Efectividad de las intervenciones enfermeras en la prevención de caídas en adultos mayores en la comunidad y en entornos sanitarios: una revisión sistemática y metaanálisis de ECA / Effectiveness of nursing interventions in the prevention of falls in older adults in the community and in health care settings: A systematic review and meta-analysis of RCT

Objetivo: Estimar la efectividad de los programas de prevención de caídas en mayores de 65 años en los que participan profesionales de enfermería. Métodos: Se incluyeron ensayos clínicos aleatorizados disponibles a texto completo sobre la prevención de caídas en la comunidad realizada por enfermeras en personas mayores de 65 años y que informaran de la incidencia de dichas caídas. Se analizaron 14 bases de datos en el período de 2016 a 2018 de publicaciones en inglés, francés, portugués y español. La calidad de los artículos se evaluó de manera independiente y ciega por los revisores, que trabajaron en parejas usando para ello los dominios de riesgo de riesgo de la Colaboración Cochrane. Se utilizó el cociente de riesgos como medida del tamaño de efecto. Se asumió un modelo de efectos aleatorios para los análisis estadísticos. La influencia de las variables moderadoras de los estudios sobre los tamaños de efecto se realizó mediante ANOVA con un intervalo de confianza del 95% para cada categoría. Resultados: Se seleccionaron 31 estudios con 25.551 participantes, donde la intervención más frecuente fue la educación (57,1%), seguida de los modelos multifactoriales (37,1%). La probabilidad de caídas se redujo significativamente en los grupos intervención (RR +=0,87). Las intervenciones multifactoriales (RR +=0,89) y basadas en la educación (RR=+0,84) redujeron significativamente la probabilidad de caídas. Conclusiones: Descartando el sesgo de publicación, los programas de prevención llevados a cabo por enfermeras producen una reducción significativa del 10% de las caídas. Las intervenciones basadas en la educación y multifactoriales son las más efectivas cuando son llevadas a cabo por enfermeras.(AU)

Objective: To estimate the effectiveness of fall prevention programs in people aged 65 years and older involving nursing professionals. Methods: We included available full-text randomized clinical trials on nurse-led prevention of falls in the community in people over 65 years of age and reporting the incidence of such falls. An extensive search was performed in 14 databases covering the period 2016 to 2018 for publications in English, French, Portuguese and Spanish. The quality of the papers was assessed independently and blindly by reviewers working in pairs using the risk of bias dominios of the Cochrane Collaboration. The hazard ratio was used as a measure of the effect size of the incidence of falls. A random-effects model was assumed for statistical analyses. The influence of moderator variables of the studies on the effect sizes was performed using ANOVAs and its 95% CI for each moderator category. Results: A total of 31 randomized clinical trials were selected with 25,551 participants. The most frequent type of intervention was education (57.1%), followed by multifactorial models (37.1%). The probability of falling was significantly reduced by 13% in the intervention groups compared to the control groups (RR +=0.87). Multifactorial (RR +=0.89) and education-based (RR=+0.84) interventions significantly reduced the probability of falls by 11% and 16%, respectively. Conclusions: Discarding publication bias prevention programs carried out by nurses produce a significant 10% reduction in falls. Education-based and multifactorial interventions are the most effective when conducted by nurses.(AU)

Effectiveness of nursing interventions in the prevention of falls in older adults in the community and in health care settings: A systematic review and meta-analysis of RCT.

OBJECTIVE: To estimate the effectiveness of fall prevention programs in people aged 65 years and older involving nursing professionals. METHODS: We included available full-text randomized clinical trials on nurse-led prevention of falls in the community in people over 65 years of age and reporting the incidence of such falls. An extensive search was performed in 14 databases covering the period 2016-2018 for publications in English, French, Portuguese and Spanish. The quality of the papers was assessed independently and blindly by reviewers working in pairs using the risk of bias dominios of the Cochrane Collaboration. The hazard ratio was used as a measure of the effect size of the incidence of falls. A random-effects model was assumed for statistical analyses. The influence of moderator variables of the studies on the effect sizes was performed using ANOVAs and its 95% CI for each moderator category. RESULTS: A total of 31 randomized clinical trials were selected with 25,551 participants. The most frequent type of intervention was education (57.1%), followed by multifactorial models (37.1%). The probability of falling was significantly reduced by 13% in the intervention groups compared to the control groups (RR+=0.87). Multifactorial (RR+=0.89) and education-based (RR=+0.84) interventions significantly reduced the probability of falls by 11% and 16%, respectively. CONCLUSIONS: Discarding publication bias prevention programs carried out by nurses produce a significant 10% reduction in falls. Education-based and multifactorial interventions are the most effective when conducted by nurses.

Impact of hospitalization on nutritional status in persons aged 65 years and over (NUTRIFRAG Study): Protocol for a prospective observational study.

BACKGROUND: Malnutrition is a recurring problem that has become more relevant in recent years. The aim of this study is to assess the risk of malnutrition and nutritional status on admission and its evolution until discharge in patients aged 65 and over admitted to medical and surgical hospitalization units in hospitals of the Spanish National Health System. METHODS: Prospective observational study to be carried out in the medical-surgical hospitalization units of 9 public hospitals between 01/09/2022 and 31/12/2024. Using consecutive sampling, a total of 4077 patients will be included (453 in each hospital). Variables included are related to the care process, functionality, cognition and comorbidity, risk profile, nutritional status and dysphagia; as well as frailty, dietary quality and contextual variables. The incidence of risk of malnutrition, undernutrition and dysphagia during the care process and at discharge will be calculated. The association with risk factors will be studied with logistic regression models and multivariate Cox regression models. In addition, an analysis of participants' satisfaction with food services will be carried out. The study was approved by the Ethics and Research Committee on 30/09/2020, approved for funding on 02/12/2021 and with registration number RBR-5jnbyhk in the Brazilian clinical trials database (ReBEC) for observational studies. DISCUSSION: Some studies address nutritional status or dysphagia in older people in various care settings. However, there is a lack of large sample studies including both processes of the impact of hospitalization. The results of the project will provide information on the incidence and prevalence of both pathologies in the study subjects, their associated factors and their relationship with the average length of stay, mortality and early readmission. In addition, early detection of a problem such as malnutrition related to the disease and/or dysphagia during a hospital stay will favor the action of professionals to resolve both pathologies and improve the health status of patients.

Evaluación de una intervención comunitaria para incrementar la cobertura vacunal de la gripe en mujeres embarazadas / Evaluation of a community-based intervention to increase influenza vaccination coverage in pregnant women

Objetivo: Conocer el impacto de la intervención educativa realizada sobre los profesionales de una zona básica de salud y su grupo de participación comunitaria, que conforman el grupo intervención (GI), y analizar su repercusión en la cobertura vacunal alcanzada para gripe en el grupo de riesgo (gestantes y puérperas) comparándola con su zona básica vecina, que conforma el grupo control (GC), durante la temporada vacunal 2019/20. Diseño: Estudio cuasiexperimental de intervención comunitaria. Emplazamiento: Dos zonas básicas de salud pertenecientes al departamento de salud Elche-Crevillente, España. Participantes: Gestantes y puérperas de 2 zonas básicas de salud y el grupo de participación comunitaria. Los profesionales de salud directamente relacionados con la campaña vacunal de gripe. Intervenciones: Sesión formativa al GI previa a la campaña de gripe 2019/20. Mediciones principales: Actitudes hacia la vacunación de gripe en profesionales sanitarios mediante el cuestionario validado CAPSVA y la cobertura vacunal de las gestantes y puérperas a través del Registro de Vacunas Nominal y su aceptación a la vacuna en la consulta de la matrona. Resultados: Los datos de cobertura vacunal en gripe registrados en el Registro de Vacunas Nominal para las mujeres gestantes y puérperas fue del 26,4% (n=207) en el GI y del 19,7% (n=144) en el GC (p=0,001), con una razón de incidencia del 1,34, lográndose así un 34% más de vacunación en el GI. La aceptación para la vacunación en las consultas de la matrona también fue elevada, inmunizándose en el GI el 96,5% vs. el 89,0% en el GC, con un RR=1,09 (IC 95% 1,01-1,62).Conclusiones: Estrategias de formación conjunta a profesionales y activos de la comunidad mejoran los resultados de cobertura vacunal.

Objective: To know the impact of the educational intervention carried out on the professionals of a basic health area and their community participation group, which make up the intervention group (IG), and to analyze its repercussion on the vaccination coverage achieved for influenza in the risk group (pregnant and puerperal women) comparing it with its neighboring basic zone, which makes up the control group (CG), during the 2019/20 vaccination season. Design: Quasi-experimental study of community intervention. SiteTwo basic health zones belonging to the Elche-Crevillente health department, Spain. Participants: Pregnant and postpartum women from 2 basic health areas and the community participation group. Health professionals directly related to the flu vaccination campaign. Interventions: Training session for the IG prior to the 2019/20 flu campaign. Main measurements: Attitudes towards influenza vaccination in health professionals through the validated CAPSVA questionnaire and the vaccination coverage of pregnant and postpartum women through the Nominal Vaccine Registry and their acceptance of the vaccine in the midwife's office. Results: The influenza vaccination coverage data recorded in Nominal Vaccine Registry for pregnant and puerperal women was 26.4% (n=207) in the IG and 19.7% (n=144) in the CG (p=0.001), with an incidence ratio of 1.34, thus achieving 34% more vaccination in the IG. Acceptance for vaccination in the midwife's office was also high, with 96.5% immunization in IG vs. 89.0% in CG, with a RR=1.09 (95% CI 1.01-1.62). Conclusions: Joint training strategies for professionals and community assets improve the results of vaccination coverage.(AU)

[Evaluation of a community-based intervention to increase influenza vaccination coverage in pregnant women]. / Evaluación de una intervención comunitaria para incrementar la cobertura vacunal de la gripe en mujeres embarazadas.

OBJECTIVE: To know the impact of the educational intervention carried out on the professionals of a basic health area and their community participation group, which make up the intervention group (IG), and to analyze its repercussion on the vaccination coverage achieved for influenza in the risk group (pregnant and puerperal women) comparing it with its neighboring basic zone, which makes up the control group (CG), during the 2019/20 vaccination season. DESIGN: Quasi-experimental study of community intervention. SITE: Two basic health zones belonging to the Elche-Crevillente health department, Spain. PARTICIPANTS: Pregnant and postpartum women from 2 basic health areas and the community participation group. Health professionals directly related to the flu vaccination campaign. INTERVENTIONS: Training session for the IG prior to the 2019/20 flu campaign. MAIN MEASUREMENTS: Attitudes towards influenza vaccination in health professionals through the validated CAPSVA questionnaire and the vaccination coverage of pregnant and postpartum women through the Nominal Vaccine Registry and their acceptance of the vaccine in the midwife's office. RESULTS: The influenza vaccination coverage data recorded in Nominal Vaccine Registry for pregnant and puerperal women was 26.4% (n=207) in the IG and 19.7% (n=144) in the CG (p=0.001), with an incidence ratio of 1.34, thus achieving 34% more vaccination in the IG. Acceptance for vaccination in the midwife's office was also high, with 96.5% immunization in IG vs. 89.0% in CG, with a RR=1.09 (95% CI 1.01-1.62). CONCLUSIONS: Joint training strategies for professionals and community assets improve the results of vaccination coverage.

Variability in Healthcare Expenditure According to the Stratification of Adjusted Morbidity Groups in the Canary Islands (Spain).

Morbidity is the main item in the distribution of expenditure on healthcare services. The Adjusted Morbidity Group (AMG) measures comorbidity and complexity and classifies the patient into mutually exclusive clinical categories. The aim of this study is to analyse the variability of healthcare expenditure on users with similar scores classified by the AMG. Observational analytical and retrospective study. Population: 1,691,075 subjects, from Canary Islands (Spain), aged over 15 years with data from health cards, clinical history, Basic Minimum Specialised Healthcare Data Set, AMG, hospital agreements information system and Electronic Prescriptions. A descriptive, bivariant (ANOVA coefficient η2) and multivariant analysis was conducted. There is a correlation between the costs and the weight of AMG (rho = 0.678) and the prescribed active ingredients (rho = 0.689), which is smaller with age and does not exist with the other variables. As for the influence of the AMG morbidity group on the total costs of the patient, the coefficient η2 (0.09) obtains a median effect in terms of the variability of expenditure, hence there is intra- and inter-group variability in the cost. In a first model created with all the variables and the cost, an explanatory power of 36.43% (R2 = 0.3643) was obtained; a second model that uses solely active ingredients, AMG weight, being female and a pensioner obtained an explanatory power of 36.4%. There is room for improvement in terms of predicting the expenditure.

Prevalencia y factores asociados de fragilidad en adultos mayores de 70 años en la comunidad / Prevalence and associated factors of frailty in adults over 70 years in the community

Objetivo: Estimar la prevalencia y analizar los factores asociados al síndrome de fragilidad en adultos ≥70 años, pertenecientes a un centro de salud de Asturias. Diseño: Estudio observacional transversal. Emplazamiento: Centro de Salud El Llano, Asturias. Participantes: Adultos ≥70 años. Mediciones principales: La fragilidad se definió por la presencia de ≥3 criterios del fenotipo de fragilidad de Fried. Variables secundarias: características sociodemográficas, estado de salud, estado funcional, estado cognitivo-afectivo y riesgo social. Se realizó un análisis bivariante y regresión logística. Resultados: Se incluyeron 408 participantes con una edad media de 79,8 (DE 6,6) años, el 59,1% eran mujeres. La prevalencia de fragilidad fue del 27,7% y del 44,9% para la prefragilidad. El perfil sociodemográfico es de una mujer (77%), de elevada edad (>84 años) (50,4%), sin estudios (65,5%), viuda (48,7%), con bajo nivel económico (47,8%) y en riesgo social (OR: 3,3; IC 95%: 2,5-4). Los factores que se asociaron estadísticamente con el síndrome de fragilidad fueron: comorbilidad alta (OR: 2,7; IC 95%: 1,5-5), polimedicación (OR: 1,9; IC 95%: 1,3-3), percepción de la calidad de vida con la salud (OR: 0,95; IC 95%: 0,93-0,97); deambulación alterada (OR: 17,9; IC 95%: 7,1-45,3), apoyo para la marcha (OR: 10,5; IC 95%: 4,7-23,4), alto riesgo de caídas (OR: 6,4; IC 95%: 3,8-10,8), dependencia para las ABVD (OR: 4; IC 95%: 2,4-6,6), AIVD (OR: 9,7; IC 95%: 4,7-20), discapacidad (OR: 37,7; IC 95%: 52,2-274,5), deterioro cognitivo (OR: 4,1; IC 95%: 1,8-9,3) y depresión (OR: 4,8; IC 95%: 2,7-8,7). Conclusiones: La fragilidad es un síndrome multifactorial de elevada prevalencia en los mayores de 70 años, en el que además de los criterios de fragilidad de Fried deben de ser analizados aspectos del estado de salud, funcionales, cognitivos-afectivos y sociales.(AU)

Objective: To estimate the prevalence and analyze the factors associated with frailty syndrome, in adults ≥70 years old, belonging to a health center in Asturias. Design: Observational cross-sectional study. Participants: Adults ≥70 years of age. Site: Health Centre of Llano (Asturias). Main measurements: Frailty was defined by the presence of ≥3 criteria of Fried's frailty phenotype. Secondary variables: sociodemographic characteristics, health status, functional status, cognitive-affective status and social risk. A bivariate analysis and logistic regression were performed. Results: Four hundred eight participants were included, with a mean age of 79.8 (SD 6.6), 59.1% female. The prevalence of frailty was 27.7% and 44.9% for pre-frailty. The sociodemographic profile is that of a woman (77%), of high age (>84 years) (50.4%), without studies (65.5%), widow (48.7%) with low economic status (47.8%) and at social risk (OR: 3.3; 95% CI: 2.5-4). Factors that were statistically associated with frailty syndrome were: high comorbidity (OR: 2.7; 95% CI: 1.5-5), polypharmacy (OR: 1.9; 95% CI: 1.3-3), perception of quality of life with health (OR: 0.95; 95% CI: 0.93-0.97), impaired ambulation (OR: 17.9; 95% CI: 7.1-45.3), support for walking (OR: 10.5; 95% CI: 4.7-23.4), high risk of falls (OR: 6.4; 95% CI: 3.8-10.8), ABVD (OR: 4; 95% CI: 2.4-6.6), AIVD (OR: 9.7; 95% CI: 4.7-20), disability (OR: 37.7; 95% CI: 52.2-274.5), cognitive impairment (OR: 4.1; 95% CI: 1.8-9.3) and depression (OR: 4.8; 95% CI: 2.7-8.7). Conclusions: Frailty is a multifactorial syndrome, with a high prevalence in those over 70 years of age, in which, in addition to Fried's criteria of frailty, aspects of health, functional, cognitive-affective and social status must be analyzed.(AU)

[Prevalence and associated factors of frailty in adults over 70 years in the community]. / Prevalencia y factores asociados de fragilidad en adultos mayores de 70 años en la comunidad.

OBJECTIVE: To estimate the prevalence and analyze the factors associated with frailty syndrome, in adults ≥70 years old, belonging to a health center in Asturias. DESIGN: Observational cross-sectional study. PARTICIPANTS: Adults ≥70 years of age. SITE: Health Centre of Llano (Asturias). MAIN MEASUREMENTS: Frailty was defined by the presence of ≥3 criteria of Fried's frailty phenotype. Secondary variables: sociodemographic characteristics, health status, functional status, cognitive-affective status and social risk. A bivariate analysis and logistic regression were performed. RESULTS: Four hundred eight participants were included, with a mean age of 79.8 (SD 6.6), 59.1% female. The prevalence of frailty was 27.7% and 44.9% for pre-frailty. The sociodemographic profile is that of a woman (77%), of high age (>84 years) (50.4%), without studies (65.5%), widow (48.7%) with low economic status (47.8%) and at social risk (OR: 3.3; 95% CI: 2.5-4). Factors that were statistically associated with frailty syndrome were: high comorbidity (OR: 2.7; 95% CI: 1.5-5), polypharmacy (OR: 1.9; 95% CI: 1.3-3), perception of quality of life with health (OR: 0.95; 95% CI: 0.93-0.97), impaired ambulation (OR: 17.9; 95% CI: 7.1-45.3), support for walking (OR: 10.5; 95% CI: 4.7-23.4), high risk of falls (OR: 6.4; 95% CI: 3.8-10.8), ABVD (OR: 4; 95% CI: 2.4-6.6), AIVD (OR: 9.7; 95% CI: 4.7-20), disability (OR: 37.7; 95% CI: 52.2-274.5), cognitive impairment (OR: 4.1; 95% CI: 1.8-9.3) and depression (OR: 4.8; 95% CI: 2.7-8.7). CONCLUSIONS: Frailty is a multifactorial syndrome, with a high prevalence in those over 70 years of age, in which, in addition to Fried's criteria of frailty, aspects of health, functional, cognitive-affective and social status must be analyzed.

Prevention of pressure injuries in critically ill children: A preliminary evaluation.

AIMS: To evaluate a prevention strategy implemented to reduce incidence and severity of positioning related pressure injuries affecting pediatric patients in a pediatric critical care unit. Secondary objective was to evaluate compliance with preventive recommendations. BACKGROUND: The skin in infants or children has important physiological and anatomical differences compared with adults. Further, factors such as the immaturity of the skin and limited activity and mobility in pediatric critical care unit, along with the pressure exerted by medical devices, increases the risk of pressure ulcers in infants and children. The most effective preventive measures specific to this intensive care population need to be evaluated. MATERIAL AND METHODS: Quasi-experimental before-after study with consecutive sampling. The effectiveness of the care bundle implementation was evaluated based on the latest evidence (intervention group) versus the application of non-standardized care (control group). Pediatric patients up to 14 years old at risk of suffering from pressure injuries and who were admitted more than 48 h in a pediatric intensive care unit (level III) participated. For the collection of data, two computer programs and the hospital clinical records of each participant were consulted. The data collection period was 6 months per group (pre and post intervention). RESULTS: A sample of 110 patients was obtained (50 control group and 60 intervention group). The cumulative incidence in pediatric patients exposed to the risk of pressure injuries was reduced from 16% to 13.3%; and in the subgroup of patients with prolonged stay (≥28 days), the incidence was reduced from 55.55% to 20%. In the intervention group, category III and IV pressure ulcers were completely reduced. In addition, the total number of pressure injuries decreased by 21.43%. The care bandle recommendations with the highest level of adhesion recorded were: skin inspection, application of hyperoxygenated fatty acids and use of a special support surface. The main risk factor found during the study was the prone position (p < 0.05). CONCLUSIONS: The application of a care bundle for prevention can be an effective solution to reduce the number and severity of LPPs in an intensive care unit. The most vulnerable subgroup of patients may benefit from the application of these resources.

Calidad de vida y autocuidado en enfermos de Parkinson de un hospital comarcal: estudio descriptivo / Quality of life and self-care in patients with Parkinson in a regional hospital: descriptive study

Objetivos: Determinar el grado de autocuidado y la calidad de vida en una muestra de pacientes con Enfermedad de Parkinson en estadios iniciales y conocer las dimensiones de autocuidado y calidad de vida más afectadas. Estudiar la relación entre los síntomas no motores con estas medidas de resultado.Metodología: Estudio observacional transversal realizado en una muestra de 21 enfermos de Parkinson grado I, II de la escala Hoenh Yarh. Se estudió el nivel de autocuidados, calidad de vida, síntomas no motores y nivel de salud percibido. Se realizó análisis descriptivo, inferencial y de correlación con el paquete estadístico SPSS v.20.Resultados: La edad media de la muestra fue de 71,86 (dt+/-8,93) años, el 52,4% eran hombres. El nivel medio de autocuidados fue de 1,14 (dt+/-0,35) siendo la dimensión más afectada el uso de medicamentos con una autonomía completa del 61,9% y 17,28 (dt+/-7,75) para la calidad de vida siendo la dimensión más afectada el disconfort corporal (m=35,03; dt+/-19,61).Se observó correlación baja entre los síntomas no motores y la calidad de vida (r=0,246;p=0,022), pero no entre los síntomas no motores y el autocuidado (r=0,010;p=0,662).Conclusiones: El nivel de autocuidados y calidad de vida de la muestra estudiada es adecuado. Las dimensiones de calidad de vida más afectadas son el disconfort corporal seguida por el deterioro cognitivo y los síntomas no motores están relacionados con el nivel de calidad de vida. Es relevante considerar estos aspectos en el desarrollo de intervenciones de educación terapéutica dirigidas a pacientes con Parkinson

Objectives: To determine the level of self-care and quality of life in a sample of patients in the early stages of Parkinson's disease and identify the most highly affected dimensions of self-care and quality of life. To study the relationship between non-motor symptoms and these outcome measures.Method: A cross-sectional study was conducted in a sample of 21 patients with stage I or II Parkinson's disease as defined by the Hoenh Yarh Scale. We studied the level of self-care, quality of life, non-motor symptoms and perceived health status. Descriptive, inferential and correlation analyses were performed using SPSS v.20.Results: Mean sample age was 71.86 (SD+/-8.93) years old, and 52.4% were males. The mean score for self-care was 1.14 (SD+/-0.35), and the most highly affected dimension was medication use, with 61.9% of the sample presenting complete autonomy, while for quality of life it was 17.28 (SD+/-7.75), and the most highly affected dimension was bodily discomfort (m=35.03; SD+/-19.61). We observed a correlation between non-motor symptoms and quality of life (r=0.246; p=0.022), but not between non-motor symptoms and self-care (r=0.010; p=0.662).Conclusions: Our sample presented an acceptable level of self-care and quality of life. The most highly affected quality of life dimensions were bodily discomfort followed by cognitive impairment, and non-motor symptoms were related to the level of quality of life. It is important to consider these aspects when designing therapeutic education interventions targeting patients with Parkinson's disease

Effectiveness of an Evidence-Based Practice educational intervention with second-year nursing students.

OBJECTIVES: to evaluate the effectiveness of an educational intervention on the knowledge, skills and attitudes of evidence-based practice among second-year nursing students. METHOD: a quasi-experimental before-and-after study. The study population consisted of 120 students enrolled in the Nursing Care in Healthcare Processes course. The educational intervention was based on theoretical and practical classes about the evidence-based practice process and the use of the critical incident technique during the clinical clerkship. Effectiveness was measured with the Evidence-Based Practice Competence Questionnaire in three paired measures using repeated-measures analysis of variance. RESULTS: the mean scores of the Evidence-Based Practice Competence Questionnaire were 79.83 (CI 95% 78.63-81.03) for the basal measurement, 84.53 (CI 95% 83.23-85.83) for the intermediate measurement, and 84.91 (CI 95% 83.26-86.55) for the final measurement, with a statistically significant difference among the three paired measurements (p<0.001). There were statistically significant differences in Attitudes (p = 0.034) and Knowledge (p <0.001) but not in Skills (p = 0.137). CONCLUSION: this educational intervention based on theoretical and practical classes about the evidence-based practice process and the use of the critical incident technique during the clinical clerkship enhances evidence-based practice competence among second-year nursing degree students.

Factores psicosociales y conductuales en la regulación del peso: autorregulación, autoeficacia y locus control / Psychosocial and behavioural factors in the regulation of weight: Self-regulation, self-efficacy and locus control

OBJETIVO: Identificar la relación y el comportamiento de la autorregulación, autoeficacia y locus control en la regulación del peso, en población adulta con obesidad, sobrepeso y normopeso. MÉTODO: Se realizó un estudio transversal en el Centro de Salud del Coto (Gijón) entre el 1 de abril al 30 de julio de 2015. La muestra estuvo formada por personas entre 18-65 años que contaran con un registro del índice de masa corporal en los dos últimos años. Los criterios de exclusión fueron: enfermedad médica grave, trastornos de la alimentación o mujeres embarazadas. Se midieron variables conductuales: autorregulación del peso corporal (Inventario de autorregulación del peso corporal), autoeficacia percibida en la regulación del peso (Inventario autoeficacia percibida en la regulación del peso) y locus control en la regulación del peso (Inventario Locus control en la regulación del peso). Variables antropométricas: peso (kg) y talla (m), índice de masa corporal. RESULTADOS: Se incluyeron 106 PARTICIPANTES: 32 con obesidad, 28 con sobrepeso y 46 con normopeso. Se encontraron diferencias estadísticamente significativas entre los 3 grupos de estudio para las variables escala total de autoeficacia (F = 61,77; p < 0,01), escala total de autorregulación (F = 45,97; p < 0,01), locus control interno (F = 13,92; p = 0,019), locus control otros poderosos (F = 9,21; p < 0,01) y locus control azar (F = 3,50; p = 0,011). CONCLUSIONES: La existencia de una relación entre el índice de masa corporal y las variables conductuales de autoeficacia, autorregulación y locus control, plantea a los profesionales sanitarios la necesidad de incluir los factores psicológicos o conductuales en cualquier actividad preventiva y de intervención dirigida al control del peso

OBJECTIVE: To identify the relationship and behaviour of the variables of self-control, self-efficacy and locus control in weight regulation of obese, overweight and normal weight adults. METHOD: Transversal study undertaken in the Health Centre of El Coto (Gijón) from 1st April to 30th July 2015. PARTICIPANTS: Subjects between 18-65 years of age with a body mass index recording within the last two years. Exclusions: serious medical illness, eating disorders or pregnant women. MAIN MEASUREMENTS: Behavioural variables: self-regulation of body weight (Inventory of self-control of body weight), perceived self-efficacy in weight regulation (Inventory of perceived self-efficacy in weight regulation) and locus control in weight regulation (Inventory of locus control in weight regulation). Anthropometric variables: weight (kg) and height (m), body mass index. RESULTS: One hundred and six participants were included: 32 were obese, 28 overweight and 46 normal weight. Significant differences were found between the 3 study groups for total scale of self-efficacy (F = 61.77; p<.01), total scale of self-regulation (F = 45.97; p < .01), internal locus control (F = 13.92; p =.019), other weighty influences of locus control (F = 9.21; p < .01) and random locus control (F = 3.50; p =.011). CONCLUSIONS: The relationship between body mass index and behavioural variables of self-efficacy, self-regulation and locus control, suggests the need for healthcare professionals to include psychological factors of behaviour in any preventive action and intervention directed at weight control

Psychosocial and behavioural factors in the regulation of weight: Self-regulation, self-efficacy and locus control. / Factores psicosociales y conductuales en la regulación del peso: autorregulación, autoeficacia y locus control☆.

OBJECTIVE: To identify the relationship and behaviour of the variables of self-control, self-efficacy and locus control in weight regulation of obese, overweight and normal weight adults. METHOD: Transversal study undertaken in the Health Centre of El Coto (Gijón) from 1st April to 30th July 2015. PARTICIPANTS: Subjects between 18-65 years of age with a body mass index recording within the last two years. EXCLUSIONS: serious medical illness, eating disorders or pregnant women. MAIN MEASUREMENTS: Behavioural variables: self-regulation of body weight (Inventory of self-control of body weight), perceived self-efficacy in weight regulation (Inventory of perceived self-efficacy in weight regulation) and locus control in weight regulation (Inventory of locus control in weight regulation). Anthropometric variables: weight (kg) and height (m), body mass index. RESULTS: One hundred and six participants were included: 32 were obese, 28 overweight and 46 normal weight. Significant differences were found between the 3 study groups for total scale of self-efficacy (F=61.77; p<.01), total scale of self-regulation (F=45.97; p<.01), internal locus control (F=13.92; p=.019), other weighty influences of locus control (F=9.21; p<.01) and random locus control (F=3.50; p=.011). CONCLUSIONS: The relationship between body mass index and behavioural variables of self-efficacy, self-regulation and locus control, suggests the need for healthcare professionals to include psychological factors of behaviour in any preventive action and intervention directed at weight control.

Comparative analysis of the psychometric parameters of two quality-of-life questionnaires, the SGRQ and CAT, in the assessment of patients with COPD exacerbations during hospitalization: A multicenter study.

The aim of this study was to assess health-related quality of life (HRQL) in patients with chronic obstructive pulmonary disease (COPD) and to discuss the different tools available for its assessment. The most widely used assessments are the St. George respiratory questionnaire (SGRQ) and the COPD assessment test (CAT) questionnaire. Both have a different difficulty in exam completion, calculation, and scoring. No studies exist that analyze the validity and internal consistency of using both questionnaires on patients admitted to the hospital for a COPD exacerbation. A multicenter, cross-sectional analytic observational study of patients admitted to the hospital due to a COPD exacerbation (CIE 491.2). During their hospital stay, they were administered the SGRQ and the CAT questionnaire within the framework of a therapeutic education program (APRENDEPOC). Descriptive and comparative analysis, correlations between the scales (Pearson's correlation index), consistency and reliability calculations (Cronbach's α), and a forward stepwise multiple linear regression were performed, with significant correlations in both questionnaires considered p < 0.01 with the total scores. A statistical significance of p < 0.05 was assumed. Altogether, 231 patients were admitted for a COPD exacerbation ( n = 77) at Hospital Clínic of Barcelona (HCB) and ( n = 154) at Hospital Universitario General of Castellón (HUGC). The sample profile was not homogeneous between both centers, with significant differences in HRQL between hospitals. Correlation were noted between both scales ( p < 0.01), along with high levels of internal consistency and reliability (CAT 0.836 vs. SGRQ 0.827). The HRQL is related to dyspnea, wheezing, daytime drowsiness, and edema, as well as to the need to sleep in a sitting position, anxiety, depression, and dependence on others in the execution of daily activities. Our regression analysis showed that the SGRQ questionnaire could predict more changes in HRQL with a higher number of variables.

Effectiveness of an Evidence-Based Practice educational intervention with second-year nursing students / Eficácia de uma intervenção educativa de Prática Baseada em Evidências com estudantes do segundo ano de enfermagem / Eficacia de una intervención educativa de Práctica Basada en la Evidencia en estudiantes de segundo año de enfermería

ABSTRACT Objectives: to evaluate the effectiveness of an educational intervention on the knowledge, skills and attitudes of evidence-based practice among second-year nursing students. Method: a quasi-experimental before-and-after study. The study population consisted of 120 students enrolled in the Nursing Care in Healthcare Processes course. The educational intervention was based on theoretical and practical classes about the evidence-based practice process and the use of the critical incident technique during the clinical clerkship. Effectiveness was measured with the Evidence-Based Practice Competence Questionnaire in three paired measures using repeated-measures analysis of variance. Results: the mean scores of the Evidence-Based Practice Competence Questionnaire were 79.83 (CI 95% 78.63-81.03) for the basal measurement, 84.53 (CI 95% 83.23-85.83) for the intermediate measurement, and 84.91 (CI 95% 83.26-86.55) for the final measurement, with a statistically significant difference among the three paired measurements (p<0.001). There were statistically significant differences in Attitudes (p = 0.034) and Knowledge (p <0.001) but not in Skills (p = 0.137). Conclusion: this educational intervention based on theoretical and practical classes about the evidence-based practice process and the use of the critical incident technique during the clinical clerkship enhances evidence-based practice competence among second-year nursing degree students.

RESUMO Objetivos: avaliar a eficácia de uma intervenção educativa sobre os conhecimentos, competências e atitudes da prática baseada em evidências em estudantes do segundo ano do curso de enfermagem. Método: estudo quase-experimental, antes e depois. A população do estudo foi composta por 120 estudantes matriculados na cadeira de Cuidados de Enfermagem em Processos de Assistência Médica. A intervenção educativa foi baseada em aulas teóricas e práticas sobre o processo da prática baseada em evidências e o uso da técnica do incidente crítico durante o estágio clínico. A eficácia foi medida com o Questionário de Competências de Práticas Baseadas em Evidências em três medidas pareadas usando análise de variância de medidas repetidas. Resultados: os escores médios do Questionário de Competências da Prática Baseada em Evidências foram 79,83 (IC95% 78,63-81,03) para a medição basal, 84,53 (IC95% 83,23-85,83) para a medição intermédia e 84,91 (IC95% 83,26-86,55) para a medição final, com uma diferença estatisticamente significante entre as três medidas pareadas (p<0,001). Houve diferenças estatisticamente significantes em Atitudes (p = 0,034) e Conhecimento (p <0,001), mas não em Competências (p = 0,137). Conclusão: esta intervenção educativa baseada em aulas teóricas e práticas sobre o processo de prática baseada em evidências e o uso da técnica do incidente crítico durante o estágio clínico aumenta a competência de prática baseada em evidências em estudantes do segundo ano do curso de enfermagem.

RESUMEN Objetivos: evaluar la efectividad de una intervención educativa de práctica basada en la evidencia sobre los conocimientos, habilidades y actitudes del estudiantado de segundo año del grado en enfermería. Método: estudio cuasi-experimental (antes-después). La población de estudio consistió en 120 estudiantes inscritos en el curso de Cuidados de Enfermería en los Procesos de Atención Sanitaria. La intervención educativa se basó en clases teóricas y prácticas sobre el proceso de práctica basada en la evidencia y el uso de la técnica de incidentes críticos durante las rotaciones clínicas. La efectividad se midió con el Cuestionario de Competencia en Práctica Basada en la Evidencia por medio de tres medidas pareadas y utilizando el análisis de varianza de medidas repetidas. Resultados: las puntuaciones medias del Cuestionario de Competencia en Práctica Basada en la Evidencia fueron 79,83 (IC 95% 78,63-81,03) para la medición basal, 84,53 (IC 95% 83,23-85,83) para la medición intermedia, y 84,91 (IC 95% 83,26-86,55) para la medición final, con una diferencia estadísticamente significativa entre las tres medidas pareadas (p <0,001). Hubo diferencias estadísticamente significativas en Actitudes (p = 0,034) y Conocimientos (p <0,001), pero no en Habilidades (p = 0,137). Conclusión: la intervención educativa basada en clases teóricas y prácticas sobre el proceso de práctica basada en la evidencia y el uso de la técnica de incidentes críticos durante las rotaciones clínicas mejoran la competencia en práctica basada en la evidencia en estudiantes de segundo año de enfermería.

Cuestionario para medir la participación de los profesionales de enfermería en la tutela de estudiantes / Questionário para medir a participação dos profissionais de enfermagem na tutela de estudantes / Questionnaire to Measure the Participation of Nursing Professionals in Mentoring Students

Objective. The aim herein was to validate a questionnaire to measure the level of participation of clinical nursing professionals in the mentorship of nursing students during clinical practices. Methods. Design and validation of a questionnaire. The psychometric properties of the tool were determined through four phases: 1- literature review; 2- evaluation of content validity; 3- pilot test, cognitive pretest and intra-observer reliability study; 4- construct validity study through an exploratory factor analysis of main components with varimax rotation in a sample of 249 nursing professionals from primary care and hospital care from different Spanish provinces. The internal consistency was studied with Cronbach's alpha coefficient. Results. The global content validity was above 0.8. The final version of the questionnaire had 33 items, with a global intraclass correlation coefficient of 0.852 and Cronbach's alpha of 0.837. Factor analysis explained 55.4% of the total variance, with a solution of five factors that made up the dimensions: Implication, Motivation, Satisfaction, Obstacles, and Commitment. Conclusion. The questionnaire evaluated has adequate validity and reliability to permit determining the level of nurse participation in the mentorship of students. (AU)

Objetivo. Validar un cuestionario para medir el nivel de participación de los profesionales de enfermería clínicos en la tutela de estudiantes de enfermería durante las prácticas clínicas. Métodos. Diseño y validación de un cuestionario. Se determinaron las propiedades psicométricas de la herramienta mediante cuatro fases: 1- revisión de la literatura; 2- evaluación de la validez de contenido; 3- prueba piloto, pretest cognitivo y estudio de la fiabilidad intraobservador; 4-, estudio de validez de constructo mediante un análisis factorial exploratorio de componentes principales con rotación varimax en una muestra de 249 profesionales de enfermería de atención primaria y de atención hospitalaria de diferentes provincias españolas. La consistencia interna se estudió con el coeficiente Alfa de Cronbach. Resultados. La validez de contenido global fue superior a 0.8. La versión final del cuestionario fue de 33 ítems, con un CCI global de 0.852 y un alfa de Cronbach de 0.837. El análisis factorial explicó el 55.4% de varianza total, con una solución de cinco factores que formaron las dimensiones Implicación, Motivación, Satisfacción, Obstáculos y Compromiso. Conclusión. El cuestionario evaluado tiene validez y fiabilidad adecuadas que permite determinar el nivel de participación de las enfermeras en la tutela de estudiantes. (AU)

Objetivo. Validar um questionário para medir o nível de participação dos profissionais de enfermagem clínicos na tutela de estudantes de enfermagem durante as práticas clínicas. Métodos. Desenho e validação de um questionário. Se determinaram as propriedades psicométricas da ferramenta mediante quatro fases: 1- revisão da literatura; 2- avaliação da validez de conteúdo; 3- prova piloto, pré-teste cognitivo e estudo da fiabilidade intra-observador; 4-, estudo de validez de construto mediante uma análise fatorial exploratório de componentes principais com rotação varimax numa amostra de 249 profissionais de enfermagem de atenção primária e de atenção hospitalar de diferentes províncias espanholas. A consistência interna se estudou com o coeficiente Alfa de Cronbach. Resultados. A validez de conteúdo global foi superior a 0.8. A versão final do questionário foi de 33 itens, com um CCI global de 0.852 e um alfa de Cronbach de 0.837. A análise fatorial explicou que 55.4% de variância total, com uma solução de cinco fatores que formaram as dimensões; Implicação, Motivação, Satisfação, Obstáculos e Compromisso. Conclusão. O questionário avaliado tem validez e fiabilidade adequadas que permite determinar o nível de participação das enfermeiras na tutela de estudantes. (AU)

Programas educativos en pacientes con Enfermedad Pulmonar Obstructiva Crónica. Revisión integradora / Educational programs for patients with Chronic Obstructive Pulmonary Disease. Integrative review

Según la OMS, el objetivo de la educación terapéutica (ET) es ayudar al paciente a adquirir los recursos necesarios para gestionar óptimamente su vida con una enfermedad crónica. La ET forma parte del tratamiento en la prevención secundaria y terciaria. La última revisión de la Cochrane ha demostrado resultados positivos, sin embargo, la heterogeneidad de las poblaciones, tipo de intervenciones y medidas de resultado hace que sea difícil establecer recomendaciones claras en este ámbito. Así como se desconoce qué instrumentos son los recomendables para evaluar el cumplimiento terapéutico en la EPOC. Por tanto es necesario realizar de una revisión con el objetivo de conocer las características de los ensayos clínicos, el perfil del paciente EPOC, los contenidos de la ET y las variables estudiadas en los mismos. Identificándose 22 ensayos clínicos con una alta calidad metodológica, escala Jadad >3 que mostraron que en los ensayos clínicos de programas de ET las variables más estudiadas son la calidad de vida, ingresos hospitalarios y las variables de función pulmonar, donde la ET disminuye los ingresos hospitalarios, favorece la deshabituación tabáquica, mejora los conocimientos de la EPOC cuyas intervenciones son sesiones grupales, con diferentes materiales educativos, existiendo un auge en el número de publicaciones en este ámbito. Existe una gran variedad en los instrumentos de evaluación y heterogeneidad de las intervenciones, para establecer conclusiones (AU)

According to WHO, the aim of therapeutic education (TE) is help the patient to acquire the resources necessary to optimally manage your life with a chronic disease. The TE is part of treatment in secondary and tertiary prevention. The latest Cochrane review has shown positive results however, heterogeneity of populations, types of interventions and outcome measures makes it difficult to establish clear recommendations in this area. And what instruments are recommended to assess the therapeutic education in patients with COPD. It is therefore necessary a review with the aim of knowing the characteristics of clinical trials, the profile of COPD patient, the contents of ET and the variables studied in them. In this review are Identified 22 clinical trials with high methodological quality, Jadad scale> 3. Which showed that in clinical trials programs ET the most studied variables are the quality of life, hospital admissions and lung function variables, where ET decreases hospital admissions, promotes smoking cessation and improving knowledge of COPD. Whose interventions are group sessions with different educational materials. There being a rise in the number of publications in this area, there is a great variety of assessment tools and heterogeneity of interventions, to draw conclusions (AU)

"Falls prevention among older people and care providers: protocol for an integrative review".

AIM: To review the evidence about the role of care providers in fall prevention in older adults aged ≥ 65 years, this includes their views, strategies, and approaches on falls prevention and effectiveness of nursing interventions. BACKGROUND: Some fall prevention programmes are successfully implemented and led by nurses and it is acknowledged the vital role they play in developing plans for fall prevention. Nevertheless, there has not been a systematic review of the literature that describes this role and care providers' views on fall's prevention initiatives. DESIGN: A convergent synthesis of qualitative, quantitative, and mixed methods studies. The eligibility criteria will be based on participants, interventions/exposure, comparisons, and outcomes for quantitative studies and on population, the phenomena of interest and the context, for qualitative studies. To extract data and assess study qualities members of the research team will work in pairs according to their expertise. The review will follow the guidelines for integrative reviews and the proposed methods will adhere to the PRISMA statement checklist complemented by the ENTREQ framework. As qualitative synthesis are emergent, all procedures and changes in procedure will be documented. DISCUSSION: The review has a constructivist drive as studies that combine methods ought to be paradigmatic driven. Review questions are broad to allow issues emerge and have purposefully left the design flexible to allow for adjustments as the review progresses. The review seeks to highlight the roles that care providers play in fall prevention and their views on fall's prevention initiatives.