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Games are increasingly being used as a means of alleviating pain and anxiety in paediatric patients, in the view that this form of distraction is effective, non-invasive and non-pharmacological. To determine whether a game-based intervention (via gamification or virtual reality) during the induction of anaesthesia reduces preoperative pain and anxiety in paediatric patients. A systematic review with meta-analysis of randomised controlled trials was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and using RevMan software. The review was based on a search of the EMBASE, CINAHL, Medline, SciELO and Scopus databases, conducted in July 2021. No restriction was placed on the year of publication. 26 studies were found, with a total study population of 2525 children. Regarding pain reduction, no significant differences were reported. For anxiety during anaesthesia induction, however, a mean difference of -10.62 (95% CI -13.85, -7.39) on the Modified Yale Preoperative Anxiety Scale, in favour of game-based intervention, was recorded. Game-based interventions alleviate preoperative anxiety during the induction of anaesthesia in children. This innovative and pleasurable approach can be helpful in the care of paediatric surgical patients. In children, preoperative management is a challenging task for healthcare professionals, and game-based strategies could enhance results, improving patients' emotional health and boosting post-surgery recovery. Distractive games-based procedures should be considered for incorporation in the pre-surgery clinical workflow in order to optimise healthcare.

Aim: To analyse the effects of active video games on physical function in independent community-dwelling older adults. Design: Systematic review and meta-analysis of randomized controlled trials. Data sources: The CINAHL, LILACS, Medline, Proquest and Scopus databases were consulted, with no restriction by year of publication. Review methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The meta-analysis was performed using RevMan software. Results: The analysis included 22 randomized controlled trials with a total of 1208 participants (all ≥55 years old). In our meta-analyses, the effects produced by playing the active video games (mean differences) were statistically significant for the variables Gait speed and Timed up-and- go. The differences between the control and experimental groups were not significant in the following tests: 6-minute walk, 30-second chair stand, balance (measured with the Berg Balance Scale), cadence, grip strength, knee extension strength, 8-Foot Up-and- Go or velocity. Conclusions: Physical exercise from participation in active video games has beneficial effects on two clinical parameters (Gait speed and Timed up-and- go) in independent community-dwelling older adults. However, the effects on other parameters do not differ from those obtained with conventional exercise training. Therefore, the clinical significance of these benefits is limited. Impact: Older adults usually perform little physical activity. In consequence, researchers have increasingly considered alternatives to traditional forms of exercise. One such is that provided by active video games, which can be a source of stimulation, encouraging adherence and motivation in exercise programmes. Our review shows that active video games can improve gait speed and mobility, but in other respects obtain no differences from conventional exercises. Further tailored randomized clinical trials should be undertaken with diverse populations of older adults to evaluate different physical function variables to determine the most appropriate training approach and its optimal design and duration.

Introduction Burnout refers to a constellation of feelings of exhaustion, depersonalization, and low sense of personal accomplishment that develops secondary to long-term occupational stress. Several studies have identified that health care professionals are a high-risk occupational group for burnout, but knowledge about this syndrome among midwives has not been fully explored. The purpose of this study was to perform a systematic review of the prevalence and levels of burnout among midwives and analyze the related factors. Methods The following databases were searched: CINAHL, LILACS, MEDLINE, ProQuest, PsycINFO, SciELO, and Scopus. Any date of publication was acceptable. Literature from different countries was included. Studies were appraised for quality following the recommendations of the Oxford Centre for Evidence-Based Medicine. Results The literature review identified 27 studies with a total of N = 5612 midwives. The main factors related to burnout were working conditions such as work overload, lack of autonomy, and professional recognition. Midwives who had less than 10 years of experience were more vulnerable to burnout than those who had more than 10 years' experience. With regard to the subcategories of burnout (emotional exhaustion, depersonalization and perceived personal achievement), midwives who did not live with a partner were more vulnerable low levels of personal accomplishment when compared with midwives who were living with a partner. The most significant protective factors against burnout were good leadership and the use of continuity models of care. Discussion Midwives had moderate levels of emotional exhaustion and low levels of personal accomplishment. Working conditions were identified as the main modifiable factors related to burnout syndrome. Intervention programs for midwives should be aimed at reducing emotional exhaustion and enhancing personal accomplishment.

To analyse the effect of mindfulness training on levels of burnout among nurses.Burnout syndrome is a common occupational hazard for nursing staff. Mindfulness training has been proposed as a valid intervention for burnout.Systematic review and meta-analysis.The CINAHL, LILACS, Medline, ProQuest, PsycINFO, Scielo and Scopus databases were consulted, using the search equation 'Nurs * AND burnout AND mindfulness'. There was no restriction on the year of publication.Papers were selected for analysis in accordance with the PRISMA guidelines. The meta-analysis was carried out using Review Manager 5.3 software.The sample was of 17 articles including 632 nurses. Mindfulness training reduces levels of burnout, producing lower scores for emotional exhaustion and depersonalization and higher for personal accomplishment. The differences in the means were 1.32 (95% CI: -9.41-6.78), 1.91 (95% CI: -4.50-0.68) and 2.12 (95% CI: -9.91-14.14), respectively, between the intervention and control groups.Mindfulness training reduces the emotional burden and hence levels of burnout, among nurses. However, further randomized clinical trials are required.目的: 分析正念训练对护士职业倦怠程度的影响。 背景: 倦怠综合征对护理人员来说是一种常见的职业危害。而正念训练被认为是一种有效的职业倦怠干预措施。 设计: 系统评估与荟萃分析。 数据来源: 通过使用搜索方程‘Nurs*和倦怠与正念’在CINAHL、LILACS、Medline、ProQuest、Psychinfo、Scielo和Scopus数据库中进行检索(不限制文献出版年份)。 评估方法: 根据PRISMA指南选择论文进行分析。使用Review Manager 5.3软件进行荟萃分析。 结果: 共选取17篇文献,包括632名护士。结果显示,正念训练可降低职业倦怠程度,而情绪衰竭和人格解体得分较低,个人成就感得分较高。干预组和对照组之间的平均值差异分别为1.32(95%CI:-9.41-6.78)、1.91(95%CI:-4.50-0.68)和2.12(95%CI:-9.91-14.14)。 结论: 正念训练可减轻护士的情绪负担,从而降低其职业倦怠程度。然而,还需开展进一步的随机临床试验进行验证。.

Coronary artery disease is the leading cause of death worldwide and patient continuity of care is essential. Health professionals can help in the transition stage by providing resources to achieve pharmacological treatment adherence, as well as social and emotional support. The objective was to analyse the effects of nursing interventions based on continuity of care in patients with coronary artery disease after hospital discharge. A systematic review of randomised controlled trials and quasi-experimental studies was carried out. Cochrane, CINAHL, Health & medical collection, Medline, and Scopus databases were consulted in January 2022. PRISMA guidelines were followed with no time limits. In total, 16 articles were included with a total of 2950 patients. Nurse-led continuity of care programs improved the monitoring and control of the disease. Positive effects were found in the quality of life of patients, and in mental health, self-efficacy, and self-care capacity dimensions. Clinical parameters such as blood pressure and lipid levels decreased. The continuity of care provided by nurses had a positive influence on the quality of life of patients with coronary artery disease. Nurse-led care focused on the needs and resources, including continuity of care, plays a key role.

Burnout in the primary care service takes place when there is a high level of interaction between nurses and patients. Explanatory models based on psychological and personality related variables provide an approximation to level changes in the three dimensions of the burnout syndrome. A categorical-response ordinal logistic regression model, based on a quantitative, crosscutting, multicentre, descriptive study with 242 primary care nurses in the Andalusian Health Service in Granada (Spain) is performed for each dimension. The three models included all the variables related to personality. The risk factor friendliness was significant at population level for the three dimensions, whilst openness was never significant. Neuroticism was significant in the models related to emotional exhaustion and depersonalization, whilst responsibility was significant for the models referred to depersonalization and personal accomplishment dimensions. Finally, extraversion was also significant in the emotional exhaustion and personal accomplishment dimensions. The analysis performed provides useful information, making more readily the diagnosis and evolution of the burnout syndrome in this collective., Junta de Andalucia P20_00627

Coronary heart disease is the leading cause of death and disability worldwide. Traditionally, cardiac rehabilitation programmes are offered after cardiac events to aid recovery, improve quality of life, and reduce adverse events. The objective of this review was to assess the health-related quality of life, after a supervised cardiac rehabilitation programme, of patients who suffered a myocardial infarction. A systematic review was carried out in the CINAHL, Cochrane, LILACS, Medline, Scopus, and SciELO databases, according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Randomised controlled trials were selected. Meta-analyses were performed for the Short Form Health Survey SF-36, Myocardial Infarction Dimensional Assessment Scale (MIDAS), MacNew Heart Disease-Health-Related Quality of Life (HRQL) questionnaire, and European Quality of Life-Visual Analogue Scale (EuroQol-VAS) with the software Cochrane RevMan Web. Ten articles were found covering a total of 3577 patients. In the meta-analysis, the effect size of the cardiac rehabilitation programme was statistically significant in the intervention group for physical activity, emotional reaction, and dependency dimensions of the MIDAS questionnaire. For the control group, the score improved for SF-36 physical functioning, and body pain dimensions. The mean difference between the control and intervention group was not significant for the remaining dimensions, and neither for the MacNew Heart Disease-HRQL and EuroQol-VAS questionnaires. Supervised cardiac rehabilitation programmes were effective in improving health-related quality of life, however, there was a potential variability in the interventions; therefore, the results should be interpreted with caution. This study supports the importance of providing care and evaluating interventions via the supervision of trained health professionals, and further randomised clinical trials are needed to analyse the positive changes in mental and physical health outcomes.

Type 2 diabetes mellitus (DM2) is a highly prevalent disease, the progression of which depends on high blood glucose levels, which are reflected in the level of glycosylated haemoglobin (HbA1c). Appropriate health education equips patients with the knowledge and skills to control their glucose and HbA1c levels to avoid long-term complications. This study was set up to compare the results of an intensive (360 min) educational intervention to improve HbA1c parameters in patients with DM2 with those of a usual 90 min intervention. For this purpose, healthcare personnel led a quasi-experimental study of 249 diabetics: 171 in the control group, and 78 in the intervention group. In the control group, the mean HbA1c value decreased from 6.97 to 6.75, while in intervention group it fell from 8.97 to 8.06. The before and after mean difference between both groups was compared with a Wilcoxon test, and the results statistically significant (W = 4530, p &lt, 0.001), indicating a higher reduction of HbA1c in the intervention group. We concluded that the intensive health education provided by nurses during the consultation helped improve HBA1c levels in persons with DM2.

A respiratory syncytial virus (RSV) is the major cause of respiratory tract infection in children under 5 years. However, RSV infection in the European Region of the World Health Organization has not been systematically reviewed. The aim was to determine the prevalence and factors associated with RSV in children under 5 years of age in European regions. A systematic review and meta-analysis was performed. CINAHL, Medline, LILACS, ProQuest, SciELO, and Scopus databases were consulted for studies published in the last 5 years, following Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The search equation was “respiratory syncytial virus AND (newborn OR infant OR child) AND (prevalence OR risk factors)”. Studies reporting the prevalence of RSV were eligible for inclusion in the meta-analysis. A total of 20 articles were included. The meta-analytic prevalence estimation of RSV, with a sample of n = 16,115 children, was 46% (95% CI 34–59%). The main risk factors were age, male gender, winter season, and environmental factors such as cold temperatures, higher relative humidity, high concentrations of benzene, exposure to tobacco, and living in urban areas. Robust age-specific estimates of RSV infection in healthy children should be promoted in order to determine the optimal age for immunization. In addition, it is necessary to analyse in greater depth the potentially predictive factors of RSV infection, to be included in prevention strategies.

Game-based learning is increasing in nursing education. Also, the assessment of the utility of the escape room game is growing. To explore nursing students' opinion about the escape room as an evaluation game, a qualitative observational study with nursing students was carried out. An ad hoc questionnaire with open questions was sent after the game learning experience. The escape room included knowledge and techniques from different specialties. The escape room learning game was a positive experience for the students. The main highlighted characteristics were fun, dynamic, and motivating way to study and learn. Other interesting variables were: "Working as a team and under pressure" (It's a group activity in which everyone must work together. It is a good challenge to learn how to work in urgent situations) and "Different way to assess students´ learning" (In this type of game, I can show more things and not only theoretical knowledge). Game-based learning is increasing in nursing education, as well as the assessment of the utility of the escape room game. Using an escape room for assessing nursing students' knowledge is a positive experience. This learning experience can be also used with nurses in different specialties to promote teamwork and working under pressure.

In emergency services is important to accurately assess and classify symptoms, which may be improved with the help of technology. One mechanism that could help and improve predictions from health records or patient flow is machine learning (ML).To analyse the effectiveness of ML systems in triage for making predictions at the emergency department in comparison with other triage scales/scores.Following the PRISMA recommendations, a systematic review was conducted using CINAHL, Cochrane, Cuiden, Medline and Scopus databases with the search equation "Machine learning AND triage AND emergency".Eleven studies were identified. The studies show that the use of ML methods consistently predict important outcomes like mortality, critical care outcomes and admission, and the need for hospitalization in comparison with scales like Emergency Severity Index or others. Among the ML models considered, XGBoost and Deep Neural Networks obtained the highest levels of prediction accuracy, while Logistic Regression performed obtained the worst values.Machine learning methods can be a good instrument for helping triage process with the prediction of important emergency variables like mortality or the need for critical care or hospitalization.

Institutional Review Board Statement: The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Ethics Committee of the Andalusian Health Service (LUNG CA SURV 2180-N-20)., Data Availability Statement: The data presented in this study are available on request from the corresponding author. The data are not publicly available due to ethical., Background: Lung cancer is typically diagnosed in an advanced phase of its natural history. Explanatory models based on epidemiological and clinical variables provide an approximation of patient survival less than one year using information extracted from the case history only, whereas models involving therapeutic variables must confirm that any treatment applied is worse than surgery in survival terms. Models for classifying less than one year survival for patients diagnosed with lung cancer which are able to identify risk factors and quantify their effect for prognosis are analyzed. Method: Two stepwise binary logistic regression models, based on a retrospective study of 521 cases of patients diagnosed with lung cancer in the Interventional Pneumology Unit at the Hospital “Virgen de las Nieves”, Granada, Spain. Results: The first model included variables age, history of pulmonary neoplasm, tumor location, dyspnea, dysphonia, and chest pain. The independent risk factors age greater than 70 years, a peripheral location, dyspnea and dysphonia were significant. For the second model, treatments were also significant. Conclusions: Age, history of pulmonary neoplasm, tumor location, dyspnea, dysphonia, and chest pain are predictors for survival in patients diagnosed with lung cancer at the time of diagnosis. The treatment applied is significant for classifying less than one year survival time which confirms that any treatment is markedly inferior to surgery in terms of survival. This allows to consider applications of more or less aggressive treatments, anticipation of palliative cares or comfort measures, inclusion in clinical trials, etc.

Aims The aim of this review and meta-analysis is to analyse the effectiveness of nursing interventions for the management of preoperative anxiety in adults. Background The perioperative process is a stressful situation for many people who are going to be operated and it can generate feelings of anxiety. Also, preoperative anxiety can appear in the perioperative period. Nursing management of preoperative anxiety through individualized interventions can be effective for reducing anxiety. Design A systematic review with meta-analysis was performed. Data sources CINAHL, CUIDEN, Pubmed, ProQuest and Scopus databases were consulted without restriction per year of publication. The search was conducted in February 2020. Review methods Experimental studies on nursing management in preoperative anxiety with adults sample (>18 years) published in English and/or Spanish were included. All types of surgery were included in the review. A random effects meta-analysis was performed to estimate the effect size for preoperative anxiety measured with STAI. Results After the selection process n = 9 quantitative studies with nursing interventions for preoperative anxiety were included. A preoperative educational and informative interview was used in six studies, one study used empathic interview, one used motivational interview and one used hand massage. The meta-analysis, including four studies using nursing interviews, had a sample of n = 419 in the intervention group and n = 445 in the control group. The mean difference in preoperative state anxiety measured with the STAI was in favour of the nursing intervention. Conclusion Nursing interventions for patients who are going to be operated seems to have a positive impact in their preoperative anxiety. However, due to the low number of studies and the heterogeneity of the sample, more research is needed about the topic.

Attention deficit/hyperactivity disorder (ADHD) is one of the most frequent neurodevelopmental disorders in childhood and adolescence. Choosing the right treatment is critical to controlling and improving symptoms. An innovative ADHD treatment is neurofeedback (NF) that trains participants to self-regulate brain activity. The aim of the study was to analyze the effects of NF interventions in children with ADHD. A systematic review was carried out in the CINAHL, Medline (PubMed), Proquest, and Scopus databases, following the PRISMA recommendations. Nine articles were found. The NF improved behavior, allowed greater control of impulsivity, and increased sustained attention. In addition, it improved motor control, bimanual coordination and was associated with a reduction in theta waves. NF combined with other interventions such as medication, physical activity, behavioral therapy training, or attention training with brain–computer interaction, reduced primary ADHD symptoms. Furthermore, more randomized controlled trials would be necessary to determine the significant effects.

Background: Respiratory syncytial virus (RSV) is the major cause of respiratory tract infection in children under 5 years. However, RSV infection in the European region of the World Health Organization has not been systematically reviewed. Aim: To determine the prevalence and factors associated with RSV in children under 5 years of age in European regions. Methods: A systematic review and meta-analysis was performed. CINAHL, Medline, LILACS, ProQuest, SciELO and Scopus databases were consulted for studies publisehd in the last 5 years, following Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The search equation was “respiratory syncytial virus AND (newborn OR infant OR child) AND (prevalence OR risk factors). Studies reporting the prevalence of RSV were eligible for inclusion in the meta-analysis. Findings: A total of 21 articles were included with a total sample of n = 24,465 children. The meta-analytic prevalence estimation of RSV, with a sample of n = 16,115 children, was 46% (95% CI 34–59%). The main risk factors were age, male gender, winter season and environmental factors such as cold temperatures, higher relative humidity, high concentrations of benzene and ozone, exposure to tobacco and living in urban areas. Interpretation: Robust age-specific estimates of RSV infection in healthy children should be promoted in order to determine the optimal age for immunization. In addition, it is necessary to analyze in greater depth the potentially predictive factors of RSV infection, to be included in prevention strategies. Funding Statement: None. Declaration of Interests: We declare no competing interests.

Currently, one of the main public health problems among children and adolescents is poor adherence to healthy habits, leading to increasingly high rates of obesity and the comorbidities that accompany obesity. Early interventions are necessary, and among them, the use of gamification can be an effective method. The objective was to analyse the effect of game-based interventions (gamification) for improving nutritional habits, knowledge, and changes in body composition. A systematic review and meta-analysis were performed in CINAHL, EMBASE, LILACS, MEDLINE, SciELO, and Scopus databases, following the PRISMA recommendations. There was no restriction by year of publication or language. Only randomized controlled trials were included. Twenty-three articles were found. After the intervention, the consumption of fruit and vegetables increased, as well as the knowledge on healthy food groups. The means difference showed a higher nutritional knowledge score in the intervention group 95% CI 0.88 (0.05–1.75). No significant effect of gamification was found for body mass index z-score. Gamification could be an effective method to improve nutritional knowledge about healthier nutritional habits. Promoting the development of effective educational tools to support learning related to nutrition is necessary in order to avoid and prevent chronic diseases.

Coronary heart disease is a public health problem and is one of the leading causes of loss of quality of life, disability, and death worldwide. The main procedure these patients undergo is cardiac catheterisation, which helps improve their quality of life, symptoms of myocardial ischemia, and ventricular function, thus helping increase the survival rate of su erers. It can also, however, lead to physical consequences, including kidney failure, acute myocardial infarction, and stroke. The objective of this study was to analyse how coronary artery bypass grafting (CABG) influences quality of life. A systematic review and meta-analysis were conducted using the CINAHL, PubMed, Scopus, and Cuiden databases in June 2020. A total of 7537 subjects were included, 16 in the systematic review and 3 in the meta-analysis. The studies analysing quality of life using the SF questionnaire showed improvements in the quality of physical and mental appearance, and those using the NHP questionnaire showed score improvements and, in some cases, di erences in quality of life between women and men. This operation seems to be a good choice for improving the quality of life of people with coronary pathologies, once the possible existing risks have been assessed., Clinical Medicine and Health Public Programme of University of Granada, Spain B 12.56.1

Finding methods to improve people’s diabetes control and management is important to prevent its complications and maintain the quality of life. The aim of this review was to assess the effect of games on the blood glucose level (glycated hemoglobin (HbA1c)). A systematic review and meta-analysis were made. Pubmed, Scopus, and CINAHL databases were consulted in July of 2020. Ten studies were selected as a final sample, most of them being clinical trials using games to improve diabetes control. Half of the studies had samples between 8 and 14.9 years old and the other half between 57 and 65 years old. The studies informed about using applications/games for mobile phones, game consoles, and board games for diabetes education and management. The meta-analysis was performed with 4 studies showing a mean difference of 0.12 (CI 95% 0.57, 0.33) of HbA1c in favor of the intervention group with p > 0.05. Games are positive for diabetes health education and promoting healthier lifestyle, but their impact on HbA1c is low.

Background: Retirement is a final life stage characterized by the ceasing of work and the loss of a routine, social relations, role, status, accomplishments, and aspirations, etc. Many times it is accompanied by negative feelings and can provoke di erent psychoemotional reactions such as depression, among others. The aim of this study is to analyze the prevalence of depression, as well as its psychoeducational approach in retirees. Methods: A paired systematic review with meta-analysis was conducted in di erent databases—Medline, Scopus, CUIDEN, CINAHL, LILACS and PsycINFO. Original studies were included in English, Spanish and French that were published in the last 10 years, and which approached depression in retirees. Results: A total of 11 articles were selected after applying inclusion and exclusion criteria. The mean value of the prevalence levels of depression in retirees obtained in the meta-analysis was 28%. Depression is more frequent in retirees, with mandatory retirement, retirement due to illness, and anticipated retirement presenting higher levels of this disease. The health role in the psychoeducational approach is highlighted in 41.6% (n = 5). Conclusions: With almost one-third of retirees su ering from depression, it is necessary to implement prevention and early detection measures to approach a public health problem.

Background Smartphones are technological devices that have a great impact on people's daily lives changing their habits and behaviors. The utilities and capabilities of these devices are increasing and the foresight is that this tendency will grow in the next years. However, the problematic use of the smartphone has increased dangerously, interfering with the clinical practice of healthcare professionals. Objective To conduct a systematic review and a meta-analysis to estimate the prevalence of smartphone addiction, also known as nomophobia, in nursing students and to identify its related factors and its negative effects. Design Systematic Review and Meta-analysis. Data sources The literature search was done in CINAHL, Proquest, Pubmed, Scopus and Web of Science databases. Review methods The search equation was “(nomophobia OR smartphone) AND nurs* student*”. n = 16 articles were identified. Results The meta-analytic estimation of nomophobia or smartphone addiction was 22% (CI95% 18%–26%] in a sample of n = 2780 nursing students. Smartphone usability is very extended during the clinical practice by nursing students. They indicated using the device or watching other students distracted with their smartphone. Some variables related to excessive use in nursing students are lower sleep quality, lower self-esteem, higher social distress, lower perceived social support or lower communication skills between others. Conclusions The main use of the smartphone by nursing students is for communication with other people and some of them indicate that it can be a distraction.

Aims and objectives To analyse the prevalence, levels, and phases of burnout syndrome in midwives and obstetrics and gynaecology nurses, and to evaluate the relationship between burnout and sociodemographic, occupational, and psychological factors. Background Burnout syndrome is a major problem in occupational health, characterized by feelings of exhaustion, depersonalisation, and a low sense of personal achievement that appears after long-term occupational stress. Recent research has found that burnout harms the physical and mental well-being of workers, and jeopardises the quality of care provided. The association between burnout and a risk profile in maternity wards has not previously been investigated but it deserves special attention since it is a highly stressful area to work in. Design A cross-sectional survey design was selected. Methods A total of 150 nurses and midwives at 18 hospitals participated in this study. The data were collected using the Maslach Burnout Inventory, NEO Personality Inventory, and the Educational-Clinical Questionnaire: Anxiety and Depression. This study adhered to the STROBE guideline. Results 17% of participants presented high levels of emotional exhaustion, 16.6% high depersonalisation, and 55.1% a sense of low personal accomplishment. The sociodemographic and occupational variables related to burnout were gender, marital status, and work shift. The three dimensions of the syndrome, emotional exhaustion, depersonalisation, and personal accomplishment were predicted by depression, neuroticism, agreeableness, and openness. Conclusions One third of the sample presented high levels of burnout, which was most strongly experienced as feelings of low personal accomplishment. Furthermore, personality factors play an important role in the development of burnout syndrome. Relevance to clinical practice Managers and policy makers should promote strategies to reduce burnout. To prevent the syndrome, personality factors should be taken into account, for the early identification of a profile of professionals most at risk of developing burnout.

The prevalence of burnout in midwives has been briefly studied. Given the negative effects of burnout syndrome in the physical and mental health, and also related to the quality of care provided, rates of absenteeism and sick leave; identifying related factors for the syndrome are needed. The aim was to determine the prevalence, levels, and factors related to the burnout syndrome, measured with the Copenhagen Burnout Inventory in midwives. A systematic review and meta-analysis were selected from CINAHL, LILACS, ProQuest, PsycINFO, PubMed, SciELO, and Scopus databases, with the search equation “burnout AND (midwife OR midwives OR nurses midwives)”. Fourteen articles were found with a total of 8959 midwives. Most of the studies showed moderate levels of personal burnout. The prevalence obtained was 50% (95% CI = 38–63) for personal burnout; 40% (95% CI = 32–49) for work-related burnout; and 10% (95% CI = 7–13) for client-related burnout. Midwives’ age, less experience, and living alone constitute the main related factors, as well as, the scarcity of resources, work environment, and the care model used. Most midwives present personal and work-related burnout, which indicates a high risk of developing burnout. Personal factors and working conditions should be taken into account when assessing burnout risk profiles of midwives.

Introduction: Diabetes mellitus is a chronic endocrine-metabolic disease, the evolution of which is closely related to people’s self-control of glycemic levels through nutrition, exercise, and medicines. Aim: To determine whether smartphone apps can help persons with diabetes to improve their % levels of glycosylated hemoglobin. Method: A systematic review and meta-analysis were done. ProQuest, Pubmed/Medline, and Scopus databases were used. The search equation used was “(Prevention and Control) AND Diabetes Mellitus AND Smartphones”. The inclusion criteria applied were clinical trials, conducted in 2014−2019. Results: n = 18 studies were included in the review. The studies tried different applications to monitor glycemia and support patients to improve glycosylated hemoglobin (HbA1c) levels. More than half of the studies found statistically significant differences in HbA1c in the intervention group compared with the control group. Eleven studies were included in the meta-analysis and the study sample was n = 545 for the experimental group and n = 454 for the control group. The meta-analytic estimation of the HbA1c % level means differences between intervention and control group was statistically significant in favour of the intervention group with a mean difference of −0.37 (−0.58, −0.15. 95% confidence interval). Conclusion: Smartphone apps can help people with diabetes to improve their level of HbA1c, but the clinical impact is low.

Background: Hospitalization disrupts children’s lives and can produce feelings such as anxiety, fear, or pain. Playing is an important part of children’s lives. Thus, it is necessary to ensure holistic care during the process, including play therapy. The aim of this study was to analyze the e ect of therapeutic play in hospitalized children. Methods: Asystematic review was performed. The search was conducted in CINAHL (Cumulative Index of Nursing and Allied Health Literature), CUIDEN, and PubMed (Medline). The search equation was “pediatric nurs* AND play therapy”. The search was performed in March 2020. Results: n = 14 studies were included in the review. The studies reveal that the application of therapeutic play in hospitalized children decreases postoperative pain, improves behavior and attitude, and reduces anxiety during the hospital stay. Conclusions: play therapy has a beneficial impact on the care of hospitalized children and should be implemented in pediatric units after assessing the resources and training needed for pediatric nurses

Palliative care nurses are exposed to hard situations, death, and duel feelings in their daily practice. These, and other work stressors, can favor burnout development. Thus, it is important to analyze the prevalence and risk factors of burnout in palliative care nurses and estimate its prevalence. A systematic review and meta-analysis was done with quantitative primary studies. n = 15 studies were included with n = 6 studies including information for the meta-analysis. The meta-analytic prevalence estimation of emotional exhaustion was 24% (95% CI 16–34%), for depersonalization was 30% (95% CI 18–44%) and for low personal accomplishment was 28% with a sample of n = 693 palliative care nurses. The main variables related with burnout are occupational variables followed by psychological variables. Some interventions to improve working conditions of palliative care nurses should be implemented to reduce burnout.