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According to the policies of the European Union, the increase of green spaces is proposed by city managers in their programmes because of their benefits on the well-being and quality of life of citizens. Urban parks can also bring economic and environmental advantages. However, the extent of new green space is limited in increasingly densely populated cities. Therefore, small green spaces isolated or, even better, connected through pedestrian zones are becoming more and more common. The city of Cáceres plans in the coming years to increase the number of green spaces, the connectivity between them and the pedestrian areas. In this sense, if different indicators for the quality of these areas are not considered, the obtained results may not be as good as expected. We believe that the sound environment is a key factor in the quality of these spaces. In this study, the situation of some green areas in the city of Cáceres is compared with that of other cities in order to quantify their quality.

RESUMEN La Década del Envejecimiento Saludable reabre oportunidades para invertir en entornos adaptados a las personas mayores y en sistemas integrados de atención sanitaria y social. El objetivo de este trabajo es analizar esas ventanas de oportunidad para Enfermería. El envejecimiento saludable implica que las personas mayores contribuyen a la sociedad durante más tiempo, con oportunidades para gozar de buena salud, y para mantener y desarrollar las capacidades, y que está determinado por la capacidad funcional, la capacidad intrínseca y el entorno físico y social. Para ello, son precisos sistemas sociales y de salud integrados, transformadores y centrados en las personas, en lugar de sistemas basados únicamente en la enfermedad. Enfermería puede contribuir cambiando la forma de pensar, de sentir y de actuar con respecto a la edad y el envejecimiento, ofreciendo una atención integrada y centrada en las personas, adaptando el modelo de cuidados, con el foco en la promoción de la salud y la prevención de la enfermedad, y la atención de las personas mayores potenciando sus capacidades y su autonomía, en especial desde la Atención Primaria. Luchar contra el edadismo, formar a enfermeras en competencia de práctica avanzada, mejorar la accesibilidad, formar a las personas mayores y sus familias en materia digital, investigando sobre estos factores, son oportunidades que vuelve a abrir el Informe sobre la Década del Envejecimiento Saludable para Enfermería. Palabras clave: envejecimiento saludable, edadismo, atención centrada en la persona, accesibilidad, enfermería. ABSTRACT The Decade of Healthy Ageing reopens opportunities to invest in age-friendly environments and integrated health and social care systems. The aim of this paper is to analyse these windows of opportunity for Nursing. Healthy ageing implies that older people contribute to society for longer, with opportunities to have good health, and to maintain and develop capabilities, and that it is determined by functional ability, intrinsic capacity and the physical and social environment. This requires integrated, transformative and people-centred health and social systems, rather than systems based on disease. Nursing can contribute by changing the way we think, feel and act about age and ageing, offering integrated and person-centred care, adapting the model of care, with a focus on health promotion and disease prevention, and care for older people by enhancing their capabilities and autonomy, especially in primary care. Fighting against ageism, training nurses in advanced practice competency, improving accessibility, training older people and their families in digital matters, researching on these factors, are opportunities that the Decade of Healthy Ageing Report reopens for Nursing. Key words: healthy aging, ageism, person-centred care, accessibility, nursing

Resumen El concepto teórico de fragilidad está ampliamente aceptado, pero su aplicación a la práctica presenta algunas limitaciones debido a la existencia de múltiples herramientas para su detección precoz y propuestas de intervención. En esta breve revisión de situación, se pretende resumir las últimas evidencias respecto a la detección precoz y el abordaje de la fragilidad en Atención Primaria.El cribado se basa en la detección oportunista de casos mediante búsqueda activa a partir de los 70 años, usando como herramientas una prueba de ejecución y la escala FRAIL. Se aconseja confirmación con el Frailty Index.Su abordaje debe ser multidimensional centrado en el entrenamiento de fuerza muscular, suplementos proteicos y la revisión de la medicación.La fragilidad es evitable, y se necesita poner el foco en la detección precoz. A pesar de los avances en los últimos años, es necesaria más investigación en busca del modelo de atención más eficaz. PALABRAS CLAVE: persona mayor, fragilidad, atención primaria, detección precoz Summary Although the theoretical concept of frailty is widely accepted, its practical application is somehow limited due to the existence of multiple tools related to its early detection and intervention proposals. In this brief review of the situation, the aim is to summarize the latest evidence regarding early detection and management of frailty in Primary Health Care. The screening is based on opportunistic case detection by active search from the age of 70, using a performance test and the FRAIL scale as tools. Confirmation using the Frailty Index is recommended. Its approach should be multidimensional and focusingon muscle strength training, protein supplementation and medication review. Frailty is preventable, and emphasis should be placed on early detection. Despite advances in recent years, more research is needed in order to find the most effective healthcare model. KEYWORDS:elderly, frailty, primary healht care, early detection

Un buen funcionamiento familiar puede ayudar a los cuidadores en la toma de decisiones y en la resolución de problemas o dudas que pudieran surgir como resultado de las demandas del cuidado. Este estudio tiene como objetivo analizar la funcionalidad familiar de los cuidadores de personas con patología neurológica y su relación con las variables sociodemográficas, el nivel de sobrecarga y el apoyo social percibido. Método: Se reclutó a 58 cuidadores de personas con patología neurológica en la región del Alentejo (Portugal). Se realizó un muestreo por conveniencia entre las asociaciones de familiares de personas con alteraciones neurológicas. Para la obtención de los datos se llevó a cabo una entrevista individual en la que se incluyó el cuestionario de APGAR Familiar, la Escala de Apoyo Social Percibido de Duke UNK-11 y la Escala de Zarit. Resultados: Un 48,3% de las familias funcionan normalmente y un 51,7% muestran disfuncionalidad. Además existe relación entre la funcionalidad familiar y las horas dedicadas a cuidar, la sobrecarga percibida y el apoyo social percibido por los cuidadores. Conclusiones: los cuidadores que pertenecen a familias disfuncionales perciben un apoyo social bajo, dedican más horas al cuidado familiar y presentan niveles de sobrecarga intensa más elevados. Palabras clave: familia, apoyo social, sobrecarga, enfermedad neurológica, cuidadores. Summary: Good family functioning can help caregivers in decision making and in the resolution of problems or doubts that may arise as a result of the demands of caregiving. This study aims to analyse the family functioning of caregivers of people with neurological pathology and its relationship with sociodemographic variables, the level of overload and perceived social support. Methods: 58 caregivers of people with neurological pathology were recruited in the region of Alentejo (Portugal). A convenience sampling was carried out among the associations of relatives of people with neurological disorders. To obtain the data, an individual interview was carried out, including the Family APGAR questionnaire, the Duke UNK-11 Perceived Social Support Scale and the Zarit Scale. Results: 48.3% of the family’s function normally and 51.7% show dysfunctionality. There is also a relationship between family functioning and hours spent on caregiving, perceived overload and caregivers' perceived social support. Conclusions: caregivers belonging to dysfunctional families perceive low social support, spend more hours on family caregiving and have higher levels of intense overload. Key words: family, social support, overload, neurological disease, caregivers.

Background: Ageing and its consequences on quality of life is one of the main issues to be addressed by public organizations; therefore the development of tools for its evaluation is a priority issue to orientate lines of action. Therefore, the objective of this research is to carry out cross-cultural adaptation and present the psychometric properties of the Spanish version of the Older People’s Quality of Life Questionnaire-Brief (OPQOL-Brief). Methods: a cross-cultural adaptation was carried out together with a process of translation and back-translation of the scale. The OPQOL-Brief and a sociodemographic questionnaire were administered to 120 older adults aged over 65 from a healthcare setting in the region of Extremadura. Results: the exploratory analysis revealed a factor structure through a matrix of polychoric correlations divided in two intercorrelated factors, consisting of 12 items and with excellent sample adequacy indices (KMO = 0.846’; Bartlett test = 1268.1; p = 0.000). Then, the confirmatory factor analysis established the definitive model with exceptional goodness-of-fit indices (NNFI = 0.99; CFI = 0.99; CMIN/DF = 0.96; Ρ (χ2) = 0.22; RMSEA = 0.037 and RMSR = 0.040). Finally, Cronbach’s alpha and McDonald’s omega for internal consistency reported good values of 0.830 and 0.851, respectively. Conclusion: our findings show that the OPQOL-Brief exhibits a solution with 12 elements and related constructs, providing stable goodness-of-fit indicators as well as good and remarkable consistency ratings.

Research shows that exercise training programmes lead to several improvements in older adults’ health-related quality of life (HRQoL) and well-being. This study will examine the effects of an active retirement programme on Portuguese older adults, investigating its effects on body composition, physical fitness, HRQoL, and physical activity level (PAL). Therefore, a parallel-group randomised controlled trial will be conducted, including body composition (height and body weight), physical fitness (strength, flexibility, agility, postural control, and gait), HRQoL, and PAL assessments before and after the application of the programme. The programme will be carried out for six months, two days per week (45 min), plus a year of follow-up. The programme will consist of six circuits with eight physical exercises each. The circuits will change at the end of the four weeks (one monthly circuit). The exercises’ difficulty will increase throughout the programme, with alternatives for all the participants. If the effectiveness of the programme is demonstrated, implementation in different services and municipalities could be advised, as the actors involved in health and social services should promote the well-being of their citizens through, among others, health-related physical activity and the prevention of diseases associated with inactivity.

People with Alzheimer’s disease (AD) diagnosis who get informal care remain at home longer, reducing the demand for healthcare resources but increasing the stress of caregiving. Research on the effectiveness of physical training, psychoeducational, cognitive–behavioural, and health education programs in reducing the caregiver load and enhancing health-related quality of life (HRQoL) exist, but none exist about an integrated interdisciplinary program. The goals of this project are (1) to assess the Integral-CARE Interdisciplinary Program (IP) applicability, safety, effects on HRQoL, and the incremental cost-effectiveness ratio for AD caregivers; (2) to evaluate the IP applicability and cost-effectiveness to enhance the physical, psychoemotional, cognitive–behavioural dimensions, and the health education status of informal caregivers, and (3) to study the transference of the results to the public and private sectors. A randomized controlled trial will be conducted with an experimental (IP) and a control group (no intervention). The PI will be conducted over nine months using face-to-face sessions (twice a week) and virtual sessions on an online platform (once a week). There will be an initial, interim (every three months), and final assessment. Focus groups with social and health agents will be organized to determine the most important information to convey to the public and private sectors in Extremadura (Spain). Applicability, safety, HRQoL, incremental cost-effectiveness ratio, and HRQoL will be the main outcome measures, while secondary measures will include sociodemographic data; physical, psychoemotional, health education, and cognitive–behavioural domains; program adherence; and patient health status. Data will be examined per procedure and intention to treat. A cost-effectiveness study will also be performed from the viewpoints of private and public healthcare resources.

Background: The Global Matrix 4.0 on physical activity (PA) for children and adolescents was developed to achieve a comprehensive understanding of the global variation in children’s and adolescents’ (5–17 y) PA, related measures, and key sources of influence. The objectives of this article were (1) to summarize the findings from the Global Matrix 4.0 Report Cards, (2) to compare indicators across countries, and (3) to explore trends related to the Human Development Index and geo-cultural regions. Methods: A total of 57 Report Card teams followed a harmonized process to grade the 10 common PA indicators. An online survey was conducted to collect Report Card Leaders’ top 3 priorities for each PA indicator and their opinions on how the COVID-19 pandemic impacted child and adolescent PA indicators in their country. Results: Overall Physical Activity was the indicator with the lowest global average grade (D), while School and Community and Environment were the indicators with the highest global average grade (C+). An overview of the global situation in terms of surveillance and prevalence is provided for all 10 common PA indicators, followed by priorities and examples to support the development of strategies and policies internationally. Conclusions: The Global Matrix 4.0 represents the largest compilation of children’s and adolescents’ PA indicators to date. While variation in data sources informing the grades across countries was observed, this initiative highlighted low PA levels in children and adolescents globally. Measures to contain the COVID-19 pandemic, local/international conflicts, climate change, and economic change threaten to worsen this situation.

Physical inactivity and sedentary lifestyles appear to be critical factors in developing mental health problems, including depression, anxiety, and other diseases in developed societies. This study analysed the associations between physical activity level (PAL) and mental health using the Goldberg General Health Questionnaire (GHQ12) in the Spanish population before the COVID-19 pandemic. A cross-sectional design, based on data from the Spanish National Health Survey (ENSE 2017), the last health survey before the pandemic, was carried out with 17,641 participants. Data did not follow a normal distribution, so non-parametric tests were used to analyse intergroup differences, differences at baseline and post hoc, and correlations between variables. Associations were found between the PAL, mental health and all its dimensions. The groups that performed moderate and intense PAL showed lower values in the GHQ12 questionnaire than those who walked or were inactive. Thus, higher PAL was associated with better mental health indicators, including successful coping, self-esteem and stress. This study provides a framework to compare outcomes between the pre- and post-pandemic periods, as the ENSE is performed every five years.

One of the main concerns of governments and organisations worldwide is the cost and burden of health services, with sedentary lifestyles being a significant impacting factor, and physical activity is one of the potential solutions. Therefore, this study aims to analyse the possible associations between the physical activity level, hospitalisation prevalence, and the use and number of visits to emergency services in the Spanish population, examining potential differences between sex and age groups. This is a cross-sectional study based on data from the Spanish National Health Survey 2017 (ENSE 2017), the last one before the COVID-19 pandemic, with 17,199 participants. A descriptive analysis was performed using median and interquartile range (continuous variables) and absolute and relative frequencies (ordinal variables). Intergroup differences were analysed with non-parametric tests: chi-square and z-test for independent proportions (categorical variables), and Kruskal–Wallis and Mann–Whitney U (continuous variables). Spearman’s rho was used to study correlations between variables. A multiple binary regression analysis was performed to predict hospitalisations. Hospitalisations and emergency services use showed a dependence relation with the physical activity level (p < 0.001): those who performed moderate and/or vigorous physical activity used those services less than sedentary individuals and those whose only activity was walking. Thus, associations could be drawn between the hospitalisation prevalence, the use and number of visits to emergency departments, and the physical activity level in the Spanish population aged 18–69 years in the pre-pandemic period.

One-third of the Spanish population over 15 years of age did not achieve a reasonable amount of physical activity (PA) before the COVID-19 pandemic. We aim to analyse the associations between the PA level (PAL) and self-perceived health (SPH) in the Spanish population aged 15–69 years during the pre-pandemic period. A cross-sectional study was conducted using the Spanish National Health Survey 2017 (ENSE 2017) data, with 17,777 participants. We carried out a descriptive analysis, analysed intergroup differences with non-parametric statistical tests, and calculated the Odds Ratio (OR) and Relative Risk (RR) of having a negative SPH according to PAL. In addition, correlations between PAL and SPH were studied, finding associations between them (p < 0.001). Thus, performing moderate and intense PA was related to better SPH than just walking or inactive. Weak and moderate correlations were found between PAL and SPH (p < 0.001). We also found high ORs and RRs of negative SPH as PAL decreased. Moderate and intense PA were related to positive SPH, while the risk of negative perception in inactive people was higher.

Providing informal care for older people, or people with chronic conditions, is associated with poorer physical and mental health and reduced quality of life. This task, in many cases, often relies on the women in the immediate family. Physical activity (PA) is a tool to enhance caregivers’ physical and mental health and their quality of life. Thus, this study aimed to analyse the associations between the physical activity level (PAL), self-perceived health (SPH) and mental health (SM) and its factors (positive coping, self-esteem, and stress) by conducting a cross-sectional study by using data from in the National Health Survey 2017 (ENSE 2017), the last one before the COVID-19 pandemic. The sample included 2225 caregivers (866 men and 1361 women). Descriptive analysis and non-parametric statistical tests, including chi-square, the Kruskal–Wallis test, the Mann–Whitney U test, and the Spearman’s rho correlation coefficient, were used. Dependence relationships were found between PAL and SPH and MH and their factors. The population groups that performed moderate or vigorous PA showed better results in both SPH and MH. Women scored worse than men in all the variables analysed. Hence, intense, or moderate PA practice may improve SPH and MH in Spanish informal caregivers, requiring the implementation of policies and programs considering the differences found between men and women in PAL, SPH, and MH.

Unrestrained urbanisation and natural space loss are reducing contact with nature in today’s society, producing negative consequences for people’s mental and physical health and wellbeing. Nature-based therapies, such as physical activity in natural settings, forest bathing, therapeutic hiking, or experiential learning, reduce anxiety and depressive symptoms and improve the quality of life in both general and specific populations. A bibliometric analysis of research on nature-based therapies was performed by applying the traditional laws of bibliometrics (exponential growth law, Bradford’s concentration law, Lotka’s law, Zipf’s law, etc.) to documents published in journals indexed in the Core Collection of the Web of Science (WoS). Graphical visualisation was performed using the VOSviewer software. Annual publications between 2006 and 2021 presented an exponential growth trend (R2 = 91%). The International Journal of Environmental Research and Public Health (MDPI) and Urban Forestry & Urban Greening (Elsevier) were the most productive and cited journals. Ikei, Miyazaki, and Song are the most cited prolific authors. The USA and South Korea were the countries with the highest scientific production. In recent years, there has been a growing interest in adventure, nature, and forest therapies among researchers. Nature-based therapies have experienced a growing interest in recent years. Positive effects on mental, physical, and emotional health have been found in different populations and research lines, although more studies with different designs and populations are needed.

Depression and anxiety are two of the most common mental diseases both in formal and nonformal caregivers. Physical activity during leisure time seems to have benefits on their practitioner’s mental health. This study aimed to analyze the associations between physical activity frequency (PAF) and depression and anxiety status, as well as antidepressant and anxiolytic use in Spanish nonformal caregivers. A cross-sectional study with data from the 2014 and 2020 European Health Interview Surveys in Spain (EHSS) including 4520 Spanish nonformal caregivers was carried out. The PAF was found to be related to depression and anxiety, as well as antidepressants and anxiolytics use (p < 0.001), with the highest proportions of these variables found in the inactive population (p < 0.05), while the active and very active populations showed the lowest proportions (p < 0.05). Weak but statistically significant correlations were found between all variables of interest (p < 0.001). Being female, older, and dedicating more hours per week to caregiving and caring for nonfamily members were found to have increased risks of depression, anxiety and antidepressants or anxiolytics use. Nonformal caregivers who were not physically active during their leisure time had higher mental disorders and psychotropic drug use proportions than the active and very active caregivers. Thus, increasing nonformal caregivers’ PAF could be a protective tool.

Intimate partner violence (IPV) is a public health problem that psychologically and physically affects the women who suffer from it. In this article, we propose an intervention protocol based on therapeutic tourism through adventure physical activities and psychological therapy that could improve the psychological and physical health of women participants. We propose a randomized study where participants will be separated into two groups, control and experimental, and we will perform measurements including self-concept, self-image, depression, and perceived stress, combining these with physiological measurements of stress level by determining stress-related hormones (Cortisol and DHEA), as well as the overall cost-effectiveness of the program. All data collected at the end of the protocol will be statistically analysed. If the final data are positive and it is feasible, this protocol could be proposed as a measure for the treatment of the sequelae of victims of gender violence.

Blood Pressure (BP) is one of the most used measured clinical parameters in health promotion and intervention. BP measures can vary due to different parameters, so we aim to study the intrasession test–retest reliability for an oscillometric method using a digital tensiometer in the Peruvian population aged over 15 with and without a diagnosis of hypertension (HT). Data were taken from the Demographic and Family Health Survey conducted in Peru in 2019. Technicians had to follow a standardized protocol on the conditions to carry out a valid and reliable measurement. Relative reliability was excellent in most cases (intraclass correlation coefficient > 0.9); absolute reliability was excellent (standard error of measurement < 5%) and smallest real difference < 10% in most cases. The Bland–Altman plot showed a systematic error of 2.36 for systolic BP in men and 2.16 in women, and 0.823 for diastolic BP in men and 0.71 for diastolic BP in women. Results suggest that the oscillometric method with a digital blood pressure monitor was reliable in absolute and relative terms in this population, so it could be used as a reliable control test to measure changes after an intervention.

Individuals with autism spectrum disorder (ASD) diagnoses present not only cognitive, emotional, communicative, and social challenges but also movement issues that affect their everyday activities, learning, and leisure. The use of the square-stepping exercise (SSE), a motor program initially created to strengthen the lower limbs of older adults, is spreading because of its advantages (e.g., balance and lower limb strength improvements). A study protocol to assess the SSE effects on motor, sensory, and cognitive skills in Spanish children and adolescents between 6 and 12 years old with ASD diagnoses is presented. A randomised clinical will be performed, recruiting 52 children and adolescents with ASD who will be distributed into two groups: an experimental (n = 26) and a control (n = 26) group. The SSE sessions will be held for 9 weeks (two times per week). The main variable will be balance, which will be measured with the Movement Assessment Battery for Children 2 (MABC2), and secondary outcomes will include sensory processing, attention, and executive functions. Assessments will be carried out before and at the end of the program implementation, including an additional follow up one month later. If this program obtains positive results, it should be implemented in different settings (schools, clinics, associations, etc.) to improve the quality of movement and development in children and adolescents with ASD, as it is an easy-to-use and structured tool.

Background: Physical activity and physical fitness play an important role in adolescence. Both are considered to be indicators of the current and future health status of young adults. The main objective of this article was to report the normative values of the Physical Activity Questionnaire for Adolescents (PAQ-A) and the International Fitness Scale (IFIS) instruments in Peruvian school adolescents. Methods: A sample of 1229 participants (622 girls and 607 boys) aged between 12 and 17 years was used. The type of study was descriptive-comparative. All measures used were obtained by means of self-administered instruments. The PAQ-A was used to assess the level of physical activity and the IFIS to assess the self-perceived physical fitness level of the adolescents. Results: It was observed that the PAQ-A questionnaire results obtained from the total sample was 2.34; significantly higher for boys (2.41) compared with girls (2.27). For the IFIS, the total score was 3.07, with boys obtaining 3.13 and girls 2.97. Conclusions: It was concluded that there was a direct relationship between the level of PA and self-perceived PF in Peruvian adolescents. Furthermore, adolescent boys were more physically active than girls and they had a better self-perceived PF with the exception of flexibility. Finally, there was a higher weight category involved at the lower level of PA.

Background: Age-related changes negatively affect physical fitness, body composition, and executive function and produce a decrease in regucalcin level expression in blood. The square-stepping exercise (SSE) is a balance and lower-limb strength training programme used to prevent falls and stimulate cognitive function in older adults. This project aims to analyse the effects of SSE on executive function, regucalcin expression, fall prevention, body composition, and physical fitness in people over 65 years old. Methods: A randomized controlled trial will be conducted. A total of 90 older people over 65 years old will be recruited and randomly assigned to 2 groups: experimental (n = 45) and control (n = 45). The experimental group will perform an SSE-based intervention for 6 months (2 times per week), while the control group do not follow any treatment. Results: The main outcome will be balance, but other motor (body mass index, upper- and lower-limb strength, flexibility, and speed-agility) and cognitive variables (executive functions and attention) will be assessed. The expression of regucalcin levels will also be evaluated. Therefore, this project aims to analyse the effect of a 6-month SSE intervention on cognitive and motor competence, physical fitness, regucalcin levels, fall risk, and body composition in older people. If the intervention proves to be effective, it could be implemented in centres, entities, and associations specialized in elderly care.

Inclusive education is a right and must be offered to all students, including those with disabilities, providing them with individualized educational attention and support. Teachers play a leading role in the inclusive education process, their preparation and attitudes being essential for this process. This study aimed to present the factor structure and reliability of a questionnaire for the assessment of teachers’ perceptions about their preparation to support inclusive education. The sample consisted of 605 Spanish primary school teachers who responded to the Evaluation of Teachers’ Inclusion Readiness (CEFI-R) Questionnaire. Exploratory and confirmatory factor analysis and reliability evaluation were performed. The results showed a factor structure with four dimensions (Conception of Diversity, Methodology, Supports and Community Participation), composed of 17 items, with good and excellent goodness-of-fit values and high reliability (Cronbach’s Alpha = 0.75–0.94). Thus, the CEFI-R can be considered a quick and easy-to-apply tool to analyze primary school teachers’ perceptions about their preparation to address their students’ diversity of needs, allowing stakeholders to take actions to promote inclusive education, The authors would like to dedicate this paper to our colleague, Andres GarciaGomez, who passed away during the publication process of this manuscript. Without his support, this project would not have been possible. Our condolences to his family and friends. Thank you for everything and may he rest in peace

Background: In Spain, people who have overcome some type of cancer have significantly worse self-perceived health (SPH) and higher rates of depression than people who have never suffered any type of cancer. Objective: to explore the relationships among physical activity levels (PAL), perceived social support (PSS), and SPH in terms of mental health and its dimensions in Spanish adults with cancerous tumours. Methods: A correlational study rooted in the National Health Survey 2017 for adults was carried out, including 627 Spanish residents who reported having malignant tumours. Results: A dependent association was found between PAL and SPH (p < 0.001). The mental health mean score decreased as PAL increased for the total sample and for both sexes, separately (p < 0.001). Low reverse associations were also observed between PAL and mental health (rho: −0.274; p < 0.001), successful coping (rho: −0.239; p < 0.001) and self-confidence (rho: −0.264; p

Physical Activity (PA) could contribute to decreasing psychological distress and improving Self-Perceived Health (SPH) in adults with Asthma. The main objective of this study was to analyse the associations between the Physical Activity Level (PAL) Perceived Social Support (PSS) and Mental Health, using the Goldberg General Health Questionnaire (GHQ-12), and SPH in the adult population with Asthma. This descriptive cross-sectional study is based on data from the 2017 Spanish National Health Survey, including 1040 participants with Asthma in the study. The Kruskal–Wallis test was performed to study the hypothetical differences between the PAL and the different variables derived from the GHQ-12. In addition, correlations between the variables generated and the items of the GHQ-12, together with the PAL and the Duke-UNC-11, were analysed using Spearman’s rho correlation coefficients. Inverse correlations were found between Mental Health and PSS (rho: −0.351) and between Mental Health and PAL (rho: −0.209), as well as in the rest of the GHQ-12 items: successful coping (rho: −0.197), self-esteem (rho: −0.193) and stress (rho: −0.145). The more active subjects had better SPH. Therefore, the research showed how higher PAL and positive SPH are related to lower psychological distress in adults with Asthma.

Simple Summary The Five Times Sit to Stand Test is a useful tool for assessing the ability to stand and sit. Its performance is dependent on lower limb muscle strength and balance control. In older adults, it is a widely used measure to assess functional mobility. However, this test is also be used in individuals with respiratory, neurological, degenerative, musculoskeletal, and other pathologies. Our study shows that the Five Times Sit to Stand Test has high reliability, defined as the overall consistency of a measure, for healthy adults or individuals with pathologies, and can be used to assess lower body strength and establish therapeutic strategies accordingly. Abstract Functional independence in adults is conditioned by lower limb muscle strength. Thus, it seems important to assess lower limb strength using reliable and easy to reproduce measurements. The purpose of this study was to conduct a systematic review and meta-analysis to collect studies that examined the test-retest reliability of the Five Times Sit to Stand Test (FTSST) in adults. The search was conducted in PubMed, Web of Science, and Scopus databases, including all studies published up to 28 December 2020. To be included, studies had to include relative reliability scores (ICC) and maximum torque or standard error of measurements (SEM) of FTSST. A total of 693 studies were initially identified, but only 8 met the eligibility criteria and were included in the meta-analysis, covering a total of 14 groups with 400 participants. Relative inter-rater reliability results (ICC = 0.937, p < 0.001, n = 400) revealed excellent reliability of FTSST to assess sitting and standing performance, lower limbs strength and balance control. Conclusion: The Five Times Sit to Stand Test is a highly reliable tool for assessing lower limbs strength, balance control, and mobility in both healthy adults and those with pathologies.

WHAT IS KNOWN ON THE SUBJECT?: Attention-deficit/hyperactivity disorder (ADHD) is characterized by problems of inattention and impulsive hyperactivity in children. Equine-assisted activities and therapies (EAATs) have been used as alternative non-pharmacological intervention option in patients with ADHD. WHAT DOES THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Nowadays, more studies of high methodological quality are needed to determine whether EAAT is an effective intervention for the treatment in children with ADHD. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Between 15 and 40 min of rising horses, 8-32 total sessions, for 4-32 weeks, seem to be beneficial to reduce the symptoms of ADHD. ABSTRACT INTRODUCTION: Attention-deficit/hyperactivity disorder (ADHD) is a disorder characterized by problems of inattention and impulsive hyperactivity. Equine-assisted activities and therapies (EAATs) have become an emerging non-pharmacological intervention option in patients with ADHD. AIM To perform a systematic review of updated literature about EAAT in children with ADHD. METHOD A systematic review was performed until 28 November 2019, in four electronic databases: PubMed, Web of Science, Embase and Google Scholar. The inclusion criteria were as follows: (a) intervention programme, with pre- and post-data, based on EAAT, (b) children with ADHD and (c) articles written in English. RESULTS A total of 9 articles were found that meet the inclusion criteria. The evidence level was C for 7 studies and B for 2 studies. The level of conclusion was 3. DISCUSSION There are few studies with high methodological quality, and there is a high heterogeneity in the variables included, what make that the level of evidence and conclusion are low. CONCLUSION There is no account with enough studies of high methodological quality to determine whether EAAT is an effective intervention for the treatment in children with ADHD.

Background: Elderly caregivers present increased physical and mental health problems. These factors can lead to a lack of autonomy and a need for social support. This study aims to analyse the relationships between perceived social support and mental health status in elderly caregivers aged 65 and older. Methods: a cross-sectional study based on data from the Spanish National Health Survey (ENSE-17) carried out on 7023 people. The study population was restricted to 431 caregivers aged &ge, 65 years. A study of the correlation between the mental health state and the perceived social support was carried out. Both variables were related to the sex of the caregiver. Results: Perceived social support by older caregivers is significantly related to mental health (p = 0.001), and stress (p &lt, 0.001). Also, there is a significant relationship between perceived social support and mental well-being (p = 0.001), self-esteem (p = 0.005) and stress (p = 0.001) in older women caregivers. Conclusions: Older caregivers have adequate mental well-being and perceive high social support. Perceived social support can contribute to improving the mental well-being of older caregivers.

espanolObjetivo: establecer los principales determinantes de la estimacion de las demandas interpuestas por usuarios del sistema sociosanitario en relacion con la aparicion de ulceras por presion. Metodo: analisis de resoluciones judiciales obtenidas a traves de una busqueda exhaustiva en bases de datos especializadas del sistema jurisprudencial en Espana entre los anos 2007 y 2017 en los ordenes civil, penal y contencioso-administrativo. Resultados: se obtuvieron un total de 22 pronunciamientos, 10 estimatorios y 12 desestimatorios, de los que se extrajeron como principales conclusiones la necesidad de cumplir con la “Lex Artis ad hoc” a traves de la aplicacion de medidas preventivas y terapeuticas adecuadas, para lo que resulta conveniente el seguimiento de protocolos o guias de practica clinica, y la relevancia del registro de las intervenciones llevadas a cabo en la historia clinica de los pacientes, documento probatorio de la diligencia de los profesionales en los diferentes procesos judiciales. Conclusiones: ademas de como medio de aseguramiento de los derechos de los pacientes, el cumplimiento de la “Lex Artis ad hoc”, y el registro de la actividad de los profesionales sanitarios en la historia clinica, sirve de defensa de los intereses de los propios profesionales, porque toda actuacion ajustada a la “Lex Artis”, que conste debidamente diligenciada en la historia clinica, se erige en salvaguarda frente a las demandas judiciales por mala praxis tal y como viene poniendo de manifiesto la jurisprudencia analizada al respecto. EnglishObjective: to establish the main determining factors used to estimate claims brought by socio-healthcare patients with bed sores. Method: analysis of judicial resolutions obtained through an exhaustive search conducted in specialised databases in the Spanish case-law system, between 2007 and 2017, in civil, criminal and contentious-administrative jurisdictions. Results: a total of 22 pronouncements were obtained, 10 ruling in favour and 12 against; the main conclusions drawn included the need to follow “lex artis ad hoc” by applying adequate preventive and therapeutic measures, for which clinical practice protocols or guides are recommended, and the relevance of entering any procedures into each patient’s medical records, constituting proof of professional care in various judicial proceedings. Conclusions: in addition to guaranteeing patient rights, compliance with “lex artis ad hoc” and the entry of healthcare professionals’ activity into medical records has become a safeguard to fight malpractice claims in court, as evidenced by the case-law analysed on the matter.

Background: Women with fibromyalgia (FM) have 2.5 falls per year compared to the 0.5 falls in people without FM. This fact poses a significant health expense. Square Stepping Exercise (SSE) is a balance training system that has been shown to be effective in preventing falls in the elderly. However, there are neither studies in people with FM nor studies that apply SSE through video-conferencing (Tele-SSE). The objectives of this project are 1) to investigate the applicability, safety, decrease in the number of falls, and incremental cost-effectiveness ratio of prevention of falls program through Tele-SSE in women with FM, and 2) to study the transfer of obtained results to the public and private socio-health economy of Extremadura. Methods/Design: A randomized controlled trial with experimental (Tele-SSE) and control (usual treatment) groups will be carried out. The application of Tele-SSE will be performed for 12 months (three times per week) and one additional follow-up month after the intervention. A focus group including agents to identify key points to transfer the findings to the public and private sectors in Extremadura. One-hundred and eighteen women with FM will be recruited and randomly distributed into the two groups: Experimental (Tele-SSE; n = 59) and control group (Usual care; n = 59). Primary outcome measures will be: 1) Applicability; 2) safety; 3) annual number of falls; and 4) incremental cost-effectiveness ratio. Secondary outcomes will be: 1) Balance; 2) fear of falling; 3) socio-demographic and clinical information; 4) body composition; 5) physical fitness; 6) physical activity and sedentary behavior; 7) quality of life-related to health, mental health, and positive health; 8) pain; 9) disability level; 10) cognitive aspects; and 11) depressive symptoms. Regarding the focus group, the acceptability of the Tele-SSE will be evaluated in social-sanitary agents and will include Tele-SSE in their services offer. A statistical analysis will be carried out by treatment intention and protocol. In addition, a cost-effectiveness analysis from the perspective of the health system will be performed. Discussion: This project aims to improve the efficiency and equity of physical therapy services based on tele-exercise in preventing falls in people with FM. Furthermore, orientations will be given in order to transfer the obtained findings into the social-sanitary system and market.

Background: Childhood obesity is one of the greatest public health problems facing advanced societies, and Spain is one of the countries with the highest incidence. There are many studies that monitor at the national level, but given the lack of specificity, lack of updating and scarcity of epidemiological data on overweight, obesity, physical condition and well-being of children and adolescents in Extremadura, it seems necessary to create a Well-being, Obesity and Motricity Observatory in Childhood and Youth (WOMO) in Extremadura in order to follow up on the evolution of this problem and to propose strategies to combat it. Therefore, this project aims (1) to obtain information on the physical condition, body composition and well-being of children and youth in Extremadura every year and (2) to evaluate the relationship between obesity, overweight, physical condition, well-being, self-perceived physical fitness, physical activity adherence, physical literacy, health-related quality of life (HRQoL), happiness and satisfaction with life, connection with nature, barriers to sports practice, self-concept and bullying in children and youth. Methods: An annual monitoring cross-sectional and follow-up study will be performed. Primary outcome measures will be (1) personal data and anthropometric measurements, (2) family and school information, (3) physical condition, (4) obesity and overweight level, and (5) well-being. Secondary outcome measures will be (1) self-perceived physical fitness, (2) physical activity adherence, (3) physical literacy, (4) HRQoL, (5) happiness and satisfaction with life, (6) connection with nature, (7) barriers to sports practice, (8) self-concept and (9) bullying. Discussion: This project will provide valuable information to adopt appropriate strategies to reduce the level of overweight and obesity in children and youth. Furthermore, orientations will be given to transfer the results obtained to the business sector or to the public sector to evaluate or change the policies adopted.

CONTEXTO: Los cuidadores constituyen una población de riesgo de alteraciones psíquicas y físicas. Las alteraciones emocionales, como la depresión y la ansiedad, son enfermedades sub-diagnosticadas en el cuidador. OBJETIVO(S): Conocer las necesidades de apoyo de cuidadores mayores que cuidan de otros mayores así como la asociación al estrés emocional. METODOLOGÍA: Estudio de carácter cuantitativo observacional, transversal y descriptivo de campo. La muestra está constituida por 107 cuidadores mayores de personas mayores, residentes en la zona rural suroeste del Área de Salud de Badajoz de la Comunidad Autónoma de Extremadura (España). La recogida de datos se llevó a cabo mediante un cuestionario estructurado y el procedimiento aplicado fue el de la encuesta. RESULTADOS: La edad media de los adultos mayores que realizan los cuidados es de 76.9 años, ligeramente predominan las mujeres (59.8 %) con respecto a los hombres (40.2 %). El 84,1% de los cuidados se realizan en las relaciones de pareja. El 70,1% de los adultos mayores cuidadores considera que necesita ayuda para realizar las actividades que requieren los cuidados. El 31,8% requiere ayuda de personal especialista por estrés emocional. Existen diferencias estadísticamente significativas (p=.009), entre las personas que necesitan ayuda y el riesgo de alteración emocional del cuidador. CONCLUSIONES: Los cuidadores de edad avanzada demandan ayuda para realizar las labores del cuidado. Además, un tercio de personas que se dedican a los cuidados requieren ayuda de un especialista por estrés emocional, y los cuidadores que necesitan ayuda presentan un mayor riesgo de estrés emocional. CONTEXTO: Os cuidadores constituem uma população em risco de alterações psíquicas e físicas. Distúrbios emocionais, como depressão e ansiedade, são doenças insuficientemente diagnosticadas no cuidador. OBJETIVO(S): Conhecer as necessidades de apoio para cuidadores idosos que cuidam de idosos bem como a sua associação ao stresse emocional. METODOLOGIA: Foi realizado um estudo de campo, quantitativo, observacional, transversal e descritivo. A amostra é constituída por 107 cuidadores idosos de pessoas idosas, moradores da área rural do sudoeste da área de saúde de Badajoz, da Comunidade Autónoma de Extremadura (Espanha). A recolha de dados foi realizada através de um questionário estruturado, aplicado através da realização de uma entrevista. RESULTADOS: A idade média dos idosos participantes é de 76,9 anos, predominam as mulheres (59,8%) em relação aos homens (40,2%). 84,1% dos cuidados ocorrem entre pessoas com relações familiares diretas. 70,1% dos cuidadores idosos consideram que precisam de ajuda para realizar as atividades que requerem cuidados. 31,8% requer ajuda de pessoal especializado devido ao stresse emocional. Existe uma relação estatisticamente significativas (p=0,009) entre as pessoas que precisam de ajuda e o risco de distúrbios emocionais do cuidador. CONCLUSÕES: Os cuidadores idosos exigem assistência para realizar as tarefas de cuidados. Além disso, um terço dos cuidadores requer ajuda de um especialista em stresse emocional, e cuidadores que precisam de ajuda têm maior risco de stresse emocional. BACKGROUND: Caregivers constitute a population at risk of psychic and physical alterations. Emotional disturbances, such as depression and anxiety, are under-diagnosed diseases in the caregiver. AIM: To know the support needs for elderly caregivers who care for the elderly as well as their association with emotional stress. METHODS: Study of quantitative observational, transversal and descriptive field. The sample is constituted by 107 elderly caregivers of elderly people, residents in the rural southwestern area of Badajoz Health Area of the Autonomous Community of Extremadura (Spain). The data collection was carried out through a structured questionnaire and the procedure applied was that of the survey. RESULTS: The average age of the elderly who perform the care is 76.9 years, slightly women predominate (59.8%) with respect to men (40.2%). 84.1% of care is carried out in marital relationships. 70.1% of elderly caregivers consider that they need help to perform the activities that require care. 31.8% requires help from specialized personnel due to emotional stress. There are statistically significant differences (p = .009) between people who need help and the risk of emotional disturbance of the caregiver. CONCLUSIONS: Elderly caregivers demand assistance to carry out the tasks of care. In addition, one third of caregivers require help from a specialist for emotional stress, and caregivers in need of help have a greater risk of emotional stress.

Nowadays, social and health representatives are putting the focus on emerging need: promote intergenerational programs and practices to generate spaces of encounter and collaboration between people of different ages. According to it, the purpose of intergenerational practices should be to achieve as aim for a society for all ages, regardless of age, an expression proposed by United Nations, not only to integrate all ages but to respond to their needs and provide them a higher quality of life.

The ageing of the population is a reality in our society nowadays. The aging process changes increase the probability that health problems occur. This fact involves that the needs of care demanded by the population increase too. The care for the elderly generally are provided in home environments, where often, the primary caregiver is another old person. In this sense, must be taken into account that this stage of life, the old age, although there has been important improvements in the quality of life and in the resolution of health problems, presents certain limitations refers to physical and mental declines that affect to the functional capacity of elderly caregivers. For this reason, it is necessary to carry out a comprehensive geriatric assessment to identify unresolved needs and establish care strategies required to attend their demands for care.

Home accidents are more common in the elderly and they can have serious consequences to the injured person's health. At home, chances to suffer accidents of any type are higher, because it's the place where old people spend most of their daily time. It is important to point out that a high percentage of domestic accidents could be easily avoided by taking some simple cautions. The main aim of this paper is to know how we can prevent most common domestic accidents in the aged population: falls, burnings, poisonings and fire prevention.

The process of comprehensive geriatric assessment is one of the key elements of geriatric care management aimed at the population. it includes evaluating the clinical, functional, mental and social aspects of aging result and/or pathological processes that appear at this stage of the life cycle. For their achievement, as well as other tools, professionals have a large number of validated rating scales specifically designed in the assessment of the different areas or fields. Its use can be very useful, especially for the objectification of evaluation results. The future of research in this area goes through deepening the adequacy of the scales to the characteristics and needs of older people in each care level or place of care.

To determine the burden and social support perceived by elderly caregivers of elderly people.Cross-sectional study using a standardized questionnaire for elderly caregivers of elderly people.In the population of elderly caregivers of elderly people, the prevalent type of care is by couples (84.1 %), and the percentages of men and women correspond to 40.2 % and 59.8 %, respectively. The 53.3 % of caregivers have burden, of which a 31.8 % present an intense burden, and a 21.5 % a slight burden. Regarding to perceived social support of elderly caregivers, it is normal in a 81.3 % of cases, compared to a 18.7 % who reflecting a low perceived social support. Finally, there is correlation between Duke social support questionnaire and Zarit scale caregiver burden.Elderly caregivers of elderly people who have higher levels of burden have lower perceived social support.