Measuring moral distress in health professionals using the MMD-HP-SPA scale.

BACKGROUND: Moral distress (MD) is the psychological damage caused when people are forced to witness or carry out actions which go against their fundamental moral values. The main objective was to evaluate the prevalence and predictive factors associated with MD among health professionals during the pandemic and to determine its causes. METHODS: A regional, observational and cross-sectional study in a sample of 566 professionals from the Public Health Service of Andalusia (68.7% female; 66.9% physicians) who completed the MMD-HP-SPA scale to determine the level of MD (0-432 points). Five dimensions were used: i) Health care; ii) Therapeutic obstinacy-futility, iii) Interpersonal relations of the Healthcare Team, iv) External pressure; v) Covering up of medical malpractice. RESULTS: The mean level of MD was 127.3 (SD=66.7; 95% CI 121.8-132.8), being higher in female (135 vs. 110.3; p<0.01), in nursing professionals (137.8 vs. 122; p<0.01) and in the community setting (136.2 vs. 118.3; p<0.001), with these variables showing statistical significance in the multiple linear regression model (p<0.001; r2=0.052). With similar results, the multiple logistic regression model showed being female was a higher risk factor (OR=2.27; 95% CI 1.5-3.4; p<0.001). 70% of the sources of MD belonged to the dimension "Health Care" and the cause "Having to attend to more patients than I can safely attend to" obtained the highest average value (Mean=9.8; SD=4.9). CONCLUSIONS: Female, nursing professionals, and those from the community setting presented a higher risk of MD. The healthcare model needs to implement an ethical approach to public health issues to alleviate MD among its professionals.

Diagnostic accuracy of anthropometric indices for metabolically healthy obesity in child and adolescent population.

BACKGROUND: A variable percentage of children and adolescents with obesity do not have cardiometabolic comorbidities. A phenotype called metabolically healthy obese (MHO) has emerged to describe this population subgroup. Early identification of this condition may prevent the progression to metabolically unhealthy obesity (MUO). MATERIAL AND METHODS: A cross-sectional descriptive study of 265 children and adolescents from Cordoba (Spain) conducted in 2018. The outcome variables were MHO, established based on three criteria: International Criterion, HOMA-IR, and a combination of the previous two. RESULTS: The prevalence of MHO ranged from 9.4% to 12.8% of the study population, between 41% and 55.7% of the sample with obesity. The highest agreement was reached between the HOMA-IR definitions and the combined criteria. The waist-to-height ratio (WHtR) was the indicator with the highest discriminant capacity for MHO in 2 of the three criteria, with its best cut-off point at 0.47 for both. CONCLUSION: The prevalence of MHO in children and adolescents differed according to the criteria used for diagnosis. The anthropometric variable with the most remarkable discriminating capacity for MHO was WHtR, with the same cut-off point in the three criteria analysed. IMPACT STATEMENT: This research work defines the existence of metabolically healthy obesity through anthropometric indicators in children and adolescents. Definitions that combine cardiometabolic criteria and insulin resistance are used to identify metabolically healthy obesity, as well as the prediction of this phenomenon through anthropometric variables. The present investigation helps to identify metabolically healthy obesity before metabolic abnormalities begin.

Dosage of Physical Activity to Avoid Impairment of Activities Due to Pain: Analysis of Population-based Conditional Processes.

BACKGROUND: Physical activity's established health benefits include pain control, yet there is no consensus on the required dosage according to the literature. AIM: To test the influence of exercise on perceived health in patients whose daily activities are limited due to pain. Besides, analyze the possible moderating effect of age and find a formula for exercise dosage based on the perceived level of health. METHODS: Cross-sectional study based on the 2017 Spanish National Health Survey with 4,123 participants reporting activity limitations in their daily activities due to pain. The International Physical Activity Questionnaire (short version) was used to calculate energy expenditure. Data included age, sex, leisure-time physical activity, sitting time, pain-related impairments, pain medication, and perceived health. Mediation regression analysis was conducted using the SPSS PROCESS 4.0 macro. RESULTS: Results indicate a decline in perceived health with age. The relationship between exercise (energy expenditure) and perceived health was highly significant (d=-0.224, p<0.001). Age moderated the association between pain and energy expenditure up to 75.61 years (0.1568, p=0.05) and between energy expenditure and perceived health up to 75.74 years (-0.289, p=0.05), but this effect diminished afterwards. A formula was developed to estimate energy expenditure based on the desired level of health. CONCLUSIONS: The perception of health in people who are limited in their daily activities due to pain (moderate to very much) is mediated by the amount of physical activity they perform. Besides, this perception is moderated by age, up to 76 years.

Impact of high prebiotic and probiotic dietary education in the SARS-CoV-2 era: improved cardio-metabolic profile in schizophrenia spectrum disorders.

BACKGROUND: The development of new aetiological premises, such as the microbiota-gut-brain axis theory, evidences the influence of dietary and nutritional patterns on mental health, affecting the patient's quality of life in terms of physical and cardiovascular health. The aim was to determine the impact of a nutritional programme focused on increasing the intake of prebiotic and probiotic food on cardio-metabolic status in individuals with schizophrenia spectrum disorders in the contextual setting of the SARS-CoV-2 era. METHODS: A randomised clinical trial (two-arm, double-blind, balanced-block, six-month intervention) was conducted in a group of 50 individuals diagnosed with schizophrenia spectrum disorder during the SARS-CoV-2 confinement period. The control group received conventional dietary counselling on an individual basis. In the intervention group, an individual nutritional education programme with a high content of prebiotics and probiotics (dairy and fermented foods, green leafy vegetables, high-fibre fruit, whole grains, etc.) was established. Data on cardiovascular status were collected at baseline, three and six months. In addition, anthropometric parameters were analysed monthly. RESULTS: Forty-four subjects completed follow-up and were analysed. Statistical differences (p < 0.05) were found in all anthropometric variables at baseline and six months of intervention. A 27.4% reduction in the prevalence of metabolic syndrome risk factors in all its components was evidenced, leading to a clinically significant improvement (decrease in cardiovascular risk) in the intervention group at six months. CONCLUSIONS: The development of a nutritional programme focused on increasing the dietary content of prebiotics and probiotics effectively improves the cardio-metabolic profile in schizophrenia spectrum disorders. Therefore, nursing assumes an essential role in the effectiveness of dietary interventions through nutritional education and the promotion of healthy lifestyles. Likewise, nursing acquires a relevant role in interdisciplinary coordination in confinement contexts. TRIAL REGISTRATION: The study protocol complied with the Declaration of Helsinki for medical studies; the study received ethical approval from referral Research Ethics Committee in November 2019 (reg. no. 468) and retrospectively registered in clinicaltrials.gov (NCT04366401. First Submitted: 28th April 2020; First Registration: 25th June 2020).

Translation and cross-cultural adaptation of the Neonatal Skin Risk Assessment Scale (NSRAS) to Italian.

PURPOSE: The Neonatal Skin Risk Assessment Scale is the only tool exclusively designed for neonatal populations and it is the most recommended for neonatal skin risk assessment. To date, the NSRAS has been validated in different languages, but an Italian version was lacking. Consequently, the purpose of this study was to translate and to provide a cross-cultural adaptation of the NSRAS into Italian. METHOD: The translation and cross-cultural adaptation were conducted following an international instrument translation guideline across five steps: (1)translation, (2)forward translation review, (3)back translation, (4)back-translation review and (5)pre-test. Content validity was measured using the content validity index (CVI), calculating Aiken's coefficient, according to the opinion of an expert group. RESULTS: The final version approved by the expert committee was well understood by all nurses who participated in the study and has obtained a good face validity and content validity. Expert evaluation provided a CVI-Total of 0.92 [0.85-0.96], with Aiken V values for each item analyzed ranging between 0.85 and 0.97. CONCLUSION: The i-NSRAS is a clear, simple, relevant, and unambiguous tool. It is also updated to current knowledge on PUs and evaluates the presence of clinical devices as a risk factor in neonatal population.

Development of predictive models for nutritional assessment in the elderly.

OBJECTIVE: To propose malnutrition screening methods for the elderly population using predictive multivariate models. Due to the greater risk of nutrition deficiencies in ageing populations, nutritional assessment of the elderly is necessary in primary health care. DESIGN: This was a cross-sectional study. Multivariate models were obtained by means of discriminant analysis and binary logistic regression. The diagnostic accuracy of each multivariate model was determined and compared with the Chang method based on receiver operating characteristic curves. The optimal cut-point, sensitivity, specificity and Youden index were estimated for each of the models. SETTING: The province of Cordoba, Spain. PARTICIPANTS: Two hundred fifty-five patients over the age of 65 years from three health centres and three nursing homes. RESULTS: Fourteen models for predicting risk of malnutrition were obtained, six by discriminant multivariate analysis and eight by binary logistic regression. Sensitivity ranged from 55·6 to 93·1 % and specificity from 64·9 to 94 %. The maximum and minimum Youden indexes were 0·77 and 0·49, respectively. We finally selected a model which does not require a blood test. CONCLUSIONS: The proposed models simplify nutritional assessment in the elderly and, except for number 2 of those calculated by binary logistic regression, have better diagnostic accuracy than the Spanish version of the Mini Nutritional Assessment screening tool. The selected model, whose validation is necessary for the future with other different samples, provides good diagnostic accuracy, and it can be performed by non-medical personnel, making it an accessible, easy and rapid tool in daily clinical practice.

Economic evaluation of workplace health promotion interventions focused on Lifestyle: Systematic review and meta-analysis.

AIM: To identify and evaluate randomized clinical trials focusing on economic evaluation of workplace health promotion (WHP) interventions based on healthy lifestyles, physical activity and nutrition. DESIGN: A systematic review and meta-analysis was carried out between March and May 2019, following the PRISMA statement. DATA SOURCES: The literature search was conducted on Cochrane Library, Scopus, WOS and Medline databases. REVIEW METHODS: The quality appraisal included the overall risk of bias (Cochrane Collaboration tool), the quality of the evidence (GRADEpro) and the quality of the health economic analysis (QHES instrument). RESULTS: Of the 15 studies selected, 3 were interventions based on nutrition, 11 were focused on lifestyle and only one on physical activity. Given the heterogeneity of included studies, it was decided to do a subgroup analysis. For the weight loss (n = 5 studies), a general increase of 0.56 Kg (95% CI = 0.76, 0.84) I2  = 99.41%, and for the Quality-adjusted Life Years achieved (n = 5 studies) a very small increase of 0.003 (95% CI = 0.002, 0.004) I2  = 99.25%, were observed. CONCLUSIONS: The implementation of lifestyle interventions in the workplace has proven to be cost-effective for both employers and society. IMPACT: What problem did the study address? There are few studies aimed at evaluating the efficiency of WHP interventions. However, those that identify and assessing interventions related to lifestyle are particularly scarce, despite the evidence showing that these researchers improve the quality of care of occupational health. What were the main findings? This systematic review demonstrates the effectiveness of the WHP interventions, and in some cases, the efficiency of these interventions for both employers and society. Additional research in this area is necessary as well as the assessment of the cost-effectiveness of such interventions. Where and on whom will the research have an impact? To know the cost-benefit of different WHP interventions allows more efficient management of resources, which helps to make political and business decisions, becoming healthier and safer workplaces.

Sex-bias in the diagnosis of malnutrition in the elderly: a pilot study.

This research aimed to show that using different cutoff points for women and men in nutritional assessment through the Mini Nutritional Assessment (MNA) and different anthropometric variables, improves the diagnostic accuracy of malnutrition among people over 65 years. A cross-sectional study was carried out in a sample of 240 patients of 65 to 104 years in Córdoba (Spain) between 2013 and 2015. Excluded were those with disabling diseases that prevented informed consent. We assessed Nutritional status using the MNA and the Chang Method (Gold Standard). Global cut points per sex were determined for each independent variable using Receiver Operating Characteristic curves, choosing the best of each according to the highest Youden´s index (J). None of the variables studied showed high precision in the diagnosis of malnutrition in the elderly. Different cutoff points were found for all variables by sex, as well as variations in their validity indexes. The number of lymphocytes was more accurate in women (J = 0.58), being the muscular circumference of the arm the best in men (J = 0.8). Regarding MNA, the Long Form version showed higher sensitivity (S) in women (S = 76%) and short versions in men (S = 71% and 59%) at different cutoff points. The introduction of the sex variable seems determinant to achieve a more accurate diagnostic of malnutrition, avoiding biases derivate from a global study without considering its effect in the development of diseases.

Validation of the Impact on Family Scale (Spanish Version) and Predictive Variables in Parents of Children with Severe Food Allergy.

BACKGROUND/PURPOSE: Severe food allergies in children have serious consequences for their daily lives, but also for their families. The aim of the present study was to validate the impact on family scale (IOFS) in families of school-age children with severe food allergies (SFA) in Spain. DESIGN/METHODS: A total of 299 families from south Spain were assessed using the IOFS. A factorial analysis was conducted to analyze the construct validity. The reliability of the questionnaire was assessed using the Cronbach's alpha coefficient and the intraclass correlation coefficient. Additionally, a multivariate analysis was conducted to study the association between the impact of the illness on families and some variables. RESULTS: The internal consistency of the scale (Cronbach's alpha) was 0.87 (95% CI) and the intraclass correlation coefficient (ICC) was 0.90. Regarding the results of the IOFS, the overall average score was 61.9 (SD = 12.4). The family-social impact subscale obtained the highest score. The number of children and the number of workers within the family showed a significance that was directly proportional to the family impact. CONCLUSIONS: The Spanish version of the IOFS is a reliable and valid tool to assess the impact of severe food allergies on families. In addition, the results point out SFA as a problem with medium-high family impact and important family availability needs. PRACTICE IMPLICATIONS: The impact on families of severe food allergy of children has become evident, therefore, the healthcare staff should pay close attention to this issue and take the required measures to reduce this impact.

[Nutritional status and associated factors in ambulatory elderly patients]. / Estado nutricional y factores asociados en pacientes ancianos ambulatorios.

OBJECTIVE: To analyze the nutritional status (NS) of patients older than 65 years and establish their relationship with sociodemographic and health variables. DESIGN: Cross-sectional observational study in patients older than 65 years. LOCATION: 3 health centers. PARTICIPANTS: 255 patients: ambulatory (AP), in domiciliary care (DP) or institutionalized (IP). They completed the study 243 (response rate 95.3%). MAIN MEASUREMENTS: The Chang method was applied to determine the NS. Sociodemographic, anthropometric variables, dependence, mood, cognitive and analytical parameters were collected. Associations were analyzed applying chi-square and analysis of variance. The prevalence ratio (PR) for malnutrition was calculated. A multivariate model was applied (binary logistic regression). Significance was considered for p<0.05. RESULTS: The average age was 81.3 years (SD=7.4) and 72.0% were women. 48.9% were AP, 26.8% DP and 24.2% IP. 29.6% (95% CI: 23.9-35.8) presented malnutrition. Greater malnutrition was established in relation to living in a residence or requiring home help (PR=5.3), age over 85 (PR=4.9), presenting a moderate or higher dependency for basic activities of daily living (PR=3.9) and instrumental (PR=3.3), need help for mobility (PR=2.9) and present moderate/severe cognitive impairment (PR=2.1). The determinants of malnutrition in the multivariate model were older than 85 years old and being IP or DP. CONCLUSIONS: Emphasis should be placed on evaluating NS in patients older than 85 years of age who live in a residence or require home care, since they are the groups at greatest risk of malnutrition.

Validation (in Spanish) of the Mini Nutritional Assessment survey to assess the nutritional status of patients over 65 years of age.

AIM: To validate the Mini Nutritional Assessment (MNA) in a Spanish population over 65 years of age with varying degrees of independence. DESIGN: This cross-sectional validation study used the Chang nutritional assessment method as a reference test. PARTICIPANTS: 248 subjects (72.2% female), with a mean age of 81.3, completed the study. They were classified into three groups: (i) autonomous patients who were able to take part in activities outside their home; (ii) patients who require help with daily self-care; (iii) patients living in a residential health care facility. SETTING: Three health centres and three residential care homes situated in Cordoba (Spain). RESULTS: The kappa values for intra-observer and inter-observer agreement were 0.870 and 0.784, respectively. The intra-class correlation coefficient intra-observer was 0.874 and the inter-observer was 0.789. The sensitivity and specificity readings for the diagnostic accuracy of MNA were 63.2% and 72.9% in the total sample, respectively. The area under the curve was 0.726. For patients in the Group A, B and C, the sensitivity was 89.3%, 60.7% and 18.8%, and the specificity was 23.3%, 56.8% and 94.1%, respectively. CONCLUSION: The results for the reliability of the survey were excellent, and its internal consistency was acceptable. The diagnostic accuracy, as measured by the sensitivity and specificity readings, was lower than that obtained with the original survey. It can therefore be considered more suitable for a population with limited autonomy, and less appropriate for independent patients. The results may not be relevant to patients outside of the Cordova region in Spain.

Occupational and work-related disease underestimated and linked to temporary disability through Primary Health Care Services.

AIM: To estimate the occupational disease linked to temporary incapacity (not work-related illness). BACKGROUND: The under-reporting of occupational disease is a recognized problem in Europe. METHODS: Cross-sectional study conducted in Spanish adult population using periods of temporary incapacity recorded in primary care during 2015. Rates of occupational disease were estimated using the García & Gadea study. RESULTS: A total of 130,771 episodes of temporary incapacity were studied from 91,448 people, and 56,092 were women (61.3%). The overall prevalence rate was 2,096 and was higher in women (2,504) than in men (1,665) (p < 0.001). It was estimated that 6,580 (7.2%) could be suffering from an occupational disease. Musculoskeletal complaints were the commonest, affecting 75,165 people (82.2%). For the binary logistic regression, the dependent variable was the existence or lack of incapacity due to a musculoskeletal pathology. Age acts as a protective factor (adjusted OR = 0.978). The periods off work due to musculoskeletal complaints are lower in the first quarter of the year [OR > 1; p < 0.001]. CONCLUSIONS: 7.2% of the population was estimated to be off work due to an occupational disease. This estimate reflects the well-known under-reporting of occupational diseases which are dealt with by the Public Health System instead of specialized clinics. IMPLICATIONS FOR NURSING MANAGEMENT: The interdisciplinary role of the occupational health nurse makes it an adequate professional to detect the cases of occupational diseases in primary care settings. Occupational Health Nursing has been recognized by the managers as the most suitable professionals to carry out the screening of occupational diseases in Primary Care.

[Study of obesity in a rural children population and its relationship with anthropometric variables]. / Estudio de la obesidad en una población infantil rural y su relación con variables antropométricas.

GOALS: To know the prevalence of obesity in primary and secondary school students, and to evaluate the diagnostic accuracy of anthropometric variables for its detection. DESIGN: Cross-sectional study. LOCATION: Rural area of Córdoba. In the year 2014. PARTICIPANTS: Student population. A stratified sampling was performed according to age, gender and educational centers. A total of 323 students from 6 to 16 years were included in the study, all parents had signed informed consent. MAIN MEASUREMENTS: The prevalence of obesity was determined and sociodemographic, anthropometric, physical condition and dietary predictor variables were collected. A binary logistic regression was performed determining crude and adjusted Odds Ratio (OR) values, ROC curves were obtained and cut-off values were determined, calculating the sensitivity, specificity and Youden index. RESULTS: The prevalence of overweight and obesity was 26.2% and 22.3%, respectively. Only 15.2% of school children had an optimal Mediterranean diet. The waist-height ratio (WtHR) was the predictive variable with the highest adjusted OR 7.1 (4.3-11.6) and the largest area under the curve 0.954 (0.928-0.979), from a global cut-off value to discriminate obesity of 0.507. This gave a sensitivity of 90% and specificity of 87.2%. CONCLUSIONS: The high prevalence of obesity, the low-medium adherence to the Mediterranean diet and the low physical fitness make this population a priority target for the prevention of future cardiovascular events. The WtHR has been the best anthropometric predictor of obesity, recommending its use for the diagnosis of obesity in children at the expense of body mass index.

[Influence of the working conditions on sickness absence due to common diseases]. / Influencia de las condiciones de trabajo sobre la incapacidad temporal por contingencias comunes.

OBJECTIVE: To estimate the importance of the working environment in sickness absence, as well as to show possible relationships with clinical-work variables. DESIGN: A descriptive observational study. SITE: Medical Inspection of an Andalusian province. PARTICIPANTS: A total of 1016 workers on certified sick leave due to a common illness. MAIN MEASUREMENTS: A self-report questionnaire was used to collect demographic data, profession, activity, risk assessment, and perceived occupational cause, on patients who voluntarily gave their consent when they were reviewed during 2015. The illness that caused certified sickness absences was verified in the computerised medical records. Using criteria applied by experts, the role of working conditions in each episode of certified sick leave was assessed. Bivariate and multivariate analyses were performed to determine any relationships between the variables. RESULTS: An inadequate work environment was found in 17.1% of the sickness processes. Health and hospitality services activities have a significant association with working conditions as a cause of sick leave (P<.001). With respect to diagnosis, anxiety-depressive disorders (P<.01) and low back pain (P<.05) were associated with working conditions. The factors related to certified sickness absence and work environment were: residence (OR=0.34, 0.21-0.6), normal/higher education (OR=1.7, 1.2-2.4), (OR=2.0 1.3-3.1), large companies (OR=1.97, 1.3-2.9), and job (OR=2.7, 1.6-3, 2). CONCLUSIONS: Sickness absence is affected by factors related to the work environment. Specific preventive actions for workers at their workplace could reduce work related diseases classified as a common illness.

[Cardiovascular risk factors in the population at risk of poverty and social exclusión]. / Factores de riesgo cardiovascular en la población en situación de riesgo de pobreza y exclusión social.

GOALS: Detect if there are differences in prevalence, distribution of cardiovascular risk factors and risk according to REGICOR and SCORE's function; between people belonging to different occupational classes and population at risk of social exclusion. DESIGN: Cross-sectional. SITE: Occupational health unit of the City Hall of Córdoba. PARTICIPANTS: Sample availability of 628 people, excluding 59 by age or incomplete data. The group of municipal workers was obtained randomly while all contracted exclusion risk was taken. INTERVENTION: No preventive, diagnostic or therapeutic actions that modify the course of the previous situation of workers were applied. MAIN MEASUREMENTS: Smoke, glucose, lipids, blood pressure and BMI as main variables. T-student were used for comparison of means and percentages for Chi2. Statistical significance attached to an alpha error <5% and confidence interval with a 95% security. Receiver operator curves (ROC) were employed to find out what explanatory variables predict group membership of workers at risk of exclusion. RESULTS: Smoking (95% CI: -.224;-.443), hypercholesterolemia (95% CI: -.127;-.320), obesity (95% CI: -.005;-0.214), diabetes (95% CI: -.060;-.211) and cardiovascular risk were higher in men at risk of exclusion. In women there were differences in the same variables except smoking (P=.053). CONCLUSIONS: The existence of inequalities in prevalence of cardiovascular risk factors is checked. In a context of social crisis, health promotion and primary prevention programs directing to the most vulnerable, they are needed to mit.

Factors Associated with Nutritional Risk Assessment in Critically Ill Patients Using the Malnutrition Universal Screening Tool (MUST).

Background: Malnutrition is an underdiagnosed condition that negatively affects the clinical outcomes of patients, being associated with an increased risk of adverse events, increased hospital stay, and higher mortality. Therefore, nutritional assessment is a required and necessary process in patient care. The objective of this study was to identify the factors associated with nutritional risk by applying the Malnutrition Universal Screening Tool (MUST) scale in a population of critically ill patients. Methods: This was an observational, analytical, and retrospective study. Sociodemographic, clinical, hematological, and biochemical variables and their relationship with nutritional risk and mortality were analyzed. Results: Of 630 patients, the leading cause of admission was pathologies of the circulatory and respiratory system (50%); 28.4% were at high nutritional risk; and mortality was 11.6% and associated with nutritional risk, hemoglobin, and plasma urea nitrogen. Conclusions: The presence of gastrointestinal symptoms and the type of nutritional support received during hospitalization could increase the likelihood of presenting a medium/high nutritional risk, while polycythemia reduced this probability. An associative model was found to determine nutritional risk with an adequate specificity and diagnostic validity index.

A scale for assessing nursing students' emotional competence: A validation study.

BACKGROUND: The wellbeing of nursing professionals can be affected by emotionally challenging situations. Emotional intelligence (EI) is a recognised ability to manage stress, reduce work overload, and improve clinical relationships and decision making. Therefore, these emotional skills should be identified and developed throughout nursing education. OBJECTIVES: The aim of this study is to create an observer-based emotional measurement tool to assess the level of emotional skills in university students. DESIGN: This is a cross-sectional study. SETTING: Complutense University in Madrid, Spain. PARTICIPANTS: A total of 415 first- and fourth-year nursing students participated. METHODS: The Situational Emotional Response Scale (ERES) is a questionnaire for observing emotional competence in nursing practice. It underwent content validation using the Delphi method with 6 experts, resulting in a final version of 34 items. Focus group sessions were conducted with nursing students to ensure readability and appropriateness. Participants completed the ERES after viewing two clinical interaction videos, resulting in two sets of responses. Half of the responses were used for exploratory factor analysis (EFA) and half for confirmatory factor analysis (CFA). RESULTS: A total of 415 nursing students participated in the study. Four factors were extracted, explaining 55.1 % of the variance. The CFA was conducted with 208 students, yielding a total of 4 factors and a variance of 55.1 %. The internal consistency of the scale was high, with Cronbach's α and McDonald's ω coefficients of 0.947 and 0.949, respectively. Test-retest reliability showed a moderate intra-class correlation coefficient of 0.604 (95 % CI: 0.503-0.688) over a 15-day interval. CONCLUSIONS: The ERES questionnaire is well grounded in the theoretical framework of emotional competence as manifested in clinical practice. The empirical evidence provided by this study suggests that the ERES is a reliable, valid, useful, and innovative instrument for measuring emotional competence in university students.

Relationship between commonly defined metabolic health phenotypes and obesity with lung function in a working population: A cross-sectional study.

BACKGROUND: Four phenotypes relate metabolism and obesity: metabolically healthy (MHO) and unhealthy (MUO) people with obesity and metabolically healthy (MHNO) and unhealthy (MUNO) people without obesity. No studies have addressed the association between these categories and lung function in the working population. OBJECTIVES: The aim was to determine the relationship of phenotypes to lung ageing as measured by lung age and its relationship to lung dysfunction. METHODS: A descriptive cross-sectional study was conducted in a working population. The outcome variable was lung function assessed by lung age. The four phenotypes of obesity and metabolic health (MHNO, MHO, MUO and MUNO) were determined using NCEP-ATP III criteria. Lung dysfunctions were classified into restrictive, obstructive, and mixed patterns. RESULTS: The mean age of the participants was 43.7 years, ranging from 18 to 67 years. Of the 1860 workers, 51.3 % were women. The prevalences found were 71.4 %, 12 %, 10.6 % and 6 % for MHNO, MUO, MHO, and MUNO, respectively. MHO (ß = 0.66; p = 0.591) was not associated with increased lung ageing compared with MHNO, but MUO (ß = 7.1; p < 0.001) and MUNO (ß = 6.6; p < 0.001) were. Concerning pulmonary dysfunctions, MUNO (OR = 1.93; p < 0.001) and MUO (OR = 2.91; p < 0.001) were found to be related to the presence of a restrictive pattern, and MUNO (OR = 2.40; p = 0.028) to the mixed pattern. CONCLUSION: The results show that metabolic abnormalities, not obesity, are responsible for premature lung ageing and, therefore, lung function decline. In our study, having obesity without metabolic abnormality was not significantly associated with the presence of dysfunctional respiratory patterns.

Physical Inactivity Increases Impairment of Daily Activities Due to Pain in Workers: An Ordinal Regression Logistic and Correspondence Analysis.

Background: The evidence for the health benefits of physical activity is growing; however, the prevalence of unhealthy lifestyles continues to contribute to the increase in chronic non-communicable diseases. We know that occupational-time physical activity does not provide the same benefits as leisure-time physical activity, which has been shown to reduce mortality and pain. We also know that multiple factors influence pain; however, there are no studies that specifically analyze the impact of type of working time and occupational-time physical activity on the impairment of daily activities due to pain. We aimed to study the influence of both personal and occupational factors on the impairment of daily activities due to pain, assessing whether leisure-time physical activity acts as a protective factor. Methods: A cross-sectional, population-based design was used based on the 2017 National Health Survey in Spain (ENSE). Sociodemographic, leisure-time physical activity, and work-related variables were collected. The outcome variable was the impairment of daily activities due to pain. Ordinal logistic regression was applied, and the analysis was complemented with simple correspondence analysis. Results: A total of 1,441 workers between 18 and 65 years of age were studied. Significant differences were found between sexes for all variables except age and leisure-time physical activity. Logistic regression revealed significant associations between sex, primary and secondary education levels, no leisure-time physical activity, and overweight with impairment of daily activities due to pain. Simple correspondence analysis showed that the categories doing leisure-time physical activity several times a week as well as several times a month are closer to the categories of little or no pain. Conclusion: Female gender, low educational level, overweight, and lack of leisure-time physical activity were associated with increases in impairment of daily activities due to pain. Occupational-time physical activity and work shift were not related to impairment of daily activities due to pain. Implications for Occupational Health Practice: Occupational Health Nursing interventions through education and counseling on the importance of leisure-time physical activity promotion programs potentially can reduce the impairment of daily activities due to pain in working populations.