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Abstract Background Most health systems are insufficiently prepared to promote the participation of chronically ill patients in their care. Strong primary health care (PHC) strengthens patients' resources and thus promotes their participation. The tasks of providing continuous care to people with chronic diseases and promoting self‐management are the responsibility of PHC nurses. Recent research assessing enablers of or barriers to nurses' efforts to support patients' participation has mostly not considered the special situation of patients with chronic diseases or focused on the PHC setting. Objective To investigate enablers of and barriers to PHC nurses' efforts to promote the participation of chronically ill patients in their care. Methods We interviewed 34 practicing PHC nurses and 23 key informants with advanced knowledge of PHC nursing practice in Brazil, Germany and Spain. The data was analyzed using thematic coding. Results We identified four categories of barriers and enablers. (1) Establishing bonds with patients: Interviewees emphasized that understanding patients' views and behaviours is important for PHC nurses. (2) Cooperation with relatives and families: Good relationships with families are fundamental, however conflicts within families could challenge PHC nurses efforts to strengthen participation. (3) Communication and cooperation within PHC teams: PHC nurses see Cooperative team structures as a potential enabler, while the dominance of a ‘biomedical’ approach to patient care is seen as a barrier. (4) Work environment: Interviewees agreed that increased workload is a barrier to patient participation. Discussion and Conclusions Supporting patient participation should be acknowledged as an important responsibility for nurses by general practitioners and PHC planners. PHC nurses should be trained in communicative competence when discussing participation with chronically ill patients. Interprofessional education could strengthen other professionals' understanding of patient participation as a nursing task. Patient or Public Contribution This study is part of a research project associated with the research network ‘forges: User‐oriented care: Promotion of health in the context of chronic diseases and care dependency’. The study's focus and provisional results were discussed continuously with partners in health and social care practice and presented to and discussed with the public at two conferences in which patient representatives, professionals and researchers participated.

Abstract Background The present study describes the effectiveness of a complex intervention that addresses multiple lifestyles to promote healthy behaviours in increasing adherence to the Mediterranean diet (MD). Methods Cluster-randomised, hybrid clinical trial controlled with two parallel groups. The study was carried out in 26 primary Spanish healthcare centres. People aged 45–75 years who presented at least two of the following criteria were included: smoker, low adherence to the MD or insufficient level of physical activity. The intervention group (IG) had three different levels of action: individual, group, and community, with the aim of acting on the behaviours related to smoking, diet and physical activity at the same time. The individual intervention included personalised recommendations and agreements on the objectives to attain. Group sessions were adapted to the context of each healthcare centre. The community intervention was focused on the social prescription of resources and activities performed in the environment of the community of each healthcare centre. Control group (CG) received brief advice given in the usual visits to the doctor’s office. The primary outcome was the change, after 12 months, in the number of participants in each group with good adherence to the MD pattern. Secondary outcomes included the change in the total score of the MD adherence score (MEDAS) and the change in some cardiovascular risk factors. Results Three thousand sixty-two participants were included (IG = 1,481, CG = 1,581). Low adherence to the MD was present in 1,384 (93.5%) participants, of whom 1,233 initiated the intervention and conducted at least one individual visit with a healthcare professional. A greater increase (13.7%; 95% CI, 9.9–17.5; p

BackgroundMultimorbidity and frailty are characteristics of aging that need individualized evaluation, and there is a 2-way causal relationship between them. Thus, considering frailty in analyses of multimorbidity is important for tailoring social and health care to the specific needs of older people. ObjectiveThis study aimed to assess how the inclusion of frailty contributes to identifying and characterizing multimorbidity patterns in people aged 65 years or older. MethodsLongitudinal data were drawn from electronic health records through the SIDIAP (Sistema d’Informació pel Desenvolupament de la Investigació a l’Atenció Primària) primary care database for the population aged 65 years or older from 2010 to 2019 in Catalonia, Spain. Frailty and multimorbidity were measured annually using validated tools (eFRAGICAP, a cumulative deficit model; and Swedish National Study of Aging and Care in Kungsholmen [SNAC-K], respectively). Two sets of 11 multimorbidity patterns were obtained using fuzzy c-means. Both considered the chronic conditions of the participants. In addition, one set included age, and the other included frailty. Cox models were used to test their associations with death, nursing home admission, and home care need. Trajectories were defined as the evolution of the patterns over the follow-up period. ResultsThe study included 1,456,052 unique participants (mean follow-up of 7.0 years). Most patterns were similar in both sets in terms of the most prevalent conditions. However, the patterns that considered frailty were better for identifying the population whose main conditions imposed limitations on daily life, with a higher prevalence of frail individuals in patterns like chronic ulcers &peripheral vascular. This set also included a dementia-specific pattern and showed a better fit with the risk of nursing home admission and home care need. On the other hand, the risk of death had a better fit with the set of patterns that did not include frailty. The change in patterns when considering frailty also led to a change in trajectories. On average, participants were in 1.8 patterns during their follow-up, while 45.1% (656,778/1,456,052) remained in the same pattern. ConclusionsOur results suggest that frailty should be considered in addition to chronic diseases when studying multimorbidity patterns in older adults. Multimorbidity patterns and trajectories can help to identify patients with specific needs. The patterns that considered frailty were better for identifying the risk of certain age-related outcomes, such as nursing home admission or home care need, while those considering age were better for identifying the risk of death. Clinical and social intervention guidelines and resource planning can be tailored based on the prevalence of these patterns and trajectories.

Abstract Background This study aimed to evaluate the effectiveness of a) a Multiple Health Behaviour Change (MHBC) intervention on reducing smoking, increasing physical activity and adherence to a Mediterranean dietary pattern in people aged 45–75 years compared to usual care; and b) an implementation strategy. Methods A cluster randomised effectiveness-implementation hybrid trial-type 2 with two parallel groups was conducted in 25 Spanish Primary Health Care (PHC) centres (3062 participants): 12 centres (1481 participants) were randomised to the intervention and 13 (1581 participants) to the control group (usual care). The intervention was based on the Transtheoretical Model and focused on all target behaviours using individual, group and community approaches. PHC professionals made it during routine care. The implementation strategy was based on the Consolidated Framework for Implementation Research (CFIR). Data were analysed using generalised linear mixed models, accounting for clustering. A mixed-methods data analysis was used to evaluate implementation outcomes (adoption, acceptability, appropriateness, feasibility and fidelity) and determinants of implementation success. Results 14.5% of participants in the intervention group and 8.9% in the usual care group showed a positive change in two or all the target behaviours. Intervention was more effective in promoting dietary behaviour change (31.9% vs 21.4%). The overall adoption rate by professionals was 48.7%. Early and final appropriateness were perceived by professionals as moderate. Early acceptability was high, whereas final acceptability was only moderate. Initial and final acceptability as perceived by the participants was high, and appropriateness moderate. Consent and recruitment rates were 82.0% and 65.5%, respectively, intervention uptake was 89.5% and completion rate 74.7%. The global value of the percentage of approaches with fidelity ≥50% was 16.7%. Eight CFIR constructs distinguished between high and low implementation, five corresponding to the Inner Setting domain. Conclusions Compared to usual care, the EIRA intervention was more effective in promoting MHBC and dietary behaviour change. Implementation outcomes were satisfactory except for the fidelity to the planned intervention, which was low. The organisational and structural contexts of the centres proved to be significant determinants of implementation effectiveness. Trial registration ClinicalTrials.gov , NCT03136211 . Registered 2 May 2017, “retrospectively registered”.

Summary: Background: Prevalence of both multimorbidity and frailty increases with age, but more evidence is needed to elucidate their relationship and their association with other health-related outcomes. We analysed the dynamics of both conditions as people age and calculate the associated risk of death, nursing home admission, and need for home care. Methods: Data were drawn from the primary care electronic health records of a longitudinal cohort of people aged 65 or older in Catalonia in 2010–2019. Frailty and multimorbidity were measured using validated instruments (eFRAGICAP, a cumulative deficit model; and SNAC-K, respectively), and their longitudinal evolution was described. Cox regression models accounted for the competing risk of death and adjusted by sex, socioeconomical status, and time-varying age, alcohol and smoking. Findings: We included 1 456 052 patients. Prevalence of multimorbidity was consistently high regardless of age, while frailty almost quadrupled from 65 to 99 years. Frailty worsened and also changed with age: up to 84 years, it was more related to concurrent diseases, and afterwards, to frailty-related deficits. While concurrent diseases contributed more to mortality, frailty-related deficits increased the risk of institutionalisation and the need for home care. Interpretation: The nature of people’s multimorbidity and frailty vary with age, as does their impact on health status. People become frailer as they age, and their frailty is more characterised by disability and other symptoms than by diseases. Mortality is most associated with the number of comorbidities, whereas frailty-related deficits are associated with needing specialised care. Funding: Instituto de Salud Carlos III through PI19/00535, and the PFIS Grant FI20/00040 (Co-funded by European Regional Development Fund/European Social Fund).

Abstract Background Multiple health behaviour change (MHBC) interventions that promote healthy lifestyles may be an efficient approach in the prevention or treatment of chronic diseases in primary care. This study aims to evaluate the cost-utility and cost-effectiveness of the health promotion EIRA intervention in terms of MHBC and cardiovascular reduction. Methods An economic evaluation alongside a 12-month cluster-randomised (1:1) controlled trial conducted between 2017 and 2018 in 25 primary healthcare centres from seven Spanish regions. The study took societal and healthcare provider perspectives. Patients included were between 45 and 75 years old and had any two of these three behaviours: smoking, insufficient physical activity or low adherence to Mediterranean dietary pattern. Intervention duration was 12 months and combined three action levels (individual, group and community). MHBC, defined as a change in at least two health risk behaviours, and cardiovascular risk (expressed in % points) were the outcomes used to calculate incremental cost-effectiveness ratios (ICER). Quality-adjusted life-years (QALYs) were estimated and used to calculate incremental cost-utility ratios (ICUR). Missing data was imputed and bootstrapping with 1000 replications was used to handle uncertainty in the modelling results. Results The study included 3062 participants. Intervention costs were €295 higher than usual care costs. Five per-cent additional patients in the intervention group did a MHBC compared to usual care patients. Differences in QALYS or cardiovascular risk between-group were close to 0 (-0.01 and 0.17 respectively). The ICER was €5,598 per extra health behaviour change in one patient and €1,727 per one-point reduction in cardiovascular risk from a societal perspective. The cost-utility analysis showed that the intervention increased costs and has no effect, in terms of QALYs, compared to usual care from a societal perspective. Cost-utility planes showed high uncertainty surrounding the ICUR. Sensitivity analysis showed results in line with the main analysis. Conclusion The efficiency of EIRA intervention cannot be fully established and its recommendation should be conditioned by results on medium-long term effects. Trial registration Clinicaltrials.gov NCT03136211 . Registered 02 May 2017 – Retrospectively registered

Introduction: Diet and physical activity are factors that have key roles in childhood overweight and obesity prevention. Appropriate assessment of these factors is an essential task in public health. Objective: The main aims of the study are to assess body composition, physical activity, and adherence to Mediterranean diet of soccer players, aged 13 to 16 years old in Asturias, Spain. It also aims to evaluate the relationships between diet, physical activity, body composition, and personal characteristics. Methods: A cross-sectional descriptive survey approach was used involving children (n = 303) with a mean age of 14.15 years (SD = 1.06), and using the KIDMED and PAQ-A questionnaires to assess adherence to Mediterranean diet and level of physical activity, respectively. Body composition was represented using the participants’ body mass index. Results: Approximately 23.1% of the participants were overweight or obese. With regards to adherence to Mediterranean diet, 54.8% of the participants had medium adherence, while 8.9% had low adherence. PAQ-A mean score was 2.69 (SD = 0.47). Excess weight was associated with being a goalkeeper (P = .001), higher PAQ-A (P = .011), and lower KIDMED scores (P = .032). Correlation analysis showed an inverse association between age and PAQ-A score (r = −0.122), and a direct association between KIDMED and PAQ-A scores (r = 0.152). Conclusion: Participants had an adequate level of physical activity. However, they had an obesogenic profile similar to that of their age population, who were not soccer players. Actions to improve adherence to healthy diet practices are highly recommended. Resumen: Introducción: La dieta y la actividad física son dos conductas que juegan un papel clave en la aparición de sobrepeso y la obesidad infantil. Es una tarea esencial en salud pública el análisis de su prevalencia en diferentes contextos. Objetivo: Describir la composición corporal, el nivel de actividad física y la adherencia a la dieta mediterránea, de jugadores de fútbol, de 13 a 16 años de Asturias. Secundariamente, determinar la relación entre dieta, actividad física, composición corporal y variables personales. Métodos: Estudio descriptivo transversal. Participaron 303 niños, con una edad media de 14,15 años (DE = 1,06). Se analizaron adherencia a la dieta mediterránea y nivel de actividad física con los cuestionarios KIDMED y PAQ-A respectivamente y se estableció su composición corporal de acuerdo con su índice de masa corporal. Resultados: Un 23,1% de los participantes presentó exceso de peso. El 54,8% y 8,9% tenían una adherencia media o baja respectivamente a la dieta mediterránea. La puntuación media del PAQ-A fue de 2,69 (DE = 0,47). El exceso de peso se asoció con jugar de portero (p = 0,001), mayor puntuación de PAQ-A (p = 0,011) y menor de KIDMED (p = 0,032). El análisis de correlación presentó una asociación inversa entre edad y puntuación de PAQ-A (r = −0,122) y directa entre las puntuaciones de KIDMED e PAQ-A (r = 0,152). Conclusiones: Los participantes en el estudio mostraron un adecuado nivel de actividad física. Sin embargo, presentaron un perfil obesogénico similar al de población de su edad y una potencial acción de mejora sobre la adherencia a las recomendaciones de la dieta saludable.

Resumen: Introducción: La dieta y la actividad física son 2 conductas que juegan un papel clave en la aparición de sobrepeso y la obesidad infantil. Es una tarea esencial en salud pública el análisis de su prevalencia en diferentes contextos. Objetivo: Describir la composición corporal, el nivel de actividad física y la adherencia a la dieta mediterránea de jugadores de fútbol de 13 a 16 años de Asturias. Secundariamente, determinar la relación entre dieta, actividad física, composición corporal y variables personales. Métodos: Estudio descriptivo transversal. Participaron 303 niños, con una edad media de 14,15 años (DE = 1,06). Se analizaron la adherencia a la dieta mediterránea y el nivel de actividad física con los cuestionarios KIDMED y PAQ-A, respectivamente, y se estableció su composición corporal de acuerdo con su índice de masa corporal. Resultados: Un 23,1% de los participantes presentó exceso de peso. El 54,8% y el 8,9% tenían una adherencia media o baja, respectivamente, a la dieta mediterránea. La puntuación media del PAQ-A fue de 2,69 (DE = 0,47). El exceso de peso se asoció con jugar de portero (p = 0,001), mayor puntuación de PAQ-A (p = 0,011) y menor de KIDMED (p = 0,032). El análisis de correlación presentó una asociación inversa entre edad y puntuación de PAQ-A (r = −0,122) y directa entre las puntuaciones de KIDMED e PAQ-A (r = 0,152). Conclusiones: Los participantes en el estudio mostraron un adecuado nivel de actividad física. Sin embargo, presentaron un perfil obesogénico similar al de la población de su edad y una potencial necesidad de mejora sobre la adherencia a las recomendaciones de la dieta saludable. Abstract: Introduction: Diet and physical activity are factors that have key roles in childhood overweight and obesity prevention. Appropriate assessment of these factors is an essential task in public health. Objective: The main aims of the study are to assess body composition, physical activity, and adherence to Mediterranean diet of soccer players, aged 13 to 16 years old in Asturias, Spain. It also aims to evaluate the relationships between diet, physical activity, body composition, and personal characteristics. Methods: A cross-sectional descriptive survey approach was used involving children (n = 303) with a mean age of 14.15 years (SD = 1.06), and using the KIDMED and PAQ-A questionnaires to assess adherence to Mediterranean diet and level of physical activity, respectively. Body composition was represented using the participants’ body mass index. Results: Approximately 23.1% of the participants were overweight or obese. With regards to adherence to Mediterranean diet, 54.8% of the participants had medium adherence, while 8.9% had low adherence. PAQ-A mean score was 2.69 (SD = 0.47). Excess weight was associated with being a goalkeeper (P = .001), higher PAQ-A (P = .011), and lower KIDMED scores (P = .032). Correlation analysis showed an inverse association between age and PAQ-A score (r = −0.122), and a direct association between KIDMED and PAQ-A scores (r = 0.152). Conclusion: Participants had an adequate level of physical activity. However, they had an obesogenic profile similar to that of their age population, who were not soccer players. Actions to improve adherence to healthy diet practices are highly recommended.

Abstract Background Confinement due to COVID-19 has increased mental ill-health. Few studies unpack the risk and protective factors associated with mental ill-health and addictions that might inform future preparedness. Methods Cross-sectional on-line survey with 37,810 Catalan residents aged 16+ years from 21 April to 20 May 2020 reporting prevalence of mental ill-health and substance use and associated coping strategies and behaviours. Results Weighted prevalence of reported depression, anxiety and lack of mental well-being was, respectively, 23, 26, and 75%, each three-fold higher than before confinement. The use of prescribed hypnosedatives was two-fold and of non-prescribed hypnosedatives ten-fold higher than in 2018. Women, younger adults and students were considerably more likely, and older and retired people considerably less likely to report mental ill-health. High levels of social support, dedicating time to oneself, following a routine, and undertaking relaxing activities were associated with half the likelihood of reported mental ill-health. Worrying about problems living at home, the uncertainty of when normality would return, and job loss were associated with more than one and a half times the likelihood of mental ill-health. With the possible exception of moderately severe and severe depression, length of confinement had no association with reported mental ill-health. Conclusions The trebling of psychiatric symptomatology might lead to either to under-identification of cases and treatment gap, or a saturation of mental health services if these are not matched with prevalence increases. Special attention is needed for the younger adult population. In the presence of potential new confinement, improved mental health literacy of evidence-based coping strategies and resilience building are urgently needed to mitigate mental ill-health.

Abstract Background The Frail-VIG frailty index has been developed recently. It is an instrument with a multidimensional approach and a pragmatic purpose that allows rapid and efficient assessment of the degree of frailty in the context of clinical practice. Our aim was to investigate the convergent and discriminative validity of the Frail-VIG frailty index with regard to EQ-5D-3L value. Methods We carried out a cross-sectional study in two Primary Health Care (PHC) centres of the Catalan Institute of Health (Institut Català de la Salut), Barcelona (Spain) from February 2017 to January 2019. Participants in the study were all people included under a home care programme during the study period. No exclusion criteria were applied. We used the EQ-5D-3L to measure Health-Related Quality of Life (HRQoL) and the Frail-VIG index to measure frailty. Trained PHC nurses administered both instruments during face-to-face assessments in a participant’s home during usual care. The relationships between both instruments were examined using Pearson’s correlation coefficient and multiple linear regression analyses. Results Four hundred and twelve participants were included in this study. Frail-VIG score and EQ-5D-3L value were negatively correlated (r = − 0.510; P

Resumen: Objetivos: Determinar el porcentaje de autorías femeninas en artículos originales publicados durante 2 períodos en la revista Atención Primaria y evaluar si existen diferencias entre categorías de autoría (primera, última autora y coautora) entre ambos. Diseño: Estudio transversal. Emplazamiento: Producción científica femenina publicada durante 2007-2008 y 2017-2018. Participantes: Centrado en los artículos originales. Mediciones principales: Se recogieron en un formulario ad hoc las variables: género con base en el nombre del autor, número total de mujeres y hombres que figuraban como autores y orden de autoría. Se calcularon las frecuencias absolutas y relativas y se utilizó la prueba de χ2 para determinar la evolución de los porcentajes por tipo de autoría y género. Resultados: Se analizaron un total de 108 artículos en el período 2007-2008 y 100 en el 2017-2018. No se observaron diferencias estadísticamente significativas entre el promedio de autoras y autores dentro de los períodos ni entre ambos. En 2007-2008 se identificaron un total de 548 autorías y 540 en 2017-2018; el porcentaje de autoras fue del 48,7% y del 54,4%, respectivamente. Solo se observó un aumento del porcentaje de primeras autoras interperíodo. Conclusiones: Prácticamente una de cada 2 autorías de artículos originales publicados en la revista Atención Primaria era femenina. Asimismo, se observó un incremento significativo en el porcentaje de primeras autoras entre ambos períodos. No obstante, y a pesar del mayor número de trabajadoras sanitarias, las últimas autoras se mantienen sin cambios, lo que apunta a la persistencia de infrarrepresentación femenina. Abstract: Objectives: To determine the percentage of female authors in original articles published during 2 periods, in the journal of Atención Primaria (Primary Care), and to examine the differences between the categories of authorship (first, last author, and co-author) between both periods. Design: Cross-sectional study. Setting: Feminine scientific production published during the periods 2007-2008 and 2017-2018. Participants: The study was focused on original articles. Main measurements: The following variables were collected in an ad hoc form: gender based on the name of the author, total number of women and men appearing as authors, and order of authorship. Absolute and relative authorship frequencies were calculated, and the χ2 test was used to examine the evolution of the percentages by type of authorship and gender. Results: A total of 108 articles were analysed in 2007-2008, and 100 in 2017-2018. No statistically significant differences were observed between the mean numbers of women authors within and between periods. In 2007-2008 a total of 548 female authors were identified and 540 in 2017-2018, the percentage of female authors was 48.7% and 54.4%, respectively. Only an increase in the percentage of first authors was observed between periods. Conclusions: Practically one out of every 2 authors of original articles published in the journal Atención Primaria was female. There was also a significant increase in the percentage of female first authors between the 2 periods. Nevertheless, and despite the greater number of health workers, the number of latest female authors remain unchanged, which points to the persistence of female under-representation.

Abstract Objective To compare the presence of comorbidities and self-perceived health and social support between long-term cancer survivors and people without a history of cancer from a clinical trial examining the effects of a multiple risk behavior intervention. Results Of the 4259 people studied, 190 (4.46%) were cancer survivors. They had a mean ± SD age of 62.8 ± 7 years vs. 58.7 ± 8 years (P

Resumen: Objetivo: Adaptar y validar el Child and Adolescent Self-Care Performance Questionnaire (CASPQ) al contexto de la población infantil sana de 8 a 12 años residente en España y evaluar sus propiedades métricas. Diseño: Estudio de validación fundamentado en la Teoría Clásica de los Tests. Emplazamiento: Cuatro centros educativos participantes en el programa «Salut i Escola» de un centro de atención primaria de Barcelona (España). Participantes: Un total de 498 alumnos y alumnas de educación primaria participaron en el estudio durante los primeros seis meses de 2016. Mediciones principales: Se realizó la adaptación cultural del cuestionario. Se evaluó el proceso de respuesta, la estructura factorial y se analizaron las relaciones de las puntuaciones del CASPQ con las del cuestionario KIDSCREEN-27. Asimismo, se evaluaron la consistencia interna y la reproducibilidad de las puntuaciones. Resultados: Se obtuvieron 489 cuestionarios. El análisis factorial confirmatorio de su estructura teórica mostró un ajuste suficiente. Se observó una asociación positiva entre las puntuaciones del cuestionario y las del KIDSCREEN-27. La consistencia interna global fue satisfactoria; no obstante, la de cada factor fue marginal o moderada. La reproducibilidad de las puntuaciones fue óptima. Conclusiones: El CASPQ adaptado a la población infantil sana de 8 a 12 años muestra unas propiedades métricas adecuadas y similares a las del cuestionario original. Por ello, es un instrumento útil para evaluar las prácticas de autocuidado y planificar intervenciones dirigidas a su promoción. Abstract: Objective: To adapt and validate the Child and Adolescent Self-Care Performance Questionnaire (CASPQ) to the context of healthy children aged 8 to 12 years residing in Spain and evaluate their metric properties. Design: Validation study based on Classical Test Theory. Location: Four schools participating in the Salut i Escola programme of a Primary Care Centre of Barcelona (Spain). Participants: Four hundred and ninety-eight elementary school students participated in the study during the first six months of 2016. Main measurements: Cultural adaptation of the questionnaire was carried out. Response process and factorial structure were evaluated and the relationships of the adapted questionnaire scores with those of the KIDSCREEN-27 questionnaire were analysed. Likewise, internal consistency and reproducibility of the scores were evaluated. Results: Four hundred and eighty-nine questionnaires were obtained. The confirmatory factor analysis of its theoretical structure showed a sufficient adjustment. A positive association was observed between the questionnaire scores and those of KIDSCREEN-27. The overall internal consistency was satisfactory; nevertheless, that of each factor was marginal or moderate. The reproducibility of the scores was optimal. Conclusions: The CASPQ adapted to the healthy child population of 8 to 12 years old shows appropriate metric properties and similar to those of the original questionnaire. Therefore, it is a useful tool to assess self-care practices and plan interventions aimed at its promotion.

Introduction Disease-related knowledge is a key component of shared decision making and a relevant outcome to measure the effectiveness of information provision interventions. However, no systematic psychometric reviews have been found that assess the measurement instruments aimed at evaluating the disease-related knowledge of people affected by multiple sclerosis. This review aims to systematically assess the quality of the measurement properties of all available disease-related knowledge measurement instruments of people affected by multiple sclerosis.Methods and analysis A systematic psychometric review will be carried out in accordance with the guidelines proposed by the international ‘COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN)’ initiative. Studies that meet the following criteria will be selected: (1) those whose aim is to measure disease-related knowledge, (2) those whose study populations are affected by multiple sclerosis and (3) those whose aims are to develop measurement instruments or evaluate one or more of their measurement properties. The information sources will be MEDLINE (via PubMed), CINAHL, PsycINFO and OpenGrey. The methodological quality will be assessed using the ‘COSMIN Risk of Bias’ checklist. Available evidence will be synthesised and graded using a modified Grading of Recommendations Assessment, Development and Evaluation approach.Ethics and dissemination As this is a systematic review, no ethics approval is needed. Study findings will be shared with multiple sclerosis patient support groups and in reports to funders. The results will be submitted to a peer-reviewed journal and will be presented at national and international conferences.PROSPERO registration number CRD42019125417.

Abstract Background Health promotion is a key process of current health systems. Primary Health Care (PHC) is the ideal setting for health promotion but multifaceted barriers make its integration difficult in the usual care. The majority of the adult population engages two or more risk behaviours, that is why a multiple intervention might be more effective and efficient. The primary objectives are to evaluate the effectiveness, the cost-effectiveness and an implementation strategy of a complex multiple risk intervention to promote healthy behaviours in people between 45 to 75 years attended in PHC. Methods This study is a cluster randomised controlled hybrid type 2 trial with two parallel groups comparing a complex multiple risk behaviour intervention with usual care. It will be carried out in 26 PHC centres in Spain. The study focuses on people between 45 and 75 years who carry out two or more of the following unhealthy behaviours: tobacco use, low adherence to the Mediterranean dietary pattern or insufficient physical activity level. The intervention is based on the Transtheoretical Model and it will be made by physicians and nurses in the routine care of PHC practices according to the conceptual framework of the “5A’s”. It will have a maximum duration of 12 months and it will be carried out to three different levels (individual, group and community). Incremental cost per quality-adjusted life year gained measured by the tariffs of the EuroQol-5D questionnaire will be estimated. The implementation strategy is based on the “Consolidated Framework for Implementation Research”, a set of discrete implementation strategies and an evaluation framework. Discussion EIRA study will determine the effectiveness and cost-effectiveness of a complex multiple risk intervention and will provide a better understanding of implementation processes of health promotion interventions in PHC setting. It may contribute to increase knowledge about the individual and structural barriers that affect implementation of these interventions and to quantify the contextual factors that moderate the effectiveness of implementation. Trial registration ClinicalTrials.gov, NCT03136211.Retrospectively registered on May 2, 2017.

Introduction An increasing number of investigations highlight the complex nature of frailty; therefore, the use of multidimensional assessment instruments could be useful in clinical decision-making. Frail people are found mainly in the community setting which is why this is the ideal environment for early screening and intervention. For this purpose, it is necessary to have valid, time-effective and easy-to-use frailty assessment instruments. The aim of this review is to critically appraise, compare and summarise the quality of the measurement properties of all multidimensional instruments with an integral approach to identify frailty in community-dwelling people.Methods and analysis Medline, Psychological Information Database (PsycINFO) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) will be searched from their inception dates. We will also conduct searches in databases of grey literature. No limits will be applied for language. A highly sensitive validated search filter will be used for finding studies on measurement properties. An additional search including the names of the instruments found in the initial search will also be undertaken. Studies aiming at the development of a measurement instrument, the evaluation of one or more measurement properties or the evaluation of its interpretability will be included. The instrument should have an integral approach (physical, psychological and social) and it should measure all three domains. The context of use should be a community setting. Two reviewers independently will screen the references and assess the risk of bias by consensus-based standards for the selection of health measurement instruments checklist. To assess the overall evidence for the measurement properties of the identified instruments, the results of the different studies, adjusted for their methodological quality, will be combined.Ethics and dissemination Ethical approval and patient consent are not required as this is a psychometric review based on published studies. The results of this review will be disseminated at conferences and published in an international peer-reviewed journal.PROSPERO registration number CRD42019120212.

Objective: To determine the prevalence of negative mood states in adolescents according to gender, to analyze variability among schools, and to evaluate the associated factors. Methods: A cross-sectional study with a cluster design was carried out. We administered the High-school students health survey to a sample of 9,340 students (aged 14-16 years) in the third and fourth year of Compulsory Secondary Education in Catalonia, Spain, during the 2005-6 academic year. The main outcome measure was evidence of a negative mood state. A multilevel logistic regression model stratified by gender was used to identify the factors associated with negative mood states and to determine variability among distinct schools. Results: Approximately 19% of adolescents reported evidence of a negative mood state, with a higher prevalence in girls (25%). The most significant factors associated with negative mood states were "use of tranquilizers" and "having eating disorders" in girls and "not exercising" and "poor self-perception of health status" in boys. In both genders, variability was found among schools in the prevalence of negative mood states (girls: variance = 0.078; p Objetivos: Determinar la prevalencia del estado de ánimo negativo entre alumnos adolescentes según sexo, analizar la variabilidad entre escuelas y evaluar los factores asociados. Métodos: Estudio transversal basado en un muestreo por conglomerados bietápico. Administramos una encuesta de salud a 9340 estudiantes de tercero y cuarto curso de Educación Secundaria Obligatoria de 14 a 16 años de edad, en Cataluña, durante el curso escolar 2005-06. La variable principal fue el estado de ánimo negativo. Se usó un modelo de regresión logística multinivel estratificado por sexo para identificar los factores asociados al estado de ánimo negativo y determinar la variabilidad entre las diferentes escuelas. Resultados: Aproximadamente el 19% de los adolescentes refirieron un estado de ánimo negativo, siendo más prevalente entre las chicas (25%). En ellas, los factores asociados significativamente con estados de ánimo negativo fueron «tomar tranquilizantes» y tener trastornos alimentarios, mientras que en los chicos fueron no realizar deporte y tener una mala percepción de su estado de salud. Hay variabilidad en la prevalencia del estado de ánimo negativo según las escuelas en ambos sexos (chicas: varianza = 0,078, p

Objective: To analyze the factors associated with sexual risk behavior in adolescent girls and boys in order to plan future school health interventions. Methods: A cross-sectional study with two-stage cluster sampling that included 97 schools and 9,340 students aged between 14 and 16 years old was carried out in 2005-2006 in Catalonia (Spain). For the survey, a self-administered paper-based questionnaire was used. The questionnaire contained items on sociodemographic variables, use of addictive substances and mood states, among other items. These variables were tested as risk factors for unsafe sexual behavior. Results: This study included 4,653 boys and 4,687 girls with a mean age of 15 years. A total of 38.7% of students had had sexual relations at least once and 82.3% of boys and 63.0% of girls were engaged in sexual risk behaviors. The prevalence of sexual relations and risk behaviors was generally higher in boys than in girls, independently of the variables analyzed. Boys had more sexual partners (PObjetivos: El objetivo de este estudio es analizar aquellos factores relacionados con conductas sexuales de riesgo en chicos y chicas para poder plantear futuras intervenciones. Métodos: Estudio transversal basado en un muestreo por conglomerados bietápico, que incluía 97 escuelas y 9.340 estudiantes de entre 14 y16 años, llevado a cabo en Cataluña durante 2005-2006. La información se recogió mediante una encuesta autoadministrada que incluía, entre otras, variables sociodemográficas, uso de sustancias adictivas y estado de ánimo de los adolescentes. Estas variables fueron analizadas como factores de riesgo de conducta sexual insegura. Resultados: El estudio incluyó 4.653 chicos y 4.687 chicas con una edad media de 15 años. El 30,7% de los estudiantes habían tenido al menos una relación sexual. El 82,3% de los chicos y el 63% de las chicas tenían un aumento de riesgo de experimentar una relación sexual insegura. La prevalencia de relaciones sexuales y de relaciones sexuales de riesgo era en general mayor en los chicos que en las chicas, independientemente de la variable analizada. Los chicos tenían más parejas sexuales (p

It has been highlighted the original article (1) contained a typesetting mistake in the authorship, and that author Caterine Vicens was omitted.