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Background: Individualizing care is the essence of nursing, and its benefits have been extensively proven in older people. The changes arisen during the COVID-19 pandemic may have affected it. The aim of this study is to analyze the changes produced in the perceptions about the individualization of care, quality of life, and care environment of elderly people living in long-term care centers before and after the pandemic. Methods: A prospective cross-sectional observational study was carried out. For data collection, the Individualized Care Scale-patient, the EuroQol-5D scale, and a reduced version of the Sheffield Care Environment Assessment Matrix test were used, and a statistical analysis was performed. Results: A total of 177 people participated in the study, with 87 pre-COVID-19 and 90 post-COVID-19, 62.7% of whom were women. The average age was 83.3 years. General activities of the individualized care obtained medians of 4, 2.5, and 3 (out of 5) in clinical situation, personal life situation, and decisional control dimensions, respectively, and no substantial change was observed pre- and post-pandemic. Nevertheless, 10 out of 17 items related with the maintenance of individuality in the last shift were higher rated after COVID-19. They are mainly related to the feelings and needs of care, daily life activities, and the expression of opinions. The median of all items was 3 despite the improvement observed after the pandemic. Residents scored an average of 6.47 points (out of 10) in the life quality self-evaluation and were satisfied with the care environment (94%). Patients with higher life quality and adherence to their environment perceived better care. Conclusions: Although slight improvements were observed in the individualized care after the pandemic, the obtained results revealed that there is still room for improvement. Particularly, it is necessary to develop strategies aimed at motivating the family participation or providing individual spaces in the residences.

Abstract Background The first waves of the COVID-19 pandemic had a negative impact on health systems and health professionals, due to the high number of cases and a lack of preparation. The aim of this study was to understand how nurses working in hospital units and in intensive care perceived the performance of nurse managers and senior hospital management during the first two waves of the pandemic. Methods The phenomenological approach proposed by Giorgi was used to investigate perceptions of the performance of nurse managers and senior hospital management during the first two waves of the COVID-19 pandemic in Spain. Fourteen clinical nurses who worked on the front line in inpatient units or intensive care units of the Health Services of Extremadura and Madrid in the first (March–April 2020) and second (October–November 2020) waves of the COVID-19 pandemic participated in this study. The data was collected through semi-structured interviews, following a script of themes, in a theoretical sample of nurses who were worked during the pandemic. Results Two main themes emerged from the analysis of the data: (1) perceptions about the performance of nurse managers and senior hospital managers during the first and second waves of the pandemic (health system failure; belief that senior hospital management professionals could have managed the pandemic better; recognizing the efforts of middle management (nursing supervisors); insufficient institutional support) and (2) strategies employed by nurses to compensate for the weaknesses in pandemic management. Conclusions The clinical nurses perceived that the nurse managers demonstrated better management of the pandemic than the hospital’s senior management, which they attribute to their proximity, empathy, accessibility, and ability to mediate between them and the senior management. The nurses also believe that the senior management of the hospitals was to blame for organisational failures and the poor management of the pandemic.

Objective: To determine the effects of multidisciplinary home-based interventions delivered by multidisciplinary teams to prevent adverse events (mortality, emergency visits, and hospital readmissions) and improve quality of life (QoL) among frail older adults. Methods: A systematic search of PubMed/MEDLINE, Scopus, the Cochrane Central Register of Controlled Trials, Web of Science, and the Cumulative Index to Nursing and Allied Health Literature was conducted until November 2023. The Risk of bias of the randomized controlled trials was assessed via the Cochrane risk of bias tool (RoB 2.0), and the synthesis and quality of evidence for each outcome were assessed via the Grading of Recommendation, Assessment, Development and Evaluation (GRADE). The effect size (ES), pooled OR (p-OR), and 95 % confidence intervals (95 % CIs) were calculated for QoL and adverse events. Subgroup analyses and meta-regressions were conducted. Results: Twenty-seven studies were included in the systematic review. The p-OR for the effect of home-based interventions on mortality was 0.88 (95 % CI: 0.75 to 1.02; I2 = 27.6 %), that for visits to the emergency department was 0.88 (95 % CI: 0.78 to 1.00; I2 = 56.4 %), that for hospital admissions in days was 0.85 (95 % CI: 0.52 to 1.37; I2 = 85.2 %), and that for hospital admissions was 0.90 (95 % CI: 0.79 to 1.01; I2 = 52.0 %). In addition, the pooled ES for the effect of home-based interventions on QoL was 0.08 (95 % CI: 0.02 to 0.17; I2 = 60.7 %). The type of intervention, type of control, evaluation of the risk of bias, duration of the intervention, mean age of the intervention group, and percentage of women in the intervention group did not modify the effect of MHBIs to prevent adverse events or to improve quality of life (QoL) among frail older adults. Conclusions: Multidisciplinary home-based interventions do not appear to reduce adverse events (mortality, visits to the emergency department, or hospital admissions/readmissions) in older people defined and/or considered frail. In addition, these interventions do not improve QoL in older people, or the evidence is unclear.

Resumen Esta revisión sistemática, tipo síntesis narrativa, analiza la eficacia del ejercicio acuático en personas mayores de 50 años prefrágiles que viven en la comunidad. Siguiendo la declaración PRISMA se realizó una búsqueda sistemática de ensayos clínicos aleatorizados, estudios cuasiexperimentales y revisiones sistemáticas publicados en inglés o castellano en Scopus, Medline (PubMed), Cochrane Library, Web of Science, ÍnDICEs CSIC, CUIDEN, PsycINFO, Cinahl y ProQuest. Siete estudios cumplieron los criterios de inclusión. El ejercicio acuático reportó incrementos significativos (p < 0,05) en la fuerza, funcionamiento ejecutivo, eficiencia del sueño, calidad de vida, estabilidad postural, índice de masa corporal, glucemia en ayunas, colesterol, rigidez y presión arterial. En un estudio, la fuerza y el equilibrio volvieron a niveles basales tras 6 semanas de desentrenamiento. Aunque el ejercicio acuático puede mejorar la calidad de vida de personas mayores prefrágiles, futuros estudios deben indagar en sus beneficios cardiovasculares y en las consecuencias del desentrenamiento.

Abstract Introduction Pregnant women with type 1 diabetes may have an increased risk of complications for both the baby and themselves. Educational programmes, preconception planning, strict glycemic control and comprehensive medical care are some of the antenatal interventions that have been proposed to improve the outcomes of pregnant women with type 1 diabetes. While some evidence‐based recommendations about antenatal care are included in clinical practice guidelines (CPGs), the views, and experiences of women with type 1 diabetes about these interventions are not well known. Aim To understand and synthesize the perceptions of women with type 1 diabetes about the interventions before pregnancy. Method A qualitative evidence synthesis (QES) was carried out with a framework analysis guided by the Cochrane Qualitative and Implementation Methods Group approach. Three online databases (Medline, Embase and Web of Science) were searched. We included qualitative articles that were published from 2011 to 2021 and which were available in English or Spanish. Findings Ten references met the inclusion criteria of the study and were included. Three main themes were identified: (a) acceptability of antenatal care, (b) feasibility and implementation consideration and (c) equity and accessibility difficulties. Conclusion Continuity of care, coordination between health professionals and services, and a more holistic approach are the key aspects women say need to be considered for more acceptable, feasible and equitable preconception and antenatal care. Patient or Public Contribution This QES was carried out as part of the CPGs on diabetes mellitus type 1, carried out as part of the Spanish Network of Health Technology Assessment Agencies. In this CPG, the representatives of the patient associations are Francisco Javier Darias Yanes, from the Association for Diabetes of Tenerife, who has participated in all the phases of the CPG; Aureliano Ruiz Salmón and Julián Antonio González Hernández (representatives of the Spanish Diabetes Federation (FEDE) who have participated as collaborator and external reviewer, respectively.

BackgroundThe use of physical activity (PA) electronic devices offers a unique opportunity to engage children and adolescents in PA. For this age group (2-17 years), parents play a key role in promoting healthy lifestyles and regulating the use of electronic devices. Therefore, parents’ perceptions of the use of electronic devices for PA in children and adolescents are critical for efficient intervention. ObjectiveThe aim of this qualitative systematic review was to improve the understanding of parents’ perceptions of the use of electronic devices for PA in children and adolescents. MethodsA systematic search of electronic databases (Medline/PubMed, SPORTDiscus, Web of Science, Scopus, OpenGrey, and Deep Blue) was conducted. Studies from inception (2010) to May 2022 were identified. Qualitative studies on the perceptions of healthy children’s and adolescents’ (aged 2-17 years) parents regarding PA interventions performed on electronic devices were included according to the Cochrane Qualitative and Implementation Methods Group Guidance Series and the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) statement. The Joanna Briggs Institute Qualitative Assessment and Review Instrument was used for methodological validity. ResultsIn total, 18 studies with 410 parents, mostly mothers, were included. Parents’ perceptions were grouped into 4 categories: usefulness, advantages, general perceptions (electronic devices for health promotion, preferences for real-life PA, and concerns), and acceptability (barriers and facilitators) of electronic devices for PA. Parents perceived electronic devices as useful for increasing PA, learning new skills, and increasing motivation for PA and valued those devices that promoted socialization and family and peer bonding. In terms of general perceptions, parents had positive attitudes toward PA electronic devices; however, they preferred outdoor and real-life PA, especially for preschoolers and children. Concerns, such as physical and psychological harm, addiction, conflicts, and compliance difficulties, were found. Facilitators were identified as ease of use, appropriate feedback, promotion of socialization, and motivational strategies, such as rewards, challenges, and attractiveness. Barriers, such as discomfort, price, and difficulties in using or understanding electronic devices, were also identified. For older children and adolescents, parents were more concerned about high levels of screen time and setting limits on electronic devices and therefore preferred PA electronic devices rather than traditional ones. ConclusionsOverall, the participants had positive attitudes toward electronic devices for PA and perceived them as an effective way to promote PA in children and adolescents. They also perceived several benefits of using electronic devices, such as health promotion, increased awareness and motivation, and socialization, as well as barriers, facilitators, and age differences. The results of this study could provide researchers with insights into designing more effective, age-appropriate PA electronic devices for children and adolescents and improving adherence to their use. Trial RegistrationPROSPERO CRD42021292340; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=292340

RESUMEN Objetivos: Sintetizar y analizar la evidencia disponible sobre la eficacia de las intervenciones multicomponente encaminadas a la promoción de la actividad física en personas mayores de 65 años residentes en la comunidad. Metodología: Revisión sistemática de ensayos clínicos aleatorizados. Se realizó una búsqueda sistemática de artículos publicados en inglés y castellano en Medline (PubMed), Scopus, Web of Science, Consejo Superior de Investigaciones Científicas, CUIDEN y CINAHL, desde 2007 a 2017, que indagaran sobre la eficacia de las intervenciones multicomponente para promover la actividad física. La selección de estudios elegibles se realizó por duplicado y de forma independiente según los criterios establecidos, consensuando posteriormente los resultados. Se encontraron 1320 estudios, de los cuales 6 cumplían los criterios de inclusión. Se siguió la declaración PRISMA. La calidad de los artículos fue evaluada con la escala de JADAD y el riesgo de sesgo con el instrumento de la Colaboración Cochrane. Resultados: Aunque la mayoría de las intervenciones que utilizaron tecnologías o su combinación con sesiones educativas mejoraron la actividad física, el funcionamiento físico y las conductas de salud, ciertos estudios no confirman que las intervenciones promovieran la actividad física. Conclusiones: Existe cierta controversia sobre la eficacia de las intervenciones multicomponente. A pesar de lo anterior, incorporar tecnologías de la información y la comunicación y su combinación con las sesiones educativas mejora la actividad física en personas mayores y las tasas de adherencia a las intervenciones. Futuros estudios deben indagar en los factores asociados al éxito de las intervenciones.

Esta investigación valoró los efectos de un programa didáctico gamificado sobre la ansiedad ante el fracaso en Educación Física. Además, pudimos reconocer las posibles causas al analizar las impresiones del alumnado sobre la experiencia. Participaron 143 estudiantes de 5º y 6º de primaria. Se siguió un diseño pre-experimental, pre-test, post-test de un solo grupo, cuantitativo-cualitativo. Se administró la subescala Ansiedad y Agobio ante el Fracaso del Test de Motivación del Logro para el Aprendizaje en Educación Física (versión validada por Ruiz-Pérez et al. (2015) del Achievement Motivation in Physical Education Test, AMPET, de Nishida (1988)) y un cuestionario ad hoc con cuatro preguntas abiertas. Los datos cuantitativos mostraron que, tras la intervención didáctica, la ansiedad disminuyó de manera significativa. Los resultados cualitativos desvelaron aspectos positivos que pudieron promover dicha disminución, como: la superación de pruebas, el trabajo cooperativo, el disfrute de los elementos de la gamificación, la superación personal, el aprendizaje y la mejora de aspectos curriculares. Sin embargo, también se reconocieron otros aspectos negativos, como el trabajo de la resistencia y los grupos estables, lo cual deja entrever algunos aspectos de mejora en este planteamiento gamificado. Abstract: This research assessed the effects of a gamified project on anxiety about failure in Physical Education, perceiving the possible causes through the impressions of the students. 143 students from 5th and 6th grade participated. A pre-experimental, pre-test, post-test single-group, quantitative-qualitative design was followed. The Anxiety and Stress subscale was administered before the Failure of the Motivation Test of Achievement for Learning in Physical Education and open questions were used after the experience (version validated by Ruiz-Pérez et al. (2015) of the Achievement Motivation in Physical Education Test, AMPET, by Nishida (1988)) and an ad hoc questionnaire with four open questions. The quantitative data showed that anxiety decreased significantly after the intervention. The qualitative results revealed positive aspects that could promote said decrease: passing tests, cooperative work, enjoyment of the elements of gamification, personal improvement, learning and improvement of curricular aspects. However, other negative aspects were also recognized, such as resistance work and stable groups, which suggests some aspects of improvement in this gamified approach.

Breastfeeding is a complex process influenced by different personal and social factors which will determine both the initiation and the resilience for its maintenance. The aim is to identify the beliefs and expectations of mothers concerning breastfeeding to determine the perception of their self-efficacy and the influence on the management of their babies’ feeding. A qualitative study through semi-structured interviews was carried out. The sample size was defined by the saturation criteria. Twenty-two women participated, eleven were from an urban environment and eleven were from a rural environment. Mothers’ knowledge of breastfeeding, their expectations of that process, their experience, and their strategies for overcoming problems associated with initiating, establishing, and continuing breastfeeding were influenced by the role of nurses and midwives in supporting their perception of self-efficacy. Likewise, maternity policies are important for the continuance of exclusive breastfeeding. This study shows the complexity of the initiation and establishment of breastfeeding and the existence of several social factors surrounding these moments. Furthermore, it demonstrates the importance and reference of nurses and midwives and the role of State maternity policies.

RESUMEN Introducción: Las respuestas de los profesionales de los centros de cuidados de larga duración ante la manifestación de comportamientos sexuales en residentes son muy variadas, primando actitudes y prácticas negativas. Además, su nivel de conocimientos en este tema es bastante limitado. Objetivos: Sintetizar y analizar la evidencia disponible acerca de las percepciones de los profesionales sobre la sexualidad en personas mayores institucionalizadas en centros de cuidados de larga duración. Métodos: Revisión sistemática de artículos cualitativos publicados en inglés o castellano hasta mayo de 2017 en Medline, Scopus, Web of Science, Consejo Superior de Investigaciones Científicas, CUIDEN, ProQuest, PsycINFO y CINHAL que indagaran en las percepciones de los profesionales sobre la sexualidad en personas mayores institucionalizadas. Resultados: Seis artículos cumplieron los criterios de inclusión. Las siguientes categorías explicaban las percepciones de los profesionales sobre la sexualidad: la influencia de estereotipos negativos, la presión de las reacciones e interpretaciones profesionales, la interferencia familiar, la necesidad de privacidad, la necesidad de regular la expresión sexual y el manejo de la sexualidad en personas con demencia, lesbianas, gais o bisexuales. Conclusiones: Existe una falta de respuesta estándar, de conciencia y de conocimientos de los profesionales ante las situaciones sexuales en personas mayores institucionalizadas. Es necesario establecer directrices que promuevan un enfoque común en los centros y la reducción de prácticas potencialmente perjudiciales.

Introducción: Es creciente el uso de nuevos agentes hemostáticos para controlar la hemorragia en entornos militares. Objetivos: Sintetizar y analizar la evidencia disponible sobre la eficacia de diferentes agentes hemostáticos utilizados en ambientes tácticos, transportados por los combatientes del ejército. Desarrollo: Se realizó una revisión narrativa de artículos publicados en inglés y español, en las bases de datos Medline (PubMed), Cochrane, Web of Science y en revistas, protocolos, libros y manuales del ámbito de urgencias y emergencias en el campo de batalla, que analizaron el fenómeno de estudio y cumplieron los criterios de inclusión y exclusión. Tras la búsqueda y selección de los estudios, 7 artículos fueron incluidos en la síntesis narrativa. En los estudios se utilizaron los siguientes agentes hemostáticos QuikClot®, HemCon®, Celox® y el ChitoGauze HemCon®; en la mayoría de los estudios, los agentes hemostáticos tuvieron una eficacia superior al 88 % para detener, disminuir y controlar la hemorragia externa en víctimas de combate, sobre todo en zonas de unión (articulaciones) y para reducir la morbilidad y mortalidad. Solo QuikClot® tuvo efectos secundarios negativos, al provocar quemaduras. El correcto manejo de los agentes hemostáticos requiere de formación previa, lo que evita errores de administración. Conclusiones: Los agentes hemostáticos son eficaces para el abordaje de la hemorragia externa y aumentan la supervivencia en víctimas de combate. Es necesario formar a los profesionales para evitar errores en su manejo. Futuros estudios deben indagar cuál de estos agentes es más eficaz.

Introduction: The use of new hemostatic agents to control hemorrhage in military environments is growing. Objectives: To synthesize and analyze the available evidence about the effectiveness of the different hemostatic agents utilized in tactical environments that are transported by army fighters. Development: A narrative review of articles published in English and Spanish, in Medline (PubMed), Cochrane and Web of Science, and magazines, protocols, books, and manuals in the field of emergency and battlefield emergencies, who analyzed the study phenomenon and met the inclusion and exclusion criteria. After searching and selecting the studies, 7 articles were included in the narrative synthesis. In the studies, the following hemostatic agents were used QuikClot®, HemCon®, Celox®, and ChitoGauze HemCon®, in most studies, hemostatic agents were more than 88 % effective in stopping, reducing, and controlling external hemorrhage in combat victims, especially in union areas, also decreasing morbidity and mortality. Only QuikClot® had negative side effects causing burns. The correct handling of hemostatic agents requires prior training, which avoids administration mistakes. Conclusions: Hemostatic agents are effective for treating external hemorrhage in combat victims and increasing their survival. It is necessary to train professionals to avoid mistakes in their handling. Future studies should investigate which of these agents is more effective.

Maternity and pregnancy involve significant biopsychosocial changes in the lives of women. These changes determine their experience of motherhood and can be a crucial aspect in the choice of parenting style. Women require a source of knowledge and support that goes beyond the technical, clinical environment, led by qualified nurses for holistic and humanized care. The objective of this study is to identify women’s beliefs, expectations, and experiences of their motherhood and its different stages, and their perception of the care they receive, in order to enhance effective management of their new role at a health and social level. A phenomenological qualitative study using thematic analysis will be used, within the theoretical framework provided by the Social Cognitive Theory and the influence of gender. The sample size will be defined by the sampling saturation criterion and should include rural and urban women, with different socioeconomic status. The information will be collected with semi-structured interviews that will be analyzed based on the codification of the texts in three levels and the subsequent triangulation of the results. The biopsychosocial aspects involved in motherhood make it a complex process, with women as the main player. Therefore, mothers’ opinions on the barriers and enablers they encounter in their environment are essential to place them at the center of the process. In addition, knowing the perceptions of women could help improve the work of nurses, having impacts on the humanization of health care and responding to women’s needs during their motherhood.

Background: Shared decision-making (SDM) is a dialogical relationship where the physician and the patient define the problem, discuss the available options according to the patient’s values and preferences, and co-construct the treatment plan. Undertaking SDM in a clinical setting with patients who have limited, impaired or fluctuating cognitive capacity may prove challenging. Supported (defined “Assisted” in the Irish context) decision-making describes how people with impaired or fluctuating capacity remain in control of their healthcare-related choices through mechanisms which build and maximise capacity. Supported and assisted decision-making (ADM) within healthcare settings is theoretically and practically novel. Therefore, there is a knowledge gap about the validity of psychometric instruments used to assess ADM and its components within clinical settings. This systematic review aims to identify and characterise instruments currently used to assess shared, supported and assisted healthcare decision-making between patients with limited, impaired or fluctuating capacity, their family carers and healthcare professionals. Methods: A systematic review and narrative synthesis will be performed using a search strategy involving the following databases (PubMed, Cinahl, Embase, Web of Science, Scopus and PsycINFO). Quantitative studies published in the last decade and describing psychometric instruments measuring SDM, supported decision-making and ADM with people having limited or fluctuating capacity will be considered eligible for inclusion. Title and abstract screening will be followed by full-text eligibility screening, data extraction, synthesis and analysis. This review will be structured and reported according to the PRISMA checklist. The COSMIN Risk of bias checklist will be used to assess the quality of the instruments. Discussion: The results will inform and be useful to HCPs and policymakers interested in having updated knowledge of the available instruments to assess SDM, supported and assisted healthcare decision-making between patients who have impaired or fluctuating capacity, their family carers and healthcare professionals. Registration: PROSPERO CRD42018105360; registered on 10/08/2018.

Objetivo: Sintetizar y analizar las revisiones sistemáticas, los estudios de casos y controles, de cohortes y metaanálisis que indaguen sobre la asociación entre la exposición a la radiofrecuencia de los teléfonos móviles y la aparición de tumores en personas adultas. Método: Se realizó una búsqueda sistemática en Scopus, Web of Science, The Cochrane Library, MedLine y Cinahl de artículos publicados en inglés y español entre enero de 2005 y febrero de 2016, que analicen el riesgo de tumor asociado a la exposición a la radiofrecuencia de los teléfonos móviles en personas adultas. Se siguieron las recomendaciones de la Declaración PRISMA y se analizó la calidad de los artículos con la herramienta AMSTAR y la Escala Newcastle-Ottawa. Resultados: Se encontraron 1034 estudios, de los cuales se incluyeron 14 en la presente revisión. La mayoría afirman que a corto plazo no es posible determinar la relación, aunque a largo plazo (más de 10 años) la radiofrecuencia emitida por los teléfonos móviles puede provocar efectos tumorales, aumentando el riesgo la exposición homolateral y la latencia. Conclusiones: Aunque la radiofrecuencia emitida por los teléfonos móviles tiene efectos tumorales sobre las personas, la evidencia científica disponible no es robusta. Son necesarios estudios más rigurosos, con mayores tamaños muestrales y periodos de seguimiento largos para conocer en profundidad los efectos a largo plazo.

Objective. Analyze and integrate studies that inquire on the benefits of nursing educational interventions to manage post-surgical pain. Methods. A systematic search was conducted in the databases of Scopus, Medline (Pubmed), Web of Science, The Cochrane Library, and CINAHL of systematic reviews, randomized clinical trials, and quasiexperimental studies published in English and Spanish until 2018 that analyzed the effectiveness of educational interventions in managing post-surgical pain in adult patients. Results. Twelve studies complied inclusion criteria, of which nine reported less pain in the group receiving the educational intervention. These interventions also helped to diminish the level of anxiety and improved functionality to perform activities of daily life. The level of quality of the studies was medium. Conclusion. Although the review showed that nursing educational interventions could influence on the relief of post-surgical pain, more rigorous studies are necessary, with bigger sample sizes and higher methodological quality, which help to establish the real effectiveness in managing post-surgical patients with pain. How to cite this article: Reaza-Alarcón A, RodríguezMartín B. Effectiveness of nursing educational interventions in managing post-surgical pain. Systematic review. Invest. Educ. Enferm. 2019; 37(2):e10.

AimTo explore the barriers and facilitators perceived by home caregivers regarding their involvement in the home care of people with pressure injuries.BackgroundAlthough home caregivers are key in the process of caring for people with pressure injuries, little is known about their perceptions regarding their involvement in the same.MethodsA qualitative study based on grounded theory involving a theoretical sample of 15 home caregivers of people with pressure injuries within the health district of Puertollano, Spain.ResultsThis study identified three barriers (feminization of care, necessary life adaptations as a home caregiver, and the organization of health services) and three facilitators (the perceived family duty for caring, willingness to provide care, and satisfaction with the care received on behalf of primary care services) associated with caregiver involvement in the home care of pressure injuries.ConclusionsThe care of a person with pressure injuries is perceived as a duty and requires important adaptations affecting the home caregiver's personal, social and work life. The emotional closeness and trust that develops between a patient and the primary care staff equals an involvement which, in turn, also has positive results for both the home caregiver and the patient.

Discrete choice experiments (DCEs) are a way to assess priority-setting in health care provision. This approach allows for the evaluation of individuals' preferences as a means of adding criteria to traditional quality-adjusted life year analysis. The aim of this systematic literature review was to identify attributes for designing a DCE in order to then develop and validate a framework that supports decision-making on health technologies. Our systematic literature review replicated the methods and search terms used by de Bekker-Grob et al. 2012 and Clark et al. 2014. The Medline database was searched for articles dated between 2008 and 2015. The search was limited to studies in English that reflected general preferences and were choice-based, published as full-text articles and related to health technologies. This study included 72 papers, 52% of which focused on DCEs on drug treatments. The average number of attributes used in all included DCE studies was 5.74 (SD 1.98). The most frequently used attributes in these DCEs were improvements in health (78%), side effects (57%) and cost of treatment (53%). Other, less frequently used attributes included waiting time for treatment or duration of treatment (25%), severity of disease (7%) and value for money (4%). The attributes identified might inform future DCE surveys designed to study societal preferences regarding health technologies in order to better inform decisions in health technology assessment.

Objetivo: Conocer la influencia de la percepción del entorno en los hábitos de actividad física de escolares de 9 a 11 años de edad de la provincia de Cuenca, España. Métodos: Estudio cualitativo diseñado y analizado desde una perspectiva fenomenológica. Se analizaron los dibujos individuales de 32 escolares de 4° y 5° curso de Educación Primaria sobre el entorno y los lugares que frecuentaban. Estos mismos escolares participaron en siete grupos focales para obtener información sobre la influencia de la percepción del entorno en sus hábitos de actividad física. Resultados: Tras el análisis emergieron cuatro categorías: residencia, configuración urbana, desplazamientos y sentido de pertenencia/adhesión al barrio. Los escolares percibían que residir en urbanizaciones cerradas o en ámbitos rurales facilita la práctica de actividad física, mientras que residir en zonas poco accesibles, la sensación de inseguridad por el tráfico, desplazarse en coche y la sensación de no pertenencia al barrio fueron percibidos como barreras para ser activos. Conclusiones: La percepción del entorno influye en los hábitos de actividad física de los escolares de la provincia de Cuenca. Para conseguir cambios en la actividad física de los escolares son necesarias estrategias específicas que tengan en cuenta el ambiente urbano donde estos viven.

The aim of the study was to know the factors that influence boys and girls’ perceptions for performing physical activity during playground recess from their own perspective. Ninety-eight schoolchildren aged 8–11 years from five schools from Cuenca (Spain) participated in 22 focus groups and carried out 98 drawings following the socioecological model as a theoretical framework. A content analysis of the transcripts from the focus groups and drawings was carried out by three researchers. Results showed that, in spite of boys and girls identified same barriers, there were gender differences in their perceptions. Gender socialization was the key as central category and helped to understand these differences. Boys preferred play football and this sport had a monopoly on the recess space. Weather was a barrier for boys. Girls and boys, who did not play football, were relegated to peripheral areas and lack of materials was a barrier for them. Teachers were a barrier for all children who did not play football. Thus, in order to promote recess physical activity, researchers, teachers and educational policy makers should take into account gender socialization and promote inclusive non-curricular physical activity in schools.

A pesar de la importancia de las percepciones familiares en el análisis de la atención en residencias de mayores, apenas se han indagado estos ascpetcos. El objetivo de este estudio es conocer las preferencias y las áreas de mejora percibidas por los familiares sobre los cuidados a personas con demencia. Se realizó un estudio cualitativo, a partir de la Teoría Fundamentada, combinando dos técnicas de recogida de datos (observación participante y entrevistas en profundidad) en una muestra teórica de familiares de personas con demencia institucionalizadas. El modelo de atención óptima a personas con demencia, percibido por los participantes, se basó en una atención especializada e individualizada y en la participación de la familia en el cuidado. Entre las áreas de mejora se incluyeron aspectos relacionados con una mayor formación específica en Geriatría, relaciones humanas y con la cultura del trabajo institucional. Frente a la vigente tendencia de tecnificación del cuidado, las familias exigen una atención personalizada y en pequeña escala, donde ellas mismas sean parte activa del proceso de atención.

BackgroundPrimary care (PC) patients have difficulties in committing to and incorporating primary prevention and health promotion (PP&HP) activities into their long-term care. We aimed to re-interpret, for the first time, qualitative findings regarding factors affecting PC patients' acceptance of PP&HP activities.Methods and findingsA meta-ethnographic synthesis was generated following electronic and manual searches that retrieved 29 articles. Papers were reviewed and translated to produce a re-interpretation of the extracted concepts. The factors affecting PC patients' receptiveness to PP&HP activities were framed in a four-level ecological model (intrapersonal, interpersonal, institutional and environment and society). Intrapersonal factors (patients' beliefs/attitudes, knowledge, skills, self-concept, motivation and resources) were the most numerous, with almost 25 different factors. Public health education to modify erroneous beliefs and values regarding PP&HP could encourage a transition to healthier lifestyles. Health care professionals' abilities to communicate and involve patients in the decision-making process can act as facilitators. Biopsychosocial training (with emphasis on communication skills) for health professionals must start with undergraduates. Increased consultation time, the use of reminders, follow-up visits and tools for communicating risk and motivating patients could be applied at the intrapersonal level. Collaborative care involving other health professionals (nutritionists or psychotherapists) and family and community stakeholders (teachers or gym trainers) was important in developing healthier habits. Patients also cited barriers related to the built environment and socioeconomic difficulties that highlighted the need for policies promoting social justice and equity. Encouraging PP&HP using social marketing strategies and regulating media to control its impact on health were also cited. Only the perspectives of PC patients in the context of chronic conditions were considered thus limiting extrapolation to other contexts.ConclusionsSeveral factors affect PP&HP. This must be taken into account when designing PP&HP activities if they are to be successfully implemented and maintained in routine practice.