CHRONOFALLS: A multicentre nurse-led intervention in the chronoprevention of in-hospital falls in adults.

BACKGROUND: Falls are among the most common and serious adverse events for hospitalised patients. In-hospital falls pose a major medical and economic challenge for public health worldwide. Nevertheless, the issue is often addressed without regard to certain relevant variables such as the time of the fall. The aim of this study was to determine the effect of the implementation of a nurse-led intervention based on the temporal patterns of falls and their aetiology on the occurrence of falls. METHODS: A mixed-method research design was carried out in three phases: a) a longitudinal prospective study (audits, chronobiological analyses and implementation of a multicentre nurse-led intervention based on temporal patterns of falls); b) a retrospective study of fall records; and c) a qualitative study based on focus groups. The protocol was published in 2021. RESULTS: A difference was observed in the number of fall records before and after the chronopreventive intervention (retrospective: 64.4% vs. 35.6%; p < 0,001). According to the interrupted series analysis, considering the influence of the COVID-19 pandemic, a reduction in falls of 2.96% (95% CI 1.70%-4.17%) was observed. The concepts of falls, the COVID-19 pandemic and the causes of non-registration have emerged as categories for qualitative analysis. CONCLUSIONS: A multicentric nurse-led program based on tailored organisational, educational and behavioural chronopreventive measures seems to lead to a reduction in the number of in-hospital falls. The findings of the present study, highlighting the implementation of chronopreventive measures, can serve as a basis for future health policies. TRIAL REGISTRATION: The project was registered on the Clinical Trials Registry NCT04367298 (29/04/2020).

Formal and Informal Services Used by Women Who Suffer Intimate Partner Violence in Spain.

Intimate partner violence (IPV) is an important public health problem. Female victims of IPV do not always use the institutional resources available to them. We conducted a cross-sectional study using data from the Spanish 2014 Macro-Survey on Violence Against Women. The findings show that 15% of the survey participants suffered from IPV in the last year. The factors associated with a higher probability of suffering IPV are being of non-Spanish nationality, being a student, having a low-educational level, having no income, being the household head, and not having a current partner. Regarding the resources used by women subjected to IPV, almost half resorted to informal sources, such as female friends and/or their own mothers. The use of formal resources was low. Therefore, IPV continues to be a problem in Spain that seems to remain in the private domain. Consequently, it is necessary to increase the availability of and access to legal resources.

Impact of sound levels on physiological and consciousness state of cardiovascular patients.

BACKGROUND: Patients treated in intensive care units (ICUs) experience life-threatening medical conditions but some external factors in ICUs do not help or even adversely affect and complicate their evolution. Among others, such factors include noise pollution due to alarms and medical clinical equipment, as well as the activities of the health care personnel themselves. AIM: This study aimed to evaluate the influence of elevated sound levels on physiological variables and the consciousness state of patients treated in a cardiovascular area in an ICU. DESIGN: A longitudinal study with several observations was carried out during 1 month in the cardiovascular area of an ICU of a third-level hospital in southern Spain. METHODS: Sound levels were monitored in different work shifts and patients' physiological data and consciousness status were recorded. Generalized additive mixed models (GAMMs) were developed to detect the variability of the sound levels together with the vital parameters of the patients in the ICU. RESULTS: Thirty-eight patients were included. The mean sound level was 54.09 dBA. The GAMM sound levels analysis showed a significant increase in sound levels from 4:30 p.m. to 8:00 p.m. (1.83 dBA; P < .001) and 8:00 p.m. to 11:30 p.m. (3.06 dBA; P < .001). An increase in heart rate (3.66 bpm; P < .001), respiratory rate (2.62 rpm; P < .001) and the Glasgow Coma Scale (0.50 units; P = .002) was detected during the 4:30 p.m.-8:30 p.m. CONCLUSIONS: Elevated sound levels in cardiovascular ICUs seem to influence positively the physiological and consciousness status of patients. Given the importance of the findings for patient safety, future intervention studies are recommended. RELEVANCE TO CLINICAL PRACTICE: The finding of this study could translate into structural changes in ICU facilities, as well as the development of clinical practice guidelines that influence the behaviour of health care professionals.

Chronoprevention in hospital falls of older people: protocol for a mixed-method study.

BACKGROUND: Accidental falls in hospitals are serious events concerning the safety of the patients. Recent studies demonstrated that the time of falls is a key factor to be considered in prevention. It has been shown that the time of day, the day of the week and the month of the year impact on the occurrence of falls. The aim of the study is to determine the effect of the application of a programme of preventive measures based on the temporal patterns of the risk factors on the hospital fall occurrence. METHODS: A mixed-method research design. The following three phases will be carried out: 1) Longitudinal prospective study in two parts: (a) audits and seminars of healthcare professionals focused on an effective and efficient hospital falls register. Multi-Component and Single Cosinor analyses will be performed to obtain the temporal patterns of hospital falls and their related variables and (b) implementation of a based-temporal patterns, multidimensional prevention programme. 2) Retrospective study of falls registered in institutional databases. 3) Qualitative study based on focus groups (physicians, nurses and nursing assistants). The study protocol was approved in 2018. DISCUSSION: With regard to the safety of patients, hospital falls are serious events. Recent studies have demonstrated that the time of falls is a key factor to be considered in prevention. It has been shown that the time of day, the day of the week and the month of the year impact on the occurrence of falls. It is imperative to study temporal patterns of hospital falls to effectively and comprehensively define the aetiology of falls and, therefore, design preventive strategies. A reduction of the number of in-hospital falls and related injuries is expected, as well as an improvement in the quality of life of patients. Considering temporal patterns and levels of mood and sleep of healthcare professionals will achieve an improvement in patient safety. TRIAL REGISTRATION: Retrospectively registered in ClinicalTrials.gov ID: NCT04367298.

Severe trauma patients and nursing practice-associated infections.

AIMS: Our study examined factors influencing the development of healthcare-associated infections in the intensive care unit (ICU) of a tertiary hospital in southern Spain. BACKGROUND: Healthcare-associated infections are a frequent adverse event, significantly lengthening patient stays in the ICU. Nursing practice is a key factor in the infection control process. DESIGN: A retrospective longitudinal study with two observation periods (admission and discharge) was performed in an ICU of a tertiary hospital. METHODS: We analysed patient records for those admitted to this unit coded as CIE 800-959.9 from 2012 to 2016. Using binomial logistic regression analysis, we analysed factors associated with healthcare-associated infections. RESULTS: We analysed 375 records (men: 78.1%; average age: 46.63 years). Of these, 9.2% patients acquired a healthcare-associated infection during their stay. Nursing practice-related factors significantly associated with the development of infection were the number of days connected to mechanical ventilation and the number of days in the ICU. CONCLUSION: Healthcare-associated infections in patients with severe trauma admitted to the ICU are mainly associated with the management of invasive techniques. A multidisciplinary approach should focus on the review of action and care plans.

Association between Physical Activity, Food Consumption and Depressive Symptoms Among Young Adults in Spain: Findings of a National Survey.

Young adults have a significant prevalence of mental disorders, which could lead to dysfunctional quality of life. Records of 1,645 Spanish adolescents were examined and multiple logistic regressions were performed. Being a woman, being older and having a sedentary life were all associated with a higher psychological vulnerability, whereas a low frequency of fresh fruit and bread/cereals consumption, as well as regular intense physical activity, were considered protective against such susceptibility. Regular physical activity and a diet with a high consumption of fruit and cereals may help reduce depressive symptoms, but sociodemographic features are as much as important as lifestyle habits.

Determinants of satisfaction with life and self-esteem in women with breast cancer.

PURPOSE: To determine satisfaction with life (LISAT) and self-esteem in women with breast cancer and the relation between sociodemographic and clinical variables with LISAT and self-esteem. METHODS: Cross-sectional study with 514 Spanish women with breast cancer. Data were collected using an online questionnaire that included the Satisfaction with Life Questionnaire (LISAT-8) and the Rosenberg self-esteem scale. Variables are age, education, occupation, marital status, surgical treatment, breast reconstruction, adjuvant treatment, time since diagnosis, the self-esteem scale, and the LISAT. A multinomial logistic regression was performed to identify possible factors associated with the LISAT and self-esteem after breast cancer. RESULTS: The average age was 46.34 (SD ± 8.28), average age at diagnosis was 42.26 (SD ± 8.56), and average time since diagnosis was 4.05 years (SD ± 5.23). Reports showed the following: good general LISAT (61.7%), economic LISAT (44.7%), and social life LISAT (75.9%) and medium sexual LISAT (41.2%). Of the respondents, 39% had lower self-esteem (p < 0.001). Those who were working (p = 0.002) and those with breast reconstruction (p < 0.037) had a good LISAT. Women with mastectomies had a worse LISAT (p < 0.001). Self-esteem was associated with the general LISAT (Pearson = 0.536, p < 0.001), social LISAT (Pearson = 0.502, p < 0.001), and sexual LISAT (Pearson = 0.329, p < 0.001). CONCLUSIONS: Women with breast cancer had a good LISAT overall; the sexual aspect was evaluated as the lowest in terms of life satisfaction. Marital status, occupation, surgical treatment and self-esteem are associated with the LISAT. Health professionals should know the variables that influence life satisfaction of women with breast cancer to plan and conduct appropriate nursing care.

Chronotype, nursing activity, and gender: A systematic review.

AIM: To synthesize evidence about the effect of individual circadian preference (chronotype) and gender in the development of sleep and mood problems in nursing professionals. BACKGROUND: Shift workers are more prone to having unhealthy habits and unfavourable clinical conditions than nonshift workers. These associations are mediated by chronotype and gender differences have also been detected. DESIGN: A quantitative systematic review. DATA SOURCES: Electronic searches were performed in MEDLINE, Scopus, ScienceDirect, and Web of Science from 1 July 2012 - 1 July 2017. REVIEW METHODS: A systematic review was conducted using the Cochrane Collaboration guidelines and two quality assessment tools: the National Heart, Lung and Blood Institute and GRADE. Inclusion criteria were quantitative studies where the sample consists entirely of nurses, analysing circadian rhythms or individual chronotype or gender and sleep/mood disturbances in nursing activity. The review was reported using the PRISMA statement. RESULTS: A total of 23 studies were included in the review (five cohort studies and 18 cross-sectional studies). Data on gender-specific attention were scarce (two studies) and showed a higher incidence of sleep problems. Female nurses with eveningness-oriented personality seem to be more prone to having sleep disorders, insomnia, fatigue, and anxiety than male and morningness ones. CONCLUSIONS: Evidence seems to show that female nurses with an evening-oriented preference suffer more problems of insomnia, sleepiness, fatigue, and anxiety. The impact of our results may affect nurses, patient safety and the quality of clinical practice.

Relationships among general health, job satisfaction, work engagement and job features in nurses working in a public hospital: A cross-sectional study.

AIM AND OBJECTIVE: To describe relations among health, job satisfaction, work engagement and job features in Spanish nurses working in a public hospital. BACKGROUND: It has been established that nursing staff health affects the quality of their work and is associated with job satisfaction, work engagement and different job features. Understanding the relationships among these variables could provide useful information to improve staff performance and prevent work-related illnesses. DESIGN: A descriptive, cross-sectional, correlational and comparative study was performed between January-April 2016. This research adheres to the Strengthening the Reporting of Observational Studies in Epidemiology guideline. METHODS: A total of 926 nurses were requested to complete an online questionnaire. Nurses on sick leave or in period of unpaid leave during data collection were excluded. The final study population reached 392 nurses. The online survey was fully completed by 373 nurses. General health, job satisfaction and work engagement were measured. Tools used were as follows: sociodemographic questions, the General Health Questionnaire, the Overall Job Satisfaction Scale and the Utrecht Work Engagement Scale. RESULTS: Significant correlations among general health, job satisfaction and work engagement were found. Specifically, general health levels were negatively correlated with job satisfaction and work engagement subscales. Job features with influence on these constructs were the type of shift, type of contract, type of service, salary, type of continuous formation and having a specialty/profile. CONCLUSIONS: Our results indicate that job-related features affect job satisfaction, general health and work engagement. The organisation should make interventions over these features to increase job satisfaction and work engagement levels, since they are relevant for nursing staff health and patient security. RELEVANCE TO CLINICAL PRACTICE: The analysis of the relationships among general health, job satisfaction, work engagement and job features in nurses could offer a basis to design preventive programmes to improve staff performance and prevent work-related illnesses.

Gender, socioeconomic, medical, and environmental factors related to domestic accidents of the elderly in Spain. Findings of a national survey.

Domestic accidents pose serious threats to the independence of the elderly. We explored associations between domestic accidents and gender, socioeconomic, medical, and environmental factors using data from the European Health Survey 2014 for elderly Spanish female and male nationals. Records of 5960 participants (mean age ± SD: 75.9 ± 7.6 years), 59.8% of whom were women, were examined. Domestic accidents occurred in 460 (7.1%) seniors, predominately in women (78.5%). Age (adjusted odds ratio [aOR]: 1.02 [95% confidence interval [CI]: 1.00-1.03, p = .003], female gender (aOR 2.04 [95% CI 1.60-2.60, p < .001]), difficulty managing 12 stairs (reference: none) (some: aOR 2.03 [95% CI 1.53-2.68, p < .001]; much: aOR 2.88 [95% CI 2.15-3.87, p < .001]; inability: aOR 3.09 [95% CI 2.14-4.45, p < .001]), and depressive symptoms severity (reference: absent) (mild: aOR 1.44 [95% CI 1.10-1.89, p = .008]; moderate: aOR 1.91 [95% CI 1.35-2.71, p < .001];. Very severe: aOR 2.53 [95% CI 1.72-3.71, p < .001]; extremely severe: aOR 2.38 [95% CI 1.45-3.93, p = .001]) were independently associated with domestic accidents. Severity of depressive symptoms was the most prominent feature for women, while inability to manage 12 stairs was the most prominent for men. Our results suggest important gender differences in factors associated with domestic accidents that are relevant to intervention and preventive programs.

Evolution of alcohol and tobacco consumption in young people in Spain, after the law 42/2010 against smoking: 2011-2014. / Evolución del consumo de alcohol y tabaco en jóvenes en España, posterior a la ley 42/2010 frente al tabaquismo: 2011-2014.

The objective of the study was to evaluate alcohol and tobacco consumption in young people in Spain, after Law 42/2010, during the interval of 2011-2014. The sample consisted of 3270 young people aged between 15 and 24 years who completed the National Survey of Health in Spain (ENSE) of 2011 and the European Survey of Health in Spain (EESE) of 2014. Variables: consumption, type of tobacco, attempts to quit smoking, consumption and type of alcoholic beverage, binge drinking, and sociodemographic variables. Logistic regression analysis was performed with the sociodemographic variables. The results indicated a decrease in tobacco and alcohol consumption from 2011 to 2014, and increased attempts to quit smoking. Beer is the most popular drink, most consumption is carried out between 1 and 2 days per week, and half of the young people who drink alcohol have taken part in binge drinking in the last 12 months. There are significant differences in tobacco and alcohol consumption. Between 2011 and 2014, the number of occasional and daily smokers, and alcohol consumption decreased, coinciding with the entry into force of Law 42/2010. Binge drinking is the most common pattern among young people. The factors that relate to greater consumption of tobacco are: being male, being married, and not having university studies. On another hand, the variables related to alcohol consumption are: being male, having Spanish nationality and university studies.

El objetivo del estudio fue evaluar el consumo de alcohol y tabaco en jóvenes en España, posterior a la ley 42/2010, periodo 2011-2014. La muestra estaba formada por 3270 jóvenes entre 15 y 24 años de la Encuesta Nacional de Salud en España (ENSE) de 2011 y la Encuesta Europea de Salud en España (EESE) de 2014. Variables: consumo, tipo de tabaco, intentos de dejar de fumar, consumo y tipo de bebida alcohólica, consumo intensivo de alcohol en una misma ocasión y variables sociodemográficas. Se realizó análisis de regresión logística con las variables sociodemográficas. Los resultados indicaron una disminución del consumo de tabaco y alcohol desde 2011 a 2014, aumentado los intentos de dejar de fumar. El tipo de bebida que más esta aumentado es la cerveza, el consumo mayoritario es entre 1 y 2 días/semana y la mitad de jóvenes que consumen alcohol han tenido un consumo intensivo en una misma ocasión en los últimos 12 meses. Existen diferencias significativas en el consumo de tabaco y alcohol. Entre 2011 y 2014 ha descendido el número de fumadores ocasionales, a diario y consumo de alcohol, coincidiendo con la entrada en vigor de la ley 42/2010. El consumo intensivo de alcohol, binge drinking, es el patrón que más se está dando entre jóvenes. Los factores que se relacionan con mayor consumo de tabaco son: ser hombre, estar casado y no tener estudios universitarios. Por otro lado, las variables relacionadas con consumo de alcohol son: sexo masculino, nacionalidad española y estudios universitarios.

Prevalence and determinants in cytology testing for cervical cancer screening in Spain (2006-14).

Background: Cervical cancer has decreased in developed countries thanks to cytology screening programmes. The aims of this study were To analyse the frequency and evolution of performing cytology tests and to determine the variables that influence their use. Methods: Cross-sectional study of non-institutionalized women who participated in the national health survey (2006, 2011/12) and the European Health Survey in Spain (2009, 2014). Study variables: cytology-testing, time since last cytology-test, reason for performing the test, age, nationality, marital status, social status, education level and place of residence. Results: The study evaluated 53 628 women in Spain over 15 years old, with a mean age of 52.68 (SD ± 19.12). About 94.1% were Spanish, 49.2% were married and 77.2% lived with a partner. In 2014, 72% had a cytology test, a number that increased significantly. Women aged 25-65 were 5.13 times more likely to undergo a cytology test than those aged 15-24 years old (odds ratio (OR): 5.13; P < 0.001); women with university educations were 9.23 times more likely to undergo a cytology test than those without university educations (P > 0.001); those of social classes I and II (high) were 1.2 more likely to undergo a cytology test than those of low social class (P = 0.026); and Spanish women were 1.74 times more likely to undergo a cytology test than foreigners living in Spain (P < 0.001). Conclusion: Frequency of cytology testing has increased in the last few years. Screening for cervical cancer is associated with higher social status, education level, age, and not being foreign.

Factors associated with late fetal mortality.

PURPOSE: Perinatal mortality has been decreasing in Europe thanks to a reduction in neonatal mortality. The causes of fetal mortality remain poorly studied. The objective was to determine the late fetal mortality rate in Spain in 2015 and the associated factors. METHODS: A cross-sectional study was performed using data regarding births in 2015 in Spain extracted from the National Institute of Statistics. Single births at 28 or more weeks of pregnancy were included. The sample comprised 340,371 births. Sociodemographic, obstetrical and neonatal variables were analyzed using univariate and multivariate logistic regression (MLR), with the fetal mortality from 28 weeks of pregnancy as the dependent variable. RESULTS: The total number of late fetal deaths was 884 (2.6 × 1000). The MLR model showed that the following factors were associated with late fetal mortality: birth before 37 weeks of pregnancy (OR 13.1); weight of the newborn < 2500 g (OR 3.22) and ≥ 4000 g (OR 3.36); low training level (OR 2.28); and others, such as African origin, maternal age ≥ 35 years, primiparity and mothers who were single. CONCLUSIONS: The rate of late fetal mortality in Spain has not decreased and has remained at the same level as in 2010. This result is related to prematurity, low birth weight, macrosomia and sociodemographic factors, such as low maternal preparation, mothers of African origin, age ≥ 35 years and mothers who are single. It is necessary to improve the quality and accessibility of prenatal care and the early detection of risk factors.

Prevalence and factors associated with polypharmacy in the older people: 2006-2014.

AIMS AND OBJECTIVES: To analyse the prevalence, risk factors and evolution over time of polypharmacy and self-medication in the older people in Spain from 2006-2014. BACKGROUND: Polypharmacy is a public health problem for older people worldwide which causes different negative effects on their health, increasing health costs and pharmaceutical spending. However, previous studies do not include nationally representative samples and none of them provide updated data. DESIGN: Cross-sectional study with community-dwelling older adults (N = 26,277) who participated in the National Health Survey in Spain in 2006 and 2011/2012 and the European Health Survey in Spain in 2009 and 2014. METHODS: Polypharmacy (defined as use of five or more medications in the last 2 weeks), excessive polypharmacy (defined as use of ten or more medications in the last 2 weeks) and self-medication (defined as use of medications without a prescription) were evaluated. A logistic regression was used for to know the association between polypharmacy and self-medication with the sociodemographic characteristic. RESULTS: The participants were 62% female and 38% male. The mean medication consumption was 2.96 (SD ± 2.11). Prevalence of polypharmacy was present in 21.9%, prevalence of excessive polypharmacy was 0.6%, and prevalence of self-medication was 10.7%. The most commonly used medications were for blood pressure (51.6%), pain (42.8%) and cholesterol (28.2%). Polypharmacy is associated with sex (females), age, being separated/divorced/widowed, lack of education, higher body mass index, being bedridden during the last 2 weeks and self-medication. CONCLUSIONS: The prevalence of polypharmacy and prevalence of self-medication are considerable, and they increased significantly from 2006-2014. RELEVANCE TO CLINICAL PRACTICE: To deal with polypharmacy is a big challenge for nurses. These data suggest to establish innovative clinical strategies in which the health professionals and the patients are involved to improve the personal behaviour with medicines and to reduce the risks and costs of polypharmacy and self-medication.

[Prevalence in the performance of mammographies in Spain: Analysis by Communities 2006-2014 and influencing factors]. / Prevalencia en la realización de mamografías en España: análisis por comunidades 2006-2014 y factores que influyen.

OBJECTIVE: To determine the frequency of the performance of mammography with preventive purpose of the screening of breast cancer in Spanish women, the evolution between the years 2006-2014, the sociodemographic profile of the women who undergo the mammography and to analyze the factors that influence in their adhesion. DESIGN: Transversal study. SITES: Spain. PARTICIPANTS: A total of 53.628 women over 15 years old that are surveyed in the National Health Survey in Spain 2006 and 2011/12 and the European Health Survey in Spain 2009 and 2014. MEASUREMENTS: The following variables were used: mammography, frequency of mammography performance and the reason for the realization, as well as sociodemographic variables. Social class was obtained from the last occupation of the main family supporter. A logistic regression analysis was performed with sociodemographic variables. RESULTS: The prevalence of mammography has been increasing from 2006 to 2014, and also for the reason that the participants had received a letter, they were telephoned or offered in their Health Center to undergo this test. There are significant differences in the performance of mammography in the different autonomous communities. CONCLUSIONS: Performing mammography has increased significantly from 2006 to 2014, although there are still differences between autonomous communities, with Ceuta and Melilla being the least percentage of performed mammography. The factors that are related to greater performed mammography are: higher educational level, higher social class, married civil status, Spanish nationality and age.

Intimate partner violence among health professionals: distribution by autonomous communities in Spain.

OBJECTIVE To determine the prevalence of intimate partner violence among health care professionals who work in the Spanish National Health System, according to the autonomous communities of Spain. METHOD This was a descriptive cross-sectional multicenter study conducted with male and female health professionals (doctors, nurses, and nursing aides) in the different autonomous communities that are part of the Spanish National Health System. The following instruments were employed: among women, an intimate partner violence screening questionnaire; and among men, a questionnaire that screened for violence in the family environment. RESULTS A total of 1,039 health professionals participated in the study. Of these, 26% had suffered some type of abuse. Among the men, this prevalence was 2.7%, while among the women, it was 33.8%. There were differences in the prevalence of intimate partner violence among different autonomous communities, with the highest percentages in the Canary Islands. In terms of profession, 19.5% of the doctors had been exposed to intimate partner violence, while this percentage was 31% and 48.6% for nurses and nursing professionals, respectively. CONCLUSION The results indicate the presence of intimate partner violence among healthcare personnel in most of the autonomous communities of Spain. The data demonstrate the need to implement action plans, both to support victims and to mitigate the problem.

Renal disease and accidental falls: a review of published evidence.

BACKGROUND: The pathogenesis of falling is complex, and identification of risk factors may be essential for prevention. The relationship between renal disease and falls is unclear, and the goal of this study was to collect the available evidence and investigate the relationship between accidental falls and renal dysfunction. METHODS: Electronic searches were performed in the MEDLINE, Scopus, Ovid SP and Web of Science databases to identify the appropriate literature. The themes used were: falls (combined in the title/abstract fall or falls or falling or faller* or fallen or slip* or trip* or (MeSH) accidental falls) and renal insufficiency (chronic or renal insufficiency or kidney diseases combined in title/abstract renal disease* or kidney disease* or renal insufficiency or kidney insufficiency or kidney failure or renal failure or MeSH renal insufficiency, chronic or renal insufficiency or kidney diseases). The incidence, risk factors, complications, and characteristics of the falls were analyzed. RESULTS: Eight prospective cohorts including five cross-sectional studies, and one case-control study were identified. No randomized controlled studies were found. The incidence of falls in chronic kidney disease patients ranged between 1.18 and 1.60 fall/patient year. These were frequent in frail older adults on hemodialysis treatment. Falling relapses in the same group of patients caused serious consequences. Data on pre-end stage renal disease (ESRD) were scarce. CONCLUSIONS: The risk of falling appears to be common in patients with renal dysfunction especially in older adults undergoing hemodialysis. On the other hand, we could not find any conclusive data on pre-ESRD patients.

Prevalence and Mode of Birth in Late Fetal Mortality in Spain, 2016-2019.

(1) Background: The rate of cesarean sections in late fetal mortality remains high. We aimed to determine the prevalence of late fetal mortality in Spain and risk factors for cesarean birth in women with stillbirth ≥ 28 weeks gestation between 2016-2019. (2) Methods: A retrospective observational study with national data between 2016-2019. A total of 3504 births with fetal dead were included. Sociodemographic, obstetrical and neonatal variables were analyzed using univariate and multivariate logistic regression (MLR), with cesarean birth with a stillborn ≥ 28 weeks gestation as the dependent variable. (3) Results: The late fetal mortality rate was 2.8 × 1000; 22.7% of births were by cesarean section. Factors associated with cesarean were having a multiple birth (aOR 6.78); stillbirth weight (aOR 2.41); birth taking place in towns with over 50,000 inhabitants (aOR 1.34); and mother's age ≥ 35 (aOR 1.23). (4) Conclusions: The late fetal mortality rate increased during the period. The performance of cesarean sections was associated with the mother's age, obstetric factors and place of birth. Our findings encourage reflection on how to best put into practice national clinical and socio-educational prevention strategies, as well as the approved protocols on how childbirth should be correctly conducted.

Perceptions of Gender Violence in Spanish Adolescents.

BACKGROUND: Gender violence among adolescents is a global problem. In the context of public healthcare, nursing professionals play an important role. OBJECTIVE: The aim of this study was to determine awareness, information, and beliefs regarding gender violence in adolescents and identify their educational needs. PARTICIPANTS AND SETTING: Data from a study conducted by the Spanish Centre for Sociological Research and the Government Office for Gender Violence in 2013 are used. The sample contained 698 adolescents aged 15-19 years. METHODS: This is a secondary analysis of a data survey. Strengthening the Reporting of Observational Studies in Epidemiology guidelines are followed. Sociodemographic variables and seven topics of interest were analyzed: gender inequality, intimate relationships, definition of abuse, identification of abuse, awareness of cases of abuse in women, and informal and formal support networks. RESULTS: The results show that adolescents are well informed, are aware of informal and formal support networks, use the word "respect," identify abuse and consider it unacceptable, and believe media coverage is useful in giving visibility to gender violence. No significant differences were found in gender, social class, or education, and their idea of romantic love remains intact. CONCLUSIONS: The researchers conclude that, in Spain, adolescents' awareness of gender violence is strongly influenced by environmental and cultural factors, because of the prevalence of gender and intimate partner violence in the country. Formal interventions such as health education provided by either nursing professionals in schools or the broader community can have a positive effect on adolescent health. Primary care nurses should use these findings to support the development of health promotion programs for young adults.

Early detection of risk for clinical deterioration in emergency department patients: validation of a version of the National Early Warning Score 2 for use in Spain. / Validación en España de la escala National Early Warning Score 2 (NEWS-2) para la detección precoz en urgencias de pacientes en riesgo de deterioro.

OBJECTIVES: To determine the ability of a Spanish translation of the National Early Warning Score 2 (NEWS2) to predict hospitalizations and adverse events during triage in hospital emergency departments. MATERIAL AND METHODS: Prospective observational study in 2 phases. Phase 1 took place in October and November 2019 and phase 2 in January and February 2020. Phase 1 involved the translation and back translation process to produce an adapted Spanish version of the NEWS2 tool, the piloting of the adapted tool, and training sessions for nurses on how to use the scale. Phase 2 was a validation study of the translated scale for use in Spain. We analyzed its psychometric properties and capacity to predict adverse events and hospital admissions. Adult patients (over the age of 18 years) were recruited consecutively in a hospital emergency department in Spain. RESULTS: We evaluated 523 patients, 81 in phase 1 and 442 in phase 2. The validated Spanish language version of the NEWS2 tool achieved a Cronbach α score of 0.70. The intraclass correlation coefficients for intra- and inter-observer reliability, respectively, were 0.996 (95% CI, 0.995-0.997) and approaching 1 (95% CI, 0.999-1). The area under the receiver operating characteristic curve was 0.969 (95% CI, 0.938-1) for adverse events and 0.881 (95% CI, 0.819-0.943) for hospitalization. CONCLUSION: The ability of the Spanish version of the NEWS2 scale to predict hospital admissions and adverse events is high when used during hospital emergency department triage.

OBJETIVO: Conocer la capacidad predictiva en términos de ingresos hospitalarios y de aparición de eventos adversos de la escala de alerta temprana National Early Warning Score 2 (NEWS-2) en la consulta de triaje de los servicios de urgencias hospitalarios (SUH). METODO: Estudio observacional prospectivo dividido en dos fases: Fase I (octubre-noviembre 2019) y Fase II (enero-febrero 2020). En la Fase I se llevó a cabo un proceso de traducción-retrotraducción, se formó al personal de Enfermería en el manejo de la escala NEWS-2 adaptada al español, y se realizó un pilotaje de la escala. En la Fase II se procedió a la validación de la escala analizando sus propiedades psicométricas y predictivas en términos de aparición de eventos adversos e ingresos hospitalarios. Se incluyeron consecutivamente a los usuarios adultos (mayores de 18 años) de un SUH en España. RESULTADOS: Se valoraron 523 pacientes, 81 en la fase I y 442 en la fase II. La versión de la escala NEWS-2 en español obtenida tras el proceso de validación mostró un valor de alfa Cronbach de 0,70. El coeficiente de correlación intraclase para la fiabilidad intra e interobservador fue de 0,996 (IC 95%: 0,995-0,997) y 1 (IC 95%: 0,999-1), respectivamente. El área bajo la curva de la característica operativa del receptor fue de 0,969 (IC 95%: 0,938-1) para eventos adversos y de 0,881 (IC 95%: 0,819-0,943) para ingreso hospitalario. CONCLUSIONES: La escala NEWS-2 tiene alta capacidad predictiva de ingresos hospitalarios y eventos adversos cuando se aplica en la consulta de triaje de los SUH.