Satisfaction of basic psychological needs and European entrepreneurs' well-being and health: The association with job satisfaction and entrepreneurial motivation.

PURPOSE: We examine an integrative model associating entrepreneurial motivation and job satisfaction with basic psychological needs satisfaction and the psychological well-being (PWB) and health problems of European entrepreneurs. In contrast with previous literature that focuses mainly on hedonic well-being, this study examines well-being by using a eudaimonic perspective and the link between entrepreneurial motivation and entrepreneurs' PWB. DESIGN/METHODOLOGY/APPROACH: Based on the self-determination theory (SDT) and using structural equation modeling, this study examines a European representative sample composed of 7,878 entrepreneurs from the sixth European Working Conditions Survey (6th EWCS; Eurofound [2015] database). FINDINGS: This study finds a positive relationship between the satisfaction of the need for autonomy and competence and opportunity motivation, which in turn is positively associated with job satisfaction. This study also finds that need satisfaction is positively associated with entrepreneurs' PWB and job satisfaction, which in turn is positively associated with entrepreneurs' PWB and health. Results highlight the relevance of SDT, opportunity motivation, and job satisfaction to understanding entrepreneurs' PWB and health. ORIGINALITY: To the best of our knowledge, this is the first integrative model relating satisfaction of basic psychological needs (autonomy and competence) and diverse individual outcomes related to work (job satisfaction, PWB, and health) of European entrepreneurs by considering entrepreneurial motivation. This study examines a large and representative European sample, in contrast with previous research focusing on the Anglosphere nations.

The association between family dynamics and Positive Youth Development in secondary education students.

INTRODUCTION: The Positive Youth Development (PYD) framework is a strengths-based approach to adolescence that states that adolescents will thrive if nurtured by the right developmental assets. The family is one of the most important developmental assets, but studies about the relationship between family dynamics and the overall PYD of adolescents are scarce. OBJECTIVE: The present study aims to examine the associations between five family dynamics indicators and PYD, while taking into account the role of gender. METHODS: A cross-sectional study was carried out with a representative sample of adolescents from the city of Huelva, Spain (n = 1,036). Data were collected in 14 randomly selected secondary education schools. A Structural Equation Model (SEM) was tested to determine the effect of family dynamics on PYD, both for the whole sample and within each gender. RESULTS: The SEM for the whole sample showed a positive effect of the family dynamics factor on the PYD factor, explaining 51.8% of its variance. The indicators of satisfaction with the relationship with the mother, satisfaction with the relationship with the father, frequency of engaging in joint family activities on weekends, and frequency of sharing daily occurrences at home showed factor loadings over 0.50, while the indicator of frequency of contribution to household chores had the lowest loading. The family dynamics factor in the model with the subsample of girls explained 54.8% of the variance in PYD, while in the SEM with the subsample of boys this factor explained 47.6% of it. Additionally, among girls, the relative influence of satisfaction in the relationship with the parents, as well as of frequently discussing the day at home, is higher than among boys. CONCLUSION: These results highlight a strong association between family dynamics indicators and PYD among adolescents and indicate that this relationship is stronger for girls than for boys. Intersectoral policies enhancing improvements in family dynamics (e.g., facilitating the practice of joint family activities on weekends) may have a relevant impact on PYD.

The socio-demographic profile associated with perinatal depression during the COVID-19 era.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has caused an increase in perinatal depression. The aim of this research was to identify which sociodemographic variables are related to the increase in perinatal depression due to the pandemic. In addition to estimating to what extent they predict perinatal depression, differentiating the prenatal and postnatal periods. METHODS: The sample consisted of 3,356 subjects, 1,402 in the prenatal period and 1,954 in the postnatal period. The Edinburgh Postnatal Depression Scale was used to assess depressive symptomatology. A subset of 14 questions was included to collect demographic data. Items from the Spanish version of the Coronavirus Perinatal Experiences Survey were also included. RESULTS: Experiencing the change of environment due to COVID-19 as negative and having a history of mental health predict perinatal depression, otherwise having higher education decreases the risk. In the prenatal stage having symptoms compatible with COVID-19 is a predictor of perinatal depression and having more than 3 years living together with the partner and being a housewife decreases the risk. In the postnatal stage being unemployed is a predictor of prenatal depression and being a first-time mother decreases the risk. CONCLUSIONS: This study highlights the relevance of sociodemographic status. It is essential to be aware of the risk factors of perinatal depression, to make adequate prevention, and to create health policies to alleviate the consequences of the pandemic.

Relationship between social support and perinatal depression during the COVID-19 pandemic.

AIMS/BACKGROUND: This research aimed to identify the sources of social support and its relationship with perinatal depression (PPD) during the coronavirus (COVID-19) pandemic. DESIGN/METHODS: We carried out a cross-sectional study with a sample of 3,356 women during perinatal period living in Spain. We used five items from the Spanish version of the Coronavirus Perinatal Experiences - Impact Survey to assess the impact of COVID-19 on social support and, the Edinburgh Postnatal Depression Scale was used to assess depressive symptomatology. RESULTS: The results obtained identified a possible relationship between seeking in-person support (OR = 0.51; 0.67, during pregnancy and after delivery respectively) and degree of feeling social support (OR = 0.77; 0.77) during the COVID-19 pandemic with a lower prevalence of depression. Otherwise, requiring the help of a mental health professional (OR = 2.92; 2.41) and weeks of confinement (OR = 1.03; 1.01) appeared to be associated with a higher prevalence of depression. During pregnancy, a possible association was found between the degree of concern about future changes in support and involvement of family and friends (OR = 1.75) with a higher prevalence of depression. On the other hand, in the postpartum period, there seems to be a relationship between seeking social support through social media (OR = 1.32) with a higher prevalence of depression and receiving support from friends (OR = 0.70) and health professionals (OR = 0.53) with a lower prevalence of depression. CONCLUSION: These results highlighted the importance of protecting perinatal mental health during the COVID-19 pandemic by protecting and developing social support networks.

The influence of lifestyles to cope with stress over mental health in pregnant and postpartum women during the COVID-19 pandemic.

The COVID-19 pandemic affected daily life routines and lifestyles of pregnant and postpartum women and increased their stress and risk of suffering from mental health problems. The aim of this study was to analyse which sociodemographic variables, COVID-19 exposure variables and lifestyles to cope with stress variables predicted anxiety, depression, and PTSD symptoms in pregnant and postpartum women during the COVID-19 pandemic. A cross-sectional design was performed with a sample of 3356 Spanish women participating in the Riseup-PPD-COVID-19 study. These participants completed an online survey composed of measures of anxiety (GAD-7), depression (EPDS), and PTSD related to COVID-19 (Checklist DSM-5), as well as demographics, exposure to COVID-19, and lifestyles to cope with stress. Regarding results, 47.2% showed depression and a third reported anxiety, whereas moderate scores were observed in PTSD symptoms. The most commonly used strategies to cope with stress in the COVID-19 pandemic were talking with friends and family and increasing time with social networks. Better results in mental health were associated with coping strategies such as talking with family and friends or participating in family activities, physical activity, sleeping well at night, eating healthier, and increasing personal care. Furthermore, poor results in mental health were observed in those participants who increased time with screens, ate fast food, reported substance use, and talked more frequently with health professionals. More symptoms were also observed in younger women, primiparous women, and those who reported more exposure to COVID-19. The results underline the need to strengthen the mental health of pregnant and postpartum women. Trial registration: ClinicalTrials.gov Identifier: NCT04595123.

Impact of the Covid-19 pandemic on perinatal mental health (Riseup-PPD-COVID-19): protocol for an international prospective cohort study.

BACKGROUND: Corona Virus Disease 19 (COVID-19) is a new pandemic, declared a public health emergency by the World Health Organization, which could have negative consequences for pregnant and postpartum women. The scarce evidence published to date suggests that perinatal mental health has deteriorated since the COVID-19 outbreak. However, the few studies published so far have some limitations, such as a cross-sectional design and the omission of important factors for the understanding of perinatal mental health, including governmental restriction measures and healthcare practices implemented at the maternity hospitals. Within the Riseup-PPD COST Action, a study is underway to assess the impact of COVID-19 in perinatal mental health. The primary objectives are to (1) evaluate changes in perinatal mental health outcomes; and (2) determine the risk and protective factors for perinatal mental health during the COVID-19 pandemic. Additionally, we will compare the results between the countries participating in the study. METHODS: This is an international prospective cohort study, with a baseline and three follow-up assessments over a six-month period. It is being carried out in 11 European countries (Albania, Bulgaria, Cyprus, France, Greece, Israel, Malta, Portugal, Spain, Turkey, and the United Kingdom), Argentina, Brazil and Chile. The sample consists of adult pregnant and postpartum women (with infants up to 6 months of age). The assessment includes measures on COVID-19 epidemiology and public health measures (Oxford COVID-19 Government Response Tracker dataset), Coronavirus Perinatal Experiences (COPE questionnaires), psychological distress (BSI-18), depression (EPDS), anxiety (GAD-7) and post-traumatic stress symptoms (PTSD checklist for DSM-V). DISCUSSION: This study will provide important information for understanding the impact of the COVID-19 pandemic on perinatal mental health and well-being, including the identification of potential risk and protective factors by implementing predictive models using machine learning techniques. The findings will help policymakers develop suitable guidelines and prevention strategies for perinatal mental health and contribute to designing tailored mental health interventions. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04595123 .

Socioeconomic Inequalities in Health Through Lifestyles: Analysing Gender and Age Differences in Andalusia, Spain.

This research aims to analyse the association between socioeconomic status (SES) and self-rated health (SRH) through its relationship with lifestyle factors, as well as examining these effects stratified by gender and age groups. A cross-sectional study was performed with a representative sample from Andalusia (Southern Spain) composed of 1200 adults. The study analysed several variables related to lifestyle (healthy diet, physical activity and tobacco and alcohol consumption) and SES (education and income), along with SRH. The joint effects of SRH and the set of variables were studied by using a hierarchical linear regression analysis. Later a path analysis was carried out to test the impact of gender and age group on these associations. The results show that a better SRH was reported by men with lower age, higher SES, more frequent physical activity, healthy diet, and lower alcohol use compared with their counterparts. Income was directly related to better SRH through more physical activity, a healthier diet and less alcohol consumption. SES had a greater positive relationship with women's health than with men's health. In addition, a greater explained variance in SRH was observed in older women based on SES and lifestyle factors. Our findings provide some cross-sectional evidence of the social inequalities in health mediated through lifestyle factors, with gender and age differences. Therefore, socioeconomic inequalities should be addressed by public and social policies considering the gender and age gaps.

Pornography Influence Among Young Students: Adaptation and Validation of Pornography Consumption Inventory into Spanish.

This manuscript intends to adapt and validate Pornography Consumption Inventory (PCI) into Spanish in a sample of 211 young students who admitted to consume pornography. They completed a questionnaire that referred to sociodemographic characteristics, sexual behavior and PCI. Results showed a factorial structure of the scale with good data fit, composed of 13 items divided into three dimensions, i.e., emotional avoidance, sexual curiosity, and excitement seeking and sexual pleasure. These factors were positively interrelated and presented excellent internal consistency reliability. Some gender differences were observed, so that men presented higher scores in the three dimensions than women.

Health-related quality of life in undergraduate women using any contraceptive.

OBJECTIVE: The aim of this research was to assess university students' health-related quality of life whether they use some contraceptive method or not. METHODS: This research is a cross-sectional study. Female participants who studied a degree in health at the University of Seville (Spain) were recruited. Respondents completed a demographic questionnaire and health-related quality of life was measured with validated instrument SEC-QoL (Sociedad Española de Contracepción- Quality of Life) in Spanish that measured five dimensions: sexual, social, breast, menstrual and psychosocial. RESULTS: A total of 992 women aged 21.37 (3.6) years old participated in this study. Women who used a contraceptive method reached higher scores at the SEC-QoL questionnaire 47.09 (17.04) and 46.91 (18.73) than those that didn't. Likewise, women who chose a hormonal method showed a better overall health-related quality of life, compared to those who used a non-hormonal method. Participants who used hormonal contraceptives obtained higher scores in all health-related quality of life domains (social, menstrual, breast and sexual), except psychological domain when compared to those who used a non hormonal method or none. Furthermore, a moderated mediation model showed that the effect of the current contraceptive method on health-related quality of life was partially explained by the moderated mediation of the time using this method, the reason for using it and the existence of a partner. CONCLUSION: The usage of hormonal contraceptives increases health-related quality of life in young women. Several variables regarding the experience with contraceptive methods should be considered in order to examine the effect on health-related quality of life in undergraduate women.

Positive youth development, thriving and social engagement: An analysis of gender differences in Spanish youth.

The framework of Positive Youth Development (PYD) arose from a strength-based conception of the transition to adulthood. Although previous literature has provided evidence for some PYD correlates, little is known about gender differences in PYD and its outcomes in thriving and social engagement, which could improve interventions" effectiveness. Thus, this study aimed to examine gender differences in PYD dimensions (i.e., competence, confidence, connection, caring, and character), individual thriving (i.e., psychological adjustment, academic adjustment, and healthy lifestyles) and social engagement, and to examine the associations between them. Data from the 'PYD in a Cross-National Perspective Project" in Spain were collected by administering a paper-based self-report to students from high school and university. Results showed greater scores in connection, caring, and character in women, as well as greater social engagement and academic adjustment. Men presented higher competence and confidence, more frequent physical activity and better psychological adjustment. In addition, more PYD was related to greater social engagement, better psychological and academic adjustment, and healthier lifestyles. Some practical implications for program design may be derived, which underscore the need to promote the five PYD dimensions equally in female and male youths in order to improve their individual thriving and social engagement.

Responses to positive affect, life satisfaction and self-esteem: A cross-lagged panel analysis during middle adolescence.

During middle adolescence, elevated stress and a greater presence of psychological disorders have been documented. The research has paid little attention to the regulation of positive affective states. Fredrickson's broaden-and-build theory suggests that cultivating positive emotions helps to build resources that boost well-being. The current research aimed to examine the longitudinal associations between responses to positive affect (emotion-focused positive rumination, self-focused positive rumination, and dampening) and psychological adjustment (self-esteem and life satisfaction) during middle adolescence. A longitudinal study with two waves separated by one year was conducted, assessing 977 adolescents (M = 13.81, SD = 0.79; 51.5% boys) with self-report measures. A cross-lagged panel analysis was performed by including within the same model the relationships between all of the variables in the two assessment points. The results indicated cross-lagged positive relationships of self-focused positive rumination with both self-esteem and life satisfaction, while dampening showed a negative cross-lagged relationship with self-esteem. Moreover, higher self-esteem predicted more emotion-focused positive rumination, and more dampening predicted lower life satisfaction. Thus, the use of adaptive responses to positive affect and a better psychological adjustment were found to be prospectively interrelated at the one-year follow-up during middle adolescence. The discussion argues for the need to implement programmes to promote more adaptive responses to positive affect to enhance psychological adjustment in the adolescent transition to adulthood.

A two-year longitudinal study of gender differences in responses to positive affect and depressive symptoms during middle adolescence.

This study aimed to analyze the prospective associations during adolescence between depressive symptoms and response styles to positive affect and to examine gender differences. A longitudinal study was conducted with three waves separated by 1 year each to assess a non-clinical sample of 622 Spanish adolescents who were 13 and 14 years old (50.2% boys, 49.8% girls). The participants completed self-report measures of depressive symptoms and responses to positive affect (emotion-focused positive rumination, self-focused positive rumination and dampening of positive emotion). The results showed that the increase in depressive symptoms was associated with an increase in dampening and decreases in emotion-focused and self-focused positive rumination. Furthermore, girls presented more depressive symptoms, as well as higher dampening and lower self-focused positive rumination, than boys. The conclusions highlight the need to consider responses to positive affect in explaining gender differences in depressive symptoms during mid-adolescence, as well as in designing prevention programs.

A scoping review of the research evidence of the developmental assets model in Europe.

Introduction: Positive Youth Development (PYD) is a strength-based perspective that focuses on the resources to promote a successful transition to adulthood, derived from the Relational Developmental Systems theory. In this line, the Developmental Assets (DA) model focuses on describing the personal resources (Internal Assets) and contextual resources (External Assets) that help to reach PYD. Most research from this approach has been carried out in United States and, to a lesser extent, in the European continent. The aim of this scoping review was to examine the evidence collected for the DA model in Europe. Methods: Web of Science database was used to search for articles published between 2013 and February 2024. Initially, there were 55 possible articles to be included, but after applying the exclusion criteria, this number was reduced to 11. Results: The findings suggested that the evidence for DA in Europe was in line with North American research, so that a higher presence of DA was related to higher well-being, better psychological adjustment, and lower risk behaviors. Internal Assets were the most influential assets, with the Positive Identity category being especially remarkable. Commitment to Learning and Social Competencies were also highlighted in the studies included in the review. Concerning External Assets, Positive Boundaries-expectations and Empowerment were emphasized as protective factors in youth development. These assets were found to present a protective effect against risk behaviors and were positively associated with PYD and socioemotional skills. Discussion: Thus, these findings support the applicability of the DA framework in promoting PYD in European context, and some intervention strategies are discussed considering cultural diversity.

Effectiveness of a Postpartum Breastfeeding Support Group Intervention in Promoting Exclusive Breastfeeding and Perceived Self-Efficacy: A Multicentre Randomized Clinical Trial.

There are numerous recognized benefits of breastfeeding; however, sociocultural, individual, and environmental factors influence its initiation and continuation, sometimes leading to breastfeeding rates that are lower than recommended by international guidelines. The aim of this study was to evaluate the effectiveness of a group intervention led by midwives supporting breastfeeding during the postpartum period in promoting exclusive breastfeeding, as well as to assess the impact of this intervention on perceived self-efficacy. This was a non-blind, multicentric, cluster-randomized controlled trial. Recruitment started October 2021, concluding May 2023. A total of 382 women from Andalusia (Spain) participated in the study. The results showed that at 4 months postpartum there was a higher prevalence of breastfeeding in the intervention group compared to formula feeding (p = 0.01), as well as a higher prevalence of exclusive breastfeeding (p = 0.03), and also at 6 months (p = 0.01). Perceived self-efficacy was similar in both groups for the first two months after delivery, which then remained stable until 4 months and decreased slightly at 6 months in both groups (p = 0.99). The intervention improved the average scores of perceived self-efficacy and indirectly caused higher rates of exclusive breastfeeding (p = 0.005). In conclusion, the midwife-led group intervention supporting breastfeeding proved to be effective at maintaining exclusive breastfeeding at 6 months postpartum and also at increasing perceived self-efficacy.

Evaluation of the Impact of a Midwife-Led Breastfeeding Group Intervention on Prevention of Postpartum Depression: A Multicentre Randomised Clinical Trial.

Postpartum depression is a significant health issue affecting both mothers and newborns during the postpartum period. Group support interventions during this period have proven effective in helping women cope with depression and improving breastfeeding rates. This study aimed to assess the effectiveness of a midwife-led breastfeeding support group intervention on breastfeeding rates, postpartum depression and general self-efficacy. This was a multicentric cluster randomised controlled trial with control and intervention groups and was not blinded. It was conducted in Andalusia (southern Spain) from October 2021 to May 2023. A total of 382 women participated in the study. The results showed a significant difference in exclusive breastfeeding rates at 4 months postpartum between the groups (control 50% vs. intervention 69.9%; p < 0.001). Additionally, there was a lower mean score on the Edinburgh Postnatal Depression Scale in the intervention group (12.49 ± 3.6 vs. 13.39 ± 4.0; p = 0.044). Similarly, higher scores of general self-efficacy were observed among breastfeeding women at 2 and 4 months postpartum (77.73 ± 14.81; p = 0.002 and 76.46 ± 15.26; p < 0.001, respectively). In conclusion, midwife-led breastfeeding support groups enhanced self-efficacy, prolonged breastfeeding and reduced postpartum depression 4 months after giving birth.

Psychometric Properties of the Online Version of the General Anxiety Disorder-7 (GAD-7): A Longitudinal Study in Pregnant and Postpartum Spanish Women.

BACKGROUND: The use of online questionnaires to assess common mental disorders such as perinatal anxiety has spread due to the proliferation of Internet-based psychological interventions and research. This study analyses the validity and reliability of the online version of the Generalized Anxiety Disorder-7 (GAD-7) in a sample of pregnant and postpartum Spanish women. METHOD: A total of 3082 pregnant ( = 1260) and postpartum ( = 1822) women were recruited via the Internet and underwent three follow-up evaluations during a six-month period. RESULTS: A one-factor solution was assigned by Exploratory Factor Analysis and confirmed by Confirmatory Factor Analysis for both pregnant (CFI = 0.998; RMSEA = 0.035) and postpartum (CFI = 0.998; RMSEA = 0.038) women. The one-factor model showed strict invariance across groups. Validity was confirmed by assessing correlations between GAD-7, the Edinburgh Postnatal Depression Scale, and the 10-item Posttraumatic Stress Disorder checklist at three time points. The reliability coefficient was .92 for the two groups. CONCLUSIONS: This study shows that the Spanish online GAD-7 version has good psychometric properties and can be used to assess anxiety symptoms during the perinatal period.

Neuropsychological Stimulation Program for Children from Low Socioeconomic Backgrounds: Study Protocol for a Randomized Controlled Trial.

BACKGROUND: Guatemala remains one of the poorest countries in Central America and suffers from high rates of social inequality and violence. In addition to the negative impact that two years without attending school has had on Guatemalan children due to the consequences of the COVID-19 pandemic, this unfavourable socioeconomic context poses a risk to children's emotional and cognitive development. This work presents a protocol for implementing a cognitive and emotional stimulation program aimed at increasing the academic performance of these children and consequently improving their quality of life. METHODS: The protocol proposes the implementation of a randomized controlled trial to assess the efficacy of a 24-session-long stimulation program. It targets the cognitive functions of attention, language, executive functions, and social cognition, using the digital neurorehabilitation platform NeuronUP. The participants (n = 480) will be randomly assigned to an Experimental or Control group. Pre- and post-intervention assessments will be carried out, together with a follow-up in the next academic year, in which both groups will change roles. Results will be compared for the first and second years, looking for differences in academic and cognitive performance between groups. DISCUSSION: Mid- and long-term outcomes are still unknown, but effective interventions based on this protocol are expected to facilitate the following benefits for participants: (1) improved cognitive and emotional development; (2) improved academic performance; (3) improved well-being. We expect to create a validated neuropsychological stimulation program that could be applied in similar socioeconomically disadvantaged contexts around the world to help these children improve their life chances.

The Importance of the 5Cs of Positive Youth Development to Depressive Symptoms: A Cross-Sectional Study with University Students from Peru and Spain.

BACKGROUND: Prior research has documented the protective role of the 5Cs of Positive Youth Development (PYD) on adjustment problems, such as depressive symptoms. Nonetheless, more research is needed, especially in non-US contexts. The main objective of the present study was to assess associations between the 5Cs and depressive symptoms in Peru and Spain, considering gender differences across contexts. METHODS: Cross-sectional data was collected from undergraduate students from Peru [n = 250] and Spain [n = 1044]. RESULTS: The results revealed significant negative associations of Competence, Confidence, Character and Connection with depressive symptoms, while Caring was positively and significantly related to depressive symptoms in both samples. Regarding gender differences, female undergraduates in both samples reported high levels of Caring, while Competence was predominant among males compared to females in both countries. Likewise, higher scores in Competence and Confidence were registered among Peruvian male undergraduates compared to Spanish students, while Caring and Character were more prevalent in Spanish female undergraduates compared to Peruvian students. CONCLUSIONS: These findings confirm the importance of targeting the 5Cs of PYD alongside the role of gender and country context in intervention programs, put together to address the mental health of students in Peru and Spain.

Health Management: Evaluating the Relationship between Organizational Factors, Psychosocial Risks at Work, Performance Management, and Hospital Outcomes.

Introduction-Health system (HS) health organizations are complex and are in constant dynamic interaction with multiple elements, including political, environmental, societal, legal, and organizational factors, along with human components, such as human resources, patients, and other stakeholders. Objective-This research aimed to study three HS organizations, identifying and characterizing the elements of health organizations and the factors related to professionals, determining their influence on economic and financial performance results, as well as results related to the professionals and to the patients comprising the institutions. Method-A quantitative study was conducted in which data were collected through questionnaires from various sources to better understand and characterize the factors related to organizations, professionals, and patients (470 health professionals and 768 patients). To test the integrated evaluation model for health organizations, path analysis was used. Results-The results reveal that the organizational culture (OC) presents a positive relationship between the professional's quality of life (QL) and the performance management (PM) of the professionals, along with a negative relationship with the psychosocial work risks (PWR). There is also a relationship between the OC and patient satisfaction (PS), professional job satisfaction (PJS), and economic and financial results (EFR). In the relationship between the processes and the results, there are significant relationships between PM and PJS and PWR and PJS. In terms of the results, there is a significant relationship between the EFR and the PS. Conclusions-This study contributes to a deeper knowledge of the factors that influence the quality of health organizations and their results and produces recommendations for health organizations to address the current challenges.

Leisure Time Activities and Subjective Happiness in Early Adolescents from Three Ibero-American Countries: The Cases of Brazil, Chile and Spain.

(1) Background: The aim of the present study is to analyze subjective happiness in relation to leisure time in 10-year-old boys and girls from Brazil, Chile and Spain and to determine which leisure time activity has a greater effect on their subjective happiness and whether there are differences according to gender. (2) Methods: Data from the third wave of the Children's Worlds Project was used, which was collected by administering self-report measures to representative samples in each country. The sample was composed of 4008 early adolescents from Brazil (22.1%, n = 886), Chile (22.8%, n = 913) and Spain (55.1%, n = 2209). The mean age of the sample was 10.17 years (SD = 0.57), and 51.7% were girls. (3) Results: In terms of subjective happiness, moderate to high means were observed, with higher scores in boys and the Spanish sample. The results showed some differences in leisure time activities among children from Brazil, Chile and Spain. Furthermore, the results highlighted the importance of relaxation time with the family to promote happiness in pre-adolescence across genders and countries. Additionally, playing outdoors and doing homework were also found to be protective factors for subjective happiness. (4) Conclusions: In Brazil, Chile and Spain the most consistent result was the positive effect of spending time relaxing with the family on subjective happiness.