Utilization of Primary Healthcare Services in Patients with Multimorbidity According to Their Risk Level by Adjusted Morbidity Groups: A Cross-Sectional Study in Chamartín District (Madrid).

Patients with multimorbidity have increased and more complex healthcare needs, posing their management a challenge for healthcare systems. This study aimed to describe their primary healthcare utilization and associated factors. A population-based cross-sectional study was conducted in a Spanish basic healthcare area including all patients with chronic conditions, differentiating between having multimorbidity or not. Sociodemographic, functional, clinical and service utilization variables were analyzed, stratifying the multimorbid population by the Adjusted Morbidity Groups (AMG) risk level, sex and age. A total of 6036 patients had multimorbidity, 64.2% being low risk, 28.5% medium risk and 7.3% high risk. Their mean age was 64.1 years and 63.5% were women, having on average 3.5 chronic diseases, and 25.3% were polymedicated. Their mean primary care contacts/year was 14.9 (7.8 with family doctors and 4.4 with nurses). Factors associated with primary care utilization were age (B-coefficient [BC] = 1.15;95% Confidence Interval [CI] = 0.30-2.01), female sex (BC = 1.04; CI = 0.30-1.78), having a caregiver (BC = 8.70; CI = 6.72-10.69), complexity (B-coefficient = 0.46; CI = 0.38-0.55), high-risk (B-coefficient = 2.29; CI = 1.26-3.32), numerous chronic diseases (B-coefficient = 1.20; CI = 0.37-2.04) and polypharmacy (B-coefficient = 5.05; CI = 4.00-6.10). This study provides valuable data on the application of AMG in multimorbid patients, revealing their healthcare utilization and the need for a patient-centered approach by primary care professionals. These results could guide in improving coordination among professionals, optimizing multimorbidity management and reducing costs derived from their extensive healthcare utilization.

The Lived Experiences of Female Immigrant Carers in Madrid, Spain: A Phenomenological Study.

BACKGROUND: Immigration and population ageing represent circumstances with important sociocultural and economic repercussions. METHODS: A qualitative study using interpretative phenomenological analysis was conducted to understand the daily lives and the work of immigrant women dedicated to caring for older citizens. In-depth interviews and discussion groups were carried out in a group of 40 immigrant carers. Data were analysed via the constant comparative method. RESULTS: Three qualitative themes emerged from the data: 'difficult lives', 'working in the home', and 'the vision of the other'. This study highlights the many difficulties encountered by this population. A sense of vulnerability was described while fulfilling their professional duties due to their migrant condition, experiences of gender inequality, and work status. An emotional connection is necessary to provide care, which is impossible in cases of discrimination. DISCUSSION: Administrative regularisation is necessary to improve the quality of immigrant carers' working conditions.

The Effect of a Sleep Intervention on Sleep Quality in Nursing Students: Study Protocol for a Randomized Controlled Trial.

We develop a protocol for assessing the impact of an intervention aimed at improving sleep quality among university nursing students. The study is designed as a pilot randomized controlled trial to be applied during the 2022-23 academic year and is registered at Clinical Trials Gov website (NCT05273086). A total of 60 nursing students will be recruited from a Spanish university. They will be divided into two groups: (30) intervention group and (30) control group. The intervention group will attend two cognitive-behavioural therapy sleep programme sessions focused on knowledge of anatomical structures involved in sleep, chronotype, synchronization, and good sleeping habits. Subjective and objective sleep quality will be assessed before and after the intervention for both groups. In addition to sleep quality, socio-demographic parameters, physical activity, lifestyle habits, and anthropometric measures will be considered prior to intervention. Finally, a satisfaction questionnaire will be applied for posterior analysis. This study is an innovative, relevant intervention that aims to improve sleep quality among university nursing students. Both the approach and the use of objective and subjective validated outcome measurements are key features of this study.

Effect of Virtual Reality on Pediatric Pain and Fear During Procedures Involving Needles: Systematic Review and Meta-analysis.

BACKGROUND: Virtual reality (VR) is used as a distraction measure during painful clinical procedures associated with the use of needles. These procedures include vaccinations, blood draws, or the administration of medications, which can cause children to feel increased levels of pain and fear. OBJECTIVE: The objective of this study was to collect and analyze the current evidence regarding the effectiveness of VR as a tool to distract children from pain and fear during needle procedures as compared to that of standard techniques. METHODS: A systematic review and meta-analysis was performed. We included randomized clinical trials (RCTs) or quasi-RCTs with participants younger than 21 years who underwent needle procedures in which the main distraction measure used was VR and where the main outcome measure was pain. The databases searched included the PubMed, Web of Science, Scopus, PsycINFO, CINAHL, and Cochrane libraries. In this systematic review, the studies were analyzed by applying the Critical Appraisal Skills Program guide in Spanish and the Jadad scale. In the meta-analysis, the effect size of the studies was analyzed based on the results for pain and fear in children. RESULTS: From 665 unique search results, 21 studies were included in this systematic review, most of which reported low methodological quality. The study sample cohorts ranged from a minimum of 15 participants to a maximum of 220 participants. Ten studies were included in the meta-analysis. The global effect of using VR as a distraction measure was a significant reduction in pain (inverse variance [IV] -2.37, 95% CI -3.20 to -1.54; Z=5.58; P<.001) and fear (IV -1.26, 95% CI -1.89 to -0.63; Z=3.92; P<.001) in children in the experimental groups. CONCLUSIONS: The quality of the studies was mostly low. The main limitations were the impossibility of blinding the participants and health care personnel to the VR intervention. Nonetheless, the use of VR as a distraction measure was effective in reducing pain and fear in children during procedures involving needles.

School Nurse Practice: A Descriptive Spanish Study.

This study aimed to describe the profile and practices of school nurses working at a network of educational centers in Spain. This was a descriptive study of the documented actions of 107 school nurses between September 2018 and June 2021 in 54 educational centers (55.6% private and 44.4% subsidized). The profile of the school nurses was young (average age 33.8 [standard deviation (SD) = 7.7] years) and predominantly female (91.6%) with a diverse and multidisciplinary education, primarily at the postgraduate level (specialized mainly in emergency care, nursing/school health, and pediatrics/neonatology). They carried out 256,499 interventions. The most frequent types of incidents they treated were accidents (30.4%) and disease-related episodes (22.2%). The interventions were usually brief (average time 7.7 min) and were resolved by the school nurse (99.1%), and the main recipients were students (87.3%). The highest incidence of interventions occurs during breaks between classes. Acute interventions occupied most of the school nurses' time, leaving little opportunity for health education (0.3%). School nurses played an important role in preserving and promoting the health of school populations and cost-savings to healthcare systems with the actions that they performed. Descriptions of these actions are essential when advocating for the continuation and expansion of school nursing services.

Student satisfaction with the Service-Learning methodology: an added value in the training of thee nursing degree / Satisfacción de los alumnos con la metodología de Aprendizaje-servicio: un valor añadido en la formación del título de enfermería

Abstract: Objective: To evaluate the effect on the satisfaction of nursing students and the participants of Service-Learning methodology in the development of Health Education workshops. Materials and methods: Service-Learning project was designed in four stages: 1) students training in knowledge about Community Nursing and Health Education; 2) development of healthy workshops for its implementation in associations; 3) implementation of the workshops; 4) reflection on Service-Learning impact. An ad hoc questionnaire was developed to assess students' satisfaction. It was also evaluated the workshops' participant's satisfaction. Results: students reported having a very high level of satisfaction by increasing their scores after improving Service-Learning methodology in the subject. In addition, participants who received health promotion workshops developed by nursing students reported a positive impact on their health. Conclusion: development of Service-Learning methodology associated with health education implies high level of satisfaction in nursing students and a social impact for the community.

Resumen: Objetivo: Evaluar la satisfacción de los estudiantes de enfermería y los participantes, con la metodología Aprendizaje Servicio en el desarrollo de talleres de Educación para la Salud. Materiales y Método: El proyecto de Aprendizaje-Servicio se diseñó en cuatro etapas: 1) Formación de estudiantes en conocimientos sobre Enfermería Comunitaria y Educación para la Salud; 2) Desarrollo de talleres saludables para su implementación en asociaciones; 3) Implementación de los talleres; 4) Reflexión sobre el impacto del Aprendizaje-Servicio. Se desarrolló un cuestionario ad hoc para evaluar la satisfacción de los estudiantes. También se evaluó la satisfacción de los participantes de los talleres. Resultados: Los estudiantes informaron tener un nivel de satisfacción muy alto, al aumentar sus puntajes luego de mejorar la metodología de Aprendizaje-Servicio en la asignatura. Además, los participantes que recibieron talleres de promoción de la salud, desarrollados por estudiantes de enfermería, reportaron un impacto positivo en su salud. Conclusión: El desarrollo de la metodología de Aprendizaje-Servicio asociado a la educación en salud, implica un alto nivel de satisfacción en los estudiantes de enfermería y un impacto social para la comunidad.

The Impact of COVID-19 on the Lifestyles of University Students: A Spanish Online Survey.

The present study aimed to investigate the perceived changes in lifestyle behaviors among Spanish university students during COVID-19-related confinement. An observational, descriptive, and cross-sectional survey study was conducted during April 2020. Sociodemographic and anthropometric data were then obtained. The FANTASTIC questionnaire was used to assess the lifestyles of the 488 participants who took part in the study. Of the participants, 76.3% were female. Overall, the lifestyles of university students significantly deteriorated during the period of confinement caused by the COVID-19 pandemic in Spain. University female students were especially affected compared to their male fellows (p = 0.010). For women, social and family relationships (p < 0.001), personality (p < 0.001), interior (p < 0.001), and career (p < 0.001) were the aspects that worsened during confinement. For men, lack of physical exercise (p < 0.001), social and family relationships (p < 0.001), and career (p = 0.002) were affected to a greater extent. In both cases, confinement was a protective factor against the consumption of tobacco, toxins (p < 0.001), and alcohol (p < 0.001). Gender (p = 0.008) and obesity (p = 0.044) were the two factors that most affected the change in the score of the FANTASTIC questionnaire. Spanish university students' lifestyles worsened during the lockdown caused by the COVID-19 pandemic, especially those of women, who were the most affected. Some aspects, such as those related to social and emotional behaviors, were deeply affected, while confinement could be a protective factor against previous toxic habits.

[Assessment of the humanitarian response to cholera in wash interventions.] / Evaluación de la respuesta humanitaria al cólera en las intervenciones WASH.

BACKGROUND: The humanitarian response to a cholera outbreak in a complex international crisis requires guaranteeing minimum conditions so that normalcy can be restored. Basic responses to a cholera outbreak include water and sanitation. The general objective of this systematic review was the analysis of the current evidence that addresses the effectiveness of different WASH measures to control cholera. METHODS: A review and analysis of the literature available in the main databases (PubMed, WoS and Scopus) and in a specific meta-search engine for humanitarian aid was carried out (reliefweb.int). Based on the establishment of the PICO research question "Can beneficiaries of humanitarian aid benefit from water, hygiene and sanitation interventions for cholera reduction?", the identification of keywords and databases to carry out the searches, as well as a selection process based on the established eligibility criteria: being studies in both English and Spanish where the WASH intervention was clearly defined, studies where health outcomes of cholera were presented, or data related to the function and use of the WASH intervention, was established. RESULTS: The initial search provided 17,185 documents susceptible of analysis that were screened using the search criteria, up to 22 references that were read in full text and the 11 that were finally analyzed. These were coded based on the measures set out in their protocols, on the interventions carried out in the improvement of water and its supply, the improvement of sanitation, the measures aimed at better hygiene and those that evaluated the complete WASH intervention. CONCLUSIONS: All the measures offered positive results, their effectiveness was conditioned by the education of the beneficiaries, the simplicity of the activities and the involvement of local actors.

OBJETIVO: La respuesta humanitaria ante un brote de cólera en una crisis compleja de carácter internacional requiere garantizar unas condiciones mínimas para que se pueda recuperar la normalidad. Entre las respuestas básicas a un brote de cólera están las correspondientes al agua y el saneamiento. El objetivo general de esta revisión narrativa fue el análisis de la evidencia actual que aborda la efectividad de las diferentes medidas WASH para controlar el cólera. METODOS: Se realizó una revisión y análisis de la literatura disponible en las bases de datos principales (PubMed, WoS y Scopus) y en un metabuscador específico de ayuda humanitaria (reliefweb.int). Basada en el establecimiento de la pregunta de investigación PICO: "¿Los beneficiarios de la ayuda humanitaria se pueden beneficiar de las intervenciones en agua, higiene y saneamiento para la disminución del cólera?" la identificación de las palabras clave y bases de datos para realizar las búsquedas, además de un proceso de selección basado en los criterios de elegibilidad establecidos; siendo estudios tanto en inglés como español donde la intervención WASH fue claramente definida, estudios donde se presentaran resultados de salud del cólera, o datos relacionados con la función y el uso de la intervención WASH. RESULTADOS: La búsqueda inicial proporcionó 17.185 documentos susceptibles de análisis que fueron cribados mediante los criterios de búsqueda hasta las 22 referencias que fueron leídas a texto completo y las 11 que fueron analizadas finalmente. Estas fueron codificadas en base a las medidas expuestas en sus protocolos, a las intervenciones realizadas en la mejora del agua y su suministro, la mejora del saneamiento, las medidas destinadas a una mejor higiene y aquellas que evaluaban la intervención WASH completa. CONCLUSIONES: Todas las medidas ofrecieron resultados positivos, su eficacia estuvo condicionada por la educación de los beneficiarios, la simplicidad de las actividades y la implicación de los actores locales.

Parental Self-Efficacy to Promote Children's Healthy Lifestyles: A Pilot and Feasibility Study.

Positive parenting programs are a key strategy to promote the development of parental competence. We designed a pilot study based on parental self-efficacy to promote healthy lifestyles in their children aged between 2 to 5 years old. In this pilot study, we aimed to assess the effects of a parenting program on parental self-efficacy and parenting styles. Twenty-five parents were allocated into intervention (N = 15) and control group (N = 10). Parents from the intervention group received four group sessions (120 mi per session) to develop a positive parenting, parenting styles and parenting skills regarding to children's diet, exercise, and screen time, and two additional sessions about child development and family games. Parents from the control group received these two latter sessions. Parental self-efficacy, parenting styles, and meal-related parenting practices were measured before and after the intervention and at 3-month follow-up. Acceptability and feasibility of the program was also measured. Quantitative data were analyzed using the repeat measures ANOVA and ANCOVA tests and the effect size calculation. Content analysis was used to analyse open questions. Positive trends were found regarding parental self-efficacy and the use of authoritative parenting style. Parents also reported a great acceptability of the program getting high satisfaction. According to the feasibility barriers and facilitators aspects were identified. The positive trends founded in this study support the development of parenting programs to promote healthy lifestyle in children.

Nurses' role in health promotion and prevention: A critical interpretive synthesis.

BACKGROUND: Role confusion is hampering the development of nurses' capacity for health promotion and prevention. Addressing this requires discussion to reach agreement among nurses, managers, co-workers, professional associations, academics and organisations about the nursing activities in this field. Forming a sound basis for this discussion is essential. AIMS AND OBJECTIVES: To provide a description of the state of nursing health promotion and prevention practice expressed in terms of activities classifiable under the Ottawa Charter and to reveal the misalignments between this portrayal and the ideal one proposed by the Ottawa Charter. METHODS: A critical interpretive synthesis was conducted between December 2018 and May 2019. The PubMed, CINAHL, Scopus, PsychINFO, Web of Science and Dialnet databases were searched. Sixty-two papers were identified. The relevant data were extracted using a pro-forma, and the reviewers performed an integrative synthesis. The ENTREQ reporting guidelines were used for this review. RESULTS: Thirty synthetic constructs were developed into the following synthesising arguments: (a) addressing individuals' lifestyles versus developing their personal skills; (b) focusing on environmental hazards versus creating supportive environments; (c) action on families versus strengthening communities; (d) promoting community partnerships versus strengthening community action; and (e) influencing policies versus building healthy public policy. CONCLUSIONS: There are notable misalignments between nurses' current practice in health promotion and prevention and the Ottawa Charter's actions and strategies. This may be explained by the nurses' lack of understanding of health promotion and prevention and political will, research methodological flaws, the predominance of a biomedical perspective within organisations and the lack of organisational prioritisation for health promotion and prevention.

Social and emotional competence as key element to improve healthy lifestyles in children: A randomized controlled trial.

AIM: To show the results of an exploratory trial based on social and emotional learning to promote healthy lifestyles in 5-6 aged children. DESIGN: A randomized controlled trial. METHOD: The study was conducted from 2015-2016. Thirty-seven children were allocated to the intervention group (N = 19) and control group (N = 18). A multi-method and multi-component evaluation approach was used to capture the preliminary efficacy, acceptability, and feasibility of the programme. Repeat measures ANOVA followed by an ANCOVA tests were applied for the inferential analysis and for qualitative data, a content analysis was used. RESULTS: Positive effects on emotional perception and resilience were found in children's intervention group. Children and families showed high programme's acceptability and a wide range of barriers and facilitators were identified during the implementation process. CONCLUSION: Predicted mechanisms to improve healthy lifestyles in children throughout social and emotional competence seem to be supported by some of the study's results. However more research is needed to replicate such results and confirm these mechanisms. ClinicalTrials.gov Identifier: NCT02975544.

Explorando el papel de la autoeficacia parental en el uso de los servicios sanitarios: revisión de la literatura / xploring the relationship between parental self-efficacy and the use of health services: a literature review

INTRODUCCIÓN: El número de consultas de urgencias pediátricas en los últimos años han experimentado un aumento notable. Muchos son los factores que influyen en el uso de los servicios sanitarios y en el uso que los padres hacen de estos servicios. Se ha demostrado que la autoeficacia parental juega un papel fundamental en el manejo de la salud y la enfermedad de los niños, y puede que también lo esté haciendo en el uso de los servicios de salud. OBJETIVO: Se plantea esta revisión narrativa de la literatura, con el propósito de explorar el papel que la autoeficacia parental tiene en el cuidado de los niños y el uso de los servicios sanitarios. MÉTODO: Se realizó una búsqueda bibliográfica en Pubmed, Cinhal y Psyc-Info. RESULTADOS: No se encontraron estudios que explorasen de manera directa la autoeficacia parental y el uso de los servicios sanitarios. Sin embargo, la relación existente entre el concepto de autoeficacia y el manejo de la salud infantil y las enfermedades menores conduce a pensar que la autoeficacia parental puede estar jugando un papel importante en el uso de los servicios sanitarios. CONCLUSIÓN: Es necesario llevar a cabo estudios que ayuden a explorar la relación entre la autoeficacia parental y el uso de los servicios. Esta información puede ser de gran ayuda para planificar acciones de educación para la salud acordes con las necesidades de esta población y contribuir a la sostenibilidad del sistema, reduciendo las visitas innecesarias a los servicios de urgencias.

INTRODUCTION: The number of visits to emergency departments in recent years has increased significantly. There are many factors that influence the use of health services and the use that parents make of these services. It has been shown that parental self-efficacy plays a fundamental role in the management of children's health and illness and may also be the case in the use of health services. OBJECTIVE: The purpose of this narrative review was to explore the role that parental self-efficacy plays in the care of children and the use of health services. METHODS: To this end, a bibliographic search was carried out in Pubmed, Cinhal and PsycINFO. RESULTS: No studies were found that directly explored parental self-efficacy and the use of health services. However, the relationship between the concept of self-efficacy and the management of children's health and minor illnesses shown in the literature points out towards the idea that parental self-efficacy may be playing an important role in the use of health services. CONCLUSION: Future observational studies are necessary to explore the relationship between parental-self-efficacy and use of service. This information can be of great help in planning health education actions according to the needs of this population and contributing to the sustainability of the system, decreasing unnecessary visits to the emergency departments.

Parental competence programs to promote positive parenting and healthy lifestyles in children: a systematic review / Programas de competência dos pais para promover parentalidade positiva e estilos de vida saudáveis em crianças: uma análise sistemática

Abstract Objective To analyze the available evidence regarding the efficacy of interventions on parents whose children were aged 2-5 years to promote parental competence and skills for children's healthy lifestyles. Source Articles published in English and Spanish, available at PubMed, Psycinfo, CINAHL, Web of Science, Eric, and Cochrane Library were reviewed. Summary of the findings The literature search yielded 2282 articles. Forty-one full texts were retrieved and assessed for inclusion using the PRISMA flow diagram. Twenty-six articles were excluded, as they did not meet the inclusion criteria. In the end, 15 studies were included. The studies were conducted between 2003 and 2016, nine in North America, four in Europe, and two in Asia. Extracted data were synthesized in a tabular format. CASPe guide was used to assess the quality of studies that was moderate overall. Parental self-efficacy was the main construct assessed in most studies. Four studies reported an increase in parental self-efficacy, although most of them were studies without control groups. Conclusions Outcomes of interventions to improve parental competence in order to promote children's lifestyles are promising, but inconsistent. Additional studies with higher methodological and conceptual quality are needed.

Resumo Objetivo Analisar as evidências disponíveis com relação à eficácia de intervenções em pais de filhos entre dois e cinco anos para promover a competência e as habilidades dos pais a respeito de estilos de vida saudáveis para as crianças. Fonte Foram analisados artigos publicados em PubMed, Psycinfo, CINAHL, Web of Science, Eric e Biblioteca Cochrane. Inglês e espanhol. Resumo dos achados A pesquisa da literatura encontrou 2.282 artigos; 41 textos completos foram selecionados e avaliados para inclusão com o fluxograma Prisma; 26 artigos foram excluídos, pois não atendiam aos critérios de inclusão. Por fim, 15 estudos foram incluídos. Os estudos foram feitos entre 2003 e 2016. Nove estudos foram conduzidos na América do Norte, quatro eram de origem europeia e dois de origem asiática. Os dados extraídos foram sintetizados em formato de tabela. O guia CASPe foi usado para avaliar a qualidade dos estudos, que, em geral, foi moderada. A autoeficácia dos pais foi o principal dado avaliado na maioria dos estudos. Quatro estudos relataram um aumento na autoeficácia dos pais, apesar de que a maioria era de estudos sem grupo de controle. Conclusões Os resultados de intervenções para melhorar a competência dos pais para promover os estilos de vida das crianças são promissores, porém incoerentes. São necessários estudos adicionais com melhor qualidade metodológica e conceitual.

Parental competence programs to promote positive parenting and healthy lifestyles in children: a systematic review.

OBJECTIVE: To analyze the available evidence regarding the efficacy of interventions on parents whose children were aged 2-5 years to promote parental competence and skills for children's healthy lifestyles. SOURCE: Articles published in English and Spanish, available at PubMed, Psycinfo, CINAHL, Web of Science, Eric, and Cochrane Library were reviewed. SUMMARY OF THE FINDINGS: The literature search yielded 2282 articles. Forty-one full texts were retrieved and assessed for inclusion using the PRISMA flow diagram. Twenty-six articles were excluded, as they did not meet the inclusion criteria. In the end, 15 studies were included. The studies were conducted between 2003 and 2016, nine in North America, four in Europe, and two in Asia. Extracted data were synthesized in a tabular format. CASPe guide was used to assess the quality of studies that was moderate overall. Parental self-efficacy was the main construct assessed in most studies. Four studies reported an increase in parental self-efficacy, although most of them were studies without control groups. CONCLUSIONS: Outcomes of interventions to improve parental competence in order to promote children's lifestyles are promising, but inconsistent. Additional studies with higher methodological and conceptual quality are needed.