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

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

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

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

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

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

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

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

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

Factors Associated with Postpartum Sexual Dysfunction in Spanish Women: A Cross-Sectional Study.

(1) Background: Female sexual dysfunction (FSD) has a high prevalence globally, and perinatal factors favor FSD, especially in the postpartum period. The aim was to determine the prevalence and factors influencing FSD in the postpartum period; (2) Methods: An observational study carried out in three primary care centers in southern Spain, with women in the postpartum period who had a single low-risk birth. One hundred and seventeen women answered the Female Sexual Function questionnaire during the 4th month postpartum, between January 2020 and December 2021. Sociodemographic, obstetric, neonatal variables and level of self-esteem were analyzed. A multiple logistic regression model was carried out; (3) Results: 78.4% had high level of self-esteem. FSD prevalence was 89.7%. Factors related to FSD were having an instrumental vaginal delivery, women with university studies, and prenatal preparation. Maternal age ≥ 35, multiparity, pathological processes in the child, a medium-low level of self-esteem and newborn weight were associated with disorders in some of domains of sexual function; (4) Conclusions: FSD is highly prevalent in the postpartum period and is associated with preventable factors. A preventive approach by health professionals to these factors is essential. Health services should implement postpartum follow-up programs, which may coincide in time and place with newborn follow-up programs.

Perceptions of Gender Violence in Spanish Adolescents.

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

Individual Circadian Preference, Eating Disorders and Obesity in Children and Adolescents: A Dangerous Liaison? A Systematic Review and a Meta-Analysis.

BACKGROUND: Obesity and other eating disorders are an actual public health problem, especially in childhood and adolescents, and could be also related with chronotype. The aim of this systematic review was to determine the relationship between eating disorders, obesity and the different chronotypes in children and adolescents. METHODS: A systematic review of observational studies evaluating young populations dealing with and evaluating chronotype was conducted. Electronic searches were performed in six international databases. A qualitative thematic-categorical analysis was carried out and a random-effects model was used for the quantitative analysis (meta-analysis). RESULTS: Fifteen studies were included, but quantitative analysis was only carried out in three of them. Children and adolescents with an evening chronotype had higher body mass index, consumed more junk food or were more predisposed to suffer from food addiction and night eating syndrome. CONCLUSIONS: Children and adolescents with evening chronotype had higher tendency to incorrect eating behaviors and were suffering from overweight/obesity. Environment but also lifestyle factors should be considered in the association between chronotype and eating disorders and obesity.

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

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

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

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

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

Risky Behaviours of Spanish University Students: Association with Mediterranean Diet, Sexual Attitude and Chronotype.

The most common drugs that are consumed by young people are alcohol and tobacco, which are especially prevalent in universities. These risk behaviours can be determined by a series of intrinsic and extrinsic factors. The aim of this study was to evaluate the consumption of alcohol and tobacco by Spanish university students and the relationship between the Mediterranean diet, sexual attitudes and opinions, and chronotype. A multicentre observational study enrolled 457 students from two public universities in Spain. The study period was from December 2017 to January 2018. The majority of the participants consumed alcohol (90.2%), tobacco consumption was low (27.2%), with a high percentage of students (78.6%) having a low dependence on nicotine. The surveyed students demonstrated a high adherence to the Mediterranean diet, which was shown to be associated with less risky alcohol consumption. The Mediterranean diet is a part of healthy lifestyle, and avoiding heavy drinking results in the intention to maintain such a lifestyle. In addition, unhealthy eating habits (skipping breakfast, eating sweets and pastries daily, and fast-food consumption) had a tendency to induce risky alcohol consumption. Therefore, to promote healthy lifestyle habits, it is considered important to establish programs that promote healthy diets in university settings and to evaluate them periodically.

Capacidad predictiva de las escalas de alerta temprana en los servicios de urgencias hospitalarios: revisión sistemática y metanálisis / Predictive power of early-warning scores used in hospital emergency departments: a systematic review and meta-analysis

Objetivos: Evaluar, en términos de ingreso hospitalario o en unidad de cuidados intensivos (UCI) y muerte, la capacidad predictiva de las escalas de alerta temprana en los servicios de urgencias hospitalariOs (SUH). Método: Revisión sistemática y metanálisis. Se consultaron las bases de datos Medline, Embase, Web of Science y Cochrane Library. Se incluyeron estudios observacionales y ensayos clínicos publicados entre e 1 de enero de 1950 y 12 de junio de 2020 en los que se empleara una escala de alerta temprana en los SUH. Las variables de resultadosprincipales fueron mortalidad (24 horas, 48 horas y más de 72 horas) e ingreso hospitalario y en UCI. Resultados: Se seleccionaron 9 estudios en la revisión sistemática, 4 se incluyeron en el metanálisis (165.580 pacientes). Hubo heterogeneidad en las escalas empleadas, siendo la escala NEWS la más utilizada. El uso de la escala NEWS mostró una buena capacidad predictiva para la mortalidad a las 24 horas [AUROC 0,88 (IC 95% 0,87-0,89);p < 0,001; I2 = 0%], a las 48 horas [AUROC 0,86 (IC 95% 0,84-0,88); p < 0,001; I2 = 49,3%] e intrahospitalaria [AUROC: 0,77 (IC 95% 0,74-0,80); p < 0,001; I2 = 96,2%]. Para el ingreso hospitalario y en UCI, NEWS mostró una capacidad predictiva adecuada. Conclusiones: El uso de las escalas de alerta temprana en los SUH muestra una capacidad predictiva buena en términos de mortalidad temprana e intrahospitalaria. (AU)

Objectives: To assess the predictive power of scores used in hospital emergency departments (EDs) to give early warning of risk for mortality and hospital ward or intensive care unit (ICU) admission. Material and methods: Systematic review and meta-analysis. We searched MEDLINE, Embase, the Web of Science, and the Cochrane Library. Observational studies and clinical trials published between January 1, 1950, and June 12, 2020 that used early-warning scores in hospital EDs were included. The main outcomes were mortality (at 24, 48, and more than 72 hours), hospital admission, and ICU admission. Results: Nine studies entered into the systematic review; 4 of them, with 165 580 patients, were included in the meta-analysis. The studies were heterogeneous with respect to the scores used. The one used most often was the National Early Warning Score (NEWS). The meta-analysis of studies using the NEWS scale showed that it had good predictive power for mortality: the area under the curve (AUC) of the receiver operating characteristic was 0.88 (95%, CI, 0.87-0.89; P .001, I2 = 0%) at 24 hours and 0.86 (0.84-0.88; P .001; I2 = 49.3%) at 48 hours. The AUC for inhospital mortality was 0.77 (95% CI, 0.74-0.80; P .001; I2 = 96.2%). The NEWS score had adequate power for predicting risk of hospital ward and ICU admission. Conclusion: Early warning scores used in hospital EDs are able to predict risk of early and in-hospital mortality. (AU)

Transferencia de los resultados de investigación al aula: registros de incidencias de las caídas / Transferring research results to the classroom: Fall incidence records

Antecedentes: Los registros completos y correctos de los eventos de caídas ayudan a implementar las medidas de prevención. Sin embargo, existe un desconocimiento entre el personal de salud sobre la existencia de un sistema de registro o la necesidad de registrar dichos eventos. El propósito de este estudio fue que los estudiantes de Enfermería realizaran registros de calidad de los eventos de caída y, en consecuencia, desarrollar e implementar un sistema de registro de incidentes de caída de pacientes (REOC) para su uso durante las prácticas clínicas de los estudiantes de enfermería. Método: La investigación-acción participativa (análisis de incidentes críticos) se llevó a cabo en una Facultad de enfermería del sur de España y su hospital de referencia. Entre otras variables, se evaluó la implementación del REOC (intervención), la complejidad de los registros y los resultados de aprendizaje de los estudiantes. Resultados: El instrumento de registro tuvo un impacto significativo en los resultados sanitarios de los pacientes. El REOC fue de complejidad media (42,9%) y baja (42,9%), mientras que el 71,4% adquirió nuevas habilidades a través de la implementación. Los resultados de aprendizaje fueron de nivel medio en el 71,5% de los casos y positivos en el 28,6%. Implicaciones para la práctica: El proyecto propuesto es un ejemplo de una experiencia de innovación-investigación-innovación llevada a cabo en un entorno de enseñanza-aprendizaje utilizando un proceso cíclico de transferencia de conocimientos y retroalimentación. (AU)

Predictive power of early-warning scores used in hospital emergency departments: a systematic review and meta-analysis. / Capacidad predictiva de las escalas de alerta temprana en los servicios de urgencias hospitalarios: revisión sistemática y metanálisis.

OBJECTIVES: To assess the predictive power of scores used in hospital emergency departments (EDs) to give early warning of risk for mortality and hospital ward or intensive care unit (ICU) admission. MATERIAL AND METHODS: Systematic review and meta-analysis. We searched MEDLINE, Embase, the Web of Science, and the Cochrane Library. Observational studies and clinical trials published between January 1, 1950, and June 12, 2020 that used early-warning scores in hospital EDs were included. The main outcomes were mortality (at 24, 48, and more than 72 hours), hospital admission, and ICU admission. RESULTS: Nine studies entered into the systematic review; 4 of them, with 165 580 patients, were included in the meta-analysis. The studies were heterogeneous with respect to the scores used. The one used most often was the National Early Warning Score (NEWS). The meta-analysis of studies using the NEWS scale showed that it had good predictive power for mortality: the area under the curve (AUC) of the receiver operating characteristic was 0.88 (95%, CI, 0.87-0.89; P .001, I2 = 0%) at 24 hours and 0.86 (0.84-0.88; P .001; I2 = 49.3%) at 48 hours. The AUC for inhospital mortality was 0.77 (95% CI, 0.74-0.80; P .001; I2 = 96.2%). The NEWS score had adequate power for predicting risk of hospital ward and ICU admission. CONCLUSION: Early warning scores used in hospital EDs are able to predict risk of early and in-hospital mortality.

OBJETIVO: Evaluar, en términos de ingreso hospitalario o en unidad de cuidados intensivos (UCI) y muerte, la capacidad predictiva de las escalas de alerta temprana en los servicios de urgencias hospitalarios (SUH). METODO: Revisión sistemática y metanálisis. Se consultaron las bases de datos Medline, Embase, Web of Science y Cochrane Library. Se incluyeron estudios observacionales y ensayos clínicos publicados entre e 1 de enero de 1950 y 12 de junio de 2020 en los que se empleara una escala de alerta temprana en los SUH. Las variables de resultados principales fueron mortalidad (24 horas, 48 horas y más de 72 horas) e ingreso hospitalario y en UCI. RESULTADOS: Se seleccionaron 9 estudios en la revisión sistemática, 4 se incluyeron en el metanálisis (165.580 pacientes). Hubo heterogeneidad en las escalas empleadas, siendo la escala NEWS la más utilizada. El uso de la escala NEWS mostró una buena capacidad predictiva para la mortalidad a las 24 horas [AUROC 0,88 (IC 95% 0,87-0,89); p 0,001; I2 = 0%], a las 48 horas [AUROC 0,86 (IC 95% 0,84-0,88); p 0,001; I2 = 49,3%] e intrahospitalaria [AUROC: 0,77 (IC 95% 0,74-0,80); p 0,001; I2 = 96,2%]. Para el ingreso hospitalario y en UCI, NEWS mostró una capacidad predictiva adecuada. CONCLUSIONES: El uso de las escalas de alerta temprana en los SUH muestra una capacidad predictiva buena en términos de mortalidad temprana e intrahospitalaria.

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

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

Chronotype, general health and quality of sleep in a population of Spanish nurses.

OBJECTIVE: The aim of this study was to investigate the association between chronotype, general health status and sleep quality in a sample of Spanish nurses. METHOD: An observational study assessing morningness-eveningness predisposition, general health status and quality of sleep was conducted between January and April 2018. Univariate and multivariate analyses were performed. A linear regression model was carried out to determine the influence of the variables on the morningness-eveningness type. RESULTS: Morning-type was associated with aging (ß = 0.249, p = 0.005), being married (ß = 3.970, p = 0.033), and with a self-assessed low daily sleepiness (ß = -0.311, p = 0.152). Good quality of sleep was moderately correlated with high values of general health (r = 0.337) and perceived quality of life (r = 0.426). CONCLUSION: Anomalies of the circadian rhythm together with the features of shift workers may play an important role in predicting self-assessed general health status or the quality of sleep in nurses.

Google Trends on Obesity, Smoking and Alcoholism: Global and Country-Specific Interest.

Unhealthy habits or lifestyles, such as obesity, smoking, and alcohol consumption, are involved in the development of non-communicable diseases. The aim of this study was to analyze different communities' interest in seeking obesity, smoking, and alcohol-related terms through relative search volumes (RSVs) of Google Trends (GT). Internet search query data on obesity, smoking, and alcohol-related terms were obtained from GT from the period between 2010 and 2020. Comparisons and correlations between different topics were calculated considering both global searches and English-, Spanish-, and Italian-speaking areas. Globally, the RSVs for obesity and alcohol-related terms were similar (mean RSVs: 76% and 77%), but they were lower for smoking (65%). High RSVs were found in winter for obesity and smoking-related terms. Worldwide, a negative correlation was found between alcohol and smoking terms (r = -0.72, p < 0.01). In Italy, the correlation was positive (r = 0.58). The correlation between obesity and alcohol was positive in all the cases considered. The interest of global citizens in obesity, smoking, and alcohol was high. The RSVs for obesity were globally higher and correlated with alcohol. Alcohol and smoking terms were related depending on the area considered.

Ácido tranexámico en el traumatismo craneoencefálico: a propósito del ensayo CRASH-3 / Tranexamic acid for head injuries: on the CRASH-3 trial

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Association between Birth Plan Use and Maternal and Neonatal Outcomes in Southern Spain: A Case-Control Study.

BACKGROUND: Birth plans are used for pregnant women to express their wishes and expectations about childbirth. The aim of this study was to compare obstetric and neonatal outcomes between women with and without birth plans. METHODS: A multicentre, retrospective case-control study at tertiary hospitals in southern Spain between 2009 and 2013 was conducted. A total of 457 pregnant women were included, 178 with and 279 without birth plans. Women with low-risk gestation, at full-term and having been in labour were included. Sociodemographic, obstetric and neonatal variables were analysed and comparisons were established. RESULTS: Women with birth plans were older, more educated and more commonly primiparous. Caesarean sections were less common in primiparous women with birth plans (18% vs. 29%, p = 0.027); however, no significant differences were found in instrumented births, 3rd-4th-degree tears or episiotomy rates. Newborns of primiparous women with birth plans obtained better results on 1 min Apgar scores, umbilical cord pH and advanced neonatal resuscitation. No significant differences were found on 5 min Apgar scores or other variables for multiparous women. CONCLUSIONS: Birth plans were related to less intervention, a more natural process of birth and better outcomes for mothers and newborns. Birth plans can improve the welfare of the mother and newborn, leading to birth in a more natural way.

Characteristics of the Spanish Older People in the Use of Accidents and Emergency Unit Services (2014-2017).

The aim of this study was to determine which factors are related to Accidents and Emergency Unit (AEU) use by the elderly Spanish population. Observational analysis of the 2014 European Survey of Health in Spain (ESHS-2014; N = 6,520) and the 2017 Spanish Health Survey (SHS-2017; N = 7,024) was employed. About one third (4,095, 30.2%) of the sample used the AEU, and they were primarily women (32.6%). Comorbidity (p = .01), presence of physical limitation in the prior 6 months to the survey, and a history of several diseases (p < .001)-as in diabetes (p < .001), osteoarthritis (p < .001), and chronic bronchitis, emphysema, or chronic obstructive pulmonary disease (p < .001)-were associated with AEU visits in both surveys. Female sex and several cardiovascular diseases were only significant in the ESHS-2014. In the SHS-2017, depressive status was an independent risk factor. This epidemiological data allow a better understanding of the use of AEU, suggesting indications for the care process.