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Although leisure constraints that individuals have to cope with can negatively affect their social inclusion and satisfaction with life, little research has addressed the link between these variables. Therefore, the current paper examined the moderator role of leisure constraints on the relationship between satisfaction with life and leisure constraints among adults living in five different European countries. The respondents were 1,382 women and 877 men adults. The findings of analysis revealed that all factors used in the study accounted for 15% of the variance in satisfaction with life and social inclusion had a significant and positive impact on satisfaction with life. As a result, it can be said that leisure constraints had a moderating effect on the relationship between satisfaction with life and social inclusion. The present research study recommends that social inclusion should be encouraged through decreasing to leisure constraints to increase the life satisfaction. [ABSTRACT FROM AUTHOR]

Objectives: Less than 5% of all harmful medicine‐related incidents (MIs) or adverse drug reactions received by the Spanish Pharmacovigilance system are notified by Registered Nurses (RNs). The main objective of this study was to determine the impact of a multifaceted institutional intervention (MII) in patient safety on the reporting competence of medication incidents of hospital RNs. Design: One‐group pre‐test–posttest design. Setting: Tertiary, public, teaching hospital in Spain. Participants: A total of 139 RNs responded to pre‐ and postintervention questionnaires constituting the paired sample subjected to analysis. Intervention: A MII, consisting of educational activities and materials, change in MI reporting form from paper to electronic and appointment of reporting support services, was designed and directed to all hospital RNs and midwifes. Main outcome measures: Overall MIs reporting competence (OC) and its dimensions (attitudes, knowledge and skills) were measured through a synthetic variable (total OC value range: 34–170 points) by means of an electronic questionnaire. Results: A statistically significant 7.96‐point increase in OC from baseline to the final measurement was obtained (CI: 5.05–10.85). There was an increase of 7.38 points in the skills dimension (CI: 5.06–9.68). After the MII, 73.4% nurses improved their OC and 33.8% reported at least one no‐harm MI postintervention compared to 4.4% pre‐intervention (p <.001). A one‐point increase in OC improved the probability of becoming reporter by 2.9% and a one‐point increase in skills by 6.4%. Conclusion: MIs reporting competence among RNs increased after a multifaceted institutional intervention, due to an improvement in the skills dimension. The MII was also effective in raising both, the rate of RNs who become reporters and the number of no‐harm MIs reported. [ABSTRACT FROM AUTHOR]

Serious games have proven to be a powerful tool in education to engage, motivate, and help students learn. However, the change in student knowledge after playing games is usually measured with traditional (paper) prequestionnaires–postquestionnaires. We propose a combination of game learning analytics and data mining techniques to predict knowledge change based on in‐game student interactions. We have tested this approach in a case study for which we have conducted preexperiments–postexperiments with 227 students playing a previously validated serious game on first aid techniques. We collected student interaction data while students played, using a game learning analytics infrastructure and the standard data format Experience API for Serious Games. After data collection, we developed and tested prediction models to determine whether knowledge, given as posttest results, can be accurately predicted. Additionally, we compared models both with and without pretest information to determine the importance of previous knowledge when predicting postgame knowledge. The high accuracy of the obtained prediction models suggests that serious games can be used not only to teach but also to measure knowledge acquisition after playing. This will simplify serious games application for educational settings and especially in the classroom easing teachers' evaluation tasks. Lay Description: What is currently known about the subject matter Serious games are a powerful tool to engage, motivate, and help students learn.Pre‐post experiments are commonly used to measure knowledge acquisition.Game learning analytics can be applied to interaction data from games. What this paper adds We present a two‐step approach combining game learning analytics and data mining to predict players' performance in serious games based on their interactions.The approach is tested in a case study with pre‐post experiments collecting interaction data with 227 students playing a serious game to determine if performance can be accurately predicted.The comparison of prediction models has helped to determine if pretest information is essential.The highly accurate prediction models obtained suggest that games can be used to teach and measure knowledge acquisition after playing. Implications of study findings for practitioners The approach aims to simplify the measurement of players' learning with serious games.It may be generalized at least to similar scenarios (e.g., games for procedural learning or game‐likesimulations) where similar interaction data are feasible.Game mechanics and educational design should define the interaction data to capture.Using an accepted standard tracking profile is a clear recommendation. [ABSTRACT FROM AUTHOR]

Background: The present study analyses the design of programming literacy in the sixth grade of Primary Education, starting from the use of simple activities with visual block‐based programming, through Scratch, and progressively linking difficulty to the use of the Unity engine, and the C# language, with simple activities identical to those created in Scratch. Objectives: This research aims to evaluate future teachers' abilities and attitudes regarding programming and its educational possibilities. We intend to evaluate the viability of a teaching proposal that combines a visual block‐based programming environment and a more advanced one, based on C#. Method: In the settings of two public Spanish universities, we analyse the possibilities in the training of future teachers who are studying for a degree in Primary Education Teaching and a degree in Pedagogy. Based on a test and three scales, descriptive data and statistical inference are detailed through a quasi‐experimental design with a Student's t‐test in the first dimension, and a Wilcoxon test in the second dimension. Results: The participants improved their performance and attitudes towards programming with the intervention of the study in the use of coding. Conclusions: It can be concluded that coding is essential in teacher training, and that a greater presence of programming training in higher education is essential. The benefits are visible in the pedagogical approach of coding related to creativity, innovation, motivation, an active approach and interest, highlighting the fact that the implementation of visual block‐based programming by blocks and engines is feasible in Elementary Education. The training proposal—provided by appropriate progression, selection, and sequencing of content—fosters basic and practical teacher training, and this can be defined as an apt training solution. Lay Description: What is already known about this topic: Visual Programming Language (Scratch) provides benefits in educational contextsEducational Technology in classroom provides motivation and encouragement.Active methods and interactions are interesting and beneficial to elementary school students What this paper adds: Visual programming and game engine are feasible in Elementary Education, detailing significant improvements regarding academic outcomesWe found benefits in this pedagogical approach related to creativity, innovation, motivation, active approach and interest. Implications for practice and/or policy: Due to the benefits and positive results obtained in this research it is recommended to implement Visual Programming LanguageWe recommend the introduction to engine in educational settings in 6th grade in primary education though a cross‐curricular implementation.We recommend to apply an active approach, innovation, and learning computational concepts. [ABSTRACT FROM AUTHOR]

Elaborative feedback (EF) containing explanations on students' responses benefits learning. Computer‐based environments provide learners with EF in different ways, for example, on an immediate question‐by‐question basis or after answering a set of questions. Recent findings also suggest that delaying EF enhances learning. However, it is unclear to what extent different types of delayed‐EF favour students' performance. This study examines whether and how two types of delayed‐EF (question‐based vs. summative) influence students' question‐answering performance and final learning over immediate‐EF. One hundred thirty‐three secondary‐school students read a scientific text and answered 12 multiple‐choice questions in a computer‐based environment. A day later, students completed a final learning test with 20 open‐ended questions. Results showed that neither question‐based delayed EF nor summative delayed EF outperformed immediate EF. However, EF moderated the relationship between students' prior knowledge and their performance outcomes, suggesting that students with higher levels of prior knowledge receiving summative delayed EF benefited more. Lay Description: What is already known about this topic: Elaborative Feedback (EF) containing explanations about the students' responses benefits learning.Computer‐based learning environments can provide students with different types of delayed and immediate EF messages.Results in regard to what type of delayed EF is best for learning are inconclusive.EF effects can vary as a function of individual differences in Prior Knowledge. What this paper adds: The role of delaying EF over immediate EF on both question‐answering and learning outcomes.The effects of summing up EF (summative)in comparison to delivering question‐based EF.The interplay between students' prior knowledge and EF on question‐answering and learning outcomes. Implications for practice and/or policy: Neither question‐based nor summative delayed EF outperformed immediate EF.Students with higher levels of prior knowledge receiving summative delayed EF benefited more.Designers of computer‐based learning environments may provide learners with delayed EF messages.The design of content‐efficient EF cannot be fully understood without considering learners' prior knowledge. [ABSTRACT FROM AUTHOR]

The present study evaluated the effects of web‐based training on Spanish pre‐service and in‐service teacher knowledge and implicit beliefs on learning to write. A sample of pre‐service teachers and in‐service teachers from Mexico, Guatemala, Ecuador, Colombia, and Spain participated in the online course. Findings suggest that teachers may improve their knowledge of transcription skills (i.e., handwriting/typing, spelling), text production, and strategies for composing as necessary components of quality writing instruction. Effects were also found on the teachers' implicit beliefs. Finally, both pre‐service and in‐service teachers positively rated the online course received. Lay Description: What is currently known about the subject: Teaching children how to write demands a high degree of specialization.The benefits of web‐based training to professional development have been well‐documented in the literature.Preparing of pre‐service and in‐service teachers through an online context is limited in the field of writing.Teachers' knowledge, satisfaction, and beliefs have been commonly used as outcome measures to define high‐quality e‐learning instruction. What this paper adds: A Spanish web‐based training was developed to improve professional development in writing instruction.The Trazo web‐based training changed teacher's beliefs about learning to write.Teachers learned more about the essential component of the writing process.Teachers' rating of the training and support website was highly positive. Implications for practitioners: Web‐based training allows teachers to learn at their own pace.Teachers can improve their knowledge from virtually at any geographic location with an Internet connection.The Trazo web‐based training offers research‐based knowledge to Spanish‐speaking teachers. [ABSTRACT FROM AUTHOR]

The Knowledge Society, along with the non‐stop growing technological evolution, entails university students acquiring new competences for them to be successful in society. These are called 21st‐century competences that come as high‐skill competences – higher‐order thinking capacities and teamwork competences – and information and communication technologies (ICT) competences – technological, pedagogical and ethical. This study aims to determine the link between ICT competences and high‐skill competences. A correlational study was conducted whose sample was formed by 983 students studying degrees at the Universidad de Valencia (Spain), selected by non‐probabilistic incidental sampling and collecting information with two questionnaires. The results indicate a positive and statistically significant relation between ICT competences with the other two considered sets: higher‐order thinking capacities and teamwork competences. Moreover, pedagogical competences are more related with the two high‐skill competence sets. This suggests the need for training plans that favour learning 21st‐century competences and for stressing pedagogical competences in ICT. Lay Description: What is already known about this topic: University students require new competences to face a changing society.21st‐century competences are made up of ICT competences, higher‐order thinking capacities and teamwork competences.The empirical relation between ICT competences with higher‐order thinking capacities and teamwork competences has been little addressed.Few empirical studies have determined the contribution of each of the competence dimensions in that relation. What this paper adds: There is a positive relation between ICT competences and higher‐order thinking capacities and teamwork competences.Pedagogical competences –ICT competences‐ are more closely related to the two sets of high‐skill competences.Problem solving and the two teamwork competences contribute more to the relation with ICT competences. Implications for practice and/or policy: University system have to development training plans in the 21st century competences for the university student.University system have to promote specific training in pedagogical competences ‐ICT competences‐ for university student. [ABSTRACT FROM AUTHOR]

To assist higher education institutions in meeting the challenge of limited student engagement in the implementation of Learning Analytics services, the Questionnaire for Student Expectations of Learning Analytics (SELAQ) was developed. This instrument contains 12 items, which are explained by a purported two‐factor structure of "Ethical and Privacy Expectations" and "Service Feature Expectations." As it stands, however, the SELAQ has only been validated with students from UK university, which is problematic on account of the interest in Learning Analytics extending beyond this context. Thus, the aim of the current work was to assess whether the translated SELAQ can be validated in three contexts (an Estonian, a Spanish, and a Dutch University). The findings show that the model provided acceptable fits in both the Spanish and Dutch samples, but was not supported in the Estonian student sample. In addition, an assessment of local fit is undertaken for each sample, which provides important points that need to be considered in future work. Finally, a general comparison of expectations across contexts is undertaken, which are discussed in relation to the General Data Protection Regulation (2018). Lay Description: What is currently known about the subject matter: Accounting for student expectations allows for a service that is meaningful.SELAQ measures student expectations towards Learning Analytics services.The 12 items of the SELAQ can be explained by a two‐factor structure (Ethical and Privacy Expectations and Service Feature Expectations). What their paper adds to this: Validation of the SELAQ in three contextsA discussion of localized sources of strainAn assessment of measurement quality in each contextA general comparison of student expectations across contexts The implications of study findings for practitioners: SELAQ can be used with Spanish and Dutch students.SELAQ responses provide a much needed input from end‐users in Learning Analytics implementations. [ABSTRACT FROM AUTHOR]

This paper studies how the integration of group awareness tools in the knowledge management system called KnowCat (Knowledge Catalyser), which promotes collaborative knowledge construction, may both foster the students' perception about the meaningfulness of visualization of group awareness information and promote better collaborative processes as well as enhance better task performance. Forty-seven university students participated in a research study, where one group of 23 students used KnowCat without the awareness console (non-awareness group); the other 24 students used KnowCat with the awareness console (awareness group). Both groups used KnowCat during one semester. Data analysis revealed that the awareness group means were higher than those of the non-awareness group in terms of participation, cognitive and metacognitive learning activities, and task performance. Moreover, students revealed that knowing what, where and how much their classmates were contributing acted as positive feedback by encouraging participation and orienting their own behaviour and their contribution to the collaborative work. In this paper, we claim that the visualization group awareness information in KnowCat, a utility allowing students to visualize and track what, where, how much and how often other participants contributed to the KnowCat knowledge area, had a positive impact on the students' collaborative behaviour. [ABSTRACT FROM AUTHOR]

Abstract: Introduction and objective: The ODHIN trial found that training and support and financial reimbursement increased the proportion of patients that were screened and given advice for their heavy drinking in primary health care. However, the impact of these strategies on professional accuracy in delivering screening and brief advice is underresearched and is the focus of this paper. Method: From 120 primary health care units (24 in each jurisdiction: Catalonia, England, the Netherlands, Poland, and Sweden), 746 providers participated in the baseline and the 12‐week implementation periods. Accuracy was measured in 2 ways: correctness in completing and scoring the screening instrument, AUDIT‐C; the proportion of screen‐negative patients given advice, and the proportion of screen‐positive patients not given advice. Odds ratios of accuracy were calculated for type of profession and for intervention group: training and support, financial reimbursement, and internet‐based counselling. Results: Thirty‐two of 36 711 questionnaires were incorrectly completed, and 65 of 29 641 screen‐negative patients were falsely classified. At baseline, 27% of screen‐negative patients were given advice, and 22.5% screen‐positive patients were not given advice. These proportions halved during the 12‐week implementation period, unaffected by training. Financial reimbursement reduced the proportion of screen‐positive patients not given advice (OR = 0.56; 95% CI, 0.31‐0.99; P < .05). Conclusion: Although the use of AUDIT‐C as a screening tool was accurate, a considerable proportion of risky drinkers did not receive advice, which was reduced with financial incentives. [ABSTRACT FROM AUTHOR]

The Wound‐QoL assesses the impact of chronic wounds on patients' health‐related quality of life (HRQoL). A 17‐item and a shortened 14‐item version are available. The Wound‐QoL‐17 has been validated for multiple languages. For the Wound‐QoL‐14, psychometric properties beyond internal consistency were lacking. We aimed to validate both Wound‐QoL versions for international samples representing a broad range of European countries, including countries for which validation data had yet been pending. Patients with chronic wounds of any aetiology or location were recruited in Austria, Lithuania, the Netherlands, Poland, Slovakia, Spain, Switzerland and Ukraine. Psychometric properties were determined for both Wound‐QoL versions for the overall sample and, if feasible, country‐wise. We included 305 patients (age 68.5 years; 52.8% males). Internal consistency was high in both Wound‐QoL‐17 (Cronbach's α: 0.820–0.933) and Wound‐QoL‐14 (0.779–0.925). Test–retest reliability was moderate to good (intraclass correlation coefficient: 0.618–0.808). For Wound‐QoL‐17 and Wound‐QoL‐14, convergent validity analyses showed highest correlations with global HRQoL rating (r = 0.765; r = 0.751) and DLQI total score (r = 0.684; r = 0.681). Regarding clinical data, correlations were largest with odour (r = −0.371; r = −0.388) and wound size (r = 0.381; r = 0.383). Country‐wise results were similar. Both Wound‐QoL versions are valid to assess HRQoL of patients with chronic wounds. Due to its psychometric properties and brevity, the Wound‐QoL‐14 might be preferrable in clinical practice where time is rare. The availability of various language versions allows for the use of this questionnaire in international studies and in clinical practice when foreign language patients are being treated. [ABSTRACT FROM AUTHOR]

Prenatal iron supplementation improves children's health and cognitive performance, but few studies explore behavioural development. This study assessed the effects of adjusting prenatal iron supplementation to maternal iron stores during early pregnancy on children's behavioural problems. Randomized controlled trial conducted in Tarragona (Spain) involving 230 nonanaemic pregnant women and their children after a 4‐year follow‐up. Based on haemoglobin (Hb) levels before gestational week (GW) 12, women receive different iron doses: those with Hb = 110–130 g/L were randomized to receive 80 or 40 mg/day and those with Hb > 130 g/L were randomized to receive 20 or 40 mg/day. Maternal iron stores at GW12 were classified using serum ferritin (SF) as low (SF < 15 µg/L), normal (SF = 15–65 µg/L), and normal‐high (SF > 65 µg/L). Children's behaviour was assessed by parents using the Child Behaviour Checklist for ages 1.5–5 years and the Behaviour Rating Inventory of Executive Function‐Preschool Version, and by teachers using the Teacher's Report Form for ages 1.5–5 years. Multivariable regression models were performed. Taking 80 mg/day of iron improved child behaviour when women had low iron stores but worsened it when mothers had normal–high iron stores, except for depressive and attention/hyperactivity problems. Taking 20 mg/day of iron improved behaviour only in those children whose mothers had SF > 65 µg/L in early pregnancy. Additionally, executive functioning improved at high doses of prenatal iron when maternal baseline SF < 15 µg/L. Adjusting prenatal iron supplementation to both maternal baseline Hb levels and iron stores reduces behavioural problems in 4‐year‐old children. Key messages: Prenatal iron supplementation succeeds in improving maternal haematological outcomes and cognitive performance of children, but few studies have focused on behavioural development.Prenatal iron supplementation adjusted to maternal iron stores reduces behavioural problems in 4‐year‐old children.Maternal iron stores early in pregnancy should be measured in addition to haemoglobin concentration.These findings contribute greatly to the advancement of public health by giving physicians the tools to prescribe the most appropriate dose of iron supplementation to contribute to better child development. [ABSTRACT FROM AUTHOR]

Aim: To analyse the perception of patient safety culture among nursing students and to compare patient safety outcomes between the different year nursing groups. Design: A cross‐sectional descriptive study was conducted with nursing students (n = 266) between first and fourth years from one university in Spain. Methods: The project was conducted during the 2020/21 academic year. The data were collected using a translated and adapted version of the "Hospital Survey on Patient Safety" developed by the Agency of Healthcare Quality (AHQR). Results: Significant differences were found between the year of study of the nursing degree and whether or not specific training in patient safety culture had been received. The nursing students who had received specific training gave scores lower than anyone else in all questionnaire items, but only the indicators of "good practice" (p = 0.00) and "frequency of reported events" (p = 0.0012) showed significant differences. In some cases, fourth‐year students had lower significant mean scores in their "perception of patient safety within unit/sector," "indicators of good practice" and "total score." Public Contribution: Adverse events related to clinical practice continue to be a global problem. Improvements in patient safety require an increase in the patient safety culture of professionals and the promotion of development facilitators. Clinical practice and specific theoretical training foster greater awareness and demand related to patient safety, which is of interest when it comes to the development of new programmes that combine both methodologies and improve their effectiveness. Patient safety will continue to be a focus for all healthcare systems. The patient safety culture of future healthcare professionals should be developed at the university level in order to avoid unnecessary adverse events. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND This study describes the perceived impact of H1N1 influenza and the adoption of the recommended measures to address the pandemic in schools. METHODS A cross-sectional self-reported survey was conducted in 433 schools in Barcelona addressed to the school principal or the H1N1 influenza designated person. A descriptive analysis was performed, stratifying by educational level and type of school. A logistic regression analysis also was conducted. RESULTS Around 70% of the respondents reported that there had been H1N1 influenza cases among students, being this percentage significantly higher among those schools offering primary education (74.4%) (p < .05). The main measures (single-use paper towels, availability of sanitizer solutions and 15 minutes ventilation per day of enclosed spaces) were implemented in most of the centers. However, the correct adoption of the main measures took place in around 30% of the schools, being the percentage lower in those offering only secondary education (Odds ratio [OR]: 0.518; 95% confidence interval [CI]:0.272-0.986) and those located in medium (OR: 0.438, 95% CI: 0.234-0.811) or low socioeconomic status (SES) districts (OR: 0.321, 95% CI: 0.159-0.649). CONCLUSIONS Despite the climate of social alarm, the perceived impact of H1N1 influenza in most schools was moderate. In future potential threats, the educational level and the SES of the school should be considered, especially when measures requiring purchasing any product are recommended but not provided. [ABSTRACT FROM AUTHOR]

Background As future health educators, nursing and physiotherapy students will play an essential role in the prevention of smoking. Aim To determine the prevalence of smoking among students and to analyse their knowledge of and attitudes towards smoking. Method This was a descriptive cross-sectional study using an anonymous questionnaire and conducted in a Spanish Faculty of Health Sciences in 2013. Findings 247 nursing and physiotherapy students (82.33%) participated in the study. The global prevalence of smoking (18.2%) was lower compare with the general population group of the same age. We have observed statistical significance in relation to previous studies. Nursing and physiotherapy students showed a low nicotine dependence. We found a lack of knowledge about the harmful effects of cigarette consumption on health. Statistically significant results were also found in relation to degree courses (p < 0.01) as regards students' opinions about their knowledge of strategies and methods to help patients stop smoking. Conclusion Most students started smoking before commencing their university studies; consequently, interventions should focus on cessation programmes. An analysis of university curricula leading to the award of a degree in the health sciences could serve to identify educational deficiencies in order to implement the necessary modifications. Implications for nursing and health policy This paper presents an update in tobacco use characteristics amongst nursing and physiotherapy students. Those results have showed a need to improve the curricula in order to develop specific programmes to improve knowledge, attitudes and beliefs. Measures to prevent smoking must be taken at school. [ABSTRACT FROM AUTHOR]

Purpose To examine the perception of registered nurses and nursing assistants regarding the use of physical restraints with residents of nursing homes located in four of the regions of Spain; and to evaluate the relationship of these perceptions to the staff respondents' level of training. Design Cross-sectional multicenter and correlational study. The research was conducted in 2013 in 19 Spanish nursing homes with 2,940 residential beds. A total of 785 nurses (170 registered nurses and 615 nursing assistants) participated in the study. Methods The Perception of Restraint Use Questionnaire (PRUQ), consisting of 17 of the most cited reasons for using these devices, was used, as was a questionnaire capturing the sociodemographic characteristics and educational or experience level of staff respondents. Findings Nurses reported the most important uses for restraints as prevention of falls and avoidance of medical device interference. As indicated by an average PRUQ score of 3.47, staff respondents supported restraint use, especially nursing assistants (3.59) as compared to registered nurses (3.00). With regard to training: 83.7% had participated in little, if any, training and only 29.2% had read three or more documents related to restraint use; 66.6% believed that their training was inadequate. No correlation was found between the results of the PRUQ and the respondents´ sociodemographic characteristics or participation in training activities. No differences were found among nurses by region. Conclusions In contrast to papers published in other countries, nurses in this study still consider it necessary to apply restraints in everyday practice. The education of nursing staff regarding restraint and knowledge of alternatives is needed; they should at least be aware of international standards of care regarding physical restraint use. Clinical Relevance Most of the staff perceived their training related to the use of these devices as insufficient. Nursing assistants considered the use of restraints more important than did the registered nurses. [ABSTRACT FROM AUTHOR]

The built environment (BE) impacts on people's disability and health, in terms of overweight, depression, alcohol abuse, poor self-rated health and presence of psychological symptoms; it is reasonable to assume that BE also impacts on participation levels. This paper presents the validation of the COURAGE Built Environment Self-Reported Questionnaire (CBE-SR), an instrument designed to evaluate BE in the context of health and disability. Subjects participating to COURAGE, a cross-sectional study conducted on 10 800 citizens of Poland, Finland and Spain, completed a protocol inclusive of the CBE-SR. Psychometric properties and factor structure were analysed, and factor scores created. Gender differences, differences between persons from different age groups and persons reporting the environment as facilitating, hindering or neutral were calculated. Eight items were deleted so that the final version of CBE-SR comprises 19 items. Cronbach's alpha ranged from 0.743 to 0.906, and test-retest stability was demonstrated for the majority of items. Four subscales were identified: Usability of the neighbourhood environment; Hindrance of walkable environment; Easiness of use of public buildings, places and facilities; and Risk of accidents and usability of the living place. Younger respondents reported their neighbourhood as more usable but perceived walkways as more hindering and public buildings as less easy to use; gender differences were almost inexistent. The CBE-SR is a four-scale instrument with good psychometric properties that measures the person-environment interaction. It is sensitive across age groups and is consistent with the subject's overall judgement of the degree to which the environment is facilitating or hindering. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message Poor built environments have a negative impact on the level of a person's participation. However, instruments measuring the person-environment interaction are lacking., The CBE-SR is a valid and reliable instrument that researchers can use to assess the relationships between the intrinsic health state and the objective features of the environment., Understanding this relationship would provide further insight into the need of addressing the individual's functioning either by means of interventions directed to the individual or by making changes to the individual's environment. [ABSTRACT FROM AUTHOR]

Objectives Lipoatrophy is a long-term adverse effect of some antiretrovirals that affects quality of life, compromises adherence and may limit the clinical impact of HIV treatments. This paper explores the effect of tenofovir/emtricitabine ( TDF/ FTC) on the amount of limb fat in patients with virological suppression. Methods A randomized, prospective clinical trial was performed to compare continuation on a zidovudine/lamivudine ( ZDV/3TC)-based regimen with switching to a TDF/ FTC-based regimen in terms of the effect on limb fat mass as assessed by DEXA over a 72-week period. Results Eighty patients were included (39 in the TDF/ FTC arm and 41 in the ZDV/3 TC arm) and 73 completed the study (37 and 36, respectively). In the switch arm, limb fat increased by a median of 540 g from baseline ( P = 0.022), while in the ZDV/3TC arm it decreased by a median of 379 g ( P = 0.112; p between groups = 0.007). Subjects with baseline limb fat ≤ 7200 g, previous time on ZDV > 5 years or a body mass index > 25 kg/m2 experienced higher limb fat gains than other subjects, and these differences were statistically significant. Haemoglobin increased by a median of 1.0 g/d L in the TDF/ FTC arm ( P < 0.001) and remained unchanged in the ZDV/3TC arm (p between groups = 0.0002). There were no significant differences between groups in other secondary endpoints (body weight, total body and trunk fat content, total body bone mineral density, laboratory parameters, CD4 cell count and viral load). Conclusions Switching from a ZDV/3TC-based to a TDF/ FTC-based regimen led to a statistically significant improvement in limb fat, in contrast to the progressive loss of limb fat in subjects continuing ZDV/3TC. [ABSTRACT FROM AUTHOR]

Objectives This paper examines the awareness and use of nonoccupational HIV post-exposure prophylaxis ( nPEP) in Spain, and the factors that influence this awareness. Methods Between June 2009 and July 2010, a mobile unit offered free, rapid HIV tests in a number of Spanish cities. A total of 2545 people were passively recruited and tested, and answered a self-administered questionnaire containing sociodemographic, behavioural and nPEP-related questions. Bivariate and multivariate analyses were performed, stratifying by gender/sexual behaviour. Results Some 34% of the responders were men who have sex with men ( MSM), 30% were men who have sex exclusively with women ( MSW), and 35% were women. Approximately 26% were foreigners, 46% had a university degree, and 51% had previously taken an HIV test. Overall, 22% were aware of nPEP. Only 2% had ever used it; 70% of these after high-risk sexual intercourse. Awareness was higher among MSM (34%) than women (16%) and MSW (15%). Multivariate analysis showed a lack of nPEP awareness to be associated with being born in Latin America, while awareness increased with the number of previous HIV tests among women and MSW. In MSM, awareness was also associated with having a university degree, the degree of interaction with gay culture, number of partners, and use of the internet as the main way of meeting partners. Conclusions nPEP awareness in the studied population was unacceptably low. The promotion of its availability should be made a major objective of prevention programmes, as a complementary measure to condom use. [ABSTRACT FROM AUTHOR]

This paper is based on a case study of the city of Girona in Catalonia, Spain, and analyses the vulnerability of commercial establishments to floods caused by the Onyar River. A mapping and statistical approach (cluster analysis) was applied to the information obtained from 568 questionnaires answered by the shops and the workshops located in the flood risk area. The results obtained allowed the authors to determine five different flood vulnerability profiles of the commercial establishments analysed. These profiles paint a picture of little individual adaptation to the risk and the possibility of suffering, sooner or later, large economic losses due to overflowing of the Onyar River. The authors established a methodology for carrying out a detailed multidimensional analysis of the flood vulnerability of the city's commercial establishments in order to provide the foundations for local government policies and for strategies for shop owners to reduce flood vulnerability. [ABSTRACT FROM AUTHOR]

Background: Studies revealed unidirectional associations between frailty and medication‐related problems (MRPs) among older adults. Less is known about the association between frailty and the risk of MRPs. We aimed to assess the bi‐directional association between frailty and the risk of MRPs in community‐dwelling older adults in five European countries. Methods: Participants were 1785 older adults in the population‐based Urban Health Centres Europe project. Repeated assessments were collected at baseline and one‐year follow‐up, including frailty, the risk of MRPs, and covariates. Linear regression analyses were conducted to examine the unidirectional associations. A cross‐lagged panel modeling was used to assess bi‐directional associations. Results: The unidirectional association between frailty at baseline and the risk of MRPs at follow‐up remained statistically significant after adjusting for covariates (β = 0.10, 95%CI:0.08, 0.13). The association between the risk of MRPs at baseline and frailty at follow‐up shows similar trends. The bi‐directional association was comparable with reported unidirectional associations, with a stronger effect from frailty at baseline to the risk of MRPs at follow‐up than reversed path (Wald test for comparing lagged effects: p < 0.05). Conclusion: This longitudinal study suggests that a cycle may exist where older adults with higher frailty levels are more likely to have a higher risk of MRPs, which in turn contributes to developing a higher level of frailty. Further research is needed to validate our findings and explore underlying pathways. [ABSTRACT FROM AUTHOR]

Objectives: To describe prevalence and factors associated with unplanned pregnancies, and social and partner support during pregnancy among women from the Cohort of the Spanish HIV/AIDS Research Network (CoRIS). Methods: We included all women recruited in CoRIS from 2004 to 2019, aged 18–50 years at recruitment who were pregnant during 2020. We designed a questionnaire, organized into the following domains: sociodemographic characteristics, tobacco and alcohol consumption, pregnancy and reproductive health, and social and partner support. The information was gathered via telephone interviews conducted from June to December 2021. We calculated prevalence of unplanned pregnancies as well as odds ratios (ORs) of association and 95% confidence intervals (CIs) according to sociodemographic, clinical and reproductive characteristics. Results: Among 53 women who were pregnant during 2020, 38 (71.7%) answered the questionnaire. Median age at pregnancy was 36 years [interquartile range (IQR) 31–39], 27 (71.1%) women were born outside of Spain, mainly in sub‐Saharan Africa (39.5%) and 17 (44.7%) were employed. Thirty‐four (89.5%) women had been through previous pregnancies and 32 (84.2%) had experienced previous abortions/miscarriages. Seventeen (44.7%) women had shared with their clinician their desire to get pregnant. Thirty‐four (89.5%) pregnancies were natural and four used assisted reproductive techniques (in vitro fertilizations; one additionally used oocyte donation). Of 34 women with natural pregnancies, pregnancy was unplanned in 21 (61.8%) and 25 (73.5%) had information on how to become pregnant avoiding HIV transmission to the baby and partner. Women who did not seek advice from their physician about becoming pregnant had a significantly increased risk of unplanned pregnancy (OR = 71.25, 95% CI: 8.96–566.67). Overall, 14 (36.8%) women reported having low social support during pregnancy and 27 (71.0%) had good/very good support by their partner. Conclusions: Most pregnancies were natural and unplanned and very few women had talked with their clinician about their desire to become pregnant. A high proportion of women reported low social support during pregnancy. [ABSTRACT FROM AUTHOR]

Background A person suffering from dementia needs increasing help from another person, who, in most cases, is a female family member. Times are changing and this traditional role can no longer be maintained. Aim The aim of this research was mainly centred on ascertaining the profile of caregivers and to find out how determinants such as age, sex and educational level and living conditions led people to assume that role. Methods A survey was designed and applied to 925 caregivers (778 of which were analysed) with the collaboration of the Alzheimer's Associations of Andalucía (Spain). Associations gave their ethical approbation for this research prior to the beginning and they informed their members. The participation was entirely voluntary, and caregivers were given the option to withdraw consent. Results Women are the main caregivers in any kind of profile. Males become carers if they are old and the partner of a patient. Males use more external services. Cohabiting and working outside the home increase the use of external support services, and having a higher level of education increases the use of nursing homes. Younger caregivers perceive more intense socio-economic consequences than the general profile. Conclusions Being a caregiver implies limitations to entering the job market and for job promotion. There is a generational gap in the caregiver profile, and more and new support services will be needed. Policymakers should take those into account. [ABSTRACT FROM AUTHOR]

Purpose: Smoking cessation interventions should be promoted in cancer centers to improve clinical outcomes among cancer patients and the quality of life of cancer‐free patients and survivors. The aim of the present study was to examine long‐term abstinence (1, 3, and 5 years) among smokers who received an intensive nurse‐led smoking cessation intervention. Design: A prospective follow‐up study was conducted in a smoking cessation clinic in Barcelona. Methods: The study included 479 smokers who received a nurse‐led smoking cessation intervention that included motivational interviewing, psychological support, behavioral change counseling, promotion of smoke‐free policies, and relapse‐prevention strategies, as well as pharmacotherapy if necessary, for 12 months. We calculated overall and sex‐specific 1‐, 3‐, and 5‐year abstinence probabilities (Kaplan–Meier curves) and adjusted hazard ratios (aHRs) of relapse with 95% confidence intervals (CIs) using Cox regression. Findings: The overall probability of abstinence at 1 and 5 years was 0.561 (95% CI: 0.516–0.606) and 0.364 (95% CI: 0.311–0.417), respectively. Females had a higher, but not significant, hazard ratio for relapse compared to males (aHR = 1.180; 95% CI: 0.905–1.538). Attending <5 visits was the most remarkable determinant of relapsing compared to attending 5–9 visits or ≥10 visits, both overall and by sex (p for trend: overall, p < 0.001; males, p = 0.007; and females, p < 0.001). Conclusions: Abstinence probability decreased over the 5‐year follow‐up but was relatively high. Males had higher abstinence rates than females in all follow‐up periods. Completeness of the intensive intervention was the main predictor of cessation. Clinical Relevance: Smoking cessation interventions should consider sex and incorporate strategies to increase adherence to obtain higher long‐term abstinence rates. [ABSTRACT FROM AUTHOR]

Background: Cannabis use is increasing among Andalusian adolescents, causing health, social and financial problems. School nurses visit schools and provide health promotion to adolescents in Andalusia. In order to better tailor health promotion programs, it is important to understand the sociodemographic and motivational factors related to cannabis use in Andalusian adolescents. Design/Methods: In this cross‐sectional study, 369 students (aged 15–18 years) from secondary schools in Andalusia were involved. An anonymous questionnaire based on the I‐Change Model was self‐administered during school hours. Cannabis users were compared with non‐cannabis users regarding sociodemographic and motivational factors. Contingency tables, mean comparison tests, and logistic regression analyses were conducted. Results: The prevalence of cannabis use in the last year was 21.6%. Non‐cannabis users had a few positive beliefs toward cannabis use (e.g. the ability to relax or medical benefits), as well as users. Users recognized some disadvantages of cannabis use but played down their importance and mentioned more advantages. Moreover, social influence, especially from peers, plays a critical role in cannabis use. Specific social situations and moods seemed to be special risk factors for cannabis use, such as being at a celebration or feeling good. Results of regression analysis showed that cannabis use is mainly associated with age, low family function, low family affluence, high pocket money, perceiving few disadvantages of cannabis use, much social modeling of cannabis use, social norm and pressure favoring cannabis, low self‐efficacy to resist using cannabis and positive intentions to use cannabis. Conclusions: Based on our results, prevention programmes lead by nurses can be tailored to the factors important to prevent cannabis use, focusing on outlining the disadvantages of cannabis use, alternatives for using cannabis when feeling good, increasing salience of healthy social influences and reinforcing self‐efficacy to resist temptations to use cannabis are recommended. Clinical Relevance: Nurses need to know the sociodemographic factors and motivations associated with the use of cannabis in adolescents in order to establish effective preventive interventions at school. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to measure of health literacy in the migrant population and establish a type of immigrant profile with a higher risk of presenting low levels of health literacy. Design: A cross‐sectional descriptive study. Methods: Health literacy was measured in a total of 278 immigrants using HLS‐EU‐Q16. An inferential descriptive and multiple regression analysis was carried out. Results: 65.1% having inadequate and problematic health literacy. Significant correlations were found between health literacy and length of stay in Spain (r =.398), age (r =.178p) and perceived social status (r =.151). Participants with shorter length of stay (β =.405 1), without health sciences education (β =.205) and low education level (β =.182) had limited health literacy. [ABSTRACT FROM AUTHOR]

The COVID‐19 pandemic had a notable impact on the psychological well‐being of a large part of the population, putting them at risk of developing depressive symptoms, different levels of anxiety disorders, and posttraumatic stress disorder (PTSD). One group considered to be at high risk are Nursing students; they were affected as learning strategies changed and clinical practices were cancelled. This study attempts to assess the psychological impact COVID‐19 pandemic had on Nursing students and to explore the sociodemographic differences that can be risk factors for mental health disturbance. The psychological impact was evaluated using the Impact of Event Scale‐Revised (IES‐R) and Hospital Anxiety and Depression Scale (HADS). The study took place 4 months after the state of alarm was declared over in Spain. From a total sample of 304 Nursing students, 26.7%, 39.8%, and 15.5% showed PTSD, anxiety, and depression symptoms, respectively. Severe levels of psychological impact have been associated with being a female, a smoker, and feeling fear and stress. Having a relative test positive has been linked to lower anxiety levels while being afraid or stressed to higher anxiety levels. Being a female, co‐habit with friends and feeling stress have been associated with higher depression levels. [ABSTRACT FROM AUTHOR]

Aim: This study explores the profile of pregnant women interested in the online assessment of their emotional status according to their sociodemographic and obstetric characteristics, history of psychopathology, and healthcare setting used (private vs. public). Design: This is a comparative and descriptive cross‐sectional study. Method: Participants were 281 Spanish pregnant women assessed with the MamáFeliz (HappyMom) website. Results: Participants were probably to be unemployed, in a relationship, and generally had a high educational level and an intermediate economic status. Most of them were primiparous, had non‐complicated natural pregnancies and presented healthy habits and good physical and emotional health, despite 31.3% of them had a history of psychological treatment. Our results reveal the profile of women interested in the online assessment of their emotional status, which can contribute to improving future initiatives to facilitate rapid screenings of perinatal mental health by nurses in both public and private settings. [ABSTRACT FROM AUTHOR]

Introduction: The informed consent process is key to safeguarding the autonomy of the participant in medical research. For this process to be valid, the information presented to the potential participant should meet their needs and be understood by them. The i‐CONSENT project has developed 'Guidelines for adapting the informed consent process in clinical trials' which aim to improve informed consent so that they are easier to understand and better adapted to the needs and preferences of the target population. The best way to tailor information to the characteristics and preferences of the target population is to involve the community itself. Methods: Following guidelines developed by i‐CONSENT, assent materials were co‐created for a mock clinical trial of the human papillomavirus vaccine in adolescents. During the process, two design thinking sessions were conducted involving a total of 10 children and 5 parents. The objectives of the sessions were to find out the children's opinion of the informed consent (assent in their case) process in clinical trials, identify the parts that were most difficult to understand and alternatives for their presentation and wording, identify the preferred formats for receiving the information and the main characteristics of these formats, design a video explaining the clinical trial and evaluate a tool for assessing comprehension. Results: Assent materials were co‐created in three formats: a web‐based material following a layered approach; a video in story format; a pdf document with an innovative way of presenting information compared to traditional assent documents. In addition, the Comprehension of Assent Questionnaire was co‐designed, based on the Quality of Informed Consent questionnaire. Conclusion: The design thinking methodology has proven to be an easy and useful tool for involving children in designing information tailored to their needs and preferences. Patient or Public Contribution: A sample of the target population participated in the design and piloting of the materials created using design thinking methodology. In addition, patient representatives participated in the design and evaluation of the guidelines developed by the i‐CONSENT project that were followed for the development of the materials in this study. [ABSTRACT FROM AUTHOR]

Objectives: The use of off‐label pharmacotherapies for neuropathic pain (NP) is growing relating to the many unmet needs of patients. However, clinical guidelines fail to address it, and the available evidence is sparse and fragmented. We arranged a formal expert consensus to address this controversial issue and provide some guidance on judicious use. Methods: A two‐round standard Delphi survey that involved pain clinic specialists with experience in the research and management of NP was done over an ad hoc 40‐item questionnaire prepared by the authors. Consensus on each statement was defined as at least either 80% endorsement or rejection after the second round. Results: Forty‐three and thirty‐seven panelists participated in the first and second round, respectively. Consensus was reached in 34 out of 40 statements. Endorsed alternatives for unresponsive patients include non‐gabapentinoid antiepileptics (oxcarbazepine and eslicarbazepine), venlafaxine, intravenous lidocaine (when doses can be optimized), and some vaporized cannabinoids (under appropriate surveillance). In addition, lacosamide, low‐dose naltrexone, propofol, or ketamine could prove beneficial if subjected to more research. Other options were rejected, and there was controversy about the usefulness of topical preparations. Discussion: For patients who do not respond to standard NP treatments, some other viable pharmacological options can be attempted before advancing to other therapeutic stages. This may help patients who are reluctant to or have some contraindication for interventional therapies. [ABSTRACT FROM AUTHOR]

Aim: To explore the impact of the COVID‐19 pandemic on the mental health of nurses working in primary, secondary, and tertiary healthcare centers in Navarre (Spain). Background: Healthcare workers, especially nurses, are at high risk for developing mental health problems during the COVID‐19 pandemic. Introduction: Spain ranks among the European countries with the highest incidence of and mortality from COVID‐19 and has a 31% deficit in the number of nurses compared with the average for the European Union. Methods: This was a cross‐sectional study involving 800 Registered Nurses in Navarre, Spain. Four standardized instruments, along with a self‐administered online questionnaire, were used to measure the impact in terms of depression, anxiety, insomnia, and posttraumatic stress disorder. The STROBE checklist for cross‐sectional studies was used to report this study. Results: Of the 800 nurses, 68% had some level of depression, anxiety, insomnia, and distress, and of these, 38% had moderate or severe symptoms. Those who worked in hospital COVID units and in nursing homes showed a higher impact on their mental health. Discussion: The sustained pressure that nurses have experienced in their work during the COVID‐19 pandemic has negatively affected their mental health. Conclusion: This study found that nurses who worked in hospital COVID units and in nursing homes during the pandemic had worse mental health outcomes. Implications for nursing/policy: Recommendations for nursing policy include the need to implement coaching and emotional programs to support nurses on the frontlines of the pandemic. There is also an urgent need for the implementation of national training programs to strengthen health emergency preparedness, improve response capacity, and increase the resilience of nurses to disasters. [ABSTRACT FROM AUTHOR]

This article argues that family firms in which the top management team (TMT) is dominated by nonfamily managers are more likely to shift risk to employees through incentive pay schemes than family firms with TMTs dominated by family members. We also argue that this tendency is aggravated in firms of bigger size, as this condition makes nonfamily managers more vulnerable. We further note that differences between family‐ and non‐family‐dominated TMTs may lessen when the sales trend is negative. The analyses conducted on a sample of 219 family‐controlled car dealerships in Spain confirm our expectations. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to determine the prevalence of feelings of being a second victim among midwives and obstetricians in Spain and to explore possible differences between the two professions. Design: Cross‐sectional descriptive‐analytical observational study. Methods: An online survey collecting several variables was administered throughout the Spanish territory. Spanish version of the Second Victim Experience and Support Tool (SVEST) was used. The data collection period was from May to December 2020. Results: A total sample of 719 obstetricians and midwives were studied. There were significant differences between the two groups with respect to seven dimensions of SVEST: greater feelings of being a second victim among obstetricians in the dimensions physical distress/p ≤.001, non‐work‐related support/p ≤.001 and absenteeism/p ≤.001 and greater feelings of being a second victim among midwives in the dimensions psychological distress/p ≤.001, supervisor support/p =.011, professional self‐efficacy/p ≤.001 and intention to change jobs/p ≤.001. [ABSTRACT FROM AUTHOR]

Background and purpose: Social engagement is an important active aging strategy to promote older adults' mental health. The purposes of this study were to compare social engagement in older populations around the world and explore associations with mental health outcomes. Materials and methods: An international cross‐sectional survey was conducted from 2017 to 2019. Data were retrieved from The International Social Survey Programme for a secondary data analysis across 30 countries. This study applied the Taxonomy of Social Activities and its six levels as operational definitions for a consistent concept of social engagement for international comparisons. Results: In total, 9403 older adults with a mean age of 72.85 ± 6.40 years responded. The highest levels of older adults' social engagement were found in Switzerland, Thailand, and New Zealand. Older adults of a higher age, with a lower educational level, who were permanently sick or disabled, who had no partner, who were widowed or whose civil partner had died, who lived alone, and who had lower self‐placement in society had significantly lower social engagement than did their counterparts. In the regression model, older adults' social engagement positively predicted general health, self‐accomplishment, and life satisfaction, but negatively predicted loneliness and depression. Conclusions: In aging societies worldwide, encouraging older adults' social engagement would be beneficial to promote mental health. Implications for nursing practice and health policies: Community professional nurses can develop strategies of social engagement based on the needs and sociodemographic factors of older adults to improve their mental health. Developing efficient strategies and local policies by learning from successful experiences in other countries is important to promote social engagement in aging societies. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to contribute to the international scientific literature that highlights the benefits of children walking to school without adult supervision, and its influence on aspects such as mobility autonomy and health (among others). The study included 215 children from a public school in the municipality of Bilbao, Spain in the 3rd, 4th, 5th and 6th grades of Primary Education. The questionnaire consisted of different validated scales on independence of mobility, self‐esteem and happiness. Our findings suggest that students who participate in the 'friendly paths' project have greater independent mobility in comparison with those who do not, whilst it is noteworthy that this type of project primarily affects the closer spaces or school journeys. Moreover, our findings indicate that variables such as gender and age are determining factors in the independence of mobility, with older children showing greater autonomy. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to evaluate the psychological impact on nursing students at the end of period of confinement during the first wave of the COVID‐19 outbreak in Spain. Design: A cross‐sectional study reported in line with the STROBE guidelines. Methods: Nursing students were invited to complete an online questionnaire at the end of the 2019–2020 academic year using convenience sampling. The questionnaire collected data on sociodemographic factors, work, and life experiences in relation to COVID‐19, habits and lifestyle using the World Health Organization Five Well‐Being Index (WHO‐5) and the Generalized Anxiety disorder‐7 scale. Variables related to anxiety were analysed using multiple lineal regression analysis, Results: The prevalence of low psychological well‐being in the 203 students was 44.3% and of anxiety 55.7%. In the multivariate analysis the variables associated with anxiety were having worked in the pandemic, having had symptoms of COVID‐19 and having been afraid of getting infected. Conclusions: The levels of anxiety due to the COVID‐19 pandemic in nursing students have been high, and levels of psychological well‐being have been low. The fact of having worked during the pandemic, having had symptoms compatible with COVID‐19 or being afraid of getting infected are associated with the highest scores for anxiety. Relevance to clinical practice: This study gives more evidence on the psychological impact on nursing students during the first wave of the pandemic in Spain. This can be used to design anxiety management programmes for inclusion into teaching syllabuses. It also gives arguments for the setting up of psychological and emotional support services for these students and other healthcare professionals working during the pandemic. [ABSTRACT FROM AUTHOR]

Objective: To analyze the impact of the foot health and health behavior and the characteristics of outdoor footwear among minority ethnic groups. Design and measures: A cross‐sectional study design using the Foot Health Status Questionnaire: foot pain, foot function, shoe, general foot health, general health, physical activity, social capacity, and vigor. Outcomes included the self‐reported type of outdoor footwear and clinical characteristics by sex were collected in 2019–2020. Sample: A total of 78 Roma participants self‐identified as members of this ethnic minority and 72 participants non‐Roma were assessed (n = 150). Results: The lower score values was recorded in the footwear and general foot health domains in Roma population. General population obtained higher scores in general health domains. The most common outdoor footwear types were running shoes and walking shoes in non‐Roma population, versus flip flops and slippers in Roma population. Clinical characteristics did not show any statistically significant differences (p <.05). Conclusion: Roma people wear flip flops and slippers and non‐Roma people running shoes and walking shoes. These findings reveal cultural differences that make it easier for the Roma population to experience a greater burden of foot health problems. General foot health and foot pain dimensions show statistically significant differences among ethnicity. [ABSTRACT FROM AUTHOR]

Introduction: Smokers are frequent users of healthcare services. Admissions to hospital can serve as a "teachable moment" for quitting smoking. Clinical guidelines recommend initiating smoking cessation services during hospitalization; however, in Southern European countries less than 5% of inpatients receive a brief intervention for smoking cessation. Objectives: The aims of this study were (i) to examine rates of smoking abstinence during and after hospitalization; (ii) to measure changes in smoking patterns among persons who continued smoking after discharge; and (iii) to identify predictors of abstinence during hospitalization and after discharge. Methods: A cohort study of a representative sample of current adult smokers hospitalized in two Spanish and two Portuguese hospitals. We surveyed smokers during hospitalization and recontacted them one month after discharge. We used a 25‐item ad hoc questionnaire regarding their smoking pattern, the smoking cessation intervention they have received during hospitalization, and hospital and sociodemographic characteristics. We performed a descriptive analysis using the chi‐square test and a multivariate logistic regression to characterize the participant, hospital, and smoking cessation intervention (5As model) characteristics associated with smoking abstinence. Results: Smoking patients from both countries presented high abstinence rates during hospitalization (Spain: 76.4%; Portugal: 70.2%); however, after discharge, their abstinence rates decreased to 55.3% and 46.8%, respectively. In Spain, smokers who tried to quit before hospital admission showed higher abstinence rates, and those who continued smoking reduced a mean of five cigarettes the number of cigarettes per day (p ≤ 0.001). In Portugal, abstinence rates were higher among women (p = 0.030), those not living with a smoker (p = 0.008), those admitted to medical‐surgical wards (p = 0.035), who consumed their first cigarette within 60 min after waking (p = 0.006), and those who were trying to quit before hospitalization (p = 0.043). Conclusions: Half of the smokers admitted into the Spanish hospitals are abstinent one month after discharge or have reduced their cigarettes per day. Nevertheless, success rates could be increased by implementing evidence‐based tobacco cessation programs at the organizational‐level, including post‐discharge active quitting smoking support. Clinical relevance: Three‐quarters of the inpatients who smoke remain abstinent during hospitalization and over half achieve to maintain their abstinence or at least reduce their consumption one month after discharge, proving that admission to hospitals is an excellent teachable moment to quit smoking. [ABSTRACT FROM AUTHOR]

Aim: The Memory Failures of Everyday (MFE) is a widely used instrument for assessing memory failure. The aim of the study was to analyze the MFE items using the Rasch model in a sample of cognitively older adults in Spain. Methods: A cross‐sectional validation study in a sample of 214 healthy people aged ≥60 years who used centers for older people in Madrid (Spain). The MFE for the assessment of memory complaints was used. The following properties of the Rasch model were assessed: data fit, reliability, unidimensionality, local dependence and lack of differential item functioning by gender, age and marital status. Results: The MFE showed a good fit to the Rasch model (χ2(140) = 160.2; P = 0.116) and high reliability (person separation index = 0.808). The questionnaire was unidimensional (6.54% t‐test; IC binomial = 0.036–0.095). The items showed lack of local dependence between them and differential item functioning. The MFE scores were transformed into linear interval scores with a median of 44.31 and an observed range of 17.9–89.2 (theoretical range: 0–100). Conclusions: The MFE is a unidimensional, reliable instrument to assess memory complaints in cognitively healthy older adults in Spain, with usefulness in clinical research and practice. The construct validity of the MFE linear score could not be fully confirmed and this deserves further investigation. Geriatr Gerontol Int 2022; 22: 332–337. [ABSTRACT FROM AUTHOR]

Rationale aims and objectives: The available evidence on the use of heuristics and their relationship with diagnostic error in primary care is very limited. The aim of the study is to identify the use of unknown thought and specifically the possible use of Representativeness, Availability and overconfidence heuristics in the clinical practice of primary care physicians in cases of dyspnoea and to analyse their possible relationship with diagnostic error. Methods: A total of 371 patients consulting with new episodes of dyspnoea in Primary Care centres in Spain were registered. Based on specific operational definitions, the use of unconscious thinking and the use of heuristics during the diagnostic process were assessed. Subsequently, the association between their use and diagnostic error was analysed. Results: In 49.6% of cases, the confirmatory diagnosis coincided with the first diagnostic impression, suggesting the use of the representativeness heuristic in the diagnostic decision process. In 82.3% of the cases, the confirmatory diagnosis was among the three diagnostic hypotheses that were first identified by the general physicians, suggesting a possible use of the availability heuristic. In more than 50% of the cases, the physicians were overconfident in the certainty of their own diagnosis. Finally, a diagnostic error was identified in 9.9% of the recorded cases and no statistically significant correlation was found between the use of some unconscious thinking tools (such as the use of heuristics) and the diagnostic error. Conclusion: Unconscious thinking manifested through the acceptance of the first diagnostic impression and the use of heuristics is commonly used by primary care physicians in the clinical decision process in the face of new episodes of dyspnoea; however, its influence on diagnostic error is not significant. The proposed explicit and reproducible methodology may inspire further studies to confirm these results. [ABSTRACT FROM AUTHOR]

Aim: To describe the impact of the COVID‐19 pandemic on stress, resilience and depression in health professionals from a public hospital in Barcelona, Spain after the first peak of pandemic. Background: The COVID‐19 pandemic in Spain has pushed boundaries in health systems and, especially, for health professionals. Analysis of resilience as an individual resource and it is essential to understand the mechanisms that make staff react unfavourably to stressors caused by the pandemic. Design: A descriptive cross‐sectional study was designed. Participants: Health professionals supervised by the nursing department, including registered nurses, health care assistants, health technicians, final year nurse student nurses, foreign nurses, and other nurse‐related health workers. Methods: The study complies with the STROBE checklist for cross‐sectional studies. An online survey was administered to all health professionals supervised by the nursing department between 6 and 27 May 2020. The survey included the ER‐14 Resilience Scale, the widely‐used PHQ‐9 depression scale, the Spanish version of the Nursing Stress Scale, and an ad‐hoc questionnaire to obtain sociodemographic and occupational variables. Results: A total of 686 participants answered the survey. Resilience was high or very high in health professionals, with an inverse correlation with stress and depression scores. Personal on fixed shifts showed better resilience. The most stressed health professionals were full‐time registered nurses, followed by health care assistants. Up to 25% of nursing professionals had depression. Conclusion: Our study showed a high degree of resilience among nurse professionals despite the overwhelming nature of the COVID‐19 pandemic. Relevant signs of depression and stress were detected among participants. Occupational factors heavily influenced nurses' resilience, stress and depression. Implications for Nursing & Health Policy: Government policy shifts are needed in Spain to improve nurses' workforce conditions, enhance the ratio of nurses to patient numbers, and avoid workforce losses. Maintaining the resilience of health professionals would assist in improving their health and their capacity to possible future emergency situations. [ABSTRACT FROM AUTHOR]

Given negative social identity, different perceptions of the structure of an intergroup relation (i.e., stability, legitimacy, permeability) should be related to different identity‐management strategies (i.e., social competition, social creativity, or individual mobility) depending on group identification. This is among the basic tenets of social identity theory (SIT). There is surprisingly little empirical support for these postulates in the context of one of the most central group identities: gender. Using a sample of female leaders in Spain in a Pilot Study (N = 649) and in Germany in the preregistered Main Study (N = 687), we tested relations between structural perceptions and identity‐management strategies. Whereas structural equation modeling yielded empirical support regarding social competition but little for other strategies in the Pilot Study, the results were even less in line with SIT's predictions in the Main Study. We discuss reasons why only weak support for SIT emerged in this intergroup context. [ABSTRACT FROM AUTHOR]

MANZANO GARCÍA G. & AYALA CALVO J. C. (2011) Emotional exhaustion of nursing staff: influence of emotional annoyance and resilience. International Nursing Review 59, 101-107 Aim: This paper aimed to study the influence of emotional annoyance and resilience on the emotional exhaustion levels of nursing staff. Background: Emotional exhaustion is one of the key factors in understanding both the performance and the quality of care that nurses give to their patients. There is a considerable body of knowledge that has focused on the study of emotional exhaustion in relation to cynicism and professional efficiency. More recently emotional annoyance and resilience have been identified as variables that could help explain levels of emotional exhaustion. Methods: Nine hundred eighty-three nurses who work in five hospitals in the north of Spain were invited to participate in the study. Five hundred questionnaires were distributed, of which 200 were fully completed. The average response rate was 40%. A personal information form, and a questionnaire concerning nurses' emotional annoyance, resilience, professional efficiency and cynicism were used as data collection instruments. To estimate a path model with latent variables, partial least squares was used. Findings: Emotional annoyance and resilience contribute to a better understanding of emotional exhaustion levels of nursing staff. There was a significant association between emotional annoyance and emotional exhaustion (β = 0.26, P = 0.020), while resilience appeared to be protective against emotional exhaustion (β = −0.22, P = 0.004). Conclusion: A more complete explanation and understanding of emotional exhaustion in nursing is achieved when emotional annoyance and resilience is measured in addition elements of burnout, which include professional efficiency and cynicism. [ABSTRACT FROM AUTHOR]

Aim: To assess pain management nursing practice in older adults with dementia through electronic health records (EHR). Design: Retrospective study. Methods: Data were collected from EHR related to pain management in older adults with dementia treated at the Acute Geriatrics Unit (AGU) of a university hospital in early 2018. Results: EHR related to the pain of 111 patients were reviewed. Pain intensity was assessed at admission in 88% of patients and a median of 1.9 times per day of stay. A disproportionate number of the assessments (39%) occurred during the late shift. A median of 1 drug per day was administered. Pain was recorded in 28% of patients' care plans, and non‐pharmacological interventions were recorded in 12%. In conclusion, exist variability in pain management nursing practice in older adults with dementia. Admission diagnosis correlated with the analgesic administration schedule, the number of drugs administered and the number of pain nursing annotations. [ABSTRACT FROM AUTHOR]

Introduction: Chemsex in a European context is the use of any of the following drugs to facilitate sex: crystal methamphetamine, mephedrone and gamma‐hydroxybutyrate (GHB)/gamma‐butyrolactone (GBL) and, to a lesser extent, cocaine and ketamine. This study describes the prevalence of self‐reported recreational drug use and chemsex in HIV‐positive men who have sex with men (MSM) accessing HIV services in four countries. It also examines the problematic impacts and harms of chemsex and access to chemsex‐related services. Methods: This is a cross‐sectional multi‐centre questionnaire study of HIV‐positive MSM accessing nine HIV services in the UK, Spain, Greece and Italy. Results: In all, 1589 HIV‐positive MSM attending HIV services in four countries completed the questionnaire. The median age of participants was 38 years (interquartile range: 32–46 years) and 1525 (96.0%) were taking antiretroviral therapy (ART). In the previous 12 months, 709 (44.6%) had used recreational drugs, 382 (24.0%) reported chemsex and 104 (6.5%) reported injection of chemsex‐associated drugs ('slamsex'). Of the 382 engaging in chemsex, 155 (40.6%) reported unwanted side effects as a result of chemsex and 81 (21.2%) as a result of withdrawal from chemsex. The reported negative impacts from chemsex were on work (25.1%, 96), friends/family (24.3%, 93) and relationships (28.3%, 108). Fifty‐seven (14.9%) accessed chemsex‐related services in the past year, 38 of whom (67%) felt the service met their needs. Discussion: A quarter of participants self‐reported chemsex in the past 12 months. There were high rates of harms from chemsex across all countries, including negative impacts on work, friends/family and relationships. Although a minority of those engaging in chemsex accessed support, most found this useful. [ABSTRACT FROM AUTHOR]

Background: The situation of the COVID‐19 global pandemic has generated an unprecedented state of emergency worldwide that has had a psychological impact on health care workers working in the ICU and this has created the need to implement different psychological strategies. Aim: This study explores (a) the prevalence of symptoms associated with generalized anxiety disorder (GAD), (b) the relationship between GAD symptoms and resilience skills, and (c) which of the resilience skills were associated with a probable GAD among the ICU professionals during the COVID‐19 pandemic. Study design Cross‐sectional survey design. Methods: We explored anxiety and resilience in 448 ICU health care workers using an online survey. Results: The participants showed high resilience levels and more than half of them presented symptoms consistent with a possible diagnosis of GAD. The GAD symptoms were more prevalent among women, nursing assistants, interns, staff who worked on rotation and health care workers who had to attend to more than 20 COVID patients. Significant negative correlations between resilience skills and GAD symptoms were found. The multiple regression analysis showed that resilience skills contribute to 14.4% of the variance for GAD symptoms. The binary logistic regression showed that the only skill that had a significant and negative predictive effect was "I usually take things in my stride" (OR = 0.774, 95% CI 0.67, 0.88; P =.000). This ability was the differentiating skill between professionals who equal or exceed the cut‐off point established for the diagnosis of a probable GAD regarding those who do not. Conclusion: ICU professionals developed symptoms consistent with a possible diagnosis of GAD due to their exposure to extremely stressful circumstances. However, resilience skills acted as a protective factor. Relevance to clinical practice: The importance of incorporating programmes that mitigate these psychological effects and to promote adaptive coping styles during pandemics has become a need after what ICU professionals have gone through. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore cross‐level mechanisms stimulating employees' innovative behavior in small firms, specifically emotional contagion between small business owners and their employees. Using data from three European countries and applying a multilevel approach, we tested how small business owners' work‐related affect—enthusiasm and comfort—relate to their employees' work‐related affect and innovative work behavior. The sample consisted of 85 small business owners and 711 employees from firms operating in the Netherlands, Poland, and Spain. Controlling for country, the results of multilevel modeling showed that small business owners' work‐related affect was positively related to their employees' work‐related affect. The hypothesized contagion of work‐related affect in small firms was, thus, supported. Employees' work‐related affect, in turn, was positively associated with their innovative behavior. Employees' work‐related affect mediated the relationship between small business owners' work‐related affect and employees' innovative behavior. The results also showed cross‐country differences in the strength of some of the relationships. The study is a step forward in understanding innovation in small firms, extending the insights gained from single‐level investigations. [ABSTRACT FROM AUTHOR]

PURPOSE: To develop a preliminary clinical validation the NANDA‐I nursing diagnosis "Grieving" in cases of perinatal loss. METHODS: Descriptive cross‐sectional study using the Fehring model. FINDINGS: The overall clinical validity index for the diagnosis was 0.15. Only four defining characteristics and five manifestations identified in the literature were validated. CONCLUSIONS: The variability of manifestations identified in the study participants is considered to be detrimental to the overall clinical validity index. IMPLICATIONS FOR NURSING PRACTICE: The clinical validity of the diagnosis could not be substantiated by the preliminary results of this study and, therefore, additional research is necessary to determine the ability of the diagnosis to adapt to perinatal loss situations in real contexts. Some manifestations have been proposed to NANDA‐I for inclusion as defining characteristics in the nursing diagnosis of grieving. OBJETIVO: Validar clínicamente de forma preliminar el diagnóstico enfermero NANDA‐I duelo en caso de pérdida perinatal. MÉTODOS: Estudio descriptivo transversal usando el modelo de Fehring. RESULTADOS: El índice de validez clínica global del diagnóstico fue de 0.15. Se validaron únicamente cuatro características definitorias y cinco manifestaciones identificadas en la literatura. CONCLUSIONES: Se considera que la variabilidad de las manifestaciones presentadas por los participantes actuó en detrimento del índice de validación clínica global. IMPLICACIONES PARA LA PRÁCTICA ENFERMERA: La validez clínica del diagnóstico no pudo ser corroborada por los resultados preliminares de este estudio y, por tanto, se necesita investigación adicional para terminar la capacidad de este diagnóstico para adaptarse a las situaciones de pérdidas perinatales en contexto reales. Se han propuesto a NANDA‐I algunas manifestaciones para que sean incluidas como Características Definitorias del diagnóstico enfermero Duelo. [ABSTRACT FROM AUTHOR]

Prevalence of chronic diseases and multimorbidity is rising, and it remains unclear what the best strategy is for activating people with chronic conditions in their self‐care. We designed a two‐group quasi‐experimental time series trial to examine the effectiveness of a nurse‐led, face‐to‐face, individually‐tailored health coaching (HC) intervention in improving patient activation and secondary outcomes (self‐efficacy, quality of life, anxiety and depression symptoms, medication adherence, hospitalization and emergency visits) among primary care users with chronic conditions. A total of 118 people with chronic conditions were recruited through a primary care center and allocated to either the intervention group (IG) (n = 58) or control group (CG) (n = 60). The IG received a nurse‐led individually‐tailored HC intervention involving 4–6 face‐to‐face multicomponent sessions covering six core activation topics. The CG received usual primary care. Data were collected at baseline, after the intervention (6 weeks after baseline for controls) and at 6 and 12 months from baseline. Compared with controls, the IG had significantly higher patient activation scores after the intervention (73.29 vs. 66.51, p =.006). However, this improvement was not maintained at follow‐up and there were no significant differences in secondary outcomes across the study period. HC may be an effective strategy for achieving short‐term improvements in the activation of primary care users with chronic conditions. Further studies with different methodological approaches are needed to elucidate how HC may improve and sustain changes in patient activation. [ABSTRACT FROM AUTHOR]

Advances in the research of work performance have been due in large part to the conceptualization of performance as a multidimensional construct. Recently, Griffin, Neal, and Parker (2007), have identified three different dimensions of work role performance: proficiency, adaptivity, and proactivity. Social effectiveness constructs (i.e., political skill) have been receiving increased attention in research and there have been recent calls for further research in the area. This study compares the explanatory capacity of political skill, professional experience and intrinsic motivation in the prediction of engineers' proficiency, adaptivity, and proactivity. The relationships were tested with structural equations analysis of 180 supervisor-engineer dyad data. Results indicate that the three dimensions of individual work performance are significantly influenced by political skill and professional experience, but not by intrinsic motivation. The results also indicate that political skill is the strongest predictor. © 2014 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]