Mapping health promotion practices across key sectors and its intersectoral approach at the local level: Study protocol.

AIMS: This study outlines a protocol aimed at identifying and mapping health promotion practices in need of development from the perspectives of key sectors responsible for it at the local level and from an intersectoral perspective across four Spanish regions. DESIGN: A complementary multi-method study combining survey methods and qualitative interviews will be adopted. METHODS: Purposive snowball sampling will be employed to select potentially rich informants from city councils, primary care centres, primary and secondary schools, and public health and civil society organizations in 12 municipalities sensitive to local health. Data on the degree of execution of health promotion activities, the level of intersectorality in their implementation, and their origins will be collected using PromoACTIVA questionnaires, an intersectoral typology model and an interview protocol. A parallel mixed analysis encompassing descriptive statistics and a 'framework analysis' will be performed. DISCUSSION: This study is expected to yield thorough and reliable insights into health promotion practices and omissions at the local level by focusing on key stakeholders, both individually and collaboratively. This information can enhance health promotion planning and improve its effectiveness, efficiency and contextual relevance. The development and testing of a methodology for the integration and interpretation of these data will ensure sustainable capacity building. IMPACT: Managers and practitioners interested in health promotion planning in the researched settings can benefit from a comprehensive map of the current state of their practices and insights into the starting points of collaboration. In addition, planners from other local settings will gain access to tools and methodologies to replicate and expand these maps to their own contexts. STAKEHOLDER ENGAGEMENT: Engaging key stakeholders with experience working in or with primary care centres, public health organizations, primary and secondary schools, civil society organizations, and city councils was vital to ensure the study's relevance and feasibility.

Use a web-app to improve breast cancer risk factors and symptoms knowledge and adherence to healthy diet and physical activity in women without breast cancer diagnosis (Precam project).

PURPOSE: This study aimed to evaluate the preliminary effectiveness of an educational intervention using a web-app to improve knowledge of breast cancer risk factors and symptoms and adherence to healthy eating and physical activity among women without breast cancer diagnosis in Asturias (Spain). METHODS: A pragmatic randomized pilot trial was conducted to evaluate the impact of a web-app-based intervention for women without breast cancer diagnosis. Women in the intervention group participated in a 6-month intervention web-app based on the Behaviour Change Wheel Model. The web-app includes information about breast cancer risk factors, early detection, physical activity and diet. RESULTS: Two hundred and eighty-fifth women aged 25-50 were invited to join the study. Two hundred and twenty-four were randomly assigned to either the intervention group (IG = 134) or control group (CG = 90) according to their place of residence. Adherence among women in the IG increased significantly from pre- to post-intervention for eight of the 12 healthy behaviors and for the identification of six risk factors and six symptoms compared to women in the CG and, among whom adherence only increased for two behaviors, the identification of one risk factor and 0 symptoms. The intervention significantly improved the mean number of risk factors + 1.06 (p < 0.001) and symptoms + 1.18 (p < 0.001) identified by women in the IG. CONCLUSIONS: The preliminary results of this study suggest that an educational intervention using a web-app and based on the Behaviour Change Wheel model could be useful to improve knowledge of breast cancer risk factors and symptoms and to improve adherence to a healthy diet and physical activity in women without a previous breast cancer diagnosis.

Utility of PHQ-2, PHQ-8 and PHQ-9 for detecting major depression in primary health care: a validation study in Spain.

BACKGROUND: Primary health care (PHC) professionals may play a crucial role in improving early diagnosis of depressive disorders. However, only 50% of cases are detected in PHC. The most widely used screening instrument for major depression is the Patient Health Questionnaire (PHQ), including the two-, eight- and nine-item versions. Surprisingly, there is neither enough evidence about the validity of PHQ in PHC patients in Spain nor indications about how to interpret the total scores. This study aimed to gather validity evidence to support the use of the three PHQ versions to screen for major depression in PHC in Spain. Additionally, the present study provided information for helping professionals to choose the best PHQ version according to the context. METHODS: The sample was composed of 2579 participants from 22 Spanish PHC centers participating in the EIRA-3 study. The reliability and validity of the three PHQ versions for Spanish PHC patients were assessed based on responses to the questionnaire. RESULTS: The PHQ-8 and PHQ-9 showed high internal consistency. The results obtained confirm the theoretically expected relationship between PHQ results and anxiety, social support and health-related QoL. A single-factor solution was confirmed. Regarding to the level of agreement with the CIDI interview (used as the criterion), our results indicate that the PHQ has a good discrimination power. The optimal cut-off values were: ⩾2 for PHQ-2, ⩾7 for PHQ-8 and ⩾8 for PHQ-9. CONCLUSIONS: PHQ is a good and valuable tool for detecting major depression in PHC patients in Spain.

Barriers to and enablers of the promotion of patient and family participation in primary healthcare nursing in Brazil, Germany and Spain: A qualitative study.

BACKGROUND: Most health systems are insufficiently prepared to promote the participation of chronically ill patients in their care. Strong primary health care (PHC) strengthens patients' resources and thus promotes their participation. The tasks of providing continuous care to people with chronic diseases and promoting self-management are the responsibility of PHC nurses. Recent research assessing enablers of or barriers to nurses' efforts to support patients' participation has mostly not considered the special situation of patients with chronic diseases or focused on the PHC setting. OBJECTIVE: To investigate enablers of and barriers to PHC nurses' efforts to promote the participation of chronically ill patients in their care. METHODS: We interviewed 34 practicing PHC nurses and 23 key informants with advanced knowledge of PHC nursing practice in Brazil, Germany and Spain. The data was analyzed using thematic coding. RESULTS: We identified four categories of barriers and enablers. (1) Establishing bonds with patients: Interviewees emphasized that understanding patients' views and behaviours is important for PHC nurses. (2) Cooperation with relatives and families: Good relationships with families are fundamental, however conflicts within families could challenge PHC nurses efforts to strengthen participation. (3) Communication and cooperation within PHC teams: PHC nurses see Cooperative team structures as a potential enabler, while the dominance of a 'biomedical' approach to patient care is seen as a barrier. (4) Work environment: Interviewees agreed that increased workload is a barrier to patient participation. DISCUSSION AND CONCLUSIONS: Supporting patient participation should be acknowledged as an important responsibility for nurses by general practitioners and PHC planners. PHC nurses should be trained in communicative competence when discussing participation with chronically ill patients. Interprofessional education could strengthen other professionals' understanding of patient participation as a nursing task. PATIENT OR PUBLIC CONTRIBUTION: This study is part of a research project associated with the research network 'forges: User-oriented care: Promotion of health in the context of chronic diseases and care dependency'. The study's focus and provisional results were discussed continuously with partners in health and social care practice and presented to and discussed with the public at two conferences in which patient representatives, professionals and researchers participated.

Impact of the COVID-19 lockdown on routine childhood vaccination coverage rates in Catalonia (Spain): a public health register-based study.

OBJECTIVE: The aim of this study was to determine the impact of the lockdown measures adopted during the COVID-19 pandemic on routine childhood vaccination coverage rates in Catalonia (Spain) and to estimate its recovery once the progressive return to 'normalcy' had begun. STUDY DESIGN: We conducted a public health register-based study. METHODS: Routine childhood vaccination coverage rates were analysed in three periods: a first pre-lockdown period (from January 2019 to February 2020), a second lockdown period with full restrictions (from March 2020 to June 2020), and, finally, a third post-lockdown period with partial restrictions (from July 2020 to December 2021). RESULTS: During the lockdown period, most of the coverage rates remained stable, concerning the pre-lockdown period; however, when comparing the vaccination coverage rates in the post-lockdown period to the pre-lockdown period, we observed decreases in all types of vaccines and doses analysed, except for coverage with the PCV13 vaccine in 2-year-olds, which experienced an increase. The most relevant reductions were observed in measles-mumps-rubella and diphtheria-tetanus-acellular pertussis vaccination coverage rates. CONCLUSIONS: Since the beginning of the COVID-19 pandemic, there has been an overall decline in routine childhood vaccine coverage rates, and the pre-pandemic rates have not yet been recovered. Immediate and long-term support strategies must be maintained and strengthened to restore and sustain routine childhood vaccination.

Research on missed nursing care during the COVID-19 pandemic: A scoping review.

BACKGROUND: Missed nursing care is defined as care that is delayed, partially completed, or not completed at all. The scenario created by the COVID-19 pandemic may have influenced multifactorial determinants related to the care environment, nursing processes, internal processes, and decision-making processes, increasing missed nursing care. AIM: This scoping review aimed to establish the quantity and type of research undertaken on missed nursing care during the COVID-19 pandemic. METHODS: This review was conducted following the Joanna Briggs Institute methodology for scoping reviews. We searched CINAHL, MEDLINE, Scopus, two national and regional databases, two dissertations and theses databases, a gray literature database, two study registers, and a search engine from November 1, 2019, to March 23, 2023. We included quantitative, qualitative, and mixed studies carried out in all healthcare settings that examined missed nursing care during the COVID-19 pandemic. Language restrictions were not applied. Two independent reviewers conducted study selection and data extraction. Disagreements between the reviewers were resolved through discussion or with an additional reviewer. RESULTS: We included 25 studies with different designs, the most common being acute care cross-sectional survey designs. Studies focused on determining the frequency and reasons for missed nursing care and its influence on nurses and organizational outcomes. LINKING EVIDENCE TO ACTION: Missed nursing care studies during the COVID-19 pandemic were essentially nurses-based prevalence surveys. There is an urgent need to advance the design and development of longitudinal and intervention studies, as well as to broaden the focus of research beyond acute care. Further research is needed to determine the impact of missed nursing care on nursing-sensitive outcomes and from the patient's perspective.

Patient-Reported Outcome Measures of Quality of Life in People Affected by Diabetic Foot: A Psychometric Systematic Review.

OBJECTIVES: This psychometric systematic review aimed to identify the most suitable patient-reported outcome measures (PROMs) of quality of life (QoL) in people affected by diabetic foot. METHODS: We performed a literature search in MEDLINE (PubMed), CINAHL (EBSCOhost), and PsycINFO (EBSCOhost) databases from inception to February 1, 2022. We also searched gray literature databases. Eligible studies were full-text reports developing a QoL condition-specific PROM or assessing one or more of its measurement properties in people affected by diabetic foot. We assessed the methodological quality of included studies independently using the "Consensus-Based Standards for the Selection of Health Measurement Instruments Risk of Bias" checklist. The measurement properties were evaluated using specific criteria. We graded the quality of the evidence using a "Grading of Recommendations Assessment, Development and Evaluation" approach modified by Consensus-Based Standards for the Selection of Health Measurement Instruments. RESULTS: Forty-three reports (46 studies) providing information on the measurement properties of 10 different PROMs were included. We did not identify any instruments that could be recommended for use. We identified 2 PROMs that were not recommended for use and 8 that were potentially recommended but would require further investigation. Of these 8 PROMs, 4 had better evidence for content validity. CONCLUSIONS: Available PROMs to measure QoL in people affected by diabetic foot have limited evidence for their measurement properties. There is no fully suitable PROM. Pending further evidence, 4 PROMs could potentially be recommended for use.

Adaptation and validation of the Interprofessional Socialization and Valuing Scale (ISVS) in Spanish university health sciences students.

Many interprofessional education programs are being designed to help students improve their collaborative practice. Traditionally, the evaluation of these programs is focused on attitudes, knowledge and skills, but according to some authors, the evaluation of these activities should be expanded to include the evaluation of the development of an interprofessional identity. The Interprofessional Socialization and Valuing Scale (ISVS) is a self-report tool used to measure interprofessional socialization, but it has not been validated with Spanish students. In this study, the tool was translated into Spanish and administered to a sample of 645 undergraduate students. The data were analyzed to estimate structural validity, internal consistency and convergent validity. Regarding the structural validity, our data supported the unidimensional model found in the English version of the ISVS-21 (normed chi-square = 2.3, RMSEA = 0.045, SRMR = 0.087, CFI = 0.963 and TLI = 0.969). The internal consistency reliability of the scale was adequate, Cronbach α = 0.913 [95% CI 0.903, 0.923]. The Spanish version of the ISVS-21 shows adequate psychometric properties in terms of the construct validity (structural validity and convergent validity) and internal consistency of its scores. This study provides the Spanish-speaking population with an adaptation of the only instrument that has been specifically developed to assess interprofessional socialization.

Cost-effectiveness analysis of a multiple health behaviour change intervention in people aged between 45 and 75 years: a cluster randomized controlled trial in primary care (EIRA study).

BACKGROUND: Multiple health behaviour change (MHBC) interventions that promote healthy lifestyles may be an efficient approach in the prevention or treatment of chronic diseases in primary care. This study aims to evaluate the cost-utility and cost-effectiveness of the health promotion EIRA intervention in terms of MHBC and cardiovascular reduction. METHODS: An economic evaluation alongside a 12-month cluster-randomised (1:1) controlled trial conducted between 2017 and 2018 in 25 primary healthcare centres from seven Spanish regions. The study took societal and healthcare provider perspectives. Patients included were between 45 and 75 years old and had any two of these three behaviours: smoking, insufficient physical activity or low adherence to Mediterranean dietary pattern. Intervention duration was 12 months and combined three action levels (individual, group and community). MHBC, defined as a change in at least two health risk behaviours, and cardiovascular risk (expressed in % points) were the outcomes used to calculate incremental cost-effectiveness ratios (ICER). Quality-adjusted life-years (QALYs) were estimated and used to calculate incremental cost-utility ratios (ICUR). Missing data was imputed and bootstrapping with 1000 replications was used to handle uncertainty in the modelling results. RESULTS: The study included 3062 participants. Intervention costs were €295 higher than usual care costs. Five per-cent additional patients in the intervention group did a MHBC compared to usual care patients. Differences in QALYS or cardiovascular risk between-group were close to 0 (- 0.01 and 0.04 respectively). The ICER was €5598 per extra health behaviour change in one patient and €6926 per one-point reduction in cardiovascular risk from a societal perspective. The cost-utility analysis showed that the intervention increased costs and has no effect, in terms of QALYs, compared to usual care from a societal perspective. Cost-utility planes showed high uncertainty surrounding the ICUR. Sensitivity analysis showed results in line with the main analysis. CONCLUSION: The efficiency of EIRA intervention cannot be fully established and its recommendation should be conditioned by results on medium-long term effects. TRIAL REGISTRATION: Clinicaltrials.gov NCT03136211 . Registered 02 May 2017 - Retrospectively registered.

Convergent and discriminative validity of the Frail-VIG index with the EQ-5D-3L in people cared for in primary health care.

BACKGROUND: The Frail-VIG frailty index has been developed recently. It is an instrument with a multidimensional approach and a pragmatic purpose that allows rapid and efficient assessment of the degree of frailty in the context of clinical practice. Our aim was to investigate the convergent and discriminative validity of the Frail-VIG frailty index with regard to EQ-5D-3L value. METHODS: We carried out a cross-sectional study in two Primary Health Care (PHC) centres of the Catalan Institute of Health (Institut Català de la Salut), Barcelona (Spain) from February 2017 to January 2019. Participants in the study were all people included under a home care programme during the study period. No exclusion criteria were applied. We used the EQ-5D-3L to measure Health-Related Quality of Life (HRQoL) and the Frail-VIG index to measure frailty. Trained PHC nurses administered both instruments during face-to-face assessments in a participant's home during usual care. The relationships between both instruments were examined using Pearson's correlation coefficient and multiple linear regression analyses. RESULTS: Four hundred and twelve participants were included in this study. Frail-VIG score and EQ-5D-3L value were negatively correlated (r = - 0.510; P < 0.001). Non-frail people reported a substantially better HRQoL than people with moderate and severe frailty. EQ-5D-3L value declined significantly as the Frail-VIG index score increased. CONCLUSIONS: Frail-VIG index demonstrated a convergent validity with the EQ-5D-3L value. Its discriminative validity was optimal, as their scores showed an excellent capacity to differentiate between people with better and worse HRQoL. These findings provide additional pieces of evidence for construct validity of the Frail-VIG index.

Multiple health behaviour change primary care intervention for smoking cessation, physical activity and healthy diet in adults 45 to 75 years old (EIRA study): a hybrid effectiveness-implementation cluster randomised trial.

BACKGROUND: This study aimed to evaluate the effectiveness of a) a Multiple Health Behaviour Change (MHBC) intervention on reducing smoking, increasing physical activity and adherence to a Mediterranean dietary pattern in people aged 45-75 years compared to usual care; and b) an implementation strategy. METHODS: A cluster randomised effectiveness-implementation hybrid trial-type 2 with two parallel groups was conducted in 25 Spanish Primary Health Care (PHC) centres (3062 participants): 12 centres (1481 participants) were randomised to the intervention and 13 (1581 participants) to the control group (usual care). The intervention was based on the Transtheoretical Model and focused on all target behaviours using individual, group and community approaches. PHC professionals made it during routine care. The implementation strategy was based on the Consolidated Framework for Implementation Research (CFIR). Data were analysed using generalised linear mixed models, accounting for clustering. A mixed-methods data analysis was used to evaluate implementation outcomes (adoption, acceptability, appropriateness, feasibility and fidelity) and determinants of implementation success. RESULTS: 14.5% of participants in the intervention group and 8.9% in the usual care group showed a positive change in two or all the target behaviours. Intervention was more effective in promoting dietary behaviour change (31.9% vs 21.4%). The overall adoption rate by professionals was 48.7%. Early and final appropriateness were perceived by professionals as moderate. Early acceptability was high, whereas final acceptability was only moderate. Initial and final acceptability as perceived by the participants was high, and appropriateness moderate. Consent and recruitment rates were 82.0% and 65.5%, respectively, intervention uptake was 89.5% and completion rate 74.7%. The global value of the percentage of approaches with fidelity ≥50% was 16.7%. Eight CFIR constructs distinguished between high and low implementation, five corresponding to the Inner Setting domain. CONCLUSIONS: Compared to usual care, the EIRA intervention was more effective in promoting MHBC and dietary behaviour change. Implementation outcomes were satisfactory except for the fidelity to the planned intervention, which was low. The organisational and structural contexts of the centres proved to be significant determinants of implementation effectiveness. TRIAL REGISTRATION: ClinicalTrials.gov , NCT03136211 . Registered 2 May 2017, "retrospectively registered".

Concordance Between the Weight of Spanish Adolescent Soccer Players, Their Self-Perceived Weight, and Their Weight as Perceived by Their Parents.

PURPOSE: In the context of soccer clubs, to analyze the concordance between players' actual weight, their self-perceived weight, and their weight as perceived by their parents; to determine which variables might explain the presence of concordance between parents' perception of adolescents' weight and their actual weight. Design and study: A cross-sectional study involving 330 soccer players aged between 13 and 16. Data on personal characteristics of adolescents and parents were analyzed, as well as parents' perceptions of adolescents' weight status and their self-perception. A descriptive analysis of the personal characteristics of the sample (adolescents and parents) and an analysis of the variables explaining the presence of concordance between the parents' perception of adolescents' weight and their actual weight were performed. RESULTS: 19% of the adolescents were overweight and 3.4% were obese. The concordance between parents' perceptions of players' weight and players' actual weight was weak. The concordance between adolescents' self-perceived weight and their actual weight was moderate. The difference in BMI scores according to presence or absence of concordance was statistically significant: these scores were higher in the absence of concordance. Discordance between adolescents' weight and their parents' perception of their weight was associated with parents having lower levels of education. CONCLUSION: A high percentage of parents and players misperceived their actual weight. This discrepancy was associated with higher BMI scores for adolescents. PRACTICE IMPLICATIONS: Nurses should include promotion of accurate weight perception in educational interventions on excess weight.

[Bibliometric analysis of female authorship in original articles in the journal ATENCIÓN PRIMARIA]. / Análisis bibliométrico de la autoría femenina en artículos originales en la revista ATENCIÓN PRIMARIA.

OBJECTIVES: To determine the percentage of female authors in original articles published during 2periods, in the journal of Atención Primaria (Primary Care), and to examine the differences between the categories of authorship (first, last author, and co-author) between both periods. DESIGN: Cross-sectional study. SETTING: Feminine scientific production published during the periods 2007-2008 and 2017-2018. PARTICIPANTS: The study was focused on original articles. MAIN MEASUREMENTS: The following variables were collected in an ad hoc form: gender based on the name of the author, total number of women and men appearing as authors, and order of authorship. Absolute and relative authorship frequencies were calculated, and the χ2 test was used to examine the evolution of the percentages by type of authorship and gender. RESULTS: A total of 108 articles were analysed in 2007-2008, and 100 in 2017-2018. No statistically significant differences were observed between the mean numbers of women authors within and between periods. In 2007-2008 a total of 548 female authors were identified and 540 in 2017-2018, the percentage of female authors was 48.7% and 54.4%, respectively. Only an increase in the percentage of first authors was observed between periods. CONCLUSIONS: Practically one out of every 2authors of original articles published in the journal Atención Primaria was female. There was also a significant increase in the percentage of female first authors between the 2periods. Nevertheless, and despite the greater number of health workers, the number of latest female authors remain unchanged, which points to the persistence of female under-representation.

Profile of Innovative Ideas Recorded by Nurses in an Ideas Bank of a Corporate Virtual Community of Open Innovation: A Cross-Sectional Study.

PURPOSE: Nurses are well-positioned to play an active role in the development of innovation in health care. However, their contribution to health innovation is poorly recognized and often invisible. The aim of this study was to determine the profile of innovative ideas recorded by nurses in the Innòbics ideas bank, a corporate virtual community of open innovation. DESIGN AND METHODS: We used a cross-sectional study design. We identified all the innovative ideas recorded in Innòbics from June 8, 2016, to July 6, 2018. To be eligible, the ideas had to be recorded by nurses. Each innovative idea recorded was assessed by the Certification Evaluation Committee of Innòbics. After collective discussion during the evaluation sessions, each committee member independently scored the idea. The screening decision was based on the overall average score. The following variables were collected from each innovative idea that was recorded: (a) level of health care where the idea originated (primary care or secondary care), (b) subject or category according to the classification of the Agency for Healthcare Research and Quality Health Care Innovations Exchange, (c) ratings relative to each screening criteria, and (d) the result of the screening decision: stored = ideas that were poorly developed and in which it was not possible to identify their potential for innovation; susceptible of improvement = potential ideas that needed to be improved and whose authors received comments from the evaluation committee; validated = ideas that continued the process to become innovation projects; forwarded = ideas that were not innovative but they were a complaint or a proposal for quality improvement (these were forwarded to the institutional department concerned). FINDINGS: A total of 246 innovative ideas were recorded in the period of the study, 61 (24.8%) of which were recorded by nurses. The subjects and categories of these ideas were diverse, highlighting aspects such as patient-centered care, quality improvement strategies, preventive and chronic care, and primary care. Thirty-five (57.4%) of these innovative ideas were stored, 13 (21.3%) were susceptible to improvement, 11 (18.0%) were forwarded, and 2 (3.3%) were validated. CONCLUSIONS: The results demonstrated that approximately a quarter of the ideas were recorded by nurses. Subjects and categories of these ideas were diverse, some of them closely related to the profession and nursing practice. Two ideas were identified as potential innovation projects. Innòbics can act as an organizational tool that promotes a climate for innovation in health care. CLINICAL RELEVANCE: This study recognizes nurses' contribution to a healthcare innovation initiative and their interest in sharing innovative ideas. Its findings provide useful insights into a virtual community of open innovation such as an organizational tool for encouraging creativity and innovation in healthcare. Likewise, there is also a need for further development of nurses to master healthcare innovation as a basic competence.

"Missed nursing care" in health promotion: Raising awareness.

AIM(S): This commentary aims to raise awareness of the possible causes of "missed nursing care" in health promotion and to propose possible solutions. BACKGROUND: Although health promotion is an essential function of nursing practice, "missed nursing care" has been scarcely studied in this area. It is crucial to know both its causes and possible strategies to prevent it. EVALUATION: We used evidence to identify possible causes of "missed nursing care" in health promotion, and we classified them into categories. We suggested the concept of capacity building to address its underlying causes. KEY ISSUE(S): Four main factors are involved in "missed nursing care" in health promotion, that is intrapersonal, interpersonal, organisational and cultural. Capacity building, including the development of knowledge, skills, commitment, structures, systems and leadership, could reduce missed care. CONCLUSION(S): "Missed nursing care" in health promotion is complex and is multifactorial in its origins. Capacity building could be a way to address its causes. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing care in health promotion is paramount and a long-term investment that can contribute to the sustainability of the health system. Organisations and managers could view capacity building processes as a tool to prevent "missed nursing care" in health promotion.

[Adapting and validating a questionnaire to measure the self-care practices in healthy child population residing in Spain]. / Adaptación y validación de un cuestionario para evaluar las prácticas de autocuidado en población infantil sana residente en España.

OBJECTIVE: To adapt and validate the Child and Adolescent Self-Care Performance Questionnaire (CASPQ) to the context of healthy children aged 8 to 12years residing in Spain and evaluate their metric properties. DESIGN: Validation study based on Classical Test Theory. LOCATION: Four schools participating in the Salut i Escola programme of a Primary Care Centre of Barcelona (Spain). PARTICIPANTS: Four hundred and ninety-eight elementary school students participated in the study during the first six months of 2016. MAIN MEASUREMENTS: Cultural adaptation of the questionnaire was carried out. Response process and factorial structure were evaluated and the relationships of the adapted questionnaire scores with those of the KIDSCREEN-27 questionnaire were analysed. Likewise, internal consistency and reproducibility of the scores were evaluated. RESULTS: Four hundred and eighty-nine questionnaires were obtained. The confirmatory factor analysis of its theoretical structure showed a sufficient adjustment. A positive association was observed between the questionnaire scores and those of KIDSCREEN-27. The overall internal consistency was satisfactory; nevertheless, that of each factor was marginal or moderate. The reproducibility of the scores was optimal. CONCLUSIONS: The CASPQ adapted to the healthy child population of 8 to 12years old shows appropriate metric properties and similar to those of the original questionnaire. Therefore, it is a useful tool to assess self-care practices and plan interventions aimed at its promotion.

Meditation techniques v. relaxation therapies when treating anxiety: a meta-analytic review.

To what extent meditation techniques (which incorporate practices to regulate attention, construct individual values, or deconstruct self-related assumptions), are more or less effective than relaxation therapy in the treatment of anxiety, is not clear. The aim of this study was to examine the effectiveness of meditation compared to relaxation in reducing anxiety. A systematic review from PubMed, Embase, PsycInfo and the Cochrane Central was conducted. A meta-analysis of 14 RCTs (n = 862 participants suffering from anxiety disorders or high trait anxiety) was performed. Effect sizes (ESs) were determined by Hedges' g. Heterogeneity, risk of publication bias, quality of studies/interventions, and researcher allegiance, were evaluated. Meditation techniques incorporated attentional elements, and five of them also added constructive practices. No studies were found using deconstructive exercises. The overall ES was g = -0.23 [95% confidence interval (CI) -0.40 to -0.07], favouring meditation (number needed to treat = 7.74). Heterogeneity was low (I2 = 2; 95% CI 0 to 56). There was no evidence of publication bias, but few studies and interventions were of high quality, and allegiance might be moderating results. Meditation seems to be a bit more effective than relaxation in the treatment of anxiety, and it might also remain more effective at 12-month follow-up. However, more research using the full spectrum of meditation practices to treat different anxiety disorders, including independent studies to avoid researcher allegiance, is needed if we are to have a precise idea of the potential of these techniques compared to relaxation therapy.

Motivations, Beliefs, and Expectations of Spanish Nurses Planning Migration for Economic Reasons: A Cross-Sectional, Web-Based Survey.

PURPOSE: Migration of nurses is not a new or recent event. During the past few decades, nursing migration flows have been a constant trend worldwide. The main objective of this study was to explore the motivations, beliefs, and expectations that Spanish nurses had when considering migration to another country in the near future. DESIGN: Cross-sectional, Internet survey of Spanish nurses planning migration for professional reasons. METHODS: Ad hoc, web-based questionnaire following the Nurses Early Exit Study guidelines. FINDINGS: One hundred seventy-two nurses responded. Fifty percent of the participants intended to emigrate in the following 6 months and had chosen the United Kingdom as their destination. The most important drivers of migration were unemployment or precarious employment, and professional development. Fifty-eight percent of the participants were very afraid of experiencing discrimination or rejection. CONCLUSIONS: This first study conducted in Spain directly exploring determinants of nurse migration highlighted globalization-driven factors and specific acculturation fears. CLINICAL RELEVANCE: Employment uncertainty and professional development remain key push drivers for migration of Spanish nurses. Discrimination and rejection due to migrancy were concerns for 60% of the participants.

Instruments to assess mental health-related stigma among health professionals and students in health sciences: A systematic psychometric review.

AIM: To evaluate the psychometric properties of the instruments to assess the mental health-related stigma among health professionals and students in health sciences. BACKGROUND: Evidence on the stigmatization by health professionals of people with mental health illness is increasingly compelling. Valid and reliable instruments are needed for the assessment of mental health-related stigma and effectiveness of anti-stigma interventions. DESIGN: Systematic psychometric review. DATA SOURCES: MEDLINE (via PubMed), CINAHL (via EBSCO), PsycINFO, Scopus, and Open Grey from their inception to August 2017. No limits were applied. REVIEW METHODS: We included studies on the development of a measurement instrument or on the evaluation of one or more of its measurement properties. The methodological quality of the included studies and quality of the measurement instruments identified were assessed using the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist. RESULTS: We included 25 studies involving 15 measurement instruments. The "Atributtion Questionnaire" (five studies) and the "Opening Minds Scale for Health Care providers (OMS-HC)" (four studies) were the most investigated instruments. Internal consistency, content validity, structural validity, and hypothesis testing were the measurement properties most commonly evaluated. Measurement error and responsiveness were investigated in only two studies. Eight psychometric properties of OMS-HC were evaluated, three of which have a positive strong level of evidence. CONCLUSIONS: A substantial number of instruments have been developed to assess mental health-related stigma among health professionals. There is a lack of any assessment of certain measurement properties. The OMS-HC is the instrument that had the strongest evidence.

Is cognitive-behavioural therapy more effective than relaxation therapy in the treatment of anxiety disorders? A meta-analysis.

BACKGROUND: It is not clear whether relaxation therapies are more or less effective than cognitive and behavioural therapies in the treatment of anxiety. The aims of the present study were to examine the effects of relaxation techniques compared to cognitive and behavioural therapies in reducing anxiety symptoms, and whether they have comparable efficacy across disorders. METHOD: We conducted a meta-analysis of 50 studies (2801 patients) comparing relaxation training with cognitive and behavioural treatments of anxiety. RESULTS: The overall effect size (ES) across all anxiety outcomes, with only one combined ES in each study, was g = -0.27 [95% confidence interval (CI) = -0.41 to -0.13], favouring cognitive and behavioural therapies (number needed to treat = 6.61). However, no significant difference between relaxation and cognitive and behavioural therapies was found for generalized anxiety disorder, panic disorder, social anxiety disorder and specific phobias (considering social anxiety and specific phobias separately). Heterogeneity was moderate (I2 = 52; 95% CI = 33-65). The ES was significantly associated with age (p < 0.001), hours of cognitive and/or behavioural therapy (p = 0.015), quality of intervention (p = 0.007), relaxation treatment format (p < 0.001) and type of disorder (p = 0.008), explaining an 82% of variance. CONCLUSIONS: Relaxation seems to be less effective than cognitive and behavioural therapies in the treatment of post-traumatic stress disorder, and obsessive-compulsive disorder and it might also be less effective at 1-year follow-up for panic, but there is no evidence that it is less effective for other anxiety disorders.