The environmental awareness of nurses as environmentally sustainable health care leaders: a mixed method analysis.

BACKGROUND: People worldwide are concerned with the possibility of climate change, microplastics, air pollution, and extreme weather affecting human health. Countries are implementing measures to reduce environmental impacts. Nurses play a vital role, primarily through Green Teams, in the process of promoting sustainable practices and minimizing the environmental footprint of health care facilities. Despite existing knowledge on this topic, assessing nurses' environmental awareness and behavior, including the barriers they face, is crucial with regard to improving sustainable health care practices. AIM: To analyze the environmental awareness and behavior of nurses, especially nurse leaders, as members of the Green Team and to identify areas for improvement with regard to the creation of a sustainable environment. METHODS: A sequential mixed-method study was conducted to investigate Spanish nurses. The study utilized an online survey and interviews, including participant observation. An online survey was administered to collect quantitative data regarding environmental awareness and behavior. Qualitative interviews were conducted with environmental nurses in specific regions, with a focus on Andalusia, Spain. RESULTS: Most of the surveyed nurses (N = 314) exhibited moderate environmental awareness (70.4%), but their environmental behavior and activities in the workplace were limited (52.23% of participants rarely performed relevant actions, and 35.03% indicated that doing so was difficult). Nurses who exhibited higher levels of environmental awareness were more likely to engage in sustainable behaviors such as waste reduction, energy conservation, and environmentally conscious purchasing decisions (p < 0.05). Additionally, the adjusted model indicated that nurses' environmental behavior and activities in the workplace depend on the frequency of their environmental behaviors outside work as well as their sustainable knowledge (p < 0.01). The results of the qualitative study (N = 10) highlighted certain limitations in their daily practices related to environmental sustainability, including a lack of time, a lack of bins and the pandemic. Additionally, sustainable environmental behavior on the part of nursing leadership and the Green Team must be improved. CONCLUSIONS: This study revealed that most nurses have adequate knowledge, attitudes, and behaviors related to environmental sustainability both inside and outside the workplace. Limitations were associated with their knowledge and behaviors outside of work. This study also highlighted the barriers and difficulties that nurses face in their attempts to engage in adequate environmental behaviors in the workplace. Based on these findings, interventions led by nurses and the Green Team should be developed to promote sustainable behaviors among nurses and address the barriers and limitations identified in this research.

Role of obesity and blood pressure in epicardial adipose tissue thickness in children.

BACKGROUND: Elevated body mass index (BMI) has been associated with cardiac changes, such as higher epicardial adipose tissue (EAT) thickness. This fat has been identified as a predictive factor of cardiovascular diseases during adulthood. However, few studies have tested the association of multiple cardiovascular risk factors (high weight or blood pressure) with EAT in adolescents and children. Therefore, the main objective of this current research was to determine the impact of BMI, overweight, obesity, and blood pressure on EAT thickness in children. METHODS: A descriptive cross-sectional study focused on elementary and high school students aged 6-16 years was carried out by utilizing diverse measurements and instruments, such as echocardiography. RESULTS: EAT thickness (N = 228) was linked to sex (more predominant in boys 2.3 ± 0.6; p = 0.044), obesity (2.3 ± 0.6; p < 0.001), and hypertension (2.6 ± 0.6; p = 0.036). The logistic regression indicated that age, sex, and BMI seemed to be more relevant factors in EAT thickness in children (adjusted R square = 0.22; p < 0.001). CONCLUSIONS: This paper examined the associations of sex, age, and cardiovascular risk factors (arthrometric measures and blood pressure) with EAT thickness, indicating that it is necessary to assess whether the findings are associated with future events. IMPACT: Excessive weight gain and blood pressure in the early stages of life have been associated with adipose tissue. This increase in weight and blood pressure has been attributed to alterations in the epicardial adipose tissue linked to anthropometric markers in adults, but no related study has been implemented in Spanish children. This study revealed how higher epicardial adipose tissue is linked to body mass index, other anthropometric parameters, and blood pressure in Spanish children. These measurements are related to high epicardial adipose tissue thickness, which in early stages does not imply pathology but increases the risk of developing cardiovascular diseases.

Nurses as agents for achieving environmentally sustainable health systems: A bibliometric analysis.

AIM: To analyse the current scientific knowledge and research lines focused on environmentally sustainable health systems, including the role of nurses. BACKGROUND: There seem to be differences between creating interventions focused on environmentally sustainable health systems, including nurses, and the scarcity of research on this topic, framed on the Sustainable Development Goals. METHODS: A bibliometric analysis was carried out, via three databases (Web of Science, Scopus and Pubmed), and the guideline recommendations were followed to select bibliometric data. RESULTS: The search resulted in 159 publications, significantly increasing the trends from 2017 to 2021 (p = .028). The most relevant countries in this area were the United States, the United Kingdom and Sweden. Also, the top articles were from relevant journals, indexed in Journal Citation Report, and the first and the second quartiles linked to the nursing field and citations (p < .001). CONCLUSION: Education is key to achieving environmentally sustainable health systems via institutions and policies. IMPLICATIONS FOR NURSING MANAGEMENT: There is a lack of experimental data and policies on achieving or maintaining environmentally sustainable health care systems, indicating that nurses have an important role and should be consulted and included in decision-making policies regarding sustainability in the health care systems.

The effects of obesity on longitudinal ventricular and atrial strain in a rural population of Spanish children and adolescents, evaluated by a new strain software.

BACKGROUND AND OBJECTIVES: Research on the relationship between body mass index (BMI) and strain values in children and adolescents is limited. Our aim was to analyse the relationship between BMI and strain values of both ventricles and left atrium in children and adolescents. METHODS: Both ventricles and left atrial strain values were compared among different BMI categories in children and adolescents from a town in the South of Spain. RESULTS: Of the 198 subjects, aged 6-17 years, 53% were of normal weight, 26% were overweight and 21% had obesity. Lower absolute values of left ventricular global longitudinal strain (25.9 ± 2.0% vs. 26.9 ± 2.2%, p = 0.002) and right ventricular free wall longitudinal strain (29.5 ± 4.2% vs. 30.8 ± 4.5%, p = 0.04) were found in subjects with obesity and overweight versus subjects with normal weight. A lower right ventricular four-chamber longitudinal strain was also observed in males with obesity and overweight (24.8 ± 3.3% vs. 26.4 ± 3.6%, p = 0.03). Statistically significant negative correlations of BMI were found for all ventricular, but not atrial, strain values in univariate analysis. This association turned non-significant for right ventricular four-chamber longitudinal strain in multivariate analysis. CONCLUSIONS: Utilizing this new strain software, children and adolescents with high BMI were associated with significantly lower values for left and right ventricular free wall longitudinal strain, without impact in left atrial strain.

Health Environment and Sustainable Development.

Although there are multiple definitions of sustainability, it can be defined as the balance of a species and the resources of its environment [...].

Validation of the Spanish Version of the Questionnaire on Environmental Awareness in Nursing (NEAT).

Environmental awareness of the ecological problems caused by this climate crisis and its impact on global health has been growing globally. Nurses are health care agents that usually hurt the environment and contribute to the unsustainability of the care system. Such behavior is perpetuated without the nurses' awareness and is even magnified by the current pandemic, jeopardizing the health systems and the Sustainable Development Goals. However, there is no Spanish version of any survey that measures the awareness of these agents, only the Nurses Environmental Awareness Tool (NEAT) is available. The current research presents a unique investigation based on a mixed method, using the Spanish version of the NEAT, also called NEAT-es. The results of the mixed analysis (N = 376), a cognitive interview, and descriptive analysis indicated perfect consistency (Cronbach's alpha > 0.80), better than the original. The survey validation achieved higher values and can be used to measure environmental awareness in Spain and Spanish-speaking countries.

Gamification as a Promoting Tool of Motivation for Creating Sustainable Higher Education Institutions.

Higher Educational Institutions (HEIs) are responsible for creating healthy and sustainable environments for students and teachers through diverse educational paradigms such as gamification. In this sense, the Healthy People 2030 and the Sustainable Development Goals indicated the imperative to provide inclusive and equitable quality education to promote a healthy environment and life. The principal objective was to analyse the impact of gamification on health development in HEIs, highlighting their positive and negative effects. To achieve such an objective, a bibliometric analysis was carried out. The 257 documents showed no significant increasing trend in the last decade (p > 0.05) related to the pandemic. Most of the publications were conferences (45%), and the few published articles were the documents with more citations (p < 0.001). According to their index in Journal Citation Reports, there were significant differences between the citations of articles published in journals (p < 0.001). The analysis of journal co-citations showed that the leading journals (such as Computers in Human Behavior) had a significant part in the clusters formed (p < 0.001), conditioning also the keywords, especially the term "motivation". These findings were discussed, concluding that the experimental studies focused on the teachers' adverse effects are yet to come.

A Mediterranean-Diet-Based Nutritional Intervention for Children with Prediabetes in a Rural Town: A Pilot Randomized Controlled Trial.

Prediabetes is a pathological condition in which the blood glucose concentration is higher than normal concentrations but lower than those considered necessary for a type 2 diabetes mellitus diagnosis. Various authors have indicated that the Mediterranean Diet is one of the dietary patterns with the most healthy outcomes, reducing high levels of HbA1c, triglycerides, BMI, and other anthropometric parameters. The main objective of this study was to determine the efficacy of the nutritional intervention for children with prediabetes, including the effectiveness of this nutritional education regarding anthropometric parameters. A randomized pilot trial with two groups, an experimental group (EG) and a control group (CG), using intervention in dietary habits with nutritional reinforcement was carried out on 29 children with prediabetes from a rural area. The nutritional intervention was analyzed through astrophotometric and glycemic measurements and validated surveys. Results: The results indicated improvement in eating habits, adherence to the Mediterranean diet, anthropometric measurements, mainly body mass index and perimeters, and analytical parameters, with a significant decrease in glycated hemoglobin in the EG compared to the CG (p < 0.001). Although the results showed that both groups' anthropometric parameters improved, a more significant decrease was observed in the experimental group compared to the control.

The Assessment of Myocardial Longitudinal Strain in a Paediatric Spanish Population Using a New Software Analysis.

BACKGROUND: Two-dimensional speckle-tracking echocardiography (2DSTE) has been present for years. However, it is underutilized due to the expertise and time requirements for its analysis. Our aims were to provide strain values in a paediatric Spanish population and to assess the feasibility and reproducibility of a new strain software analysis in our environment. METHODS: A cross-sectional study of 156 healthy children aged 6 to 17 years. Longitudinal strain (LS) analysis of the left ventricle, right ventricle, and left atrium was performed. Feasibility and reproducibility were assessed. The associations of clinical and echocardiographic variables with strain values were investigated by multivariate analysis. RESULTS: Mean age was 11 ± 3 years (50% female). Feasibility of LS measurement ranged from 94.2% for left ventricle global LS (LVGLS) to 98.1% for other chamber strain parameters. Strain values were 26.7 ± 2.3% for LVGLS; 30.5 ± 4.4% and 26.9 ± 4% for right ventricle free wall LS (RVFWLS) and four chambers view LS (RV4CLS) respectively; and 57.8 ± 10.5%, 44.9 ± 9.5%, and 12.9 ± 5.5% for left atrium LS reservoir phase (LALSr), conduct phase (LALScd) and contraction phase (LALSct), also respectively. Body surface area (BSA) and age presented a negative correlation with strain values. Higher values were found in females than in males, except for LALScd. Excellent intra- and inter-observer reproducibility were found for right and left ventricular strain measurement, with intraclass correlation coefficients (ICC) ranging from 0.88 to 0.98, respectively. In conclusion, we described strain values in a healthy Spanish paediatric population. LS assessment by this new strain analysis software by semi-automatic manner was highly feasible and reproducible.

Monitoring Sound and Its Perception during the Lockdown and De-Escalation of COVID-19 Pandemic: A Spanish Study.

The lockdown measures in Spain due to the SARS-CoV-2 or COVID-19 (Coronavirus disease 2019) pandemic from 13 March to 21 June 2020 had extensive social and environmental implications. This study aims to understand how the measures of lockdown have influenced noise levels, as well as people's perception of sound quality before and after lockdown, including de-escalation. For this purpose, an online survey was carried out. Moreover, the noise linked to the Global Positioning System (GPS) position of each individual respondent was recorded aiming to correlate the noise level with the result of the survey. An average reduction of over 30 dB was observed compared with the sound pressure level before lockdown. Furthermore, it was found that the loudness parameter, together with the overall level, increased as the country started relaxing restrictions. Additionally, results showed that the perception of noise quality changed depending on the phase of de-escalation (p < 0.01), the type of property (p < 0.05), and the outside noise (p < 0.01). Moreover, noise annoyance was determined considering age (p < 0.01), gender (p < 0.05), type of property (p < 0.001), and home refurbishment (p < 0.05). It may be concluded that the most important measure to decrease noise levels is the reduction of traffic noise, through using eco-friendly public transportation or bicycles and limiting nightlife hours.