FDs) in older persons with dementia. It demonstrated good sensitivity and specificity in detecting malnutrition, similar to the MNA, and, more importantly, detecting risk and also identifying changes in nutritional status over time., Conclusions: The EdFED scale provides a means of evaluating nutritional problems, making it possible to work on prevention.

Aim: This study explores contextual factors affecting evidence-based practice (EBP) adoption among Spanish nurses, examining their interaction with sociodemographic and practice variables to enhance implementation strategies., Design: A national multicenter study employing a cross-sectional online survey design was conducted with an intentional sample of 934 voluntary Spanish practicing nurses., Methods: Participants completed the 12-item Barriers/facilitators dimension of the HS-EBP instrument, along with sociodemographic, training and practice information relevant to EBP implementation. Psychometric networks have been utilised as a novel analytical approach., Results: The HS-EBP scores confirm validity and reliability for assessing EBP barriers and facilitators among Spanish nurses. Primary barriers include inadequate EBP discussion spaces, lack of guidance, resistance to change, patient apathy, time constraints and support gaps. Key facilitators are higher academic qualifications, EBP training, professional development participation, educational institution employment and student supervision. Focus is needed on rural nurses and those with heavy clinical duties, facing major EBP barriers., Conclusion: Spanish nurses encounter organisational barriers to EBP implementation, including insufficient incentives and support. Prioritising hands-on training, professional development in teaching and research and robust programs can enhance nurses' ability to advance EBP implementation., Impact: The HS-EBP questionnaire is reliable in measuring organisational and contextual factors affecting EBP implementation., Implications for the Profession: Successful implementation of evidence-based practice (EBP) in the Spanish healthcare system depends on developing an appropriate organisational culture and securing support from formal leaders. Additionally, fostering an understanding of the importance of patients and their families among Spanish nurses is crucial for promoting EBP adoption., (© 2024 The Author(s). Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Background: Children with medical complexity (CMC) are at increased risk of admission in intensive care. Despite improvements in mortality rates, there remains a burden of morbidity, long-term health care needs and hospital readmissions. Beyond clinical factors, socio-demographic determinants could impact utilization of acute services., Aim: To identify risk factors that can differentiate CMC who are admitted to the paediatric intensive care unit (PICU)., Study Design: A 6-year longitudinal retrospective cohort study evaluated clinical, socio-demographic and health care utilization., Results: A total of 248 CMC were included, with a median age of 13 years (9.75-17.00). Intensive care admission rate was 47.2%. The risk of PICU admission was higher for children undergoing surgical interventions (HR = 1.58, 95% CI 1.34-1.86, p < .001) and those using medical devices (HR = 1.81, 95% CI 1.54-2.13, p < .001). Mother's higher educational level was a protective factor (HR = 0.66, 95% CI 0.55-0.79, p < .001). Multivariable analysis revealed significant associations between risk of admission and the presence of malignancy, comorbidities, home medical devices, surgical procedures and higher health care utilization. Children's age and higher maternal educational level acted as protective factors., Conclusion: Socio-demographic factors should be considered in the provision of care to CMC. Individualized assessments to guide supportive interventions adapted to socio-economic factors may prevent PICU admissions., Relevance to Clinical Practice: This study highlights the importance of integrating individualized assessments of socio-demographic risk factors, such as maternal educational level, into the clinical practice of paediatric nurses. Moreover, targeted interventions, including educational resources and community support programmes, may optimize care., (© 2024 The Author(s). Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)

Background: Psychosis is often associated with loneliness, the absence of a confidant and a perceived lack of social support. In addition, the social isolation and solitude experienced can aggravate internalised stigma, depressive symptoms and/or suicidal tendencies, and worsen the course of the disorder., Aim: This study explores the experiences and perceptions of persons with psychosis concerning how their interpersonal relationships have evolved from the earliest symptoms of the disorder to its subsequent clinical stabilisation., Method: A qualitative content analysis was performed of the findings from five focus groups and six in-depth interviews (36 participants)., Results: In the prodrome and initial symptoms stage, five themes were coded: social withdrawal, loss of friends, loss of personal skills, communication difficulties and breakdown of life project. During the recovery phase, four themes were coded: family support, partner support, loneliness and the desire for more close relationships. Finally, during the clinical stabilisation phase, three themes were coded: the recovery of interpersonal relationships, including with peers; reconstruction of the life project and increased interpersonal sensitivity., Conclusions: These findings highlight the impact that psychosis can have on social life and show that recovery is also related to the development of maeningful interpersonal relationships.

Evidence shows that caring for a family member with a psychotic disorder generates a significant emotional impact and repercussions on social functioning. However, this caregiving experience can be influenced by cultural factors. The aim of this study is to explore the experience and perception of a group of family caregivers of patients with psychotic disorders of different durations regarding the emotional and social functioning repercussions of caregiving on them in Andalusia. Three focus groups (28 participants) were conducted. Data were subject to a thematic analysis. Three themes emerged from the data: 1) Emotional invasion; 2) Disruption in the caregiver's life project; and 3) Changes in the family system. Participants reported experiencing sadness, fear, overwhelm, hopelessness, and uncertainty. Caregivers' accounts reflected an interruption of their daily tasks, as well as the need to reformulate plans or goals outside the family life that require long-term commitment, such as professional development or even their residence. The narratives indicated an impact on all roles within the family system, particularly for the mother. The results are consistent with existing research. Healthcare professionals and programs should take into account the costs associated with caregiving in order to minimize them, given the impact it has on both the patient's and the caregivers' health., Competing Interests: Declaration of competing interest During the preparation of this work the authors ChatGPT in order to help to traduce. After using this tool, the authors reviewed and edited the content as needed and take full responsibility for the content of the publication., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Aim: To develop a new tool for identifying joint hypermobility of the paediatric foot and ankle, based on a dichotomous scoring system utilising the Lower Limb Assessment Score (LLAS), to separate the foot and ankle items., Material and Methods: A total of 205 children, aged between 5 and 10 years, participated in a cross-sectional study. The new tool Foot and Ankle Flexibility Index (FAFI) was predicated upon the last 7 items of LLAS, which are specific to the foot and ankle. The internal consistency was measured with Cronbach's test. Kappa statistics with 95% CI were calculated to verify the level of inter-rater and intra-rater agreement for the FAFI., Results: Cronbach's alpha returned 0.82. The correlations between items returned a mean of 0.59 (range: 0.43-0.74). The discrimination score on the ROC curve (4 points) showed that the model can be used to identify children with joint hypermobility of the foot and ankle. Inter-rater reliability was largely good (ICC = 0.89). Excellent intra-rater reliability was found (ICC = 0.96) CONCLUSIONS: This study identified high reliability between evaluators, and high sensitivity and specificity, for a new reliable and valid tool for the identification of foot and ankle joint hypermobility., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: Palliative sedation (PS) consists of the use of drugs to alleviate the suffering of patients with refractory symptoms, through a reduction in consciousness. The aim of this study is to describe the incidence of and indications for PS in patients treated by pediatric palliative care teams (PPCT), and the relationship between PS, the place of death, and the characteristics of the care teams., Methods: Ambispective study with the participation of 14 PPCT working in Spain., Results: From January to December 2019, a total of 164 patients attended by these PPCT died. Of these, 83 (50.6%) received PS during their last 24 hours. The most frequent refractory symptoms were terminal suffering ( n  = 40, 48.2%), dyspnea ( n  = 9, 10.8%), pain ( n  = 8, 9.6%), and convulsive state ( n  = 7, 8.4%). Sedation in the last 24 hours of life was more likely if the patient died in hospital, rather than at home (62.9% vs. 33.3%, p  < 0.01); if the parents had not expressed their preference regarding the place of death (69.2% vs. 45.2%, p  = 0.009); and if the PPCT had less than 5 years' experience (66.7% vs. 45.5%, p  = 0.018)., Significance of Results: PS is a real possibility in pediatric end-of-life care and relates to care planning and team expertise.

Purpose: The objective was analysed the patterns use of healthcare services of this population and the influence of their clinical and sociodemographic characteristics., Design and Methods: A six-year longitudinal follow-up study was performed to evaluate the annual healthcare resources use and clinical data among children with complex chronic diseases in Spain between 2015 and 2021. The sample trends in healthcare usage and the associated factors were analysed using ANCOVA and multivariable linear regression models., Results: Patients had high attendance during the follow-up period, with >15 episodes year. This trend decreased over time, especially in children with oncological diseases compared with other diseases (F (16.75; 825.4) = 32.457; p < 0.001). A multivariable model showed that children with a greater number of comorbidities (β = 0.17), shorter survival time (β = -0.23), who had contact with the palliative care unit (β = 0.16), and whose mothers had a higher professional occupation (β = 0.14), had a greater use of the healthcare system., Conclusions: Children with a higher number of comorbidities and the use of medical devices made a greater frequentation of health services, showing a trend of decreasing use over time. Socioeconomic factors such as mothers' occupational status determine healthcare frequentation. These results suggest the existence of persistent gaps in care coordination sustained over time., Practical Implications: Systematized and coordinated models of care for this population should consider the presence of inequalities in health care use., Competing Interests: Declaration of competing interest The authors have no conflicts of interest relevant to this article., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Delirium is one of the most common adverse events in older people during hospitalization, especially in the emergency department. Reliable, easy-to-use instruments are necessary to properly manage delirium in this setting. This study aims to evaluate the diagnostic validity of the Spanish version of the 4 'A's Test (4AT) in the ED., Methods: A diagnostic accuracy study was conducted in patients over 65 years old admitted to the Emergency Department who did not have a formal diagnosis of dementia or a severe mental health disorder. Face and content validity were evaluated by an expert panel. Emergency nurses performed the evaluation with 4AT, whilst blinded and trained researchers assessed patients with the Revised Delirium Rating Scale as the gold standard. The content validity index, sensitivity, specificity, positive and negative predictive values, likelihood ratios, Youden's Index and ROC curves were calculated to evaluate the diagnostic accuracy of the instrument., Results: Of 393 eligible patients, 380 were finally analyzed. Content validity yielded a median content validity index of 4 (interquartile range: 0). The Spanish 4AT sensitivity (95.83%; 95% ECI: 78.9-99.9%), specificity (92.98%; 95% CI: 89.8-95.4%), positive predictive value (47.92%) and negative predictive value (99.7%) were satisfactory. Youden's index was 0.89. Positive likelihood ratio was 13.65, and negative likelihood ratio 0.045. The area under the curve was 0.97., Conclusions: The Spanish version of the 4AT for use in the Emergency Departments is easy-to-use and applicable. The validation results indicate that it is a valid instrument with sufficient predictive validity to identify patients at risk of delirium in the Emergency Departments. Moreover, it is a tool that facilitates the management of an adverse event that is associated with increased mortality and morbidity., (© 2024. The Author(s).)

Background: Foot pain has been associated to factors like: fat, body mass index, age increased, female gender and the presence of pathologies. Although evidence is limited. The purpose is to determine the predictive factors for foot pain in the adult population., Methods: From January to December 2021, 457 patients were > 18 years, gave signed informed consent to take part to this cross sectional study. All completed demographic data and various questionnaires related to pain: Foot Function Index, EuroQoL-5D and Visual Analogue Scale (foot pain). Anthropometric measurements were obtained using McPoil platform and foot posture was assessed by the Foot Posture Index (FPI). To determine whether a volume change is a predictive factor for foot pain, a parameter was established: the volumetric index for footwear (VIF). Factors linked to the presence of pain, including the considered VIF variables, were analyzed through multivariable logistic regression., Results: Among the study population, 40.7% were male and 59.3% female. The mean age of 39.06 years and a body mass index of 25.58 Kg/cm 2 . The logistic regression model had a classification capability of 72.4%, a sensitivity of 72.3% and a specificity of 73%, in which, the predictors considered were the variables found to have a significant association with FFI-pain > 45 points,, showed that younger women, with a higher BMI, higher values of right FPI (pronation), poorer overall perceived health and with problems in walking were more likely to experience foot pain., Conclusion: Predictive factors for foot pain in the adult population include gender, age, Body Mass Index, FPI on the right foot, perceived health and mobility. Clinical implication, the presented measure aids physicians in assessing their patients´ foot pain likelihood., (© 2024. The Author(s).)

Aim: To explore what factors determine communication with awake intubated critically ill patients from the point of view of critical care nursing professionals., Background: Impaired communication frequently affects mechanically ventilated patients with artificial airways in the intensive care unit. Consequences of communication breaches comprise emotional and ethical aspects as well as clinical safety, affecting both patients and their conversation partners. Identification of determining factors in communication with awake intubated patients is needed to design effective action strategies., Design: A qualitative phenomenological approach was used., Methods: Semi-structured interviews were used as the data collection method. A total of 11 participants from three intensive care units of three Majorcan public hospitals, selected by purposive sampling, were interviewed., Findings: Three major themes regarding the communication determinants of the awake intubated critically ill patients were identified from the interviewees' statements: factors related to the patient (physical and cognitive functionality to communicate, their relational and communicative style and their personal circumstances), to the context (family presence, ICU characteristics, workload, availability/adequacy of communication aids, features of the messages and communication situations) and, finally, those related to the professionals themselves (professional experience and person-centredness)., Conclusions: The present study reveals determinants that influence communication with the awake intubated patient, as there are attitudes and professional beliefs., Relevance to Clinical Practice: The discovery of relations between different kinds of determinants (of patient, context or professionals) provides a multi-factor perspective on the communicative problem which should be considered in the design of new approaches to improve communicative effectiveness. This study is reported according to the COREQ checklist.

Background: The aim of this study was to evaluate the impact of a multifaceted intervention to implement an adapted guideline for the management of depression in primary health care., Methods: A hybrid trial was carried out to determine the effect of a multicomponent provider-centred intervention to improve the detection and diagnosis of depression in primary care, as part of the guideline implementation process, and to collect information about barriers and facilitators in a real-world context. Before the multicomponent intervention, a descriptive cross-sectional study was performed to assess the population prevalence of depression in the participating health centres and to detect possible differences. Subsequently, a quasi-experimental two-phase study was carried out with a concurrent control group to assess the impact of the multicomponent intervention on the main outcomes (detection of depression, evaluation of its severity and the use of structured methods to support the diagnosis)., Results: Nine-hundred seventy-four patients took part in the first phase. According to their clinical records, the prevalence of depression ranged from 7.2% to 7.9%, and there were no significant differences between the health centres scheduled to receive the intervention and those in the control group. In the experimental phase, 797 randomly selected participants received the multicomponent intervention. Adjusted multivariable analysis performed before the implementation revealed no significant differences in depression between the experimental and control groups. However, after the intervention, modest but significant differences were observed, which persisted at 1 year after the intervention., Conclusions: A multicomponent intervention for the implementation of a clinical guideline for the management of depression in primary care produced improvements in the identification of depression and in the degree of severity recorded.

Introduction: Multipathological patients are a vulnerable population with high comorbidity, functional impairment, and nutritional risk. Almost 50% of these hospitalized patients have dysphagia. There is no consensus on whether placement of a percutaneous endoscopic gastrostomy (PEG) tube provides greater clinical benefit. The purpose of this study was to know and compare 2 groups of multipathological patients with dysphagia according to the mode of feeding: PEG vs. oral., Method: Retrospective descriptive study with hospitalized patients (2016-19), pluripathological, with dysphagia, nutritional risk, over 50 years with diagnoses of: dementia, cerebrovascular accident (CVA), neurological disease, or oropharyngeal neoplasia. Terminally ill patients with jejunostomy tube or parenteral nutrition were excluded. Sociodemographic variables, clinical situation, and comorbidities were evaluated. Bivariate analysis was performed to compare both groups according to their diet, establishing a significance level of p < .05., Results: 1928 multipathological patients. The PEG group consisted of 84 patients (n122). A total of 84 were randomly selected to form the non-PEG group (n434). This group had less history of bronchoaspiration/pneumonia (p = .008), its main diagnosis was stroke versus dementia in the PEG group (p < .001). Both groups had more than a 45% risk of comorbidity (p = .77)., Conclusions: multipathological patients with dysphagia with PEG usually have dementia as their main diagnosis, however, stroke is the most relevant pathology in those fed orally. Both groups have associated risk factors, high comorbidity, and dependence. This causes their vital prognosis to be limited regardless of the mode of feeding., (Copyright © 2023 Elsevier España, S.L.U. All rights reserved.)

Background: The restrictions imposed during the management of the pandemic led to lack of care of other health problems., Purpose: To assess changes in the health status of complex multimorbidity elderly, functional and cognitive capacities, perception of the social surroundings, care provided by the nurses, including nursing diagnosis and interventions, use of health services, adverse events, and use of devices and technical help during the first 6 months of the Covid-19 pandemic., Design: A 1-year longitudinal cohort study was conducted., Methods: Ninety-seven complex multimorbid elderly attended in primary care were evaluated every 3 months in a health area of the Spanish National Health System (SNHS). The research was called "SAMAC3 study"., Results: Significant negative changes were observed in the functional and cognitive capacity of the elderly, and in several nursing diagnoses. A decrease was observed in the frequency of visit to the nurses, hospital admittance, length of hospital stays, and falls., Conclusions: The functional and cognitive capacities of the cohort became worse. However, a significant decrease in the frequency of use of health services was observed. The nurses detected significant changes in activity-exercise, cognitive-perception, and roles-relationships, but their interventions were mostly centered on resolving clinical matters that required immediate attention., Clinical Relevance: The present study allowed us to observe that a situation of social and health stress has worsened the health indicators of multimorbid elderly, and the clinical care of community nurses was insufficient to providing care for the deterioration of the physical and cognitive domains., (© 2022 The Authors. Journal of Nursing Scholarship published by Wiley Periodicals LLC on behalf of Sigma Theta Tau International.)

The current article provides information that facilitates early identification of a new form of checking obsessive-compulsive disorder (OCD) detected in physicians during the COVID-19 pandemic. This article describes three cases of professional checking OCD in physicians. Physicians with checking OCD are obsessively concerned about making a mistake that will result in fatal consequences. The most frequent strategies of neutralization include avoiding direct contact with patients by taking sick or vacation leaves; compulsively studying for many hours daily (neglecting other aspects of life); checking the status of their patients by arranging additional follow-up consultations or making phone calls even out of working hours; repeatedly checking the medical history of their patients, and persistently recalling the last appointment. Physicians with check OCD often seek reassurance from their colleagues and consult the scientific literature for information about issues they used to be competent in. These patients may also experience anticipatory anxiety and mental blocks. However, egodystony is milder than in other forms of OCD. The COVID pandemic may have exacerbated these neutralization behaviors, since it has forced physicians to adapt to a new work environment. The recommended treatments (Exposure with Response Prevention Therapy or/and SSRI) provide beneficial effects in a short time., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Authors.)

Objective: To evaluate the effectiveness of different interventions in reducing pain-related fear outcomes in people with knee osteoarthritis who have or have not had previous knee surgery, and to analyze whether included trials reported their interventions in full detail., Methods: Systematic searches were carried out in the Cochrane CENTRAL, CINAHL, EMBASE, PEDro, PsycINFO, PubMed, and SPORTDiscus from the inception of the database up to November 2019. Searches were manually updated to July 2021. We included randomized clinical trials that evaluated pain-related fear outcomes as a primary or secondary outcome in adults with knee osteoarthritis. The Cochrane Risk of Bias Tool 2 and the GRADE approach evaluated the risk of bias and the certainty of the evidence, respectively., Results: Eighteen trials were included. Four trials evaluated pain-related fear as a primary outcome and all evaluated kinesiophobia in samples that had previously undergone a knee surgical procedure. These trials found that interventions based primarily on cognitive aspects (e.g. cognitive-behavioral principles) can be effective in reducing kinesiophobia. Trials evaluating pain-related fear as the secondary outcome also found that interventions that included cognitive aspects (e.g. pain neuroscience education) decreased the levels of pain-related fear (e.g. fear of falling or kinesiophobia) in patients with or without a previous knee surgery. However, serious to very serious risk of bias and imprecisions were found in included trials. Thus, the certainty of the evidence was judged as low and very low using the GRADE approach. All trials reported insufficient details to allow a complete replication of their interventions., Conclusions: Interventions that include cognitive aspects may be the best option to reduce pain-related fear in people with knee osteoarthritis. However, we found a general low and very low certainty of the evidence and the findings should be considered with caution.

Each year, more than 8 million children worldwide require specialized palliative care, yet there is little evidence available in pediatrics on the characteristics of the end of life in this context. Our aim is to analyze the characteristics of patients who die in the care of specific pediatric palliative care teams. This is ambispective, analytical observational, multicenter study conducted between 1 January and 31 December 2019. Fourteen specific pediatric palliative care teams participated. There are 164 patients, most of them suffering from oncologic, neurologic, and neuromuscular processes. The follow-up time was 2.4 months. The parents voiced preferences in respect of the place of death for 125 of the patients (76.2%). The place of death for 95 patients (57.9%) was at the hospital and 67 (40.9%) was at home. The existence of a palliative care team for over 5 years is more likely to be related to families voicing preferences and their fulfillment. Longer follow-up times by pediatric palliative care teams were observed in families with whom preferences regarding the place of death were discussed and in patients who died at home. Patients who did not receive home visits, when the pediatric palliative care team did not provide full care and when preferences regarding the place of death were not discussed with parents, were more likely to die in the hospital.   Conclusions: Advance planning of end-of-life care is one of the most important aspects of pediatric palliative care. The provision of services by the teams and the follow-up time are related to parents' expressed preferences and the place of death. What is Known: • Various studies have shown how the availability of pediatric palliative care services improves the quality of life of patients and their families while reducing costs. • The place of death is an important factor influencing the quality of end-of-life care for dying people. The increase in palliative care teams increases the number of deaths in the home and having this care available 24/7 increases the probability of dying at home. What is New: • Our study identifies how a longer follow-up time of patients by palliative care teams is significantly associated with death at home and with express and comply with the preferences expressed by families. • Home visits by the palliative care team increase the likelihood that the patient will die at her home and that the preferences expressed by the palliative care team families will be cared for., (© 2023. The Author(s).)

Background: Caregivers for children with complex chronic illnesses may experience emotional and physical strain, especially as concerns attention overload and the perceptions of their own psychosocial situation. These concerns, together with the additional financial cost and the socioeconomic inequalities that arise from caregiving responsibilities, create major challenges to the health status of this population group., Methods: A prospective analytical longitudinal study will be conducted, based on an exposed cohort of adult caregivers (parents or guardians) for children with complex chronic processes, to evaluate the impact of caregiving responsibilities on the health status of this population group., Conclusions and Implications: The practical implications of this study are of great significance for clinical practice. The results of this study have the potential to inform the decision-making process in the healthcare sector and guide future research initiatives. The findings of this study will provide crucial insights into the health-related quality of life of caregivers of children with complex chronic illnesses, which will be valuable in addressing the challenges faced by this population group. This information can be used to improve the availability and accessibility of appropriate health services and to facilitate the development of more equitable health outcomes for caregivers of children with complex chronic illnesses. By highlighting the extent to which this population is affected both physically and mentally, the study can contribute to the development of clinical practices that prioritize the health and well-being of caregivers in the care of children with complex chronic illnesses.

The mental health recovery model is based on shared decision making, in which patients' preferences and perceptions of the care received are taken into account. However, persons with psychosis usually have very few opportunities to participate in this process. The present study explores the experiences and perceptions of a group of patients with psychosis-in some cases longstanding, in others more recently diagnosed-concerning their participation in the decisions taken about the approach to their condition and about the attention received from healthcare professionals and services. For this purpose, we performed a qualitative analysis of the outcomes derived from five focus groups and six in-depth interviews (36 participants). Two major themes, with five sub-themes, were identified: shared decision-making (drug-centred approach, negotiation process, and lack of information) and the care environment and styles of clinical practice as determinants (aggressive versus person-centred environments, and styles of professional practice). The main conclusions drawn are that users want to participate more in decision making, they want to be offered a range of psychosocial options from the outset and that their treatment should be based on accessibility, humanity and respect. These findings are in line with the guidelines for clinical practice and should be taken into account in the design of care programmes and the organisation of services for persons with psychosis.

Background: The objective was to assess fatigue in children with complex chronic diseases (CCCDs) and analyze its relationship with clinical and sociodemographic characteristics, use of healthcare services, and quality of life (QoL)., Methods: Cross-sectional study carried out in CCCDs attended in a tertiary hospital during 2016. Fatigue (PedsFacit-F questionnaire) and quality of life (PedsQL) were determined, and the following variables were registered: use of health resources, disease group, time with disease, and educational level and type of employment of the parents. A multiple regression model was developed to predict the use of healthcare resources., Results: Seventy children were included in this study; mean age 10.5 years (range: 8-17), 41.4% girls, and cancer was the most frequent group disease (28.6%). Annual use of healthcare resources (38.86; SD: 30.73) increased with fatigue (r=-0.292; p=0.015). Higher levels of fatigue were determined for children with cancer (24.9; SD: 10.7) in comparison to other pathologies, while lower levels were found for heart diseases (44.5; SD: 7.9). The QoL perceived by CCCDs (20.6; SD: 16.5) directly correlated (p<0.001) with that of their parents (22.8; SD: 16.8); a correlation with fatigue was seen in both cases (r=0.528 and r= 0.441; p<0.0001). The adjusted effect of higher levels of fatigue (lower scores), lower length of disease duration, and higher level of education of the mother, predicted greater use of healthcare resources., Conclusion: CCCDs with higher fatigue levels use healthcare resources more often and perceive a worse QoL. This should be considered when providing care to this population.

Background: Pressure ulcers are a common adverse event in healthcare. To date, no flowmetry studies have been conducted to compare hyperoxygenated fatty acids (HFA) vs. extra-virgin olive oil (EVOO) in alleviating this condition., Aims: To determine and evaluate the effect of the application of HFA vs. EVOO on tissue oxygenation and perfusion in heels under pressure, in healthy persons and in hospitalised patients., Design: Two-phase experimental study., Methods: Phase 1 will be conducted with healthy subjects, using a randomised, open study design, evaluating an intrasubject control group. Phase 2 will focus on hospitalised subjects, with a randomised, open study group vs. a control group., Discussion: This Project is undertaken to identify the mechanisms that intervene in the genesis of pressure ulcers and to determine whether there are differences in outcomes between the application of HFA vs. EVOO as a preventive measure The results of this study are of economic importance (due to the price difference between the products used) and will also impact on usual clinical practice for patients with impaired mobility and liable to suffer from pressure ulcers, by considering an alternative to established preventive measures., (Copyright © 2022. Published by Elsevier Ltd.)

Background: Recruitment into randomized trials of hydroxychloroquine (HCQ) for prevention of COVID-19 has been adversely affected by a widespread conviction that HCQ is not effective for prevention. In the absence of an updated systematic review, we conducted a meta-analysis of randomized trials that study the effectiveness of HCQ to prevent COVID-19., Methods: A search of PubMed, medRxiv, and clinicaltrials.gov combined with expert consultation found 11 completed randomized trials: 7 pre-exposure prophylaxis trials and 4 post-exposure prophylaxis trials. We obtained or calculated the risk ratio of COVID-19 diagnosis for assignment to HCQ versus no HCQ (either placebo or usual care) for each trial, and then pooled the risk ratio estimates., Results: The pooled risk ratio estimate of the pre-exposure prophylaxis trials was 0.72 (95% CI: 0.58-0.90) when using either a fixed effect or a standard random effects approach, and 0.72 (95% CI: 0.55-0.95) when using a conservative modification of the Hartung-Knapp random effects approach. The corresponding estimates for the post-exposure prophylaxis trials were 0.91 (95% CI: 0.72-1.16) and 0.91 (95% CI: 0.62-1.35). All trials found a similar rate of serious adverse effects in the HCQ and no HCQ groups., Discussion: A benefit of HCQ as prophylaxis for COVID-19 cannot be ruled out based on the available evidence from randomized trials. However, the "not statistically significant" findings from early prophylaxis trials were widely interpreted as definite evidence of lack of effectiveness of HCQ. This interpretation disrupted the timely completion of the remaining trials and thus the generation of precise estimates for pandemic management before the development of vaccines., (© 2022. Springer Nature B.V.)

(1) Background: There is currently a global consensus that the quality of comprehensive care for acutely hospitalised elderly people should include addressing functionality and mobility, cognitive status, prevention of pressure ulcers, urinary incontinence, falls and delirium, as well as pain control and medication-related problems. The aim of this study is to develop and validate a clinical prediction rule for multimorbid patients admitted to an acute care hospital unit for any of the five adverse events included in our vulnerability pentad: falls, pressure ulcers, urinary incontinence, pain and delirium. (2) Methods: Longitudinal analytical clinimetric study, with two cohorts. The study population will consist of multimorbid patients hospitalised for acute care, referred from the Emergency Room. A clinical prediction rule will be proposed, incorporating predictive factors of these five adverse outcomes described. This study has received funding, awarded in November 2020 (PI-0107-2020), and was approved in October 2019 by the Research Ethics Committee ″Costa del Sol″. (3) Conclusions: Preventing adverse events in hospitalised patients is particularly important for those with multimorbidity. By applying a clinical prediction rule to detect specific risks, an estimate can be obtained of their probability of occurrence.

(1) Background: Identifying differences in the competencies of different areas of nursing is a crucial aspect for determining the scope of practice. This would facilitate the creation of a formal structure for clinical practice in advanced and specialised services. The aims of this study are to analyse the distribution of advanced competencies in registered, specialist and advanced practice nurses in Spain, and to determine the level of complexity of the patients attended by these nurses. (2) Methods: A cross-sectional study was developed on registered, specialist and advanced practice nurses, all of whom completed an online survey on their perceived level of advanced competencies and their professional characteristics. (3) Results: In total, 1270 nurses completed the survey. Advanced practice nurses recorded the highest self-perceived level of competency, especially for the dimensions of evidence-based practice, autonomy, leadership and care management. (4) Conclusions: Among registered, specialist and advanced practice nurses, there are significant differences in the level of self-perceived competencies. Patients attended by advanced practice nurses presented the highest levels of complexity. Understanding these differences could facilitate the creation of a regulatory framework for clinical practice in advanced and specialized services.

Objective: The study aim was to cross-culturally adapt the Self-reported Foot and Ankle Score (SEFAS) into Spanish and French-language versions, to validate them and to evaluate their psychometric properties., Methods: The cross-cultural translation from the original SEFAS into French and Spanish was performed in accordance with the guidelines of the ISPOR. The participants were recruited from some private healthcare institutions in France and Sapin, from June to August 2019. The following inclusion criteria were applied: aged at least 18 years, with foot and/or ankle deformity, had a history of subtalar and/or ankle and/or talonavicular or hindfoot pain, did not make daily use of walking aids, and were able to achieve the normal range of motions in the ankle, subtalar and midtarsal joints. All patients gave signed informed consent and completed the SF-36 and SEFAS questionnaires in the Spanish or French version., Results: The analysis was based on 319 participants. Internal consistency was excellent (Cronbach's alpha values of 0.94 for the Spanish version and 0.88 for the French version). No floor/ceiling effect was observed in any item, in either version., Conclusion: The Spanish and French versions of SEFAS are valid, reliable instruments for evaluating foot and ankle pain and function.IMPLICATIONS FOR REHABILITATIONSelf-report questionnaires specific to patients with rheumatoid arthritis are needed to assess the degree of pain, disability, and disability caused by foot problems.The Spanish and French versions of SEFAS show the necessary psychometric characteristics.Each version provides a valid, reliable tool ensuring the correct evaluation of pain, function and limitation of function in the foot and/or ankle in the target population.

Introduction: Around 2000 children and adolescents die each year in Spain, however, we know little about the particularities of deaths in paediatrics. The purpose of this study is to document the characteristics of patients who die in the care of paediatric palliative care teams in Spain., Patients and Methods: Retrospective, descriptive, multicentre study. Fourteen teams from all over the country participated., Results: Data were obtained from 164 patients. In most cases the underlying disease stemmed from oncological, neurological or neuromuscular processes. The median age at death was 6.9 years (RIC 11.2). The median follow-up time by the team was 0.3 years (RIC 0.8 years). The most frequent symptoms in the last week of life were dyspnoea, pain, increased secretions and sleep disorders. The median number of drugs administered to each patient one week prior to death was 6 (RIC 4). The place of death for 95 of the patients (57.9%) was hospital while 67 (40.9%) died at home., Conclusions: There was a wide age range of patients and they had substantial exposure to polypharmacy. The follow-up time shows that patients have late access to palliative care programmes. An effort should be made to introduce this care earlier rather than relegating it to the end of life. In Spain there is an unequal distribution of resources and not all teams can provide care at home. The place of death should be interpreted with caution., (Copyright © 2021 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.)

Background: To evaluate the impact of a nurse navigation program on treatment adherence and resolution of hepatitis C infection in patients with severe mental disorder., Methods: An open, randomized, controlled trial with blinded outcome assessment. The intervention group will engage in a nurse navigation program designed by mental health nurses. The program involves active screening for patients with severe mental disorder. The patients and caregivers included in the program will receive information, training, support and guidance throughout the treatment and recovery process, which involves different healthcare professionals and units. The control group will receive the standard of care, which includes follow-up by a family physician, referral to the hepatologist, serological testing, new referral to the hepatologist, onset of treatment, and follow-up. Multidisciplinary care will be provided along a coordinated and seamless clinical pathway led by a nurse navigator. The primary endpoints are total recovery (hepatitis C cure) and treatment adherence. Occurrence of symptoms of schizophrenia and health-related quality of life will be also recorded. Follow-up of patients will be performed three and six months after the administration of antiviral treatment. The study was authorised by the Ethics Committee of Malaga in December 2021. Funding was approved in March 2021., Discussion: If this intervention is proven to be effective in improving treatment access and adherence, it will represent a step forward in addressing a chronic health issue that is 16 times more prevalent in the population with severe mental disease. Finally, this intervention may lead to the detection of undertreated HCV infection in this population of patients., Trial Registration: This protocol has been registered in ClinicalTrials.gov with identifier code NCT04891445 on May 18, 2021., (© 2022. The Author(s).)

Aims and Objectives: To investigate the possible association between hyponatremia and falls, in a sample of hospitalised adult patients., Background: In-hospital falls are a problem of major importance, provoking a significant decline in the quality of life of many patients. Recent studies have identified a relationship between such falls and the presence of hyponatremia., Design: Analytical retrospective observational case-control study., Methods: The study population consisted of hospitalised patients who had suffered an in-hospital fall during the period 2014-2016. For each case, two controls who had not suffered any such fall were recruited. These cases and controls were matched according to gender, age, hospitalisation unit and date of admission. Study data were obtained from the hospital's record of falls, regarding the patients' socio-demographic factors, physical and psychological conditions and blood levels of sodium, potassium, urea and creatinine. The study is reported in accordance with STrengthening the Reporting of OBservational studies in Epidemiology guidelines., Results: The study sample consisted of 555 patients (185 cases and 370 controls). Hyponatraemia was detected in 57 cases (30.8%). A statistically significant relationship was found between the presence of hyponatraemia and the occurrence of falls: OR = 2.04. Other risk factors for falls were hypercreatinaemia OR 2.49, hyperuraemia OR 1.82, disorientation, need for ambulatory assistance and longer hospital stay., Conclusions: From the study findings, we conclude that hyponatraemia is a predictor of falls by acute hospitalised patients. Further research is needed on the relationship between hypercreatinaemia, hyperuraemia and falls., Relevance to Clinical Practice: The assessment of risk factors for falls, such as hyponatraemia, can alert us to the possibility of this event occurring and facilitate the implementation of preventive measures. This parameter should be included as a significant new factor in assessment instruments designed to assess the risk of falls, thus enhancing the reliability and diagnostic validity of these instruments., (© 2021 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

Introduction: The incidence of acute coronary syndrome is rising in step with the growth of life expectancy. An increase in the age of patients with coronary artery disease has been related to in-hospital mortality, which has seen an upsurge over a short period of time. However, there is no consensus about the percutaneous coronary angioplasty strategy to follow for older patients with multivessel coronary artery disease (MVCAD). Complete revascularisation (CR) or incomplete revascularisation (ICR) strategy depends on prognosis but this has not yet been accurately described because of geriatric conditions and comorbidities. The aim of this study is to evaluate changes of clinical and biochemical parameters in older patients with MVCAD undergoing revascularisation and to establish a prognostic stratification model for CR and ICR., Methods and Analysis: This observational, longitudinal, prospective study will include 150 patients with MVCAD and subsequent revascularisation who attend the Hospital Universitario Virgen de la Victoria (Málaga, Spain). Because of the dropout rates, 180 patients will be recruited at the beginning. Sociodemographic characteristics, clinical and angiographic parameters, and biochemical variables, such as cardiovascular, metabolic, inflammatory, stress oxidative biomarkers, will be collected in the admission for coronary revascularisation and three follow-ups at 6, 12 and 18 months. Statistical analyses will be conducted with these data using CR and ICR as the primary exposure variable. Relevant explanatory variables will be selected from a predictive model for their inclusion in a prognostic stratification model. The primary outcome measures will be major adverse cardiovascular events., Ethics and Dissemination: Protocols and patient information have been approved by the regional research ethics committee (CEIm Provincial de Málaga-PEIBA (PI0131/2020). The results will be disseminated in international peer-reviewed journals, presented at conferences in Cardiology and Gerontology, and sent to participants, medical and health service managers, clinicians and other researchers., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Children with complex chronic conditions have a high need for health and social care resources. Many parents explore parallel resources such as alternative therapies, associations, psychological support, private medical consultations, and other out-of-pocket expenses for healthcare. The use of these alternative health resources is sometimes unclear and may lead to health inequalities. To characterize the use made of alternative healthcare resources for children with complex chronic conditions. Additionally, we evaluate the influence of sociodemographic factors on the distribution of this utilization of resources; (2) Methods: Cross-sectional study. Children with complex chronic diseases were treated at a tertiary hospital in Granada, Spain in 2016. We analyzed their use of healthcare resources and socioeconomic variables. This research complies with STROBE guidelines for observational studies; (3) Results: In total, 265 children were analyzed (mean age 7.3 years, SD 4.63). A total of 105 children (39.6%) attended private consultations with specialists, and 12.1% ( n = 32) of the children had additional private health insurance. One out three parents belonged to a mutual support association ( n = 78), and 26% ( n = 69) of the children used alternative therapies. Furthermore, 75.4% ( n = 199) of the children received no psychological support. Children whose parents had a higher educational level and occupations status made greater use of parallel healthcare resources.; (4) Conclusions: A significant proportion of children used multiple health resources in addition to the public healthcare system depending on sociodemographic determinants. Studies are needed to determine whether the use of these alternative services achieves better levels of health.

Health-related quality of life of children with complex chronic conditions could be affected by sociodemographic factors. Most studies focus exclusively on the parents' perceptions of quality of life. This study aimed to determine the health-related quality of life of these children, according to their parents and the children themselves. A cross-sectional study was developed on children aged over five years with complex chronic conditions. Health-related quality of life, educational attainment, and social status were evaluated. A total of 101 children were included with a mean age of 10.48 years, and 35.6% were female. The most frequent disease was oncological (28.7%). Children perceived a better health-related quality of life, compared to their parents' assessment: median difference -8.4 (95%CI: -9.2 to -3.8). Moreover, differences were observed by socioeconomic factors. Parents and children with complex chronic conditions perceive differently the health-related quality of life. Social determinants associate with an uneven perceived quality of life.

Background: Informal caregivers of patients with multiple chronic conditions are socially good, promoting the sustainability of a large part of home care provision. However, this very demanding activity causes health problems that increase their own need for health services. This study analyses the use of health services by informal carers, comparing it with the use made by the general population with similar characteristics., Methodology: Cross-sectional analytical study carried out in the Malaga-Valle Guadalhorce Primary Health Care District (Spain). Healthcare demand and perceived health were measured in the family caregivers, compared to the general population. Strobe Statement for observational studies has been used to strength the report of the results., Results: Final sample consisted of 314 family caregivers together with a subsample of 2.290 non-caregivers taken from data of the National Health Survey. This subsample was paired by gender with our sample. Formal caregivers make fewer annual visits to the health services, with respect to the general population, regardless of the perceived level of health. The difference of the means between those who perceive their health as very poor was 0.11 (95% CI: 0.01 to 0.20) consultations with the family doctor, 0.21 (95% CI: 0.15 to 0.26) consultations with medical specialists and 1.70 (95% CI: 1.52 to 1.87) emergency room attention. Three independent factors were identified that predispose to the increased use of health services: background of greater education achievement (OR 8.13, 95% CI: 1.30 to 50.68), non-cohabitation with the care recipient (OR 3.57, 95% CI: 1.16 to 11.11) and a more positive physical quality of life component (OR 1.06; 95% CI: 1.03 to 1.09)., Discussion and Implications: Intrinsic components of the caregiver reveal their independent relationship with the provision of informal care and the use of health services. A broader vision is needed for the factors that influence the health of these caregivers to develop multipurpose interventions and improve the consistency and effectiveness of the health services offered to the caregiver., (© 2021 John Wiley & Sons Ltd.)

Lower socio-economic status (SES) is significantly associated with metabolic syndrome (MS) prevalence, possibly affecting women more than men, although evidence in Spain is still limited. The present cross-sectional study analyzed the association between MS and SES by age and gender among 42,146 working adults living in the Balearic Islands (Spain). Prevalence was higher in men (9.4% by ATP-III; 12.3% by IDF) than women (3.8% by ATP-III; 5.7% by IDF) and in the lower social class (7.9% by ATP-III; 10.7% by IDF) than the higher (4.1% by ATP-III; 5.9% by IDF). The SES gradient in MS prevalence was larger in women (PR 95% CI: 3.38, 2.50-4.58 by ATP-III; 3.06, 2.43-3.86 by IDF) than in men (1.23, 1.06-1.41 by ATP-III; 1.15, 1.03-1.30 by IDF) and was already evident from early adulthood, reaching the highest ratio at the late stages of middle adulthood (4.34, 1.11-16.98). Among men, it was significant during the late stages of early adulthood only (1.80, 1.19-2.73). Lower SES influenced MS prevalence in both genders, however, women seemed more affected than men. From a public health perspective, SES could be strongly associated with the burden of MS; in an effort to reduce its prevalence, public health policies should focus on gender differences in socio-economic inequality and consider women with low socio-economic resources as a priority.

The objective of this study was to analyze the cross-sectional and longitudinal association between pain catastrophizing and opioid misuse, opioid use, and opioid dose in people with chronic musculoskeletal pain. For this systematic review, CINAHL, Embase, PsycINFO, PubMed, manual searches, and grey literature were searched from inception to May 2020. Observational studies were included if they evaluated the association between pain catastrophizing and opioid dose, opioid use, and/or opioid misuse in people with chronic musculoskeletal pain. Two reviewers independently performed the study selection, data extraction, risk of bias assessment, and the certainty of the evidence judgment. Seven observational studies (all cross-sectional designs) satisfied the eligibility criteria, with a total sample of 2,160 participants. Pain catastrophizing was associated with opioid misuse. The results were inconsistent regarding the association between pain catastrophizing and opioid use. A lack of association was found considering pain catastrophizing and the opioid dose. However, the presence of risk of bias and imprecision was serious across the included studies, and therefore, the overall certainty of the evidence was judged as very low for all the outcome measures. This report concludes that pain catastrophizing seem to be associated with opioid misuse in people with chronic musculoskeletal pain. However, the very low certainty of the current evidence confers to interpret the finding of this review as exclusively informative. PERSPECTIVE: This article shows that pain catastrophizing seem to be associated with opioid misuse in people with chronic musculoskeletal pain. The overall certainty of the evidence was judged to be very low, thus, these results should be interpreted with caution., (Copyright © 2021 United States Association for the Study of Pain, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Trauma-related symptoms are often experienced after a first psychotic episode., Objective: In this study, we conduct a qualitative analysis of referred traumatic experiences of outpatients diagnosed with psychotic disorders., Method: Focus groups were formed and in-depth interviews conducted with 30 participants, focusing on their experience with the disorder and the health care received. Given the frequency with which trauma and psychosis have been associated in the scientific literature, the nature of this relation is addressed as a secondary objective, via a qualitative analysis., Results: Analysis revealed two main themes in the patients' discourse. On many occasions, traumatic experiences were related to the development of the disorder. Although most participants referred to traumatic experiences during childhood, episodes during adult life were also reported, which may have triggered the disorder. The second theme was that of the interlocking relationship between the psychotic experience and certain coercive practices undergone during the provision of health care for psychosis, and the traumatic effects thus generated., Conclusions: The participants considered both themes to be highly important. Accordingly, these issues should be carefully assessed and managed in order to provide appropriate person-centred care., Competing Interests: No potential conflict of interest was reported by the author(s)., (© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Introduction: Around 2000 children and adolescents die each year in Spain, however, we know little about the particularities of deaths in paediatrics. The purpose of this study is to document the characteristics of patients who die in the care of paediatric palliative care teams in Spain., Patients and Methods: Retrospective, descriptive, multicentre study. Fourteen teams from all over the country participated., Results: Data were obtained from 164 patients. In most cases the underlying disease stemmed from oncological, neurological or neuromuscular processes. The median age at death was 6.9 years (RIC 11.2). The median follow-up time by the team was 0.3 years (RIC 0.8 years). The most frequent symptoms in the last week of life were dyspnoea, pain, increased secretions and sleep disorders. The median number of drugs administered to each patient one week prior to death was 6 (RIC 4). The place of death for 95 of the patients (57.9%) was hospital while 67 (40.9%) died at home., Conclusions: There was a wide age range of patients and they had substantial exposure to polypharmacy. The follow-up time shows that patients have late access to palliative care programmes. An effort should be made to introduce this care earlier rather than relegating it to the end of life. In Spain there is an unequal distribution of resources and not all teams can provide care at home. The place of death should be interpreted with caution., (Copyright © 2021 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.)

Aim: To evaluate the changes that take place in the perfusion, oxygenation and local temperature of the skin of the sacrum and trochanter when subjected to direct pressure for 2 h., Methods: Quasi-experimental study in the preclinical phase with healthy subjects acting as their own controls (intrasubject control). The outcome variables were measured with a laser Doppler system (local temperature and oxygenation) and by near-infrared spectroscopy (perfusion). The pressure exerted was measured with a capacitive pressure sensor. No more than one week elapsed between the sacrum and trochanter measurements., Results: The study sample consisted of 18 persons. The comparative analysis of the fluctuations in the parameters measured on the skin of the trochanters and sacrum, according to the time elapsed, revealed a statistically significant increase in temperature and in the pressure exerted. On the other hand, the changes in capillary blood flow and in SaO2 were not statistically significant., Conclusion: Our study results show that changes found in terms of temperature and pressure should be taking into account when planning personalised repositioning to patients according to biomechanical and biological situations that vary between anatomical areas. In future research, the changes reported could be evaluated in patients with risk factors for the development of pressure ulcers, thus facilitating the introduction of more personalised planning in the care and prevention of these injuries., (Copyright © 2021 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.)

Objective: To assess the distribution of citations of nursing authors in Spanish in Google Scholar as well as to compare the possible differences between this source and Web of Science and Scopus., Method: This is a descriptive cross-sectional study based on the citation systems offered by Google Scholar, Web of Science, and Scopus., Results: Nursing researchers present a verified mean h-index of 7.82 in Academic Google. 74% of researchers belong to the academic field, compared to 26%, who are in health services. Most of them live in Spain (83%), followed by Colombia (12%), Mexico (4%), and Chile (1%). In Spain, the community with the largest number of researchers is Andalusia (41.5%), followed by Valencia (14.6%), and Madrid (7.3%)., Conclusion: The Google Scholar citation system requires adjustments in its algorithm for selecting works and citations, and it should also allow some system of confirmation by authors. Nursing can have relatively low h-index values compared to other courses due to short research development.

Background: Chronic pain has a disproportionate impact on members of vulnerable population groups, and women are at substantially greater risk than men of suffering multiple chronic pain disorders. Moreover, one of the aspects most affected by the presence of chronic pain is that of health-related quality of life (HRQoL), worsening over time, as the disease persists., Objectives: To describe the profile of patients who suffer non-malignant chronic pain, from a gender perspective, and to identify factors related to their HRQoL and mental health., Design: A cross-sectional study was carried out in patients with chronic non-cancer pain., Methods: Sociodemographic variables, pain intensity at rest and in motion, SF-36 health questionnaire, anxiety, and depression were evaluated., Results: The study population consisted of 531 subjects, of whom 64.2% were women. The mean age was 52.9 (SD: 10.4) years. The pain intensity recorded on the visual analogue scale was 6 (SD: 2.7) at rest and 8 (SD: 2) in motion. Physical component score and mental component score of quality of life were worse in women vs men: 33.73 (6.77) vs 32.33 (6.20), for the physical component; 36.89 (12.77) vs 32.91 (11.51), for mental component. Anxiety, depression and pain intensity, showed poorer results in women., Conclusion: Gender is a factor that should be considered in assessing and managing chronic pain, due to its influence on the perception of pain, and HRQoL., Impact Statement: Gender is an important modifier of the perception of pain, and HRQoL. To achieve a patient-centred approach, nurses should incorporate gender as a differential factor to adapt and individualize pain management and patient education.