Examining the influence of mental health and structural determinants of health on the stage of motivational readiness for health behaviour changes: A path analysis study

This study explores the influence of mental health and structural determinants of health on motivational readiness for health behaviour change in 1462 Spanish primary healthcare users. Chi-square test and structural equation modelling were performed. Results showed that depression and anxiety were negatively associated with being in the action stages of motivational readiness for a healthy diet and physical activity. This association was statistically significant only for motivational readiness for a healthy diet and depression (β = - 0 . 076 ; p = 0 . 046 ). Furthermore, women and workers were more likely to be in the action stages of motivational readiness for a healthy diet while older adults and adults with higher health-related quality of life were more likely to be in the action stages of motivational readiness for physical activity. The present study suggests that structural (being older, being a woman and being employed) and intermediary (suffering from depression and higher health-related quality of life) determinants of health influence motivational readiness for health behaviour changes.

Mapping health promotion practices across key sectors and its intersectoral approach at the local level: Study protocol

AIMS

This study outlines a protocol aimed at identifying and mapping health promotion practices in need of development from the perspectives of key sectors responsible for it at the local level and from an intersectoral perspective across four Spanish regions.

DESIGN

A complementary multi-method study combining survey methods and qualitative interviews will be adopted.

METHODS

Purposive snowball sampling will be employed to select potentially rich informants from city councils, primary care centres, primary and secondary schools, and public health and civil society organizations in 12 municipalities sensitive to local health. Data on the degree of execution of health promotion activities, the level of intersectorality in their implementation, and their origins will be collected using PromoACTIVA questionnaires, an intersectoral typology model and an interview protocol. A parallel mixed analysis encompassing descriptive statistics and a 'framework analysis' will be performed.

DISCUSSION

This study is expected to yield thorough and reliable insights into health promotion practices and omissions at the local level by focusing on key stakeholders, both individually and collaboratively. This information can enhance health promotion planning and improve its effectiveness, efficiency and contextual relevance. The development and testing of a methodology for the integration and interpretation of these data will ensure sustainable capacity building.

IMPACT

Managers and practitioners interested in health promotion planning in the researched settings can benefit from a comprehensive map of the current state of their practices and insights into the starting points of collaboration. In addition, planners from other local settings will gain access to tools and methodologies to replicate and expand these maps to their own contexts.

STAKEHOLDER ENGAGEMENT

Engaging key stakeholders with experience working in or with primary care centres, public health organizations, primary and secondary schools, civil society organizations, and city councils was vital to ensure the study's relevance and feasibility.

Research on missed nursing care during the COVID-19 pandemic: A scoping review

BACKGROUND

Missed nursing care is defined as care that is delayed, partially completed, or not completed at all. The scenario created by the COVID-19 pandemic may have influenced multifactorial determinants related to the care environment, nursing processes, internal processes, and decision-making processes, increasing missed nursing care.

AIM

This scoping review aimed to establish the quantity and type of research undertaken on missed nursing care during the COVID-19 pandemic.

METHODS

This review was conducted following the Joanna Briggs Institute methodology for scoping reviews. We searched CINAHL, MEDLINE, Scopus, two national and regional databases, two dissertations and theses databases, a gray literature database, two study registers, and a search engine from November 1, 2019, to March 23, 2023. We included quantitative, qualitative, and mixed studies carried out in all healthcare settings that examined missed nursing care during the COVID-19 pandemic. Language restrictions were not applied. Two independent reviewers conducted study selection and data extraction. Disagreements between the reviewers were resolved through discussion or with an additional reviewer.

RESULTS

We included 25 studies with different designs, the most common being acute care cross-sectional survey designs. Studies focused on determining the frequency and reasons for missed nursing care and its influence on nurses and organizational outcomes.

LINKING EVIDENCE TO ACTION

Missed nursing care studies during the COVID-19 pandemic were essentially nurses-based prevalence surveys. There is an urgent need to advance the design and development of longitudinal and intervention studies, as well as to broaden the focus of research beyond acute care. Further research is needed to determine the impact of missed nursing care on nursing-sensitive outcomes and from the patient's perspective.

Contribution of Frailty to Multimorbidity Patterns and Trajectories: Longitudinal Dynamic Cohort Study of Aging People

BACKGROUND

Multimorbidity and frailty are characteristics of aging that need individualized evaluation, and there is a 2-way causal relationship between them. Thus, considering frailty in analyses of multimorbidity is important for tailoring social and health care to the specific needs of older people.

OBJECTIVE

This study aimed to assess how the inclusion of frailty contributes to identifying and characterizing multimorbidity patterns in people aged 65 years or older.

METHODS

Longitudinal data were drawn from electronic health records through the SIDIAP (Sistema d'Informació pel Desenvolupament de la Investigació a l'Atenció Primària) primary care database for the population aged 65 years or older from 2010 to 2019 in Catalonia, Spain. Frailty and multimorbidity were measured annually using validated tools (eFRAGICAP, a cumulative deficit model; and Swedish National Study of Aging and Care in Kungsholmen [SNAC-K], respectively). Two sets of 11 multimorbidity patterns were obtained using fuzzy c-means. Both considered the chronic conditions of the participants. In addition, one set included age, and the other included frailty. Cox models were used to test their associations with death, nursing home admission, and home care need. Trajectories were defined as the evolution of the patterns over the follow-up period.

RESULTS

The study included 1,456,052 unique participants (mean follow-up of 7.0 years). Most patterns were similar in both sets in terms of the most prevalent conditions. However, the patterns that considered frailty were better for identifying the population whose main conditions imposed limitations on daily life, with a higher prevalence of frail individuals in patterns like chronic ulcers &peripheral vascular. This set also included a dementia-specific pattern and showed a better fit with the risk of nursing home admission and home care need. On the other hand, the risk of death had a better fit with the set of patterns that did not include frailty. The change in patterns when considering frailty also led to a change in trajectories. On average, participants were in 1.8 patterns during their follow-up, while 45.1% (656,778/1,456,052) remained in the same pattern.

CONCLUSIONS

Our results suggest that frailty should be considered in addition to chronic diseases when studying multimorbidity patterns in older adults. Multimorbidity patterns and trajectories can help to identify patients with specific needs. The patterns that considered frailty were better for identifying the risk of certain age-related outcomes, such as nursing home admission or home care need, while those considering age were better for identifying the risk of death. Clinical and social intervention guidelines and resource planning can be tailored based on the prevalence of these patterns and trajectories.

Grandchildren of grandparents with Alzheimer's disease: Exploratory study of the impact of the disease on their relationships

The aim of this study was to describe the perception of changes that Alzheimer's disease in grandparents has made to the relationship with their grandchildren of between 6 and 13. Qualitative methodology was used. Semi-structured interviews were carried out with 25 grandchildren living in Catalonia, Spain. Participants reported a change in roles from being the care receiver to being the caregiver, changes in the activities that they did together and a positive impact on the grandparent's emotional wellbeing. In the physical sphere, sleeping problems were reported in grandchildren that cohabited with their grandparents. The feelings they described include fear of not being recognized by their grandparents and sadness, as well as satisfaction resulting from their affection and participating in caring. These findings suggest the need to provide information and resources for grandchildren and their families to enable them to deal with the disease.

Nutritional content and quality of processed foods and beverages advertised near schools in three cities in the north of Spain

The advertisement of food and beverages on television and social media has been widely assessed, evidencing its powerful influence on children's dietary patterns and the development of childhood obesity. However, there is a gap in the evidence about advertisements near schools. The aim of this study was to describe and classify the nutritional quality and information of processed foods and alcoholic and non-alcoholic beverages advertised near schools in three cities in the north of Spain. A descriptive analysis was performed from September to December 2021 in the cities of Oviedo, Gijón and Avilés in the Principality of Asturias (Spain). The nutritional quality and information of processed foods or beverages advertised within a 500 m radius of schools were assessed. The Nutri-Score system was used for the classification of the nutritional quality of products and nutritional information, calories, fat, saturated fat, carbohydrates, sugars, protein and salt in 100 g or ml of each product was calculated. A total of 73.5% of the products were classified as "foods to eat less often and in small amounts," and 22.6% and 46.3% were classified as D or E, respectively, according to the Nutri-Score system. Finally, 57.5%, 56.4% and 78.5% of the products showed a medium to high content of fat, saturated fat and sugar, respectively. In conclusion, the food and drink advertisements surrounding schools in the assessed cities promote many products of low nutritional value, rich in fat, saturated fat and sugars, which have high obesogenic potential.

Patient-Reported Outcome Measures of Quality of Life in People Affected by Diabetic Foot: A Psychometric Systematic Review

OBJECTIVES

This psychometric systematic review aimed to identify the most suitable patient-reported outcome measures (PROMs) of quality of life (QoL) in people affected by diabetic foot.

METHODS

We performed a literature search in MEDLINE (PubMed), CINAHL (EBSCOhost), and PsycINFO (EBSCOhost) databases from inception to February 1, 2022. We also searched gray literature databases. Eligible studies were full-text reports developing a QoL condition-specific PROM or assessing one or more of its measurement properties in people affected by diabetic foot. We assessed the methodological quality of included studies independently using the "Consensus-Based Standards for the Selection of Health Measurement Instruments Risk of Bias" checklist. The measurement properties were evaluated using specific criteria. We graded the quality of the evidence using a "Grading of Recommendations Assessment, Development and Evaluation" approach modified by Consensus-Based Standards for the Selection of Health Measurement Instruments.

RESULTS

Forty-three reports (46 studies) providing information on the measurement properties of 10 different PROMs were included. We did not identify any instruments that could be recommended for use. We identified 2 PROMs that were not recommended for use and 8 that were potentially recommended but would require further investigation. Of these 8 PROMs, 4 had better evidence for content validity.

CONCLUSIONS

Available PROMs to measure QoL in people affected by diabetic foot have limited evidence for their measurement properties. There is no fully suitable PROM. Pending further evidence, 4 PROMs could potentially be recommended for use.

The Tilburg Frailty Indicator: A psychometric systematic review

BACKGROUND

The Tilburg Frailty Indicator (TFI) is one of the most prominent multidimensional frailty assessment instruments. This review aimed to critically appraise and summarise its measurement properties.

METHODS

Reports were eligible if they included results of studies aimed at developing the TFI or evaluating its measurement properties. We performed a literature search in MEDLINE, CINAHL, and PsycINFO databases from their inception until December 8, 2021. We also searched grey literature databases. We assessed the methodological quality of the included studies using the "COSMIN Risk of Bias". The measurement properties were evaluated using specific criteria. We graded the quality of the evidence using a GRADE approach.

RESULTS

Sixty-three studies were included. We found moderate sufficient evidence for TFI content validity, although it is still insufficient for the comprehensiveness of its items. TFI construct validity was based on sufficient evidence from two studies of its structural validity as well as multiple hypothesis-testing for construct validity studies with inconsistent results. We did not find any studies that assessed cross-cultural validity. Only one of TFI's three dimensions showed sufficient evidence for the internal consistency of its scores, and results in test-retest reliability were inconsistent. The TFI showed high sufficient concurrent validity with the comprehensive geriatric assessment. We identified several studies assessing its predictive validity for adverse frailty-related outcomes, although most of the evidence from these studies was insufficient. We did not find any studies that assessed the responsiveness of TFI scores.

CONCLUSIONS

The TFI had evidence gaps in several relevant measurement properties. Further research is needed to strengthen its usefulness as a clinical decision-making tool.

Adaptation and validation of the Interprofessional Socialization and Valuing Scale (ISVS) in Spanish university health sciences students

Many interprofessional education programs are being designed to help students improve their collaborative practice. Traditionally, the evaluation of these programs is focused on attitudes, knowledge and skills, but according to some authors, the evaluation of these activities should be expanded to include the evaluation of the development of an interprofessional identity. The Interprofessional Socialization and Valuing Scale (ISVS) is a self-report tool used to measure interprofessional socialization, but it has not been validated with Spanish students. In this study, the tool was translated into Spanish and administered to a sample of 645 undergraduate students. The data were analyzed to estimate structural validity, internal consistency and convergent validity. Regarding the structural validity, our data supported the unidimensional model found in the English version of the ISVS-21 (normed chi-square = 2.3, RMSEA = 0.045, SRMR = 0.087, CFI = 0.963 and TLI = 0.969). The internal consistency reliability of the scale was adequate, Cronbach α = 0.913 [95% CI 0.903, 0.923]. The Spanish version of the ISVS-21 shows adequate psychometric properties in terms of the construct validity (structural validity and convergent validity) and internal consistency of its scores. This study provides the Spanish-speaking population with an adaptation of the only instrument that has been specifically developed to assess interprofessional socialization.

Multiple health behaviour change primary care intervention for smoking cessation, physical activity and healthy diet in adults 45 to 75 years old (EIRA study): a hybrid effectiveness-implementation cluster randomised trial

BACKGROUND

This study aimed to evaluate the effectiveness of a) a Multiple Health Behaviour Change (MHBC) intervention on reducing smoking, increasing physical activity and adherence to a Mediterranean dietary pattern in people aged 45-75 years compared to usual care; and b) an implementation strategy.

METHODS

A cluster randomised effectiveness-implementation hybrid trial-type 2 with two parallel groups was conducted in 25 Spanish Primary Health Care (PHC) centres (3062 participants): 12 centres (1481 participants) were randomised to the intervention and 13 (1581 participants) to the control group (usual care). The intervention was based on the Transtheoretical Model and focused on all target behaviours using individual, group and community approaches. PHC professionals made it during routine care. The implementation strategy was based on the Consolidated Framework for Implementation Research (CFIR). Data were analysed using generalised linear mixed models, accounting for clustering. A mixed-methods data analysis was used to evaluate implementation outcomes (adoption, acceptability, appropriateness, feasibility and fidelity) and determinants of implementation success.

RESULTS

14.5% of participants in the intervention group and 8.9% in the usual care group showed a positive change in two or all the target behaviours. Intervention was more effective in promoting dietary behaviour change (31.9% vs 21.4%). The overall adoption rate by professionals was 48.7%. Early and final appropriateness were perceived by professionals as moderate. Early acceptability was high, whereas final acceptability was only moderate. Initial and final acceptability as perceived by the participants was high, and appropriateness moderate. Consent and recruitment rates were 82.0% and 65.5%, respectively, intervention uptake was 89.5% and completion rate 74.7%. The global value of the percentage of approaches with fidelity ≥50% was 16.7%. Eight CFIR constructs distinguished between high and low implementation, five corresponding to the Inner Setting domain.

CONCLUSIONS

Compared to usual care, the EIRA intervention was more effective in promoting MHBC and dietary behaviour change. Implementation outcomes were satisfactory except for the fidelity to the planned intervention, which was low. The organisational and structural contexts of the centres proved to be significant determinants of implementation effectiveness.

TRIAL REGISTRATION

ClinicalTrials.gov , NCT03136211 . Registered 2 May 2017, "retrospectively registered".

Disease-related knowledge measurement instruments of people affected by multiple sclerosis: protocol for a systematic psychometric review

INTRODUCTION

Disease-related knowledge is a key component of shared decision making and a relevant outcome to measure the effectiveness of information provision interventions. However, no systematic psychometric reviews have been found that assess the measurement instruments aimed at evaluating the disease-related knowledge of people affected by multiple sclerosis. This review aims to systematically assess the quality of the measurement properties of all available disease-related knowledge measurement instruments of people affected by multiple sclerosis.

METHODS AND ANALYSIS

A systematic psychometric review will be carried out in accordance with the guidelines proposed by the international 'COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN)' initiative. Studies that meet the following criteria will be selected: (1) those whose aim is to measure disease-related knowledge, (2) those whose study populations are affected by multiple sclerosis and (3) those whose aims are to develop measurement instruments or evaluate one or more of their measurement properties. The information sources will be MEDLINE (via PubMed), CINAHL, PsycINFO and OpenGrey. The methodological quality will be assessed using the 'COSMIN Risk of Bias' checklist. Available evidence will be synthesised and graded using a modified Grading of Recommendations Assessment, Development and Evaluation approach.

ETHICS AND DISSEMINATION

As this is a systematic review, no ethics approval is needed. Study findings will be shared with multiple sclerosis patient support groups and in reports to funders. The results will be submitted to a peer-reviewed journal and will be presented at national and international conferences.

PROSPERO REGISTRATION NUMBER

CRD42019125417.

Cost-effectiveness analysis of a multiple health behaviour change intervention in people aged between 45 and 75 years: a cluster randomized controlled trial in primary care (EIRA study)

BACKGROUND

Multiple health behaviour change (MHBC) interventions that promote healthy lifestyles may be an efficient approach in the prevention or treatment of chronic diseases in primary care. This study aims to evaluate the cost-utility and cost-effectiveness of the health promotion EIRA intervention in terms of MHBC and cardiovascular reduction.

METHODS

An economic evaluation alongside a 12-month cluster-randomised (1:1) controlled trial conducted between 2017 and 2018 in 25 primary healthcare centres from seven Spanish regions. The study took societal and healthcare provider perspectives. Patients included were between 45 and 75 years old and had any two of these three behaviours: smoking, insufficient physical activity or low adherence to Mediterranean dietary pattern. Intervention duration was 12 months and combined three action levels (individual, group and community). MHBC, defined as a change in at least two health risk behaviours, and cardiovascular risk (expressed in % points) were the outcomes used to calculate incremental cost-effectiveness ratios (ICER). Quality-adjusted life-years (QALYs) were estimated and used to calculate incremental cost-utility ratios (ICUR). Missing data was imputed and bootstrapping with 1000 replications was used to handle uncertainty in the modelling results.

RESULTS

The study included 3062 participants. Intervention costs were €295 higher than usual care costs. Five per-cent additional patients in the intervention group did a MHBC compared to usual care patients. Differences in QALYS or cardiovascular risk between-group were close to 0 (- 0.01 and 0.04 respectively). The ICER was €5598 per extra health behaviour change in one patient and €6926 per one-point reduction in cardiovascular risk from a societal perspective. The cost-utility analysis showed that the intervention increased costs and has no effect, in terms of QALYs, compared to usual care from a societal perspective. Cost-utility planes showed high uncertainty surrounding the ICUR. Sensitivity analysis showed results in line with the main analysis.

CONCLUSION

The efficiency of EIRA intervention cannot be fully established and its recommendation should be conditioned by results on medium-long term effects.

TRIAL REGISTRATION

Clinicaltrials.gov NCT03136211 . Registered 02 May 2017 - Retrospectively registered.

Assessment of diet quality and physical activity of soccer players aged 13 to 16, from the Principality of Asturias, Spain

INTRODUCTION

Diet and physical activity are factors that have key roles in childhood overweight and obesity prevention. Appropriate assessment of these factors is an essential task in public health.

OBJECTIVE

The main aims of the study are to assess body composition, physical activity, and adherence to Mediterranean diet of soccer players, aged 13 to 16 years old in Asturias, Spain. It also aims to evaluate the relationships between diet, physical activity, body composition, and personal characteristics.

METHODS

A cross-sectional descriptive survey approach was used involving children (n = 303) with a mean age of 14.15 years (SD = 1.06), and using the KIDMED and PAQ-A questionnaires to assess adherence to Mediterranean diet and level of physical activity, respectively. Body composition was represented using the participants' body mass index.

RESULTS

Approximately 23.1% of the participants were overweight or obese. With regards to adherence to Mediterranean diet, 54.8% of the participants had medium adherence, while 8.9% had low adherence. PAQ-A mean score was 2.69 (SD = 0.47). Excess weight was associated with being a goalkeeper (P = .001), higher PAQ-A (P = .011), and lower KIDMED scores (P = .032). Correlation analysis showed an inverse association between age and PAQ-A score (r = -0.122), and a direct association between KIDMED and PAQ-A scores (r = 0.152).

CONCLUSION

Participants had an adequate level of physical activity. However, they had an obesogenic profile similar to that of their age population, who were not soccer players. Actions to improve adherence to healthy diet practices are highly recommended.

Convergent and discriminative validity of the Frail-VIG index with the EQ-5D-3L in people cared for in primary health care

Background

The Frail-VIG frailty index has been developed recently. It is an instrument with a multidimensional approach and a pragmatic purpose that allows rapid and efficient assessment of the degree of frailty in the context of clinical practice. Our aim was to investigate the convergent and discriminative validity of the Frail-VIG frailty index with regard to EQ-5D-3L value.

Methods

We carried out a cross-sectional study in two Primary Health Care (PHC) centres of the Catalan Institute of Health (Institut Català de la Salut), Barcelona (Spain) from February 2017 to January 2019. Participants in the study were all people included under a home care programme during the study period. No exclusion criteria were applied. We used the EQ-5D-3L to measure Health-Related Quality of Life (HRQoL) and the Frail-VIG index to measure frailty. Trained PHC nurses administered both instruments during face-to-face assessments in a participant’s home during usual care. The relationships between both instruments were examined using Pearson’s correlation coefficient and multiple linear regression analyses.

Results

Four hundred and twelve participants were included in this study. Frail-VIG score and EQ-5D-3L value were negatively correlated (r = − 0.510; P < 0.001). Non-frail people reported a substantially better HRQoL than people with moderate and severe frailty. EQ-5D-3L value declined significantly as the Frail-VIG index score increased.

Conclusions

Frail-VIG index demonstrated a convergent validity with the EQ-5D-3L value. Its discriminative validity was optimal, as their scores showed an excellent capacity to differentiate between people with better and worse HRQoL. These findings provide additional pieces of evidence for construct validity of the Frail-VIG index.

Health status, lifestyle habits, and perceived social support in long-term cancer survivors: a cross-sectional study

OBJECTIVE

To compare the presence of comorbidities and self-perceived health and social support between long-term cancer survivors and people without a history of cancer from a clinical trial examining the effects of a multiple risk behavior intervention.

RESULTS

Of the 4259 people studied, 190 (4.46%) were cancer survivors. They had a mean ± SD age of 62.8 ± 7 years vs. 58.7 ± 8 years (P < 0.01) for non-cancer people and were more likely to be on long-term sick leave (11.9 vs. 3.5%, P < 0.001). No differences were observed for smoking, adherence to the Mediterranean diet, physical activity, obesity, or social support. Cancer survivors were more likely to have worse self-perceived health (OR 1.82; 95% CI 1.02-2.75), more comorbidities (OR 1.68; 95% CI 1.18-2.39), COPD (OR 2.17; 95% CI 1.25-3.78), and depression (OR 1.65; 95% CI 1.06-2.57). Older age and worse self-perceived health were independent predictors of survivorship in the adjusted analysis.

"Missed nursing care" in health promotion: Raising awareness

AIM(S)

This commentary aims to raise awareness of the possible causes of "missed nursing care" in health promotion and to propose possible solutions.

BACKGROUND

Although health promotion is an essential function of nursing practice, "missed nursing care" has been scarcely studied in this area. It is crucial to know both its causes and possible strategies to prevent it.

EVALUATION

We used evidence to identify possible causes of "missed nursing care" in health promotion, and we classified them into categories. We suggested the concept of capacity building to address its underlying causes.

KEY ISSUE(S)

Four main factors are involved in "missed nursing care" in health promotion, that is intrapersonal, interpersonal, organisational and cultural. Capacity building, including the development of knowledge, skills, commitment, structures, systems and leadership, could reduce missed care.

CONCLUSION(S)

"Missed nursing care" in health promotion is complex and is multifactorial in its origins. Capacity building could be a way to address its causes.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing care in health promotion is paramount and a long-term investment that can contribute to the sustainability of the health system. Organisations and managers could view capacity building processes as a tool to prevent "missed nursing care" in health promotion.

Profile of Innovative Ideas Recorded by Nurses in an Ideas Bank of a Corporate Virtual Community of Open Innovation: A Cross-Sectional Study

PURPOSE

Nurses are well-positioned to play an active role in the development of innovation in health care. However, their contribution to health innovation is poorly recognized and often invisible. The aim of this study was to determine the profile of innovative ideas recorded by nurses in the Innòbics ideas bank, a corporate virtual community of open innovation.

DESIGN AND METHODS

We used a cross-sectional study design. We identified all the innovative ideas recorded in Innòbics from June 8, 2016, to July 6, 2018. To be eligible, the ideas had to be recorded by nurses. Each innovative idea recorded was assessed by the Certification Evaluation Committee of Innòbics. After collective discussion during the evaluation sessions, each committee member independently scored the idea. The screening decision was based on the overall average score. The following variables were collected from each innovative idea that was recorded: (a) level of health care where the idea originated (primary care or secondary care), (b) subject or category according to the classification of the Agency for Healthcare Research and Quality Health Care Innovations Exchange, (c) ratings relative to each screening criteria, and (d) the result of the screening decision: stored = ideas that were poorly developed and in which it was not possible to identify their potential for innovation; susceptible of improvement = potential ideas that needed to be improved and whose authors received comments from the evaluation committee; validated = ideas that continued the process to become innovation projects; forwarded = ideas that were not innovative but they were a complaint or a proposal for quality improvement (these were forwarded to the institutional department concerned).

FINDINGS

A total of 246 innovative ideas were recorded in the period of the study, 61 (24.8%) of which were recorded by nurses. The subjects and categories of these ideas were diverse, highlighting aspects such as patient-centered care, quality improvement strategies, preventive and chronic care, and primary care. Thirty-five (57.4%) of these innovative ideas were stored, 13 (21.3%) were susceptible to improvement, 11 (18.0%) were forwarded, and 2 (3.3%) were validated.

CONCLUSIONS

The results demonstrated that approximately a quarter of the ideas were recorded by nurses. Subjects and categories of these ideas were diverse, some of them closely related to the profession and nursing practice. Two ideas were identified as potential innovation projects. Innòbics can act as an organizational tool that promotes a climate for innovation in health care.

CLINICAL RELEVANCE

This study recognizes nurses' contribution to a healthcare innovation initiative and their interest in sharing innovative ideas. Its findings provide useful insights into a virtual community of open innovation such as an organizational tool for encouraging creativity and innovation in healthcare. Likewise, there is also a need for further development of nurses to master healthcare innovation as a basic competence.

[Bibliometric analysis of female authorship in original articles in the journal ATENCIÓN PRIMARIA]

OBJECTIVES

To determine the percentage of female authors in original articles published during 2periods, in the journal of Atención Primaria (Primary Care), and to examine the differences between the categories of authorship (first, last author, and co-author) between both periods.

DESIGN

Cross-sectional study.

SETTING

Feminine scientific production published during the periods 2007-2008 and 2017-2018.

PARTICIPANTS

The study was focused on original articles.

MAIN MEASUREMENTS

The following variables were collected in an ad hoc form: gender based on the name of the author, total number of women and men appearing as authors, and order of authorship. Absolute and relative authorship frequencies were calculated, and the χ² test was used to examine the evolution of the percentages by type of authorship and gender.

RESULTS

A total of 108 articles were analysed in 2007-2008, and 100 in 2017-2018. No statistically significant differences were observed between the mean numbers of women authors within and between periods. In 2007-2008 a total of 548 female authors were identified and 540 in 2017-2018, the percentage of female authors was 48.7% and 54.4%, respectively. Only an increase in the percentage of first authors was observed between periods.

CONCLUSIONS

Practically one out of every 2authors of original articles published in the journal Atención Primaria was female. There was also a significant increase in the percentage of female first authors between the 2periods. Nevertheless, and despite the greater number of health workers, the number of latest female authors remain unchanged, which points to the persistence of female under-representation.

Multidimensional instruments with an integral approach to identify frailty in community-dwelling people: protocol for a systematic psychometric review

INTRODUCTION

An increasing number of investigations highlight the complex nature of frailty; therefore, the use of multidimensional assessment instruments could be useful in clinical decision-making. Frail people are found mainly in the community setting which is why this is the ideal environment for early screening and intervention. For this purpose, it is necessary to have valid, time-effective and easy-to-use frailty assessment instruments. The aim of this review is to critically appraise, compare and summarise the quality of the measurement properties of all multidimensional instruments with an integral approach to identify frailty in community-dwelling people.

METHODS AND ANALYSIS

Medline, Psychological Information Database (PsycINFO) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) will be searched from their inception dates. We will also conduct searches in databases of grey literature. No limits will be applied for language. A highly sensitive validated search filter will be used for finding studies on measurement properties. An additional search including the names of the instruments found in the initial search will also be undertaken. Studies aiming at the development of a measurement instrument, the evaluation of one or more measurement properties or the evaluation of its interpretability will be included. The instrument should have an integral approach (physical, psychological and social) and it should measure all three domains. The context of use should be a community setting. Two reviewers independently will screen the references and assess the risk of bias by consensus-based standards for the selection of health measurement instruments checklist. To assess the overall evidence for the measurement properties of the identified instruments, the results of the different studies, adjusted for their methodological quality, will be combined.

ETHICS AND DISSEMINATION

Ethical approval and patient consent are not required as this is a psychometric review based on published studies. The results of this review will be disseminated at conferences and published in an international peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42019120212.

Meditation techniques v. relaxation therapies when treating anxiety: a meta-analytic review

To what extent meditation techniques (which incorporate practices to regulate attention, construct individual values, or deconstruct self-related assumptions), are more or less effective than relaxation therapy in the treatment of anxiety, is not clear. The aim of this study was to examine the effectiveness of meditation compared to relaxation in reducing anxiety. A systematic review from PubMed, Embase, PsycInfo and the Cochrane Central was conducted. A meta-analysis of 14 RCTs (n = 862 participants suffering from anxiety disorders or high trait anxiety) was performed. Effect sizes (ESs) were determined by Hedges' g. Heterogeneity, risk of publication bias, quality of studies/interventions, and researcher allegiance, were evaluated. Meditation techniques incorporated attentional elements, and five of them also added constructive practices. No studies were found using deconstructive exercises. The overall ES was g = -0.23 [95% confidence interval (CI) -0.40 to -0.07], favouring meditation (number needed to treat = 7.74). Heterogeneity was low (I2 = 2; 95% CI 0 to 56). There was no evidence of publication bias, but few studies and interventions were of high quality, and allegiance might be moderating results. Meditation seems to be a bit more effective than relaxation in the treatment of anxiety, and it might also remain more effective at 12-month follow-up. However, more research using the full spectrum of meditation practices to treat different anxiety disorders, including independent studies to avoid researcher allegiance, is needed if we are to have a precise idea of the potential of these techniques compared to relaxation therapy.

[Adapting and validating a questionnaire to measure the self-care practices in healthy child population residing in Spain]

Objetivo

Adaptar y validar el Child and Adolescent Self-Care Performance Questionnaire (CASPQ) al contexto de la población infantil sana de 8 a 12 años residente en España y evaluar sus propiedades métricas.

Diseño

Estudio de validación fundamentado en la Teoría Clásica de los Tests.

Emplazamiento

Cuatro centros educativos participantes en el programa «Salut i Escola» de un centro de atención primaria de Barcelona (España).

Participantes

Un total de 498 alumnos y alumnas de educación primaria participaron en el estudio durante los primeros seis meses de 2016.

Mediciones principales

Se realizó la adaptación cultural del cuestionario. Se evaluó el proceso de respuesta, la estructura factorial y se analizaron las relaciones de las puntuaciones del CASPQ con las del cuestionario KIDSCREEN-27. Asimismo, se evaluaron la consistencia interna y la reproducibilidad de las puntuaciones.

Resultados

Se obtuvieron 489 cuestionarios. El análisis factorial confirmatorio de su estructura teórica mostró un ajuste suficiente. Se observó una asociación positiva entre las puntuaciones del cuestionario y las del KIDSCREEN-27. La consistencia interna global fue satisfactoria; no obstante, la de cada factor fue marginal o moderada. La reproducibilidad de las puntuaciones fue óptima.

Conclusiones

El CASPQ adaptado a la población infantil sana de 8 a 12 años muestra unas propiedades métricas adecuadas y similares a las del cuestionario original. Por ello, es un instrumento útil para evaluar las prácticas de autocuidado y planificar intervenciones dirigidas a su promoción.

Instruments to assess mental health-related stigma among health professionals and students in health sciences: A systematic psychometric review

AIM

To evaluate the psychometric properties of the instruments to assess the mental health-related stigma among health professionals and students in health sciences.

BACKGROUND

Evidence on the stigmatization by health professionals of people with mental health illness is increasingly compelling. Valid and reliable instruments are needed for the assessment of mental health-related stigma and effectiveness of anti-stigma interventions.

DESIGN

Systematic psychometric review.

DATA SOURCES

MEDLINE (via PubMed), CINAHL (via EBSCO), PsycINFO, Scopus, and Open Grey from their inception to August 2017. No limits were applied.

REVIEW METHODS

We included studies on the development of a measurement instrument or on the evaluation of one or more of its measurement properties. The methodological quality of the included studies and quality of the measurement instruments identified were assessed using the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist.

RESULTS

We included 25 studies involving 15 measurement instruments. The "Atributtion Questionnaire" (five studies) and the "Opening Minds Scale for Health Care providers (OMS-HC)" (four studies) were the most investigated instruments. Internal consistency, content validity, structural validity, and hypothesis testing were the measurement properties most commonly evaluated. Measurement error and responsiveness were investigated in only two studies. Eight psychometric properties of OMS-HC were evaluated, three of which have a positive strong level of evidence.

CONCLUSIONS

A substantial number of instruments have been developed to assess mental health-related stigma among health professionals. There is a lack of any assessment of certain measurement properties. The OMS-HC is the instrument that had the strongest evidence.

Is cognitive-behavioural therapy more effective than relaxation therapy in the treatment of anxiety disorders? A meta-analysis

BACKGROUND

It is not clear whether relaxation therapies are more or less effective than cognitive and behavioural therapies in the treatment of anxiety. The aims of the present study were to examine the effects of relaxation techniques compared to cognitive and behavioural therapies in reducing anxiety symptoms, and whether they have comparable efficacy across disorders.

METHOD

We conducted a meta-analysis of 50 studies (2801 patients) comparing relaxation training with cognitive and behavioural treatments of anxiety.

RESULTS

The overall effect size (ES) across all anxiety outcomes, with only one combined ES in each study, was g = -0.27 [95% confidence interval (CI) = -0.41 to -0.13], favouring cognitive and behavioural therapies (number needed to treat = 6.61). However, no significant difference between relaxation and cognitive and behavioural therapies was found for generalized anxiety disorder, panic disorder, social anxiety disorder and specific phobias (considering social anxiety and specific phobias separately). Heterogeneity was moderate (I2 = 52; 95% CI = 33-65). The ES was significantly associated with age (p < 0.001), hours of cognitive and/or behavioural therapy (p = 0.015), quality of intervention (p = 0.007), relaxation treatment format (p < 0.001) and type of disorder (p = 0.008), explaining an 82% of variance.

CONCLUSIONS

Relaxation seems to be less effective than cognitive and behavioural therapies in the treatment of post-traumatic stress disorder, and obsessive-compulsive disorder and it might also be less effective at 1-year follow-up for panic, but there is no evidence that it is less effective for other anxiety disorders.

Factors related to the development of health-promoting community activities in Spanish primary healthcare: two casecontrol studies

OBJECTIVE

Spanish primary healthcare teams have the responsibility of performing health-promoting community activities (CAs), although such activities are not widespread. Our aim was to identify the factors related to participation in those activities.

DESIGN

Two case-control studies.

SETTING

Performed in primary care of five Spanish regions.

SUBJECTS

In the first study, cases were teams that performed health-promoting CAs and controls were those that did not. In the second study (on case teams from the first study), cases were professionals who developed these activities and controls were those who did not.

MAIN OUTCOME MEASURES

Team, professional and community characteristics collected through questionnaires (team managers/professionals) and from secondary sources.

RESULTS

The first study examined 203 teams (103 cases, 100 controls). Adjusted factors associated with performing CAs were percentage of nurses (OR 1.07, 95% CI 1.01 to 1.14), community socioeconomic status (higher vs lower OR 2.16, 95% CI 1.18 to 3.95) and performing undergraduate training (OR 0.44, 95% CI 0.21 to 0.93). In the second study, 597 professionals responded (254 cases, 343 controls). Adjusted factors were professional classification (physicians do fewer activities than nurses and social workers do more), training in CAs (OR 1.9, 95% CI 1.2 to 3.1), team support (OR 2.9, 95% CI 1.5 to 5.7), seniority (OR 1.06, 95% CI 1.03 to 1.09), nursing tutor (OR 2.0, 95% CI 1.1 to 3.5), motivation (OR 3.7, 95% CI 1.8 to 7.5), collaboration with non-governmental organisations (OR 1.9, 95% CI 1.2 to 3.1) and participation in neighbourhood activities (OR 3.1, 95% CI 1.9 to 5.1).

CONCLUSIONS

Professional personal characteristics, such as social sensitivity, profession, to feel team support or motivation, have influence in performing health-promoting CAs. In contrast to the opinion expressed by many professionals, workload is not related to performance of health-promoting CAs.

Nurse prescribing in Spain: The law and the curriculum

In this cross-sectional study, we explored course content related to pharmacology and/or healthcare products and supplies in all nursing degree programs in Spain. Changes in nurse-prescribing legislation in Spain require that nurses take a certification course before prescribing over-the-counter products and medications. Using a cross-sectional descriptive study, between July and September 2014, the degree programs of all centers that offer a degree in nursing in Spain were examined, selecting those with course information available online. All centers offered at least one pharmacology course. One-third of the required courses had content related to pharmacology and healthcare products/supplies. The analysis showed that the course content and training received during the current nursing degree program provides the knowledge and skills needed to prescribe healthcare products/supplies and medications that do not now require a doctor's prescription, without the need for additional training and certification. It is essential that government regulation of nursing education be aligned with nursing competencies, curriculum standards, clinical practice, and evidence-based research to provide the maximum level of confidence for nursing professionals and their patients.

Instruments to assess self-care among healthy children: A systematic review of measurement properties

AIM

To identify, critically appraise and summarize the measurement properties of instruments to assess self-care in healthy children.

BACKGROUND

Assessing self-care is a proper consideration for nursing practice and nursing research. No systematic review summarizes instruments of measurement validated in healthy children.

DESIGN

Psychometric review in accordance with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) panel.

DATA SOURCES

MEDLINE, CINAHL, PsycINFO, Web of Science and Open Grey were searched from their inception to December 2016.

REVIEW METHODS

Validation studies with a healthy child population were included. Search was not restricted by language. Two reviewers independently assessed the methodological quality of included studies using the COSMIN checklist.

RESULTS

Eleven studies were included in the review assessing the measurement properties of ten instruments. There was a maximum of two studies per instrument. None of the studies evaluated the properties of test-retest reliability, measurement error, criterion validity and responsiveness. Internal consistency and structural validity were rated as "excellent" or "good" in four studies. Four studies were rated as "excellent" in content validity. Cross-cultural validity was rated as "poor" in the two studies (three instruments) which cultural adaptation was carried out.

CONCLUSION

The evidence available does not allow firm conclusions about the instruments identified in terms of reliability and validity. Future research should focus on generate evidence about a wider range of measurement properties of these instruments using a rigorous methodology, as well as instrument testing on different countries and child population.

Safety of the reuse of needles for subcutaneous insulin injection: A systematic review and meta-analysis

OBJECTIVE

Many people with diabetes often reuse disposable needles for subcutaneous insulin injection. We aimed to identify, critically appraise and summarize the available evidence about the safety of this practice.

DESIGN

Systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

DATA SOURCES

MEDLINE (via PubMed), CINALH (via EBSCO), SCOPUS, Web of Science, Cochrane Central Register of Controlled Trials and Open Grey were searched from their inception to December 2015, with no language restrictions.

REVIEW METHODS

Epidemiologic and experimental studies assessing adverse effects of reusing needles in people of any age or sex, with or without diabetes, were included. Two reviewers independently assessed the methodological quality of included studies using a multi-design tool.

RESULTS

In total, 25 studies were included. All studies had a high risk of bias and data from only nine studies could be pooled. Five studies showed no association between infection at site of injection and reuse of needles (risk difference=-0.00; 95% confidence interval=-0.12-0.11; P=0.99); heterogeneity between these studies was substantial (I(2)=66%; P=0.02). Five cross-sectional studies showed an association between lipohypertrophy and needle reuse (risk difference=0.16, 95% confidence interval=0.05-0.28, P=0.006); there was strong evidence of heterogeneity between these studies (I(2)=87%; P<0.001). Pooled data of two studies with no evidence of heterogeneity between them showed more perceived pain among reusers (risk difference=0.24; 95% confidence interval=0.06-0.43; P=0.006). Reusing a pen needle or disposable syringe-needle was not associated with worse glycaemic control.

CONCLUSIONS

There is currently no clear scientific evidence to suggest for or against the reuse of needles for subcutaneous insulin injection. This practice is very common among people with diabetes; consequently, further research is necessary to establish its safety.

Cardiovascular disease predicts diabetic peripheral polyneuropathy in subjects with type 2 diabetes: A 10-year prospective study

BACKGROUND

The relationship between cardiovascular disease and diabetic peripheral neuropathy is mainly sustained by data retrieved from cross-sectional studies focused on cardiovascular risk factors. We aimed to assess the presence of cardiovascular disease as a risk factor for developing diabetic peripheral neuropathy in a type 2 diabetes mellitus population.

METHOD

A 10-year prospective, primary care, multicentre study in a randomly selected cohort. Cardiovascular disease presence included stroke, coronary artery disease and/or peripheral ischaemia. Diabetic peripheral neuropathy diagnosis was based on clinical neurological examination as well as the neuropathy symptoms score and nerve conduction studies.

RESULTS

Three hundred and ten (N=310) patients were initially recruited. Two-hundred and sixty seven (N=267) patients were included in the study. Diabetic peripheral neuropathy cumulative incidence was 18.3% (95% confidence intervals 14.1-23.4; N=49). Diabetic peripheral neuropathy development was significantly more frequent in participants presenting with cardiovascular disease at baseline (P=0.01). In the final logistic regression analysis, the presence of cardiovascular disease remained associated with an increased risk for diabetic peripheral neuropathy (odds ratio 2.32, 95% confidence intervals 1.03-5.22) in addition to diabetes duration and low density lipoprotein-cholesterol levels.

CONCLUSIONS

In our series, type 2 diabetes mellitus patients with cardiovascular disease at baseline present with an increased risk of developing diabetic peripheral neuropathy at 10 years of follow-up. Our results suggest that measures aimed at the prevention, control and treatment of cardiovascular disease can also help prevent diabetic peripheral neuropathy development.

Angiotensin-converting enzyme gene single polymorphism as a genetic biomarker of diabetic peripheral neuropathy: longitudinal prospective study

BACKGROUND

Identifying patients at risk of developing diabetic peripheral neuropathy (DPN) is of paramount importance in those with type 2 diabetes mellitus (T2DM) to provide and anticipate secondary prevention measures as well as intensify action on risk factors, particularly so in primary care. Noteworthy, the incidence of DPN remains unknown in our environment.

AIMS

(i) To analyze a single angiotensin-converting enzyme (ACE) gene polymorphism (D/I) as a genetic marker of risk of developing DPN, and (ii) to determine the incidence of DPN in our environment.

RESEARCH DESIGN AND METHODS

Longitudinal study with annual follow-up for 3years involving a group of T2DM (N=283) randomly selected. ACE gene polymorphism distribution (I=insertion; D=deletion) was determined. DPN was diagnosed using clinical and neurophysiology evaluation.

RESULTS

Baseline DPN prevalence was 28.97% (95% CI, 23.65-34.20). ACE polymorphism heterozygous genotype D/I presence was 60.77% (95% CI, 55.05-66.5) and was independently associated with a decreased risk of DPN (RR, 0.51; 95% CI, 0.30-0.86). DPN correlated with age (P<0.001) but not with gender (P=0.466) or time of evolution of T2DM (P=0.555). Regarding end point, DPN prevalence was 36.4% (95% CI, 30.76-42.04), and accumulated incidence was 10.4% 3years thereafter. In the final Poisson regression analysis, the presence of heterozygous genotype remained independently associated with a decreased risk of DPN (RR, 0.71; (95% CI, 0.53-0.96). DPN presence remained correlated with age (P=0.002), but not with gender (P=0.490) or time of evolution (P=0.630).

CONCLUSIONS

In our series, heterozygous ACE polymorphism (D/I) stands as a protective factor for DPN development. Accumulated incidence of DPN was relevant. Further prospective studies are warranted.

[Prevalence of food habits and nutritional status in adult population served in primary care]

OBJECTIVE

To identify dietary patterns and nutritional status of the population between 18-44 years visited at a health center (HC) and explore the associated factors.

METHODS

Cross-sectional study conducted in an urban HC in a random sample of 201 people. Were analyzed socio-demographic data, anthropometric measurements, 24 hours latest reminder intake, weekly food frequency questionnaire.

RESULTS

The mean age of participants was 32.81 years (standard deviation 6.72). 63.68% (128) were women and 62.69% (126) immigrants. 45.27% (91) expressed no exercise. About 60% of participants related a deficit in consumption milk, fruits, meat and farinaceous and 80% vegetables, 58% related excessive fat. 44.4% (56) of immigrants was 20.3% with respect to obese (15) of native (P = 0.001). The proportion of people with "waist-risk" was higher among immigrants as compared to the native (19.0% vs 6.8%, P = 0.017) and among those who did not exercise with respect to each other (17.6% vs 8.1%, P = 0.049). Immigrants perform less physical activity related to the native (42.1% vs 62.7%, P = 0.013). Being an immigrant was the variable explaining of distribution acceptable daily macronutrient intake (Odds Ratio 4.7, Confidence Interval 95% 2.02-11.03).

DISCUSSION

The participants related excessive consumption of fats and deficient in the rest of food groups. Obesity and the "risk waist" were more common among immigrants and sedentary population. Immigrants talked of a better distribution of nutrients in your daily diet.