Impact of the COVID-19 pandemic on stress and sleep in emergency room professionals.

AIMS AND OBJECTIVES: To analyze stress levels, sleep quality, sleepiness and chronotypes on emergency room (ER) professionals before and during the COVID-19. BACKGROUND: ER healthcare professionals are exposed to high stress levels, and they often present with poor sleep quality. DESIGN: Observational study conducted into two different phases (before the COVID-19 and during the first wave of the COVID-19). METHOD: Physicians, nurses and nursing assistants working in the ER were included. Stress, sleep quality, daytime sleepiness and chronotypes were assessed by the Stress Factors and Manifestations Scale (SFMS), the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), and the Horne and Österberg Morningness-Eveningness questionnaire, respectively. The first phase of the study was performed between December 2019 and February 2020, and the second between April and June 2020. The STROBE checklist was used to report the present study. RESULTS: In total, 189 ER professionals in the pre-COVID-19 phase and 171 (of the initial 189) during COVID-19 were included. The proportion of workers with a morning circadian rhythm increased during the COVID-19, and stress levels were significantly higher during COVID-19 compared to the previous phase (38.34 ± 10.74 vs. 49.97 ± 15.81). ER professionals with poor sleep quality presented higher stress in the pre-COVID-19 phase (40.60 ± 10.71 vs. 32.22 ± 8.19) and during COVID-19 (55.27 ± 15.75 vs. 39.66 ± 9.75). Similarly, workers with excessive sleepiness had higher stress in the pre-COVID-19 phase (42.06 ± 10.95 vs. 36.64 ± 10.24) and during COVID-19 (54.67 ± 18.10 vs. 48.44 ± 14.75). Positive associations were also found between the SFMS and the PSQI, as well as with the ESS in both phases of the study. CONCLUSIONS: Emergency room professionals had increased stress levels during the COVID-19 pandemic. Stress was particularly higher in those with poor sleep quality or with excessive daytime sleepiness. RELEVANCE TO CLINICAL PRACTICE: These results should aim to impulse the implementation of measures to improve the working conditions of ER professionals.

The stigma of mental health professionals towards users with a mental disorder.

Individuals with mental disorders are labeled in such a way that it leads to stigmatization. This generates a disadvantage as regards to the rest of the members of the society, limiting their participation as active members within it and at the same time being deleterious to their way of life. Mental health professionals are not safe from internalizing these stereotypes and prejudices assumed from their environment, thereby showing stigmatizing attitudes and behaviors towards the users in the different mental health resources.

Pharmacokinetics and bioavailability of hydroxytyrosol are dependent on the food matrix in humans.

PURPOSE: Several studies have demonstrated the properties of hydroxytyrosol, a phenolic compound present in olive oils and olives with a well-characterized impact on human health. Nevertheless, some knowledge gaps remain on its bioavailability and metabolism; overall concerning to the real rate per cent of absorption and biovailability of dietary hydroxytyrosol and the influence of the dietary food-containing hydroxytyrosol on it. METHODS: A double-blind study was performed including 20 volunteers who ingested 5 mg of hydroxytyrosol through diverse food matrices, to discover the influence on pharmacokinetics and bioavailability of HT metabolites (hydroxytyrosol acetate, 3,4-dihydroxyphenylacetic acid (DOPAC), tyrosol, and homovanillic alcohol) of the distinct matrices by UHPLC-ESI-QqQ-MS/MS. RESULTS: The HT pharmacokinetics after consumption of different food matrices was strongly dependent on the food matrix. In this aspect, the intake of extra virgin olive exhibited significantly higher plasma concentrations after 30 min of oral intake (3.79 ng/mL) relative to the control. Regarding the hydroxytyrosol bioavailability, the intake of extra virgin olive oil, as well as fortified refined olive, flax, and grapeseed oils provided significantly higher urinary contents (0.86, 0.63, 0.55, and 0.33 µg/mg creatinine, respectively) compared with basal urine, whereas hydroxytyrosol metabolites showed no significant changes. No differences were found between men and women. CONCLUSIONS: The metabolic profile of hydroxytyrosol is influenced by the food matrix in which is incorporated, with the oily nature for the final bioavailability being relevant. Extra virgin olive oil was identified as the best matrix for this compound. The results described contribute to the understanding of the relevance of the food matrices for the final absorption of hydroxytyrosol and hence, the achievement of the highest health protection potential.

Relationship between sleep habits and academic performance in university Nursing students.

BACKGROUND: Sleep disorders are composed of a group of diseases of increasing prevalence and with social-health implications to be considered a public health problem. Sleep habits and specific sleep behaviors have an influence on the academic success of students. However, the characteristics of sleep and sleep habits of university students as predictors of poor academic performance have been scarcely analyzed. In the present study, we aimed to investigate sleep habits and their influence on academic performance in a cohort of Nursing Degree students. METHODS: This was a cross-sectional and observational study. An anonymous and self-administered questionnaire was used, including different scales such as the 'Morningness and Eveningness scale', an author-generated sleep habit questionnaire, and certain variables aimed at studying the socio-familial and academic aspects of the Nursing students. The association of sleep habits and other variables with poor academic performance was investigated by logistic regression. The internal consistency and homogeneity of the 'sleep habits questionnaire' was assessed with the Cronbach's alpha test. RESULTS: Overall, 401 students (mean age of 22.1 ± 4.9 years, 74.8 % females) from the Nursing Degree were included. The homogeneity of the 'sleep habits questionnaire' was appropriate (Cronbach's alpha = 0.710). Nursing students were characterized by an evening chronotype (20.2 %) and a short sleep pattern. 30.4 % of the Nursing students had bad sleep habits. Regarding the academic performance, 47.9 % of the students showed a poor one. On multivariate logistic regression analysis, a short sleep pattern (adjusted OR = 1.53, 95 % CI 1.01-2.34), bad sleep habits (aOR = 1.76, 95 % CI 1.11-2.79), and age < 25 years (aOR = 2.27, 95 % CI 1.30-3.98) were independently associated with a higher probability of poor academic performance. CONCLUSIONS: Almost 1/3 of the Nursing students were identified as having bad sleep habits, and these students were characterized by an evening chronotype and a short sleep pattern. A short sleep pattern, bad sleep habits, and age < 25 years, were independently associated with a higher risk of poor academic performance. This requires multifactorial approaches and the involvement of all the associated actors: teachers, academic institutions, health institutions, and the people in charge in university residences, among others.

A new tool to assess patients' comfort during hospitalization: The Hospital Discomfort Risk questionnaire.

AIM: We aimed to develop a tool for the assessment of the risk of patient discomfort in Spanish hospital wards. BACKGROUND: Several studies described tools to assess comfort but most are long and complex. METHODS: Cross-sectional study performed in three phases ((a) initial design; (b) refinement and psychometric testing; and (c) internal validation of the Hospital Discomfort Risk [HDR] questionnaire). RESULTS: A voluntary expert panel proposed the HDR questionnaire. Internal consistency and factorial analysis were investigated in 270 (53.7% men, mean age 57.33 ± 18.7 years) inpatients. Based on the Cronbach's α, three items were removed to the final 8-item version of the questionnaire. The HDR questionnaire showed a good predictive ability for identifying the risk of discomfort (c-index: .897, 95% CI 0.854-0.930; p < .001). CONCLUSIONS: The HDR questionnaire could be useful for identifying inpatients at risk of discomfort, but further prospective studies should externally validate these results. IMPLICATIONS IN NURSING MANAGEMENT: Nurses are the healthcare professionals with better access to patients and the first in identifying complications of hospitalization. Patients' discomfort could be routinely assessed during hospitalizations using the HDR questionnaire. Nurse managers should play an important role in this accomplishment, by promoting its use and knowledge among the nurse staff.

Midwives and gynecologists: knowledge about sterile water injections for pain relief in labor.

Presently, there is great interest in nonpharmacologic methods of pain relief during labor. The aim of this study was to determine whether gynecologists and midwives are aware of the use of sterile water injections for pain relief during childbirth, whether they use this pain relief method, and if not, would they do so in the future. We designed a quantitative, observational, descriptive, prospective and transversal study. Study participants were recruited from the 16th Health Department of Alicante, Spain. The data collection method used was a questionnaire of self-realization. The most relevant results indicate that those with less working experience (8.06 ± 6.82 years) used the technique most often compared with the group with more working experience (16.92 ± 11.90 years; p = .04). The results determined that women have more knowledge about the technique (79.3%), whereas only 33.3% of men are aware of it (p = .02). The results of this study showed a lack of knowledge regarding this technique, as well as educational interest in the fact that women have more knowledge than men. Increased use was observed in younger, less experienced professionals.

Sleep analysis of hospital and out-of-hospital emergency professionals.

INTRODUCTION: Sleep deprivation is associated with poorer cognitive functioning and a greater risk of serious diseases. Herein, we analyzed differences in the quality of sleep and excessive daytime sleepiness between hospital emergency services and out-of-hospital emergencies services, and investigated its association with sociodemographic and labor variables. METHOD: This is a cross-sectional observational study carried out between April 2019 and February 2020, including healthcare professionals from different emergency departments, who were evaluated through the following instruments: "Pittsburgh Sleep Quality Index" and "Epworth Sleepiness Scale". RESULTS: Four-hundred and four healthcare professionals were included (mean age 40.4 ± 11.1 years), predominantly women (61.4%) from hospital emergency departments (62.6%). A total of 65.3% of the workers had poor sleep quality and 27.7% had excessive sleepiness. Women had poorer sleep quality (p = 0.022) and higher sleepiness (p = 0.010) than men. Hospital emergency workers presented 2-fold increased risk of poor sleep quality (OR = 1.93, p = 0.003) and sleepiness (OR = 1.93, p = 0.009) than out-of-hospital emergency workers. The more optimistic were less likely to have poor sleep quality (OR = 0.73, p = 0.01) or sleepiness (OR = 0.70, p = 0.002). Nurses, emergency medical technicians and nursing assistants also had a higher risk of poor sleep quality compared to physicians (OR = 1.60; p = 0.043). CONCLUSIONS: Emergency healthcare professionals working in hospital emergency departments had a two-times higher risk of poor sleep quality and sleepiness than out-of-hospital emergency healthcare professionals.

Breaking the Stigma in Mental Health Nursing through High-Fidelity Simulation Training.

The social stigma toward individuals with mental health problems is habitual among nursing students, which can lead to poor quality of health care services for patients with mental illnesses. The purpose of the present study was to learn about nursing students' perceptions of providing care to patients with severe mental disorders before and after participating in a simulated student clinical case. A descriptive qualitative study was conducted through 39 interviews. The difficulties expected by the students and their perceptions about patients were explored before the simulation training. Their perceptions about the use of clinical simulation for learning about the adequate management of these patients were analyzed afterwards. Results: Before the simulation training, the students assessed the case as being complicated, expressed their lack of specific training, and felt fear and insecurity, thus reproducing the stigma towards mental health patients. After this training, they positively valued the usefulness of the clinical simulation for gaining confidence and overcoming the stigma. Discussion: The use of high-fidelity simulation offers nursing students the opportunity to approach patients with mental health conditions, overcoming their fears and normalizing mental disorders. Simulation training allows nursing students to analyze the reasoning of clinical judgment and to detect the influence of previous prejudices about mental illness in their clinical decision. This study was not registered.

Triggers of Agitation in Psychiatric Hospitalization Ward According to Professional Experience Questionnaire.

AIM: To create and analyze an instrument to assess the possible agitation triggers of hospitalized psychiatric patients. BACKGROUND: No tools exist for identifying according to a professional's experience. METHODS: Descriptive and cross-sectional study. The questionnaire of possible triggers of agitation behaviors of patients hospitalized in psychiatric wards according to professional experience (TAPE) was designed and analyzed. RESULTS: The questionnaire was provided to 156 mental health workers (76.9% women, average work experience: 10.15 ± 8 years, 46.8% were nurses specialized in mental health, and 21.2% psychiatrists). A good internal consistency was obtained, with a Cronbach α value of 0.791 in the initial test, and 0.892 in the retest. The factorial analysis found four factors: factor 1 "personnel", factor 2 "routines", factor 3 "norms-infrastructure", and factor 4 "clinic". Factor 1 obtained the highest value, with a mean of 4.16 ± 0.63, highlighting the item "lack of specialized personnel" (mean 4.38 ± 0.81). The specialized professionals provided higher scores to the items from the factors associated with the training of the personnel and routines (p = 0.017; p = 0.042). CONCLUSIONS: The TAPE questionnaire is useful for identifying the possible triggers that could lead to situations of agitation of hospitalized patients.

Adaptation of the Highly Sensitive Person Scale (HSP) and Psychometric Properties of Reduced Versions of the Highly Sensitive Person Scale (R-HSP Scale) in Spanish Nursing Students.

Sensory processing sensitivity (SPS) can be defined as a personality characteristic that includes the individual characteristics of sensitivity towards endogenous and exogenous stimuli. The differences in environmental sensitivity can play a crucial role in the academic context of health professionals, thus defining it as an area of research that must be addressed. The reduced scale for highly sensitive people (HSP) is a short (16 items) and adapted version of the original scale for highly sensitive people (HSP). This study aims to analyze the psychometric properties of reduced versions of the Highly Sensitive Person Scale (r-HSP Scale) in Spanish nursing students. Once the questionnaire was translated, its psychometric characteristics were analyzed. The Spanish version of the r-HSP scale was administered to 284 university students enrolled in the Nursing Degree. The results from the factorial analysis confirmed the structure of sensitiveness of six factors in our sample. This structure included the following dimensions: (1) Instability, (2) Surroundings, (3) Interaction with others, (4) Sensoperception, (5) Sensitivity, and (6) Insecurity. Additionally, the Cronbach's α values indicated that the Spanish version of the r-HSP scale had an adequate reliability (α = 0.702). The r-HSP scale is defined as a reliable, valid, and agile replica of the original structure of sensitivity in Spanish university students.

Romani Women and Health: The Need for a Cultural-Safety Based Approach.

The Romani are the main European ethnic minority. The Romani people's situation of social vulnerability and their difficulties accessing the health system make their health indicators worse than those of the non-Romani population. The present study will delve into health beliefs, and experiences with health services and professionals, through the perspectives of Romani women. In this qualitative study, 16 women of different ages were interviewed in a city located in the South of Spain. Four themes emerged from the analysis of the data: the construction of the identity of Romani women, difficulties in life, health and disease beliefs and barriers to accessing the health system. We conclude that every project for the improvement of the health of the Romani community must take into account the active participation of Romani women and must consider the principles of Cultural Safety, by delving into the intercultural training of health professionals and addressing the social determinants of health which affect the Romani collective.

Stress in Emergency Healthcare Professionals: The Stress Factors and Manifestations Scale.

Background: Healthcare workers are continuously exposed to a high level of stress, especially emergency department professionals. In the present research, we aimed to determine the internal consistency and validity of the Stress Factors and Manifestations Scale for in-hospital and out-of-hospital emergency workers. Methods: A quantitative, prospective, cross-sectional, and observational study including 269 emergency service professionals. Results: The scale was composed of 21 items, with a Cronbach's α value of 0.908. The hospital workers (38.4 ± 10.8 vs. 35.1 ± 9.9, p = 0.014) and women (39.3 ± 11.4 vs. 34.2 ± 8.6, p < 0.001) had higher levels of stress. The sensitivity, specificity, and predictive values of the scale were adequate. Conclusion: In the present study, including in-hospital and out-of-hospital emergency workers, the Stress Factors and Manifestations Scale presented appropriate usefulness, internal consistency, and validity, with optimal predictive ability. Higher levels of anxiety, female gender, being less optimistic, and working in hospital emergency departments were related to increased stress levels. Further studies are warranted to validate our results and potentially extend the Stress Factors and Manifestations Scale to other contexts.

Occupational Therapy in Severe Mental Disorder-A Self-Controlled Quasi-Experimental Study.

Severe mental disorder (SMD) produces a significant functional limitation that affects the performance of daily activities. The occupational therapist intervenes on this limitation by seeking greater autonomy of these patients through specific activities. This study aims to identify the main limitations of people with SMD and to examine whether an occupational intervention has any effect in helping to overcome or ameliorate these limitations. A quasi-experimental study including 103 participants was carried out. An evaluation using the World Health Organization Disability Assessment Schedule (WHODAS 2.0) questionnaire was performed before and after the intervention. Within the activity program, those with a higher attendance rating during cognitive stimulation, cooking workshop, therapeutic walks, relaxation, and creative activities were mainly men. Both patients and professionals indicated that Understanding and Communicating, Participation in Society, and Activities of Daily Living were the main perceived limitations. Upon discharge, patients and professionals reported positive outcomes. The intervention programs carried out by occupational therapy, along with the other aspects of the treatment that SMD patients received, played an important part in improving the performance and occupational interests of these patients.

Phytoprostanes and phytofurans modulate COX-2-linked inflammation markers in LPS-stimulated THP-1 monocytes by lipidomics workflow.

Inflammation is a fundamental pathophysiological process which occurs in the course of several diseases. The present work describes the capacity of phytoprostanes (PhytoPs) and phytofurans (PhytoFs) (plant oxylipins), present in plant-based foods, to modulate inflammatory processes mediated by prostaglandins (PGs, human oxylipins) in lipopolysaccharide (LPS)-stimulated THP-1 monocytic cells, through a panel of 21 PGs and PG's metabolites, analyzed by UHPLC-QqQ-ESI-MS/MS. Also, the assessment of the cytotoxicity of PhytoPs and PhytoFs on THP-1 cells evidenced percentages of cell viability higher than 90% when treated with up to 100 µM. Accordingly, 50 µM of the individual PhytoPs and PhytoFs 9-F1t-PhytoP, 9-epi-9-F1t-PhytoP, ent-16-F1t-PhytoP, ent-16-epi-16-F1t-PhytoP, ent-9-D1t-PhytoP, 16-B1-PhytoP, 9-L1-PhytoP, ent-16(RS)-9-epi-ST-Δ14-10-PhytoF, ent-9(RS)-12-epi-ST-Δ10-13-PhytoF, and ent-16(RS)-13-epi-ST-Δ14-9-PhytoF were evaluated on their capacity to modulate the expression of inflammatory markers. The results obtained demonstrated the presence of 7 metabolites (15-keto-PGF2α, PGF2α, 11ß-PGF2α, PGE2, PGD2, PGDM, and PGF1α) in THP-1 monocytic cells, which expression was significantly modulated when exposed to LPS. The evaluation of the capacity of the individual PhytoPs and PhytoFs to revert the modification of the quantitative profile of PGs induced by LPS revealed the anti-inflammatory ability of 9-F1t-PhytoP, ent-9-D1t-PhytoP, 16-B1-PhytoP, 9-L1-PhytoP, and ent-9(RS)-12-epi-ST-Δ10-13-PhytoF, as evidenced by their capacity to prevent the up-regulation of 15-keto-PGF2α, PGF2α, PGE2, PGF1α, PGDM, and PGD2 induced by LPS. These results indicated that specific plant oxylipins can protect against inflammatory events, encouraging further investigations using plant-based foods rich in these oxylipins or enriched extracts, to identify specific bioactivities of the diverse individual molecules, which can be useful for nutrition and health in the frame of well-defined pathophysiological processes.

Fatty Acid Hydroxytyrosyl Esters of Olive Oils Are Bioaccessible According to Simulated In Vitro Gastrointestinal Digestion: Unraveling the Role of Digestive Enzymes on Their Stability.

Recently, new bioactive compounds were identified in olive oil, lipophenols, which are composed of a fatty acid (FA) and a phenolic core, such as HT (HT-FA). However, their bioaccessibility remains unknown. Thus, the present study uncovers the impact of the separate phases of gastrointestinal digestion on the release and stability of HT-FAs from oily matrices under in vitro simulated conditions. Accordingly, it was found that the bioaccessibility of HT derivatives is largely dependent on the type of FA that esterifies HT, as well as the food matrix. Also, the generation of HT-FAs during intestinal digestion was observed, with pancreatin being the enzyme responsible, to a higher extent, for the de novo formation of lipophenolic derivatives. These findings prompt us to identify new applications to oily matrices and their byproducts as potential functional ingredients for the promotion of health, where the possible formation of new lipophenols during digestion should be taken into consideration.

Effectiveness of music therapy and progressive muscle relaxation in reducing stress before exams and improving academic performance in Nursing students: A randomized trial.

BACKGROUND: Nursing students experiencing high stress levels before exams could suffer worse academic performance. OBJECTIVE: We evaluated an intervention combining Progressive Muscle Relaxation (PMR) and music therapy on the decrease of before exams stress and the improvement of academic results. DESIGN AND METHODS: Randomized controlled trial including students from the Nursing Degree during the first semester of the 2017-2018 academic year. All participants were randomized to the control (CG) or the experimental group (EG). The CG took the exam as usual whereas in the EG, PMR and music therapy were performed before exams. Blood samples were drawn to investigate variations in biochemical parameters. The academic performance was assessed by the score obtained in the "Clinical Nursing" exam. RESULTS: We included 112 students (75% females, mean age 24.3 ±â€¯6.2 years, 56 students in every group). There were no differences in any parameter during the first measurement. Regarding the second measurement, we observed a reduction in heart rate for the EG and an increase in blood pressure, heart rate, and cortisol for the CG. Indeed, these parameters were significantly higher compared to the EG. The EG had a mean score of 5.07 ±â€¯1.59 in the Clinical Nursing exam, which was significantly higher compared to the CG (4.42 ±â€¯1.58, p = 0.033). The proportion of fails in the CG was also higher (62.5% vs. 42.9%, p = 0.037). CONCLUSION: In this study including students from the Nursing degree, the combination of PMR and music therapy was effective for the control and decrease of stress before exams, and also demonstrated improvements in academic results.

Work Shift and Circadian Rhythm as Risk Factors for Poor Sleep Quality in Public Workers from Murcia (Spain).

The purpose of this study was to determine the prevalence of sleep quality and to investigate variables predicting the risk of poor sleep quality in public workers from Murcia (Spain). A cross-sectional and prospective study was conducted from October 2013 to February 2016 in 476 public workers. The Pittsburgh Sleep Quality Index was used to measure the quality of sleep, and the reduced scale of the Horne and Österberg Morningness-Eveningness Questionnaire was applied to analyze the circadian typology. The predictive variables of self-reported poor sleep quality were identified by multivariate logistic regression. No significant differences were found according to sex in the overall sleep quality scores (5 ± 2.9 versus 5.1 ± 3, p = 0.650), but there were in the duration of sleep. Three percent of females slept <5 hours compared to 2% of men (p = 0.034). Fixed morning shifts (OR = 1.9, 95% CI 1.3-3.1; p = 0.007) and evening chronotypes (OR = 1.6, 95% CI 1.0-2.3; p = 0.017) were independent predictors of suffering from poor sleep quality. In conclusion, the frequency of self-reported poor sleep quality among public workers from Murcia was 37.4%. Being a public worker with a fixed morning shift and having an evening chronotype demonstrated to be associated with the quality of sleep.

Reliability and Validity of a Stress Scale in Public Employees from Murcia (Spain).

Stress is common in all work environments. Technostress and the difficulty of separating the family arena from the work environment are some of the new and emerging risks faced by companies, employees and society in general. Most of the available instruments for measuring stress in workers have been focused on education professionals and healthcare workers. Therefore, it is necessary to validate simple and friendly-use tools to detect stress levels in public workers. The aim of this study was to determine the internal consistency of an adapted version of the Student Stress Inventory-Stress Manifestations (SSI-SM) for public employees and to determine if high-stress levels are related to personal and work-related factors. A cross-sectional and descriptive study was conducted from October 2016 to February 2019 including 468 Spanish public workers based in Murcia. An adapted version of the SSI-SM was administered and data on personal and work-related factors were collected. Results showed that all of the factors had Cronbach's α over 0.700, and no items need to be deleted due to correlations with the factor exceeding 0.300. Factor 1, "Self-concept", has a Cronbach's α of 0.868, with values of 15.62 ± 4.99; factor 2, "Sociability", Cronbach's α: 0.853, with mean values of 13.33 ± 4.17; factor 3, "Somatization", Cronbach's α: 0.704, mean value of 5.35 ± 1.90 and: factor 4, "Uncertainty", Cronbach's α: 0.746, with a mean value of 8.19 ± 2.51. In conclusion, the internal consistency of the adapted SSI-SM for public employees with different work positions and shifts has been validated and determined. This study provides a useful tool for the early detection of stress in public employees and may be potentially useful for preventing the harmful consequences of stress.

The COVID-19 Pandemic and Its Impact on Homebound Nursing Students.

University students are predisposed to stress, which could be even higher in Nursing students since they are directly related to the COVID-19 pandemic given their health training and area of knowledge. Our purpose was to assess the stress levels of Nursing students before and during lockdown due to the COVID-19 pandemic in Murcia (Spain), its influence on taking an online exam and how it was affected by physical exercise. This was an observational and prospective study including Nursing students from the second year of the Nursing Degree from 3 February to 23 April 2020. Three measurements were performed: one before lockdown and two during lockdown. Stress increased substantially during lockdown. Financial, family or emotional problems, as well as physical exercise, also increased. Indeed, at 40 days of lockdown, those students with financial, family or emotional problems, and less physical exercise reported significantly higher stress levels. In addition, those who passed the online exam had lower stress levels compared to those who failed. In conclusion, during lockdown, stress in Nursing students increased. This could be triggered by students' personal problems, and physical exercise may be used as a way to reduce stress. Academic performance was better in those students reporting less stress.

Risk factors for mental workload: influence of the working environment, cardiovascular health and lifestyle. A cross-sectional study.

OBJECTIVES: Mental workload is a condition which can negatively influence the overall health of workers. In this study, we aimed to investigate the risk factors for the onset of mental workload, including working conditions, cardiovascular comorbidities and lifestyle habits, in a working population. METHODS: This is a cross-sectional study including 408 workers from a risk prevention service of small/medium companies in Murcia (Spain). Workers from the secondary and tertiary sectors or primary/secondary sectors with administrative management tasks who underwent a routine medical examination between 1 January 2017 and 31 April 2017 were included. Workers from the primary sector and construction were excluded to avoid a sex and age bias. RESULTS: From 408 workers, 206 (50.5%) were females; with mean age 36.8±10.4 years. 164 (40.2%) workers had a moderate to significant risk of mental workload. Based on multivariate logistic regression analyses, independent predictors of mental workload were age ≥30 years (OR 2.42, 95% CI 1.22 to 4.80; p=0.012), working in tertiary (OR 7.89, 95% CI 3.59 to 17.31; p<0.001) or administrative sectors (OR 87.57, 95% CI 35.22 to 217.79; p<0.001) and alcohol consumption (OR 2.08, 95% CI 1.16 to 3.73; p=0.014). Smoking habit (OR 0.47, 95% CI 0.26 to 0.85; p=0.012) was found as a protective variable so non-smoking was considered as a risk factor. CONCLUSION: In the present study from a risk prevention service including workers of small/medium companies from the secondary and tertiary sectors and workers with administrative tasks, the labour sector, age, alcohol consumption and smoking habits, are independently associated with a higher risk of developing moderate to significant mental workload.