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Compulsory home confinement due to COVID-19 pandemic has had an influence on the physical and emotional health. Nevertheless, it has been more prevalent in women and in people with chronic illness such as multiple sclerosis, so the aim of this study was to know the experience of women with multiple sclerosis during the home confinement period in Spain. Seven women aged over 18 years, with a definitive diagnosis of multiple sclerosis and who belonged to multiple sclerosis associations completed semi-structured interviews. Two main themes and multiple subthemes were identified. The first them was "living with multiple sclerosis during home confinement" which included the physical and emotional impact, confinement coping ability and time for reflection. The second theme was "the environment during confinement" and it included solidarity and support, family cooperation, importance of peer contact and adjustments in the health environment during the pandemic. The period of compulsory home confinement in Spain did not worsen the physical and emotional symptoms of these women. This might be related to the increased support they had received as well as the continuity of their rehabilitation activities at home. Regarding changes in health system, the participants referred the necessity to return to face-to-face visits.

Introduction: In recent years, the importance of training healthcare professionals in nontechnical skills using effective methodologies has been increasingly recognised as a means of preventing clinical errors in the practice of health care. The aim of this study was to evaluate the effectiveness of educational interventions on nontechnical skills in the emergency medical services and/or critical care unit settings. Methods: A systematic search was carried out in the PubMed, SCOPUS, CINAHL, and Web of Science databases according to predetermined inclusion and exclusion criteria. After the initial search, 7952 records were selected after duplicates removed. Finally, a selection of 38 studies was included for quantitative analysis. Separate meta-analyses of standardised mean changes were carried out for each outcome measure assuming a random-effects model. Cochran's Q-statistic and I2 index were applied to verify study heterogeneity. Weighted analyses of variance and meta-regressions were conducted to test the influence of potential moderators and funnel plots using Duval and Tweedie's trim-and-fill method, and Egger's regression test were used to examine publication bias. Results: All the variables analysed had a significant effect size, with the exception of situational awareness (d+ = −0.448; 95% confidence interval [CI] = −1.034, 0.139). The highest mean effect size was found for knowledge (d+ = −0.925; 95% CI = −1.177, −0.673), followed by the mean effect sizes for global nontechnical skills (d+ = −0.642; 95% CI = −0.849, −0.434), team nontechnical skills (d+ = −0.606; 95% CI = −0.949, −0.262), and leadership nontechnical skills (d+ = −0.571; 95% CI = −0.877, −0.264). Similar mean effect sizes were found for attitude (d+ = −0.406; 95% CI = −0.769, −0.044), self-efficacy (d+ = −0.469; 95% CI = −0.874, −0.064), and communication nontechnical skills (d+ = −0.458; 95% CI = −0.818, −0.099). Large heterogeneity among the standardised mean changes was found in the meta-analyses (I2 > 75% and p < .001), except for self-efficacy where I2 = 58.17%, and there was a nonstatistical result for Cochran's Q. This great variability is also reflected in the forest plots. Discussion: The use of simulation interventions to train emergency and critical care healthcare professionals in nontechnical skills significantly improves levels of knowledge, attitude, self-efficacy, and nontechnical skills performance.

To the best of our knowledge, no studies have yet examined the emotional repercussions of the care processes among people infected with the human immunodeficiency virus who participate in preventive anal cancer screening programs.This study aimed to explore the knowledge, emotions, sexuality, barriers, and facilitators perceived by this patient group during the process of anal cancer screening and diagnosis.Detailed, semistructured, qualitative interviews were completed with 17 men and 3 women to explore their knowledge, experiences, and emotions regarding the screening process. Purposive sampling was conducted on the basis of age, gender, and type of lesion diagnosed in the anal biopsy.Four major themes were identified: 1) knowledge of the disease and its treatment, 2) emotions perceived by the patients, 3) the influence of screening on sexual practices, and 4) facilitators and obstacles during the care provision process. Patients reported appropriate knowledge of anal cancer and human papillomavirus. Predominant emotions were worry and fear with avoidance as one of the coping strategies.These results suggest that communication of information and clinical results can be improved.Understanding the facilitators and barriers to the program will allow the integration of interventions designed to improve healthcare provision into direct care.

Symptoms of fatigue and lack of energy are very common in caregivers of palliative care (PC) patients, traditionally associated with variables such as burden or depression. There are no Spanish-language instruments validated for assessing fatigue levels in this population. The Fatigue Assessment Scale (FAS) is a useful and simple instrument for assessing fatigue in this group. The aim of this study was to examine its psychometric properties (factor structure, reliability and validity) in a sample of caregivers of PC patients. Instrumental design for instrument validation was performed. One hundred and eight caregivers of PC patients participated and completed measures of fatigue, family functioning, life satisfaction, caregiver burden, anxiety, depression, resilience and quality of life. A confirmatory factor analysis was performed; non-linear reliability coefficient and Pearson correlations and t-tests were conducted to assess evidence of reliability and validity. The Spanish version of the FAS was found to have a one-dimensional structure. Reliability was 0.88. Validity evidence showed that FAS scores were positively associated with levels of burden, anxiety and depression. They were negatively associated with family functioning, life satisfaction, resilience and quality of life. The Spanish version of the FAS in caregivers of PC patients shows adequate psychometric properties., Carlos III Health Institute (ISCIII) belonging to the Spanish Ministry of Health, Fondos FEDER (European Regional Development Fund-A way of making Europe) PI17/00328, Institute for Health and Biomedical Research of Alicante (ISABIAL) UGP-18-255 UGP-19-253 UGP-20-038

On March 19 World Health Organization declare the pandemic situation by outbreak coronavirus disease 2019 in the world. The pressure on the health care system has been very high in several countries. Spanish National Transplant Organization (ONT) have made many efforts in maintaining transplantation activity. Although the impact of the pandemic on organ activity has been analysed, to date, less data exist regarding the impact on tissue activity. The aim of this study has been the evaluation of the possible impact on the procurement, processing and distribution of tissues during the peak period of the pandemic COVID-19 in Spain. For this study, a multicentre analysis has been made with a survey of the tissue banks in Spain, during the period March 1 to April 30, 2020. Our data suggest that the impact of coronavirus in Spain has affected dramatically tissue donation but with a moderate effect on stored tissues such as bone, valves, vessels or skin. Tissue banks should prepare if future next pandemic waves surges so that tissue provision is guaranteed both in urgent and elective surgeries.

The prevalence of mild cognitive impairment (MCI) has significantly increased in recent years. No specific instruments are available in Spanish for assessing health‐related quality of life (HRQoL) in people with MCI. The aim of this study was to adapt transculturally and validate the mild cognitive impairment questionnaire (MCQ) in Spanish people with MCI. A standardized transcultural adaptation process was carried out, and the structural equivalence of the Spanish version of the scale was examined. In addition, we studied the reliability and construct validity of the instrument. The sample comprised 100 people with MCI, with a mean age of 79.5 years. In a confirmatory factor analysis, we found the instrument had a one‐factor structure and adequate internal consistency. Related to the construct validity, we found meaningful relationships with measures of HRQoL and depression. Our results indicate that the Spanish version of the MCQ is a reliable and valid tool for measuring HRQoL in Spanish patients with MCI. The availability of specific tools, such as the MCQ allows nurses to evaluate new intervention strategies to improve the HRQoL of these patients. Furthermore, this scale can be used by researchers and clinicians to improve the standards of care provided to this population.

Objective: To evaluate the effectiveness of interventions aimed at improving the sexuality of women with multiple sclerosis. Data sources: MEDLINE, CINAHL, PsycINFO, Web of Science, Scopus, Embase and the Cochrane Library, as well as doctoral thesis databases Teseo and ProQuest Dissertations & Theses Global and the grey literature database Opengrey were searched, last on 15 October 2019. Journals related to the topic were also consulted. The bibliographic references of the articles included were reviewed. Method: Studies were selected if they included women with multiple sclerosis in whom interventions aimed at reducing sexual dysfunction were applied. Data extraction was carried out by two independent reviewers. The Jadad scale was used to evaluate the methodological quality of the studies included. Results: In total, 12 clinical trials were selected, and 611 patients were examined. Studies were classified into six interventions: sexual therapy (4), pharmaceutical drugs (3), pelvic floor exercises (2), yoga (1), mindfulness (1) and vaginal devices (1). Most of them improved some primary outcomes of sexual dysfunction such as lubrication, arousal, desire or orgasm. Pain was the most common secondary outcome evaluated and it became better in two studies including sexual therapy and in one intervention with pelvic floor exercises. Tertiary outcomes such as anxiety or depression were rarely examined, and they improved with sexual therapy and with OnabotulinumtoxinA. Conclusion: Sexual therapy, administration of OnabotulinumtoxinA, pelvic floor muscles exercises alone or combined with electrostimulation and the use of clitoral devices could be the most recommended interventions to improve the sexuality in women with multiple sclerosis.

Background: Standardised patient simulations seem to be useful for improving the communication skills of health sciences students. However, it is important to define the effectiveness of these types of interventions in complex scenarios linked to disease chronicity and end-of-life contexts. Methods: A quasi-experimental study with pre- and post-intervention measures was carried out in a single group. A total of 161 nursing students completed different assessment instruments to measure their attitudes towards communication (Attitude Toward Communication Scale), self-efficacy (Self-Efficacy of Communication Skills, SE-12), and communication skills (Health Professionals Communication Skills Scale, EHC-PS) before and after simulation training with standardised patients. The objective of the program was to train students in non-technical skills for complex situations involving chronicity and end-of-life care. It comprised eight sessions lasting 2.5 h each. Results: The results showed notable baseline gender differences in attitudes towards communication and in the informative communication dimension, with women obtaining higher scores. The participants’ self-efficacy and communication skills significantly improved after completing the intervention, with no significant differences being found for the attitudes towards communication variable. Conclusion: The standardised patient simulation programme for complex scenarios related to chronicity and end-of-life contexts improved communication self-efficacy and communication skills in these nursing students. In future work it will be important to analyse the influence of gender and attitudes towards communication as variables in the learning of communication skills in nursing students., Program Redes-I 3CE for Research in University Teaching of the Institute of Education Science (Vice-Chancellorship of Quality and Educational Innovation) of the University of Alicante, edition 2018-19 (No. XARXES-I3CE-20184344).

Purpose To understand how women with multiple sclerosis (MS) experience their sexuality. Material and methods This was a qualitative study in which eight women belonging to MS associations in Elche or Alicante (Spain) completed semi-structured interviews. We subsequently carried out a thematic analysis of this data. Results Four main themes and multiple sub-themes were identified. The first theme was the 'influence of stereotypes on sexual expression', which included social and gender perspectives; the second theme was 'physical and emotional causes of sexual dysfunction', which were classified as primary, secondary, and tertiary; the third theme was 'experiencing sexuality in a personalised way', which included relationships with a partner, the concept of sexuality, and resources for improving sexual function; and the final theme was 'external support', which included sexual assistance, professional care, and peer support. Conclusions Sexual needs change in women with MS after diagnosis of the disease. However, this is not addressed routinely by health professionals. In their search for resources, women with MS highlighted that support from partners and from associations, could constitute a support network for the expression of their sexuality.IMPLICATIONS FOR REHABILITATIONWomen with MS refer changes in their sexual function, and these changes are not addressed routinely by healthcare providers.Inclusion of the sexual partners of women with MS in consultations regarding the treatment of sexual dysfunctions should be considered with previous consent.The positive experience of a woman with MS who used sexual assistant services may justify further research.MS associations can also play an important role in the sexual field as a meeting place for peers with shared experiences.

Background Simulation training programs in crisis resource management must be evaluated using valid and reliable instruments. We translated into Spanish and linguistically validate The Mayo High Performance Teamwork Scale (MHPTS) and Ottawa Crisis Resource Management Global Rating Scale (Ottawa GRS) non-technical skills assessment instruments. Method We performed a standardised cross-cultural adaptation process. The psychometric properties of both instruments in their versions adapted to Spanish were subsequently evaluated in a sample of 100 students by using exploratory factor analysis and assessing internal consistency and convergent validity through a total of 94 simulation scenarios in urgent medical situations Results Our results for the MHPTS showed a one-dimensional structure containing 8 items which explained a total variance of 72.84%; the Ottawa GRS also had a one-dimensional structure, this time with 5 items, which explained a total variance of 91.79%. According to the Cronbach alpha, the internal consistency for the MHPTS was 0.94 (1–8 items) and 0.98 for the Ottawa GRS. In addition, there was a strong correlation between the MHPTS and Ottawa GRS (r = 0.97; p Conclusion We found strong evidence for the high validity and reliability of the Spanish versions of both these tools when tested in Spanish simulated emergency contexts.

Objective: To adapt the Pregnancy-Related Thoughts Scale into Spanish (Spanish PRTS) and evaluate its psychometric properties. Design: Instrument translation (Phase 1), validation, and psychometric testing (Phase 2). Setting: Phase 2 was conducted in three general hospitals in eastern Spain. Participants: A convenience sample of 180 women during the third trimester of pregnancy participated in Phase 2. Methods: After a standard process of linguistic validation in Phase 1, we used the Spanish PRTS with other instruments to evaluate its psychometric properties in Phase 2. The participants completed a battery of questionnaires during prenatal visits in the third trimester (28–42 weeks gestation) at health care centers. Responses to the postnatal depression questionnaire were obtained through an online questionnaire between the first and third months after childbirth. We evaluated the factor structure; reliability; and convergent, discriminant, and predictive validity of the Spanish PRTS. Results: The Spanish PRTS had a Cronbach’s alpha coefficient of .81 and McDonald’s omega coefficient of .82. The confirmatory factor analysis showed that the best adjustment of the scale was one factor with two pairs of correlated residuals. The Spanish PRTS scores were positively correlated to scores on pregnancy worries, state and trait anxiety, fatigue, symptoms of postnatal depression, and poor quality of life and inversely correlated to scores on self-efficacy for coping with stress. Conclusion: The findings support the validity and reliability of the Spanish PRTS to evaluate pregnancy-related anxiety; this tool can be used to measure outcomes of interventions for the prevention or treatment of women’s anxiety during pregnancy. Funded by the General Sub-Directorate for Evaluation and Promotion of Research (Institute of Health Carlos III, ISCIII) and by the European Regional Development Fund (FEDER) “A way to make Europe’’ (Project reference PI14/01549).

Background Adequate communication skills in healthcare professionals are one of the key elements required for achieving high-quality healthcare. Thus, measurement instruments able to assess the dimensions related to these skills, including attitudes towards communication, are useful and convenient tools. Objectives To (a) cross-culturally adapt and validate a scale to measure attitudes towards communication in a sample of nursing students in the Spanish environment; (b) describe the perceived attitudes of nursing degree students towards communication. Methods We conducted an instrumental study. First, we adapted the scale by applying a standardised linguistic validation procedure. After that, we determined its structural equivalence and evaluated its psychometric properties. Participants A total of 255 students participated; their average age was 22.66 years (SD = 4.75) and 82% were female. Results The internal consistency of the scale was adequate (0.75), and the data fit well with the model (CFI = 0.99; TLI = 0.99; RMSEA = .01 95% CI [.00–.05]). The overall instrument score poorly correlated with the self-efficacy in communication skills variable. Conclusions The attitudes towards communication scores for these nursing students were high. The Spanish version of the Attitudes Towards Health Communication scale had adequate psychometric properties and this tool could quickly and easily be applied to assess the attitudes of health profession students.

espanolFundamento. Desarrollar y validar un instrumento especifico de identificacion de pacientes complejos, el Indice de Evaluacion de Casos Complejos (IECC). Metodos. Estudio instrumental con dos fases: 1) Elaboracion del instrumento: se definieron y operacionalizaron las variables extraidas de la literatura que, posteriormente, fueron sometidas al juicio de expertos. El IECC incluyo catorce variables divididas en dos dimensiones: complejidad del manejo clinico y complejidad del manejo comunitario. 2) Estudio psicometrico: evaluacion de la fiabilidad por equivalencia entre observadores (r Pearson), de la validez de criterio respecto al sistema de clasificacion Clinical Risk Groups (CRG) y de la validez de constructo a traves de grupos conocidos y a traves del estudio de conglomerados jerarquicos. Los analisis se realizaron con el paquete estadistico SPSS.v.17. Resultados. La fiabilidad entre observadores para la subescala clinica fue r = 0,97, para la subescala comunitaria r = 0,74 y para la puntuacion total r = 0,89. El 88,4% (n = 458) de los 518 casos identificados como complejos por el IECC fueron categorizados por el sistema CRG en las categorias de mas complejidad clinica (niveles 6 a 9). Los resultados sustentan la validez de constructo de la escala. El analisis de conglomerados mostro dos clusters diferentes, aunque relacionados. Conclusion. El IECC es un indice breve y de facil aplicacion, con una buena adecuacion conceptual y evidencias de su fiabilidad y validez dirigido a la deteccion de pacientes con necesidades complejas. EnglishBackground. The aim was to develop and validate the Complex Case Assessment Index (CCAI), a specific instrument to identify complex patients. Methods. Instrumental study in two phases: 1) Development of the scale: the variables extracted from the literature were firstly defined and operationalized, and then submitted for expert judgment. The CCAI included 14 variables divided into two dimensions: complexity of clinical management and complexity of community management. 2) Psychometric study: evaluation of the reliability and validity of the scale by equivalence between observers (Pearson’s r), criterion validity with respect to the Clinical Risk Groups (CRG) classification system, and construct validity through known groups and study of hierarchical clusters were examined. The analyses were carried out with the SPSS version 17 statistical package. Results. Reliability by equivalence between observers was r = 0.97 for the clinical subscale, r = 0.74 for the community subscale, and r = 0.89 for the total score. The CCAI identified 518 cases as complex; 458 of them (88.4%) were categorized by the CRG system in the categories of greatest clinical complexity (levels 6 to 9). The results support the construct validity of the scale. The cluster analysis showed two different, although related, clusters. Conclusion. The CCAI is a fast and easy-to-use index, with good conceptual adequacy and evidence of reliability and validity for screening patients with complex needs.

Background Dying at home is the most frequent preference of patients with advanced chronic conditions, their caregivers, and the general population. However, most deaths continue to occur in hospitals. The objective of this study was to analyse the socioeconomic inequalities in the place of death in urban areas of Mediterranean cities during the period 2010–2015, and to assess if such inequalities are related to palliative or non-palliative conditions. Methods This is a cross-sectional study of the population aged 15 years or over. The response variable was the place of death (home, hospital, residential care). The explanatory variables were: sex, age, marital status, country of birth, basic cause of death coded according to the International Classification of Diseases, 10th revision, and the deprivation level for each census tract based on a deprivation index calculated using 5 socioeconomic indicators. Multinomial logistic regression models were adjusted in order to analyse the association between the place of death and the explanatory variables. Results We analysed a total of 60,748 deaths, 58.5% occurred in hospitals, 32.4% at home, and 9.1% in residential care. Death in hospital was 80% more frequent than at home while death in a nursing home was more than 70% lower than at home. All the variables considered were significantly associated with the place of death, except country of birth, which was not significantly associated with death in residential care. In hospital, the deprivation level of the census tract presented a significant association (p Conclusions The probability of dying in hospital, as compared to dying at home, increases as the socioeconomic deprivation of the urban area of residence rises, both for palliative and non-palliative causes. Further qualitative research is required to explore the needs and preferences of low-income families who have a terminally-ill family member and, in particular, their attitudes towards home-based and hospital-based death.

Communication is one of the determining factors of healthcare quality, however, a health model that prioritizes clinical over non-technical skills remains prevalent. The aims of this article were: (a) to validate a communication skills scale in a sample of fourth-year nursing degree students from two Spanish universities and (b) determine their perception of communication skills. The study included 289 fourth-year nursing undergraduate students with a mean age of 22.7 (SD = 4.87) years, 81.7% were female. The Health Professionals Communication Skills Scale (HP-CSS) questionnaire was adapted for use among nursing students. We analysed the psychometric properties and relationships with the variable attitudes toward communication skills. The HP-CSS showed a high internal consistency (0.88) and good fit of data to the model (TLI = 0.98, CFI = 0.97, RMSEA = 0.05 [95% CI = 0.04&ndash, 0.06]). The total score and subscale scores correlated with the variable attitude towards communication skills. High scores were obtained for the students&rsquo, perception of communication skills. The HP-CSS is a valid and reliable tool to assess the communication skills in nursing students. This scale provides university teachers with a rapid and easily applied instrument to assess the level of communication skills and relationship with patients.

Background and objectives The objective of mindfulness-based stress reduction (MBSR) programmes is to promote awareness of the present moment without judging, evaluating or reacting to the different thoughts or emotions that may arise. Development of these abilities appears especially important for healthcare professionals. The objective of this study was to evaluate the effectiveness and medium- and long-term effects of a MBSR programme for primary care (PC) health professionals on their health-related quality of life and quality of work life. Design Randomised clinical trial using an intervention and control group with follow-up of the experimental group. Setting Primary Care centres in the Alicante Public Health Service (Spain). Participants Participants were PC health professionals (N = 58) divided between an intervention group receiving the 8-week MBSR programme and a control group receiving a theoretical training session alone. Method Both groups were evaluated at baseline and at 8 weeks, and the intervention group was additionally evaluated at 3-, 6-, 9- and 12-month postprogramme. Results In comparison to the control group, the intervention group obtained higher scores postintervention for mindfulness, health-related quality of life, mood and compassion satisfaction and a lower score for burnout. Improvements in mindfulness, mood and burnout syndrome persisted at 12 months after the programme. Conclusions In conclusion, MBSR is an effective intervention to enhance the health-related quality of life and quality of work life of Primary Care Health professionals.

Background Pressure injuries are an important problem in hospital care. Detecting the population at risk for pressure injuries is the first step in any preventive strategy. Available tools such as the Norton and Braden scales do not take into account all of the relevant risk factors. Data mining and machine learning techniques have the potential to overcome this limitation. Objectives To build a model to detect pressure injury risk in intensive care unit patients and to put the model into production in a real environment. Methods The sample comprised adult patients admitted to an intensive care unit (N = 6694) at University Hospital of Torrevieja and University Hospital of Vinalopó. A retrospective design was used to train (n = 2508) and test (n = 1769) the model and then a prospective design was used to test the model in a real environment (n = 2417). Data mining was used to extract variables from electronic medical records and a predictive model was built with machine learning techniques. The sensitivity, specificity, area under the curve, and accuracy of the model were evaluated. Results The final model used logistic regression and incorporated 23 variables. The model had sensitivity of 0.90, specificity of 0.74, and area under the curve of 0.89 during the initial test, and thus it outperformed the Norton scale. The model performed well 1 year later in a real environment. Conclusions The model effectively predicts risk of pressure injury. This allows nurses to focus on patients at high risk for pressure injury without increasing workload.

Background Home-based noninvasive ventilation has proven cost-effective. But, adherence to therapy still constitutes a common clinical problem. We hypothesized that a behavioral intervention supported by a mobile health (mHealth) app could enhance patient self-efficacy. It is widely accepted that mHealth-supported services can enhance productive interactions among the stakeholders involved in home-based respiratory therapies. Objective This study aimed to measure changes in self-efficacy in patients with chronic respiratory failure due to diverse etiologies during a 3-month follow-up period after the intervention. Ancillary objectives were assessment of usability and acceptability of the mobile app as well as its potential contribution to collaborative work among stakeholders. Methods A single-blind, single-center, randomized controlled trial was conducted between February 2019 and June 2019 with 67 adult patients with chronic respiratory failure undergoing home-based noninvasive ventilation. In the intervention group, a psychologist delivered a face-to-face motivational intervention. Follow-up was supported by a mobile app that allowed patients to report the number of hours of daily noninvasive ventilation use and problems with the therapy. Advice was automatically delivered by the mobile app in case of a reported problem. The control group received usual care. The primary outcome was the change in the Self Efficacy in Sleep Apnea questionnaire score. Secondary outcomes included app usability, app acceptability, continuity of care, person-centered care, and ventilatory parameters. Results Self-efficacy was not significantly different in the intervention group after the intervention (before: mean 3.4, SD 0.6; after: mean 3.4, SD 0.5, P=.51). No changes were observed in adherence to therapy nor quality of life. Overall, the mHealth tool had a good usability score (mean 78 points) and high acceptance rate (mean score of 7.5/10 on a Likert scale). It was considered user-friendly (mean score of 8.2/10 on a Likert scale) and easy to use without assistance (mean score of 8.5/10 on a Likert scale). Patients also scored the perception of continuity of care and person-centered care as high. Conclusions The integrated care intervention supported by the mobile app did not improve patient self-management. However, the high acceptance of the mobile app might indicate potential for enhanced communication among stakeholders. The study identified key elements required for mHealth tools to provide effective support to collaborative work and personalized care. Trial Registration ClinicalTrials.gov NCT03932175; https://clinicaltrials.gov/ct2/show/NCT03932175

Background. Dying at home is the most frequent preference, with the institutionalized context being the most common place of death. To determine the place of death in conditions requiring palliative care of residents in Spain aged 15 or over by Autonomous Community (AC) and to examine the relationship with oncological vs . non-oncological causes of death. Methods. Population-based cross-sectional study analysing medical death certificates. Adjusted effects of socio-demographic variables, AC and causes on the place of death were estimated calculating odds of death in hospital vs . at home (O H/H ) and in a nursing home vs . at home (O N/H ), and odds ratio (OR H/H and OR N/H ) by multinomial logistic regression models. Results. During 2012-2015, 1,611,767 deaths were recorded, 64.8% corresponding to the target population. Death in hospital was 77% more frequent than death at home, while death in a nursing home was 53% lower. Male sex, lower age, lower academic level, place of birth other than Spain, bigger city size and civil status other than married displayed a relationship with death in hospital, while the same variables except female sex and higher age did so in a nursing home. Adjusted O H/H > 1 and O N/H < 1 were observed in all AC, except Catalonia. Oncological causes made O H/H < 1 in almost 50% of AC, while O N/H continue to be < 1. Conclusions . Most deaths were in hospital and fewer at nursing homes, despite oncological causes increasing deaths at home (adjusted effect).

WHAT IS KNOWN ON THE SUBJECT?: The Psychiatric/Mental Health Clinical Placement Survey preplacement, validated in English and widely used, assesses nursing student attitudes towards the mental health field. There are no validated scales in Spanish to assess students' attitudes towards mental health, nor is there evidence of attitudes in Spanish students. WHAT DOES THIS ARTICLE ADD TO EXISTING KNOWLEDGE?: The present study was the first to address the validity of a scale which evaluates nursing student attitudes towards mental health issues, in Spanish. Until now, no knowledge was available on nursing student attitudes towards mental health issues in the Spanish context. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The results provide faculty professors with a validated tool to use to assess attitudinal changes in students, following theoretical and practical training in mental health. To have an up-to-date perspective on student attitudes towards both the field of mental health and people with severe mental illness, thereby providing the opportunity to focus on those aspects requiring improvement. Abstract Introduction The encouragement of positive attitudes towards mental health is necessary in order to improve the quality of healthcare assistance. The attitudes of nursing students towards mental health are unknown, and there are no validated scales for their assessment. Aims To adapt the Psychiatric/Mental Health Clinical Placement Survey (PMHCPS) to Spanish and examine its psychometric properties; to describe the attitudes of nursing students towards the mental health field. Method Confirmatory factorial analysis (CFA), internal consistency and construct validity were performed. An assessment of the students' attitudes was also conducted. Results The CFA showed appropriate fit, and total internal consistency was adequate. With regard to construct validity, knowledge was associated with practicum mark. The students achieved above mid-range scores for all subscales, except negative stereotypes. Gender differences were observed. Discussion The PMHCPS, translated to Spanish, enables the students' attitude towards the mental health field to be assessed, thus identifying those areas of student attitudes and competencies requiring improvement. Implications for practice To provide Spanish nursing faculties with access to a scale, with which to assess changes in student attitudes. The assessment results may then be utilized to formulate teaching methods in order to improve the quality of health care the students might provide as future nursing professionals.

WHAT IS KNOWN ON THE SUBJECT?: AHDs in mental health are fundamental tools in advance care planning processes. It is an important method for involving mental healthcare users in clinical decisions and in providing effective healthcare based around user preferences. AHDs can be applied in situations in which the person may forfeit their legal capacity, according to the Convention on the Rights of Persons with Disabilities. However, the use of AHDs as described above is not yet a reality in Spain. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The present study surveys the knowledge and attitudes of mental healthcare providers towards AHDs in clinical practice. Although providers had a moderate-low level of knowledge about AHDs, they presented positive attitudes towards them. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The use of AHDs in mental healthcare practice poses challenges to the Spanish mental healthcare system. Acquiring up-to-date data on the knowledge and attitudes of providers towards AHDs allows organizations to address aspects of their service that require reinforcement. This data could also be used by other countries just starting to use AHDs, as an initial step towards supporting the implementation of a multistage intervention process. More in-depth training for providers would help improve their competence to implement or honour the statements set out in AHDs, the related legal and ethical issues, and liability issues related to their implementation. The Spanish mental healthcare system requires structural changes so that providers can embrace new ways of relating to users and to organize partnerships and a continuity of care centred on user preferences. ABSTRACT: Introduction Advance healthcare directives (AHDs) in mental health offer important information regarding service users' preferences. However, whether AHDs are truly understood by providers is questionable. Aim To survey the knowledge and attitudes of mental health professionals towards AHDs and examine any associations with sociodemographic and occupational variables. Method We cross-sectionally surveyed the knowledge and attitudes of 113 mental health professionals by using two validated questionnaires. Results Participants showed very positive attitudes and high levels of knowledge about the conceptual definition and application of AHDs in clinical practice but their knowledge of the legalities, procedure and registration of AHDs was poor. Working in a community, having a career specializing in mental health or having personally signed an AHD was associated with enhanced knowledge about them. Moreover, female sex or employment as an auxiliary nursing-care technician was associated with stronger positive attitudes. Discussion Legal and structural changes will be needed to implement AHDs in Spain and to promote competence among healthcare providers in order to include AHDs in everyday practice. Implications for practice The Spanish mental healthcare system requires legal and structural changes and must improve healthcare providers' competence in AHDs before they are implemented.

Resumen: Objetivo: Evaluar el grado de conocimiento y las actitudes sobre el documento de voluntades anticipadas (DVA) del personal médico y de enfermería de dos departamentos sanitarios, así como examinar su asociación con variables sociodemográficas y laborales de los profesionales. Método: Se realizó una encuesta transversal a 329 profesionales a través de Internet y mediante un procedimiento estandarizado. Se examinaron los conocimientos y las actitudes hacia el DVA utilizando dos cuestionarios validados de 17 y 12 ítems, respectivamente. Se recogieron datos sociodemográficos y profesionales. Resultados: El 45% fueron médicos/as, con una media de 13,1 (desviación típica [DT]: 8,3) años de experiencia profesional. El 67,5% fueron mujeres, con una edad media de 38,9 (DT: 9,2) años. Tuvieron actitudes muy positivas hacia el documento (media: 75,37; DT: 11,97; R = 0-90), a pesar de que su nivel de conocimientos fue medio-bajo (media: 9,31; DT: 2,73; R = 0-18). Tanto el nivel de conocimientos como su autopercepción se asociaron a la formación previa en cuidados paliativos, a la experiencia en el manejo del documento, su lectura o la demanda de información. La suscripción del documento se relacionó con la autopercepción de los conocimientos. Las actitudes se asociaron con la experiencia en el manejo y la actitud positiva hacia la formación. Conclusiones: Los/las profesionales mostraron actitudes positivas hacia el DVA, pero escasos conocimientos sobre el mismo. La experiencia con el DVA fue la única variable que se asoció tanto a los conocimientos como a las actitudes de los profesionales. Abstract: Objective: To evaluate the degree of knowledge and attitudes of medical and nursing professionals in two health departments to advance directives, as well as to examine their association with the sociodemographic and occupational variables of the professionals. Methods: A cross-sectional survey on 329 health professionals was carried out through the internet and a standardised procedure. The knowledge and attitudes of the professionals about advance directives were examined using two validated questionnaires of 17 and 12 items, respectively. Sociodemographic and professional data were also collected from the participants. Results: 45% of the professionals were physicians, with X¯=13,1 (SD: 8.3) years of professional experience. Sixty-seven point five percent were women and the mean age was 38.9 (SD: 9.2) years. Professionals had very positive attitudes towards the advance directives document (X¯=75.37;SD: 11.97;R = 0-90), although their level of knowledge about them was medium-low (X¯=9.31;SD: 2.73;R = 0-18). Both the level of knowledge and self-perception were associated with previous training in palliative care, experience with document management, reading, or the demand for information. Completing the document related to self-perception of knowledge. Attitudes towards the document related to experience in its use and a positive attitude toward training. Conclusions: The professionals showed positive attitudes towards the advance directive document although low knowledge about it. Experience with the document was the only variable associated with both the knowledge and the attitudes of the professionals. Palabras clave: Voluntades anticipadas, Testamento vital, Actitud del personal de salud, Derechos del paciente, Planificación anticipada de decisiones, Keywords: Advance directive, Living wills, Attitude of health personnel, Patient rights, Advance care planning

The complexity of palliative care means that the emotional distress and burden that primary family caregivers su er under can be particularly high. The objective of this study was to determine the level of burden endured by these primary family caregivers and to identify the variables that predict it in the caregiving relatives of people who require home-based palliative care. A descriptive-correlational cross-sectional study was conducted. Socio-demographic and clinical data were collected from caregivers through a self-administered questionnaire that included questions from the 12-Item Short Form Health Survey (SF-12), Zarit Caregiver Burden Interview (ZBI), Hospital Anxiety and Depression Scale (HADS), Brief Resilient Coping Scale (BRCS), Post Traumatic Growth Inventory (PTGI), and Fatigue Assessment Scale (FAS). A total of 77 caregivers participated; 66.2% were women, and the mean age was 61.5 years. Most (62.3%) were providing care to cancer patients. From among these data, the presence of anxiety as a clinical problem (48.1%), a high average fatigue score (FAS) of 23.0 (SD = 8.5), and the prevalence of intense overload (41.6%) stood out. We found statistically significant correlations between the variables of burden, fatigue, post-traumatic growth, anxiety, and depression, with the latter two being the main predictive variables of burden. In addition, caregiver burden was associated with a worsening of health. Identifying the factors that influence the appearance of overburden will allow the specific needs of careers to be assessed in order to o er them emotional support within the healthcare environment., This work was supported by grants UGP-18-255 from ISABIAL, PI17/00328 from the Carlos III Health Research Institute (ISCIII) belonging to the Spanish Ministry of Health, and by FEDER (“A way of making Europe”) project funds.

ObjectivesTo explore the experiences of caregivers living with relatives affected by Crohn’s disease (CD) in a context in which the family provides social support.DesignA qualitative study based on a phenomenological approach was conducted through in-depth interviews.SettingParticipants living in Alicante (Spain) were recruitedParticipantsEleven family caregivers of people with CD were interviewed.MethodsThe in-depth interviews took place in the participants’ homes and were audio recorded and then transcribed for a qualitative thematic analysis.ResultsFive themes and accompanying subthemes were identified: (1) adaptation to the caring experience, (2) dichotomy ‘with or without me’, (3) unending burden, (4) need for knowledge and control of the disease, and (5) getting used to CD and normalising life.ConclusionThe findings contribute to an increase in the knowledge and comprehension of the experience of being the caregiver of a relative with CD, which could be useful for professionals towards improving the quality of the CD caring process. Due to the temporal dimension of CD with frequent bouts of exacerbation and remission, family caregivers must adapt and acquire skills during chronic illness evolution. Moreover, the lack of family caregivers’ inclusion and follow-up within the Spanish health system makes them feel invisible and useless, which may contribute to caregivers’ burdens.

The dramatic increase in the number of older people with Mild Cognitive Impairment (MCI) entails a serious public health problem. MCI involves different degrees of dependence that has been previously related to a decrease in Health-Related Quality of Life (HRQoL), due to impairment in the performance of activities of daily living. Resilient coping, as an adaptive coping style, could reduce the associated limitations derived by the characteristic deficits of MCI, and hence improve HRQoL. The principal objective of this work was to compare the level of autonomy (measured in terms of independence in the performance of basic (ADL) and instrumental (IADL) activities of daily living), and HRQoL between resilient and non-resilient individuals with MCI. The results showed a positive relationship between resilience, autonomy, and HRQoL. Hence, resilient participants exhibited higher independence in daily living activities and better HRQoL than non-resilient individuals. Mediation analyses confirmed an indirect influence of resilience on HRQoL through the mediation effect of better performance in IADLs. These findings underline the relevance of resilience as a coping style to compensate deficits in daily living in people with MCI. The inclusion of intervention programs, oriented to the promotion of resilience coping for older adults, might increase the autonomy levels in this population, improving their HRQoL. This research was supported by the Program of Networks-I3CE of Investigation in University Teaching (Program Networks) from the Vice-Rectorate of Quality and Educational Innovation and Education Sciences Institute of the University of Alicante (2017–2018). Ref.: (4253).

Aims and objectives: To evaluate the availability of, adherence to, and perceived usefulness of guidelines and protocols for managing hydration and subcutaneous hydration in palliative care settings. Background: Hydration at the end of life and the use of a subcutaneous route to hydrate generate some controversy among health professionals for different reasons. Having guidelines and protocols to assist in decision‐making and to follow a standard procedure may be relevant in clinical practice. Design: Cross‐sectional telephone survey, with closed‐ended and open‐ended questions designed specifically for this study. Methods: Data were obtained from 327 professionals, each from a different palliative care service. Mean, standard deviation, minimum and maximum were calculated for continuous variables; frequency distributions were obtained for categorical variables. A qualitative content analysis was performed on the open‐ended questions. The article adheres to the STROBE guidelines for reporting observational studies. Results: Only 24.8% of the participants had guidelines available to assist in making decisions regarding hydration, and 55.6% claimed to follow them ‘always or almost always’. Of the participants, 38.8% had subcutaneous hydration protocols available, while 78.7% stated that they ‘always or almost always’ followed these protocols. The remaining participants considered the protocols as useful tools despite not having them available. Conclusions: Only 25% of the participants' services had guidelines for hydration, and less than 40% had protocols for subcutaneous hydration. However, adherence was high, especially in cases where protocols existed. Among the participants who did not have guidelines and protocols, attitudes were mostly favourable, but mainly as a reference and support for an individualised clinical practice. Relevance to clinical practice: Guidelines and protocols on hydration in palliative care may be more useful as a solid reference and support for individualised practice than as instruments for standardising care. From this perspective, their development and availability in palliative care services are recommended. This study has been funded by a grant from the Institute of Health Carlos III (PI10/00847) of the Ministry of Economy and Competitiveness (Spain) and the European Regional Development Fund (FEDER).

Background Although studies suggest that most people prefer to die at home, not enough is known about place of death patterns by cause of death considering sociodemographic factors. The objective of this study was to determine the place of death in the population and to analyze the sociodemographic variables and causes of death associated with home as the place of death. Methods Cross-sectional population-based study. All death certificate data on the residents in Spain aged 15 or over who died in Spain between 2012 and 2015 were included. We employed multinomial logistic regression to explore the relation between place of death, sociodemographic variables and cause of death classified according to the International Classification of Diseases, 10th revision, and to conditions needing palliative care. Results Over half of all deaths occurred in hospital (57.4%), representing double the frequency of deaths that occurred at home. All the sociodemographic variables (sex, educational level, urbanization level, marital status, age and country of birth) were associated with place of death, although age presented the strongest association. Cause of death was the main predictor with heart disease, neurodegenerative disease, Alzheimer’s disease, dementia and senility accounting for the highest percentages of home deaths. Conclusions Most people die in hospital. Cause of death presented a stronger association with place of death than sociodemographic variables; of these latter, age, urbanization level and marital status were the main predictors. These results will prove useful in planning end-of-life care that is more closely tailored to people’s circumstances and needs.

In health and clinical studies, health-related quality of life is often assessed using the well-established KIDSCREEN-52 questionnaires as well as the Vécu et Santé Perçue de l’Adolescent (VSP-A). The purpose of this study was twofold: to perform an adjusted linguistic validation of the Colombian version of the KIDSCREEN-52 and to assess its psychometric properties in children and adolescents. A total of 146 children and adolescents completed the KIDSCREEN-52, adolescents (n = 48) additionally completed the VSP-A. Psychometric analyses focused on the internal consistency as well as the convergent and discriminant validity of the KIDSCREEN-52 Colombian version. Syntactic and semantic modifications were made to 19 items in the adapted version of the KIDSCREEN-52. Cronbach’s α ranged from .74 to .89 for eight dimensions, while α < .70 was obtained for self-perception and social acceptance. We found evidence of good convergent validity with the VSP-A dimensions. Regarding known-groups validity, children aged between 8 and 10=years, male, with a high socioeconomic level and no chronic health condition obtained higher scores compared to the other categories. The developed Colombian version of the KIDSCREEN-52 showed acceptable reliability and validity. This study provides a cultural adaptation of the Spanish version of the KIDSCREEN-52 for Colombian children and adolescents. This study was supported by funding from Becas Alban (Code E03D23369COER-23369-89-DXXRVPUKOU) and co-financed by the University of Applied and Environmental Sciences UDCA (Colombia) and the University of Alicante (Spain).

WHAT IS KNOWN ON THE SUBJECT?: Advance care planning (ACP) in mental health is a useful tool to avoid human rights violations in mental health settings. However, ACP is not yet a reality in the Spanish context. The advance healthcare directive (AHD) is a document reflecting healthcare preferences, drafted within the framework of the ACP process, to be applied in situations in which an individual's legal capacity may be questionable. No study has explored the viewpoint of Spanish mental healthcare professionals towards AHDs in the mental health field. Considering their extensive use, further study of providers' knowledge and attitudes is warranted. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: The study adds knowledge about the viewpoint of Spanish mental healthcare professionals towards the implementation of AHDs in their clinical practices. This study illuminates the prevailing paternalistic provider-user relationship as the main barrier surrounding AHD management in terms of decision-making. Our findings support the need for broader awareness, staff training regarding the documentation, the conversation process and communication skills, and personalized assistance in the mental health services to implement AHDs in everyday practice. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Advance healthcare directives are a recovery tool that offers major information regarding mental health user preferences. Although they pose challenges for clinical practice, AHDs should be incorporated into interventional mental health care. Obtaining up-to-date perspectives held by mental healthcare professionals regarding AHDs allows the administration to determine the aspects requiring reinforcement. The implementation of AHDs in the Spanish mental health system requires macro- and micro-changes, both ethically and structurally, so that mental healthcare professionals relinquish their paternalistic approach and embrace new ways of relating to users. Abstract Introduction An advance healthcare directive (AHD) is a written document that contains a patient-in-care's will and preferences concerning the treatment options available to them, should they lack decision-making capacity. AHDs are completed within a broader framework known as advance care planning. No study has explored the viewpoint of Spanish mental healthcare professionals towards AHDs. Aim To explore the viewpoint of mental health professionals towards the implementation of AHDs in mental health. Method A qualitative study was conducted using semi-structured interviews that were thematically analysed. Findings Three main themes were identified: care planning culture; barriers for the practical management of AHDs; and reasons to not honour patient-in-care AHDs. Discussion Professionals find it pragmatically difficult to stop applying traditional paternalistic practices. To implement AHDs, improving the knowledge and awareness of AHDs and management of non-technical skills through training is required. Such training should include users and families and allow for compliance with United Nations requirements. Implications for practice Advance healthcare directives offer important information regarding user preferences, although they pose challenges for practices. Acquiring an up-to-date perspective on the attitudes of professionals towards AHDs allows organizations to attend to particular aspects that require reinforcement. Wider awareness, staff training and new ways of relating to users are necessary to implement AHDs in Spanish context. Relevance statement A better understanding of the attitudes of Spanish mental health professionals towards AHDs was achieved. Despite the implementation of AHDs being an important and potentially beneficial initiative, mental health professionals find many pragmatic issues that need addressing before AHDs become a reality in their clinical practice. Wider awareness, staff training, personalized assistance and new ways of relating to users are required to implement AHDs in everyday practice.

Adenomyosis was the main topic in the 2016 Society of Endometriosis and Uterine Disorders (SEUD) Congress. Latest evidence in endometriosis and other uterine disorders, such as fibroids and abnormal uterine bleeding (AUB) were also covered. About 106 oral communications, practical sessions, and debates on etiology, pathogenesis, diagnosis and treatment of the different themes were presented. Posters on the same topics were on view. Live surgical sessions and video sessions were also held. Six “tips and tricks” sessions in endometriosis and uterine disorders were scheduled at the beginning of each day throughout the congress. Monographic own-language sessions comprising Canadian, Spanish, Asian, Russian and Latin American participants were held with presenters contributing their own vision of the congress topics. Finally, the congress ended with a patient session: dedicated to those who are affected by endometriosis: pain, quality of life, sex-life, and environment were issues covered by specialists and the testimonies of the patients also had their place in the congress.

The objective of this study was to perform cross-cultural adaptation of the Mediterranean Islands Study Food Frequency Questionnaire (MEDIS-FFQ) and to evaluate its reproducibility and validity in a population over 60 years of age in the Spanish Mediterranean. Three hundred forty-one people completed the food frequency questionnaire (FFQ), which was administered twice (FFQ1 and FFQ2) with nine 24-h dietary recalls (24-HDRs) over a nine-month period to assess its reproducibility and validity. Cross-cultural translation and adaptation were performed according to the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guidelines and included direct translation, back-translation, and a pilot comprehension test. Reproducibility was evaluated with Pearson&rsquo, s and interclass correlation coefficients. Validity was estimated using correlations between the FFQ food groups and the 24-HDR mean. The levels of agreement and misclassification were expressed as the proportions of individuals classified by comparing the estimated information from the FFQ2 and the 24-HDR. Reproducibility correlation coefficients ranged from r = 0.44 to r = 0.90. Validity indices ranged from 0.71 to 0.99. More than 80% of the subjects were classified in the same quartile on both instruments. The kappa statistic showed a moderate to high level of agreement (0.70&ndash, 0.95) between the two instruments. In conclusion, the MEDIS-FFQ showed good reproducibility and validity in estimating the nutrient intake of the elderly population in the Spanish Mediterranean.

Resumen Objetivo: exponer los resultados del registro de nutrición enteral domiciliaria (NED) de los años 2016 y 2017 del Grupo NADYA-SENPE. Material y métodos: se recopilaron los pacientes introducidos en el registro del 1 de enero al 31 de diciembre de 2016 y la mismas fechas de 2017 para proceder al análisis descriptivo y analítico de los datos. Resultados: en el año 2016 se obtuvieron 4.578 pacientes activos (prevalencia = 98,33 pacientes/millón de habitantes) y en 2017 fueron 4.777 (prevalencia = 102,57). Por sexos, hubo un 50,8% de varones en 2016 y un 50,5% en 2017. En el periodo 2016-17, la edad mediana fue de 71,5 años (IIQ 57-83); asimismo, finalizaron 1.558 episodios de NED y la causa principal fue el fallecimiento (793 pacientes, 50,89%). Los varones adultos fueron más jóvenes que las mujeres (65,3 vs. 73,3 años, p-valor < 0,001) y el diagnóstico más frecuente fue la enfermedad neurológica que cursa con afagia o disfagia severa (59%). La sonda nasogástrica (SNG) fue la vía de acceso más utilizada (48,3%) y se observa, además, que esta es la vía que se utiliza en los pacientes más ancianos (p < 0,001). Se registraron 126 pacientes pediátricos (57,1% niñas). La edad mediana de inicio de la NED fue de cuatro meses. Otras patologías fue el grupo diagnóstico más registrado (41,3%), seguido por la enfermedad neurológica que cursa con afagia o disfagia severa. Se alimentaban a través de gastrostomía en el 57,6% de los casos. Se observó que los niños más pequeños eran los que se alimentaban preferentemente por SNG (p-valor 0,001). Conclusiones: el número de pacientes del registro, así como el número de centros participantes, se va incrementando progresivamente. Las principales características de los pacientes no han variado. A pesar del aumento de posibilidades diagnósticas en la población pediátrica, llama la atención la clasificación dentro del grupo de Otras patologías.

Objectives: Evaluate the relationship between adherence to the Mediterranean diet and health-related quality of life and degree of life satisfaction among older adults. Design and Setting: Cross-sectional descriptive study. Participants: A total of 351 people older than 60 years participated in the study. Measurements: The Mediterranean Diet Score (MDS) was calculated to assess the degree of adherence to the MD. MD adherence was related to health-related quality of life using the Short Form Healthy Survey (SF-12) questionnaire, to life satisfaction using the Satisfaction with Life Scale (SWLS), and to sociodemographic, clinical and lifestyle variables. Multiple logistic regression models were used to analyse this relationship. Results: Mediterranean diet adherence was related to health-related quality of life. Participants with better adherence to the MD were more physically active (p=0.01) and had better health-related quality of life (p0.05) but not for that of men (p=0.31). Conclusions: The adherence to the MD is directly associated with the self-perceived physical and mental function of both sexes and with the life satisfaction of women. Further studies in older adult populations should be performed to obtain conclusive results on the MD effect on health-related quality of life, including wellness indicators.

ObjectiveThe aim of this review was to evaluate the conceptual suitability, applicability and psychometric properties of scores used internationally to measure adherence to the Mediterranean diet (MD).DesignThis was a systematic review to identify original articles that examined some aspects of the conceptual suitability, applicability or psychometric properties of the MD adherence score. Electronic searches were carried out on the international databases MEDLINE, Scopus, Web of Science and EMBASE (from January 1980 to 31 December 2015).Eligibility criteria for selecting studiesThe study included original articles that examined some aspects of the conceptual suitability, applicability or psychometric properties of the MD adherence score. The studies where MD adherence scores were administered but did not bring forward any evidence about their performance related to conceptual suitability, applicability or psychometric properties were excluded.Data extractionInformation relating to the scales was extracted in accordance with the quality criteria defined by the Scientific Advisory Committee of the Medical Outcomes Trust for measurement of health results and the quality criteria recommended by Terwee: (1) conceptual, (2) applicability and (3) psychometric properties. Three authors independently extracted information from eligible studies.ResultsTwenty-seven studies were identified as meeting the inclusion criteria, yielding 28 MD adherence scores. The results showed that evidence is scarce and that very few scores fulfilled the applicability parameters and psychometric quality. The scores developed by Panagiotakoset al, Bucklandet aland Sotos-Prietoet alshowed the highest levels of evidence.ConclusionsScores measuring adherence to MD are useful tools for identifying the dietary patterns of a given population. However, further information is required regarding existing scores. In addition, new instruments with greater conceptual and methodological rigour should be developed and evaluated for their psychometric properties.

To evaluate the degree of knowledge and attitudes of medical and nursing professionals in two health departments to advance directives, as well as to examine their association with the sociodemographic and occupational variables of the professionals.A cross-sectional survey on 329 health professionals was carried out through the internet and a standardised procedure. The knowledge and attitudes of the professionals about advance directives were examined using two validated questionnaires of 17 and 12 items, respectively. Sociodemographic and professional data were also collected from the participants.45% of the professionals were physicians, with X¯=13,1 (SD: 8.3) years of professional experience. Sixty-seven point five percent were women and the mean age was 38.9 (SD: 9.2) years. Professionals had very positive attitudes towards the advance directives document (X¯=75.37;SD: 11.97;R=0-90), although their level of knowledge about them was medium-low (X¯=9.31;SD: 2.73;R=0-18). Both the level of knowledge and self-perception were associated with previous training in palliative care, experience with document management, reading, or the demand for information. Completing the document related to self-perception of knowledge. Attitudes towards the document related to experience in its use and a positive attitude toward training.The professionals showed positive attitudes towards the advance directive document although low knowledge about it. Experience with the document was the only variable associated with both the knowledge and the attitudes of the professionals.

Objetivo: exponer los resultados del registro de nutrición enteral domiciliaria (NED) del año 2014 y 2015 del Grupo NADYA-SENPE. Métodos: se recopilaron los pacientes introducidos en el registro desde el 1 de enero al 31 de diciembre de 2014 y la mismas fechas de 2015, y se procedió al análisis descriptivo y analítico de los datos. Resultados: en el año 2014, se registraron 3.749 pacientes y en 2015, 4.202; la prevalencia fue de 80,58 pacientes/millón de habitantes en el año 2014 y de 90,51 en 2015. Por sexos, hubo un 49,9% de mujeres en 2014 y un 50,3% en 2015. La edad media fue de 73 años (IIQ 59-83) en ambos años. Finalizaron 684 episodios de NED en 2014 y 631 en 2015, la causa principal fue el fallecimiento en el 54,9% y 50,4% de los casos, respectivamente. Los portadores de sonda nasogástrica presentan una edad media superior a los pacientes con cualquier otra vía (p < 0,001). Se registraron 67 pacientes pediátricos en 2014 (56,7% niñas) y 77 en 2015 (55,8% niñas). La vía principal de administración fue la gastrostomía en el 52,0% de los casos de 2014 y sonda nasogástrica en el 50,8% de los casos de 2015. La causa principal de fi nalización de la nutrición fue el fallecimiento (57,1% en 2014 y 38,5% en 2015). Se observó que los niños más pequeños eran los que se alimentaban preferentemente por SNG (p 0,004 vs. 0,002).Tanto en pacientes pediátricos como en adultos el diagnóstico principal que motivó la necesidad de NED fue la enfermedad neurológica que cursa con afagia o disfagia severa. Conclusiones: se ha incrementado el número de pacientes del registro, así como el número de centros participantes y el número medio de pacientes comunicados por cada centro respecto a años anteriores, sin que se hayan modificado sustancialmente las características de los pacientes, salvo mayor duración de los episodios, Objective: To present the results of the Spanish home enteral nutrition (HEN) registry of the NADYA-SENPE group for the years 2014 and 2015. Methods: From January 1st 2014 to December 31st 2015 the HEN registry was recorded and afterwards a further descriptive and analytical analysis was done. Results: In 2014, 3749 patients were recorded, and 4202 in 2015; prevalence was 80.58 patients/one million inhabitants in Spain in 2014 and 90.51 in 2015. There were 49.9% females in 2014 and 50.3% in 2015. Median age was 73 years (IQI 59-83) in 2014 as well as in 2015. 684 episodes fi nished in 2014 and 631 in 2015, with death as the main cause, in 54.9% and 50.4%, respectively. The ones who were fed through nasogastric tube had a mean age higher than the ones fed by any other route (p-value < 0.001). Sisty-seven paediatric patients were recorded in 2014 (56.7% females) and 77 in 2015 (55.8% females). Median age at the beginning of HEN among children was 5 months in 2014 and 5 months in 2015. The main route of administration was gastrostomy, in 52.5% in 2014 and nasogastric tube in 50.8% in 2015. 7 episodes fi nished in 2014 and 13 in 2015, having death as the main cause (57.1% in 2014 and 38.5% in 2015). It was found that were younger children the ones who were mainly fed by nasogastric tubes (p-value 0.004 vs. 0.002). Among paediatric patients as well as adults, the main diagnosis leading to HEN was neurological disease which gives aphagia or severe dysphagia. Conclusions: There has been an increase in the number of patients in the registry as well as the participating centers and the number of patients per center, without any signifi cant change in the characteristics of the patients other than longer duration of the episodes

Background: Parkinson’s caregivers are frequently affected by a range of physical and psychological factors affecting to the quality of life (QoL) of patients and caregivers. However, while there are well-validated QoL instruments for patients, few specific measures has been developed for caregivers of patients with PD. This study examined the psychometric properties of the Spanish version of the Parkinson Disease Questionnaire–Carer (PDQCarer) for use in PD caregivers. Methods: The PDQ-Carer and the Short Form-36 Health Survey (SF-36) were completed by sample of 73 caregivers of patients with PD in Spain (71.8 % females; 63.6 ± 12.3 years old). Results: Psychometric analysis confirmed the reliability and validity of the Spanish version of the PDQ-Carer. The internal consistency was found to be satisfactory for the four PDQ-Carer domains: Personal and Social Activities, Depression and Anxiety, Self-care and Stress with Cronbach’s alpha values ranging 0.80 to 0.95. The PDQ-Carer was significantly correlated with the eight SF-36 domains (r = -0.31 to -0.59, p < 0.001) supporting the concurrent validity of the instrument. Conclusions: Overall, these results provide preliminary evidence of the utility of the Spanish version of the PDQ-Carer in non-professionals caregivers

ResumenObjetivoAportar nuevos valores de referencia de la Short Physical Performance Battery (SPPB) para personas de 70 y más años, en atención primaria de salud (APS), y analizar su asociación con variables demográficas, de función física, estado de salud y clínicas.DiseñoEntrevistas y observaciones basales de un estudio longitudinal sobre función física y resultados adversos de salud.Emplazamiento5 centros de atención primaria de las provincias de Alicante y Valencia.Participantes593 personas de 70 y más años.Mediciones principalesLa SPPB se aplicó mediante observación directa y el resto de variables mediante entrevista. Se calcularon valores de referencia según sexo y 3 grupos de edad (70-75, 76-80, > 80 años) y se examinó la validez de la batería mediante estadísticos de asociación con variables demográficas, clínicas y de funcionamiento.ResultadosLos valores de referencia indicaron peor desempeño en las mujeres y progresivamente peor desempeño a través de los 3 grupos de edad. La batería SPPB se asoció significativamente (p 80 years), and the validity of the Battery was analysed using association statistics with the demographic, clinical, and function data.ResultsThe reference values showed a poor performance in women, and a gradually poorer performance through the three age groups. The SPPB was significantly associated (P < 0.01) with age, sex, number of drugs taken, morbidity, body mass index, dependency in basic activities of daily living (BADL), instrumental activities of daily living (IADL) for health reasons, the 10-item Physical Functioning Scale (PF-10), depression and health perception.ConclusionsThe reference values of the complete SPPB by age and sex are provided, based category scores in Primary Care patients 70 years-old and over. The Battery results can give a rapid and valid assessment of the functional state of elderly patient in Primary Care.