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.

Intervenciones educativas en asma infantil: Una revisión sistemática / Educational interventions in childhood asthma: A systematic review

Objetivo: Analizar intervenciones educativas en pacientes pediátricos asmáticos para conseguir una técnica adecuada de inhalación y mejorar su automanejo. Diseño: Revisión sistemática basándose en las recomendaciones PRISMA. Fuentes de datos: Se revisaron las bases de datos PubMed, Scopus, Cuiden, Web of Science y Google académico. Selección de estudios: Se incluyeron 16 artículos publicados entre 2014-2021, con acceso a texto completo, idiomas: inglés, francés y español y población pediátrica: 0-18 años. Extracción de datos: Participaron 2.313 niños/as. Las variables analizadas fueron: nivel asistencial, tipo de intervención, realización correcta de la técnica de inhalación, seguimiento de la técnica, entrega de recomendaciones por escrito, categoría profesional-educador, variables relacionadas con la patología respiratoria, absentismo escolar, calidad de vida y costes económicos. Resultados: El nivel de atención sanitaria fue atención primaria, hospitalaria y comunitaria, donde destacaron como educadores: médicos especialistas, enfermeras y farmacéuticos. Las intervenciones educativas más prevalentes son demostración in situ y entrega de recomendaciones o intervenciones multimedia. Varios artículos reportan que no se realiza correctamente la educación en asma, otros enuncian que su técnica mejora tras la intervención, pero la mayoría de ellos resalta la importancia de una revisión periódica de la técnica. Conclusiones: Los autores refieren mejoría de la técnica de inhalación en todas ellas, así como un mayor automanejo de la enfermedad y adherencia al tratamiento. Es necesario intensificar la educación a los pacientes en el correcto manejo de los dispositivos, y el seguimiento y revisión posterior para optimizar el control de la enfermedad.(AU)

Objective: To analyze educational interventions in pediatric asthmatic patients to achieve an adequate inhalation technique and improve their self-management. Design: Systematic review based on the PRISMA recommendations. Data sources: Pubmed, Scopus, Cuiden, Web of Science and Google Scholar databases were reviewed. Study selection: Sixteen articles published between 2014 and 2021 were included, with access to full text, languages: English, French and Spanish and pediatric population: 0–18 years. Data extraction: Two thousand three hundred and thirteen children were participated. The variables analyzed were: level of care, type of intervention, correct performance of the inhalation technique, follow-up of the technique, delivery of written recommendations, professional-educator category, variables related to respiratory pathology, school absenteeism, quality of life and economic costs. Results: The health care level was primary, hospital and community care, where specialist doctors, nurses and pharmacists stood out as educators. The most prevalent educational interventions are on-site demonstration and delivery of recommendations or multimedia interventions. Several articles report that asthma education is not carried out correctly, others state that their technique improves after the intervention, but most of them highlight the importance of periodic review of the technique. Conclusions: The authors report improvement in the inhalation technique in all of them, as well as greater self-management of the disease and adherence to treatment. It is necessary to intensify the education of patients in the correct handling of the devices, and the follow-up and subsequent review to optimize the control of the disease.(AU)

[Educational interventions in childhood asthma: A systematic review]. / Intervenciones educativas en asma infantil: Una revisión sistemática.

OBJECTIVE: To analyze educational interventions in pediatric asthmatic patients to achieve an adequate inhalation technique and improve their self-management. DESIGN: Systematic review based on the PRISMA recommendations. DATA SOURCES: Pubmed, Scopus, Cuiden, Web of Science and Google Scholar databases were reviewed. STUDY SELECTION: Sixteen articles published between 2014 and 2021 were included, with access to full text, languages: English, French and Spanish and pediatric population: 0-18 years. DATA EXTRACTION: Two thousand three hundred and thirteen children were participated. The variables analyzed were: level of care, type of intervention, correct performance of the inhalation technique, follow-up of the technique, delivery of written recommendations, professional-educator category, variables related to respiratory pathology, school absenteeism, quality of life and economic costs. RESULTS: The health care level was primary, hospital and community care, where specialist doctors, nurses and pharmacists stood out as educators. The most prevalent educational interventions are on-site demonstration and delivery of recommendations or multimedia interventions. Several articles report that asthma education is not carried out correctly, others state that their technique improves after the intervention, but most of them highlight the importance of periodic review of the technique. CONCLUSIONS: The authors report improvement in the inhalation technique in all of them, as well as greater self-management of the disease and adherence to treatment. It is necessary to intensify the education of patients in the correct handling of the devices, and the follow-up and subsequent review to optimize the control of the disease.

Distrés psicológico en estudiantes de enfermería: relación con tiempo de pantalla, dieta y actividad física / Psychological distress in nursing students: relationship with screen time, diet and physical activity / Sofrimento psicológico em estudantes de enfermagem: relação com tempo de tela, alimentação e atividade física

Objetivo: determinar la prevalencia de síntomas de ansiedad y depresión, al igual que su asociación con el tiempo de pantalla, la dieta y la actividad física, en una cohorte de estudiantes de enfermería. Método: estudio descriptivo y transversal sobre una muestra de 648 estudiantes de enfermería. Se utilizaron la Hospital Anxiety and Depression Scale, la versión corta del International Physical Activity Questionnaire y el Índice de Alimentación Saludable español. Se llevaron a cabo diferentes modelos de regresión lineal múltiple para analizar la asociación entre los síntomas de ansiedad y depresión, y el tiempo de pantalla, la dieta y la actividad física. Resultados: la prevalencia de síntomas de ansiedad y depresión fue de 24,1% y 3,7%, respectivamente. El tiempo de pantalla prolongado (>6 horas por día), baja actividad física y dieta inadecuada se asociaron de manera independiente y significativa con una mayor sintomatología psicológica. Conclusión: la salud mental de los estudiantes de enfermería podría beneficiarse de implementarse iniciativas que promuevan estilos de vida saludables.

Objective: to determine the prevalence of anxiety and depression symptoms, as well as their association with screen time, diet and physical activity, in a cohort comprised by nursing students. Method: a descriptive and cross-sectional study conducted with a sample of 648 Nursing students. The instruments used were the Hospital Anxiety and Depression Scale, the short version of the International Physical Activity Questionnaire and the Spanish Healthy Eating Index (Índice de Alimentación Saludable Español, IASE). Different multiple linear regression models were performed to analyze the association between anxiety/depression symptoms and screen time, diet and physical activity. Results: the prevalence values for anxiety and depression symptoms were 24.1% and 3.7%, respectively. Prolonged screen times (>6 hours a day), low levels of physical activity and inadequate diet were independently and significantly associated with deeper psychological symptoms. Conclusion: Nursing students' mental health might benefit from the implementation of initiatives promoting healthy lifestyles.

Objetivo: determinar a prevalência de sintomas de ansiedade e depressão e sua associação com tempo de tela, dieta e atividade física em uma coorte de estudantes de enfermagem. Método: estudo descritivo transversal com amostra de 648 estudantes de enfermagem. Utilizou-se a Hospital Anxiety and Depression Scale, a versão curta do International Physical Activity Questionnaire e o Índice Espanhol de Alimentação Saudável. Foram realizados diferentes modelos de regressão linear múltipla para analisar a associação entre sintomas de ansiedade e depressão e tempo de tela, dieta e atividade física. Resultados: a prevalência de sintomas de ansiedade e depressão foi de 24,1% e 3,7%, respectivamente. O tempo prolongado de tela (>6 horas por dia), a baixa atividade física e a dieta inadequada foram associados de forma independente e significativa ao aumento da sintomatologia psicológica. Conclusão: a saúde mental dos estudantes de enfermagem pode ser beneficiada com a implementação de iniciativas que promovam estilos de vida saudáveis.

Actividad física durante el embarazo y su relación con la ganancia de peso gestacional / Physical activity during pregnancy and its relationship with gestational weight gain / Atividade física durante a gestação e sua relação com o ganho de peso gestacional

Objetivo: describir los patrones de actividad física de una cohorte de gestantes de nuestro medio y explorar su asociación con la ganancia de peso en cada uno de los trimestres del embarazo. Método: estudio descriptivo longitudinal sobre una muestra de 151 mujeres. Se utilizó el Cuestionario Internacional de Actividad Física para evaluar la actividad física durante el embarazo en función del volumen, intensidad y ámbito de realización. Se llevaron a cabo diferentes modelos de regresión lineal múltiple para analizar la asociación entre actividad física y ganancia de peso gestacional. Resultados: la actividad física disminuyó durante el embarazo, tanto en tiempo como en intensidad. El índice de masa corporal pre-gestacional fue el principal factor asociado con una menor ganancia de peso a lo largo de todo el embarazo. La influencia de la actividad física sobre la ganancia de peso gestacional se limitó al tercer trimestre del embarazo en el que se observó una asociación inversa entre ambas variables. Conclusión: los resultados de este estudio muestran un importante descenso de la actividad física en la época del embarazo y sugieren una influencia limitada de ésta sobre la ganancia de peso gestacional.

Objective: to describe the physical activity patterns of a cohort comprised by pregnant women from our environment and to explore its association with weight gain in each of the trimesters of pregnancy. Methods: a descriptive and longitudinal study conducted with a sample of 151 women. The International Physical Activity Questionnaire was used to assess physical activity during pregnancy based on volume, intensity and setting where it is performed. Different multiple linear regression models were performed to analyze the association between physical activity and gestational weight gain Results: physical activity decreased during pregnancy, both in terms of time and intensity. Pre-gestational Body Mass Index was the main factor associated with lower weight gain throughout pregnancy. The influence of physical activity on gestational weight gain was limited to the third trimester of pregnancy, where an inverse association was observed between both variables. Conclusion: the results of this study show an important reduction in physical activity during pregnancy and suggest that it exerts a limited influence on gestational weight gain

Objetivo: descrever os padrões de atividade física de uma coorte de gestantes em nosso meio e explorar sua associação com o ganho de peso em cada um dos trimestres de gestação. Método: estudo descritivo longitudinal com uma amostra de 151 mulheres. O Questionário Internacional de Atividade Física foi utilizado para avaliar a atividade física durante a gestação de acordo com o volume, intensidade e escopo do desempenho. Diferentes modelos de regressão linear múltipla foram utilizados para analisar a associação entre atividade física e ganho de peso gestacional. Resultados: a atividade física diminuiu durante a gestação, tanto em tempo quanto em intensidade. O índice de massa corporal pré-gestacional foi o principal fator associado ao menor ganho de peso ao longo da gestação. A influência da atividade física no ganho de peso gestacional limitou-se ao terceiro trimestre de gestação, no qual foi observada associação inversa entre ambas as variáveis. Conclusão: os resultados deste estudo mostram uma diminuição significativa da atividade física no momento da gravidez e sugerem uma influência limitada desta no ganho de peso gestacional.

Nomophobia in university students during COVID-19 outbreak: a cross-sectional study.

Introduction: Currently, access to the Internet through smartphones has led to their functions going beyond purely communicative ones, allowing the management of massive, instantaneous, and easily accessible information. This research analyzed the differences in smartphone use and the prevalence of nomophobia, mainly according to gender and university degree of Health Sciences students at the University of Zaragoza during the COVID-19 confinement in Spain. Methods: A descriptive cross-sectional study was carried out on a sample of 318 first and second-grade students, who completed an online questionnaire sent to their institutional email, which included sociodemographic questions, other questions about smartphone use, and the Nomophobia Questionnaire (NMP-Q) scale. Results: Compared to men (n = 58), women (n = 260) were more likely to use their smartphones more intensively daily, as were occupational therapy students compared to the other degree programs studied. The prevalence of nomophobia was moderate, being around the risk of suffering from it. No significant differences in scores for nomophobia among students were found according to gender, university degree, or population nucleus for the nomophobia scores of the students. Discussion: The present study extends the existing literature on nomophobia by providing results of interest in terms of gender and the exceptional healthcare context of COVID-19. The results suggest that despite intense daily smartphone use young people did not reach severe nomophobia figures. This fact underlines the need for appropriate and healthy technology education. Understanding the characteristics of the populations that use the smartphone the most may help to analyze nomophobia rates and the massive use of the device.

Quality of Life after Radical Prostatectomy: A Longitudinal Study.

BACKGROUND: Men with prostate cancer who undergo radical prostatectomy experience a decrease in quality of life, often related to sexual disfunction and urinary incontinence. Knowing and measuring the impact of radical prostatectomy on the individual's social, emotional, and family quality of life could help to plan and develop an appropriate, patient-centred therapeutic approach. AIM: In this study, we aimed to evaluate changes in quality of life of patients with prostate cancer before and after radical prostatectomy. METHODS: A longitudinal, observational study of 114 participants was conducted using the method of test-retest. Quality of life before and after radical prostatectomy was measured through the following self-administered questionnaires: (1) The EORTC QLQ-C30 in its Spanish version was used to assess the generic quality of life the participants; (2) the EORTC QLQ-PR25 in its Spanish version was used to assess the specific, health-related quality of life of prostate cancer patients. RESULTS: A total of 114 men took part in this study. The results from the QLQ-C30 questionnaire indicated an improvement in the dimensions of emotional role and cognitive function, as well as in the symptoms of fatigue, pain, nausea and vomiting, insomnia, and loss of appetite, after surgery. Patients scored lower in the dimensions of role functioning, social function, and economic impact after radical prostatectomy. According to the results from the QLQ-PR25 questionnaire, 61.40% of the participants experienced sexual impotence and 26.31% suffered urinary incontinence after surgery. There were significant differences in some postsurgical outcomes between patients who had neurovascular bundles preserved and those who had not. CONCLUSIONS: In-depth knowledge of, and measurement of changes in, quality of life after radical prostatectomy should allow for comprehensive, multidisciplinary, patient-centred care planning. Psychosocial assessment, both before and after surgery, is crucial in patients with prostate cancer. This study was prospectively registered with the CEIC-A on 2012-06-27, with registration number C.P.-C.I. PI12/0088.

Psychological distress in nursing students: relationship with screen time, diet and physical activity. / Distrés psicológico en estudiantes de enfermería: relación con tiempo de pantalla, dieta y actividad física.

OBJECTIVE: to determine the prevalence of anxiety and depression symptoms, as well as their association with screen time, diet and physical activity, in a cohort comprised by nursing students. METHOD: a descriptive and cross-sectional study conducted with a sample of 648 Nursing students. The instruments used were the Hospital Anxiety and Depression Scale, the short version of the International Physical Activity Questionnaire and the Spanish Healthy Eating Index (Índice de Alimentación Saludable Español, IASE). Different multiple linear regression models were performed to analyze the association between anxiety/depression symptoms and screen time, diet and physical activity. RESULTS: the prevalence values for anxiety and depression symptoms were 24.1% and 3.7%, respectively. Prolonged screen times (>6 hours a day), low levels of physical activity and inadequate diet were independently and significantly associated with deeper psychological symptoms. CONCLUSION: Nursing students' mental health might benefit from the implementation of initiatives promoting healthy lifestyles.

Factors related with nursing students' health literacy: a cross sectional study.

Background: Nursing professionals have a crucial role in promoting health literacy in health services, so it is necessary to ensure health literacy skills in future health professionals. Objective: The objective of the study was to examine the health literacy of nursing students and its associated factors. Methods: A cross-sectional descriptive study was carried out on 460 nursing students. For data collection, a semi-structured questionnaire was obtained on sociodemographic characteristics, perception and health care, use of the health system and lifestyles. In addition, health literacy was assessed using the European Health Literacy Questionnaire. Results: 6.1% of the participants had an inadequate level of health literacy and 36.5% problematic. The probability of having sufficient health literacy is directly associated with age; and inversely with smoking, prolonged screen time and living alone (p < 0.05). Conclusion: A large percentage of nursing students need to improve their health literacy skills. It is necessary to integrate a greater number of contents in health literacy in the curriculum of nursing students.

Physical activity during pregnancy and its relationship with gestational weight gain. / Actividad física durante el embarazo y su relación con la ganancia de peso gestacional.

OBJECTIVE: to describe the physical activity patterns of a cohort comprised by pregnant women from our environment and to explore its association with weight gain in each of the trimesters of pregnancy. METHODS: a descriptive and longitudinal study conducted with a sample of 151 women. The International Physical Activity Questionnaire was used to assess physical activity during pregnancy based on volume, intensity and setting where it is performed. Different multiple linear regression models were performed to analyze the association between physical activity and gestational weight gain. RESULTS: physical activity decreased during pregnancy, both in terms of time and intensity. Pre-gestational Body Mass Index was the main factor associated with lower weight gain throughout pregnancy. The influence of physical activity on gestational weight gain was limited to the third trimester of pregnancy, where an inverse association was observed between both variables. CONCLUSION: the results of this study show an important reduction in physical activity during pregnancy and suggest that it exerts a limited influence on gestational weight gain.

Ageism and nursing students, past or reality?: A systematic review.

OBJECTIVE: This systematic review aimed to summarise and update existing knowledge about ageism among nursing students through the following research question: what is the perception and attitudes of ageism among student nurses? DESIGN: A systematic review of longitudinal and cross-sectional studies of ageism in nursing students was carried out. DATA SOURCES: The literature search was conducted in the scientific databases Pubmed and Scopus in February 2021. REVIEW METHODS: After the screening process, 22 studies meeting the selection criteria were selected; 8 more were identified after manually searching the selected paper' reference lists. A total of 30 studies were included in the review. The JBI Critical Appraisal Checklists for Analytical Cross-Sectional studies and for Cohort Studies were used to appraise the articles' quality. RESULTS: There was large variability in the manifestation of ageism among student nurses, as well as in the instruments used for assessment. Most of the articles analysed attitudes towards old age, the majority of which were positive. Being a female student, being on the final year of study and having regular contact or cohabitation with an older adult were three of the main determinants in the expression of positive attitudes towards the elderly. CONCLUSIONS: Our findings suggest that student nurses generally have positive attitudes towards old age, although ageist beliefs and discriminatory behaviours were identified and should be studied in greater depth. Training programs for future care professionals have a responsibility to educate from a non-stereotypical perspective based on current societal needs.

Translation, Cultural Adaptation and Validation of the Nurses Self-Concept Instrument (NSCI) to Spanish.

Professional self-concept in nurses is understood as the way nurses think and feel about themselves in their nursing role and is both a predictor of quality of care and a protective factor against burnout. The aim of this study was to translate, culturally adapt and validate the Spanish version of the Nurses Self-Concept Instrument in a sample of 483 Spanish registered nurses. In addition, we analyzed gender differences in its dimensions in the same sample. Internal reliability was evaluated using Cronbach's Alpha, while construct validity was assessed using both exploratory and confirmatory factor analysis. The differences between groups were analyzed using the Mann-Whitney U test. Factor distribution was different from the original model. A gender gap was observed in the Nurse Thinking and Perception of Capabilities dimensions with higher values in the women group, while in the Leadership dimension, higher values were observed in the men group. While the Spanish version of the Nurses Self-Concept Instrument is a valid and reliable tool to measure this construct, the differences in its dimensions lead to a deeper understanding of the cultural differences in the construction of professional self-concept.

Health-related behaviors and symptoms of anxiety and depression in Spanish nursing students: an observational study.

Background: Symptoms of anxiety and depression are prevalent among young adults and are a significant public health issue. College students are at a higher risk of experiencing poor mental health than other young people due to several factors, including moving away from home, financial pressures, heavy workload, poor time management skills, competitivity, new processes of socialization and insufficient coping mechanisms, among others. In addition, nursing students' mental and physical health may also be affected by unhealthy lifestyle habits and health-related behaviors. Aim: To determine the prevalence of symptoms of depression and anxiety, and the association between these symptoms and health-related behaviors, in a population of Spanish student nurses. Methods: Cross-sectional study on a sample of 339 nursing students. We used the Hospital Anxiety and Depression Scale, the International Physical Activity Questionnaire-Short form, the Spanish Healthy Eating Index and an "ad hoc" questionnaire for sociodemographic variables. The association between psychological symptoms and health-related behaviors was analyzed through binary logistic regression models. Results: The prevalence of symptoms of depression and anxiety was 3.8% and 24.5%, respectively. Negative health-related behaviors were frequent, namely tobacco and alcohol consumption, suboptimal physical activity and diet. Moderate physical activity was associated with a lower probability of experiencing depressive symptoms. Symptoms of anxiety were related to a low level of physical activity, an unhealthy diet and alcohol consumption ≥2 times a week. Conclusion: Student nurses could benefit from the implementation of both physical and mental health promotion initiatives.

Predictors of the Quality of Life of University Students: A Cross-Sectional Study.

Quality of life (QOL) is a complex and multifaceted concept that has been used to study different aspects of people's lives, including physical and psychological wellbeing, financial independence, social relationships, personal beliefs and living situation. In this study, we aimed to assess the QOL of a group of Spanish university students and identify associated factors. METHOD: We completed a cross-sectional study of the QOL of 868 university students using the WHOQOL-BREF questionnaire. In addition, data regarding sociodemographic information and self-esteem (Rosenberg Self-Esteem Scale), physical activity (International Physical Activity Questionnaire-Short version), diet (Spanish Index of Healthy Eating), alcohol consumption (CAGE questionnaire) and sleep quality (Pittsburgh Sleep Quality Index) were collected. RESULTS: A total of 66.2% of participants assessed their QOL positively, while 58.8% favorably evaluated their overall health. Students reported the highest scores for the physical health domain of QOL, whereas they gave the lowest scores for the psychological health domain. Age was inversely associated with QOL. Higher self-esteem and satisfaction with academic performance, as well as sleep and diet quality, were directly associated with higher QOL. The physical health domain of QOL was scored more highly by participants who had a healthy body weight or those who reported moderate levels of physical activity. Higher scores in the social relationships domain of QOL were directly linked to alcohol intake, smoking and low body weight in addition to being inversely associated with screen time. The psychological domain of QOL was lower for those who were overweight or lived alone. CONCLUSION: Many sociodemographic, academic and behavioral variables are associated with university students' QOL. The present findings underscore the need to direct further initiatives toward identifying and overcoming barriers to increased QOL for university students.

Migrant and ethnic minority nurses' experience of working in European health services: a qualitative study.

OBJECTIVE: To analyze the perception of culture and experience of working in European health services of a purposive sample of qualified migrant and ethnic minority nurses currently living in Belgium, Portugal, Spain and Turkey. METHOD: A qualitative phenomenological method was chosen. Individual interviews took place with 8 qualified migrant and ethnic minority nurses currently living in four European countries. Thematic analysis was conducted using Braun and Clark's stages after qualitative data had been verbatim transcribed, translated into English, and analyzed. RESULTS: Four themes and 4 subthemes emerged from thematic analysis of the transcripts. CONCLUSION: Migrant and ethnic minority nurses working in the European Union experience and witness discrimination and prejudice from patients and colleagues due to cultural differences. European health services should closely monitor and address discrimination and prejudice towards migrant and ethnic minority staff and patients, and take initiatives to reduce and, eventually, eradicate them.

An evaluation of undergraduate student nurses' gameful experience whilst playing a digital escape room as part of a FIRST year module: A cross-sectional study.

BACKGROUND: The circumstances arising from the COVID-19 pandemic have accelerated the use of digital teaching and learning in health professions education. Digital gamification-based teaching and learning activities are innovative and versatile tools for the acquisition of professional competencies in higher education, which can be used on a range of topics and can be supplemental to other teaching methods. OBJECTIVES: This study aimed to investigate nursing students' gameful experience whilst playing a digital escape room. In addition, we aimed to analyze the students' motivation, learning experience and outcome of the activity, and the students' perception of the degree of achievement of the intended learning outcomes. DESIGN: Cross-sectional descriptive study. PARTICIPANTS: A total of 136 undergraduate first year student nurses enrolled in a "Fundamentals of Nursing" course. METHOD: The digital escape room game took place online during the academic year 2020-2021. The measures included the GAMEX scale in its Spanish version and a self-reported questionnaire to evaluate the outcome of the scape room game and the degree of achievement of the intended learning outcomes. RESULTS: More than 80 % of the participants were moderately to very motivated to play the game. Three GAMEX dimensions achieved a mean score of 3 or above 3, namely Enjoyment, Creative Thinking and Absence of Negative effects. The mean score for each of the outcome variables was over 3. However, the degree of achievement of the learning outcomes after exiting the digital escape room was uneven. CONCLUSION: Gamification-based teaching and learning activities, such as digital escape rooms, can be effective in fostering specific skills, including teamwork, communication and critical thinking. However, they should be designed carefully, and used as a complement, rather than a substitute, of other educational activities.

The Association between Diet and Sleep Quality among Spanish University Students.

While it has long been recognized that diet is a leading behavioral risk factor for human health, recent scientific findings have also suggested that diet and sleep quality may be connected. The purpose of the present study is to evaluate the association between diet and sleep quality among a group of Spanish university students. To do so, a cross-sectional study of 868 students was carried out. Sleep quality was assessed using the Spanish version of the Pittsburgh Sleep Quality Index (PSQI), while diet was assessed using the Spanish Healthy Eating Index (SHEI). The study revealed a noteworthy rate of bad sleepers (51.6%) and students whose diet needed modifications (82.2%). Unhealthy eaters were more likely to have poor sleep quality (aOR = 4.20; CI 95%: 2.07-8.52). The unbalanced intake of vegetables (aOR = 1.63; CI 95%: 1.14-2.34), fruits (aOR = 4.08; CI 95%: 2.90-5.74), dairy products (aOR = 1.96; CI 95%: 1.41-2.72), lean meats (aOR = 1.82; CI 95%: 1.19-2.78), legumes (aOR = 1.43; CI 95%: 1.00-2.02), sweets (aOR = 1.60; CI 95%: 1.13-2.25) and sugary soft drinks (aOR = 1.46; CI 95%: 1.07-1.99) was associated with lower sleep quality.

Psychometric properties and cultural adaptation of "LifeConScale" -Life Conditions Scale for Adolescents.

Promoting the adoption of healthy habits represents a great challenge for health and education professionals. In this sense, childhood and adolescence are propitious times for the acquisition and consolidation of behaviors and skills, being that numerous and different determinants act in the genesis of behavior. The purpose of this study was to test the Psychometric properties and cultural adaptation of "LifeConScale" -Life Conditions Scale for Adolescents-. A cross-sectional and multicenter study was carried out in a representative sample of adolescents enrolled in 1st and 2nd year of Compulsory Secondary Education in 18 educational centers in Aragon, during the 2018-2019 school year. Sociodemographic characteristics, life skills, daily habits, and academic performance were analyzed using an adapted questionnaire from different scales and previous studies. For the adaptation of the questionnaire, the expert panel technique was used and for its validation, exploratory factor analysis was carried out and Cronbach's Alpha was applied, assessing the global internal consistency and of each one of the factors. The instrument showed a Kaiser-Meyer-Olkin sample size adequacy of 0.8122. A 6-dimensional model was chosen that explained 75.25% of the variance. The goodness of fit obtained a value of 0.802 in the Nomed Fix Index. The Comparative Fit Index was 0.891. The result of the analysis of variances and covariances carried out according to the Standardized Root Mean Square Residual yielded a value of 0.093 The analysis showed excellent application conditions in the study population and construct validity. This instrument will be useful for the evaluation of educational programs that work to promote health in educational centers, such as Health Promoting Schools.

Qualified Nurses' Perceptions of Cultural Competence and Experiences of Caring for Culturally Diverse Patients: A Qualitative Study in Four European Countries.

BACKGROUND: European nurses are expected to provide appropriate care for patients from diverse cultural backgrounds. However, there is limited knowledge and understanding of this process. The aim of this study was to analyse the perceptions of culture and experiences of caring for patients from diverse cultural backgrounds of a purposive sample of qualified nurses from four European countries, namely Belgium, Portugal, Spain and Turkey. METHODS: A qualitative phenomenological approach was selected in order to understand complex phenomena through the participants' lived experiences, meanings and perspectives. Individual interviews and focus groups took place with 28 staff nurses and 11 nurse managers from four European countries. The sociodemographic and cultural characteristics of the sample were described and analysed using descriptive statistics. Qualitative data were transcribed verbatim, translated into English and analysed following Braun and Clark's phases for thematic analysis. RESULTS: Five themes and twelve subthemes emerged from thematic analysis of the transcripts. The themes included: (1) relevance of culture for nursing; (2) culture in the healthcare service; (3) qualities of the healthcare professionals; (4) challenges to culturally competent care; (5) becoming a culturally competent nurse. CONCLUSIONS: There are challenges to the delivery of culturally congruent care, namely language and communication difficulties, prejudices and stereotyping in the health service, a tendency for ethnocentrism, a lack of education and training in cultural competence and a lack of support from the health service to facilitate new ways of acting.

Psychological distress and fear of Covid-19 in student nurses before clinical placement: a cross-sectional study.

OBJECTIVE: To determine the degree of psychological distress and fear of COVID-19 experienced by undergraduate student nurses who were about to begin their clinical placements. METHOD: A cross-sectional study was carried out with 100 second- and third-year undergraduate student nurses of the University of Zaragoza (Spain). Measures included the Fear of COVID-19 Scale and the Depression Anxiety Stress Scales. RESULTS: Regularly, student nurses did not think of themselves as vulnerable to COVID-19. However, a significant association was observed between the student nurses' level of psychological distress and cohabiting with relatives or people who were considered vulnerable to the infection (p = 0.035). The Depression Anxiety Stress Scale results revealed a low level of psychological distress in general; the Fear of COVID-19 Scale indicated moderate fear (2.94). CONCLUSION: Student nurses who lived with their relatives experienced higher levels of stress due to the perceived risk of transmission, but were less fearful of loss of work and income. Anxiety in our sample was associated principally with not knowing their upcoming placement location.