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Niveles séricos de vitaminas en pacientes críticos y su relación con el pronóstico
(Aula medica ediciones; Aran ediciones, S L, 2025-10-31) Garnacho Montero, José; María Ascensión González-García; Fernández Castillo, Rafael Jesús; González-Caro, M.D.; Gutiérrez‐Pizarraya, Antonio; Arrobas Velilla, Teresa; Sánchez Margalet, Víctor; Enfermería; Bioquímica Médica y Biología Molecular e Inmunología; CTS1141: Investigación Clínica Aplicada a los Cuidados y Nuevos Paradigmas Asistenciales; CTS151: Bioquímica Medica
Objetivos: conocer los niveles séricos de vitaminas (A, D, E, K, B1, B6 y B12) en pacientes críticos, sus cambios y su impacto en la mortalidad en la unidad de cuidados intensivos. Métodos: estudio prospectivo. Se midieron los niveles séricos de vitaminas A, D, E, K, B1, B6 y B12 basalmente, en día 7 y día 14, así como las diferencias en los mismos según si el paciente recibía o no NP con un complejo multivitamínico que no contiene vitamina K. Se realizó análisis multivariante para estudiar factores relacionados con mortalidad. Resultados: se analizaron 99 pacientes. La edad mediana fue 59 años y el 35,4 % (n = 35) mujeres. Los niveles de vitamina A, K y D estaban bajos al ingreso; aumentaron en los días 7 y 14 alcanzando valores normales en el primer caso, no así para la K y D. Los valores de las vitaminas B1 y E se encuentran dentro de la normalidad y elevados los niveles de las vitaminas B6 y B12. Valores más altos de NUTRIC score (OR: 1,38, IC 95 %: 1,07-1,77) y de vitamina E al ingreso se relacionaron independientemente con un peor y mejor pronóstico, respectivamente. En los pacientes con NP los niveles de vitamina A y E suben significativamente a los 7 y 14 días respecto al basal sin cambios significativos en el resto de las vitaminas estudiadas. Conclusiones: en este grupo heterogéneo de pacientes críticos, los niveles de las vitaminas A, D y K se encuentran disminuidos, normales los de las vitaminas B1 y E y elevados los de las vitaminas B6 y B12. La nutrición parenteral con suplementación vitamínica, pero sin vitamina K, mantiene adecuados niveles séricos de la vitamina K. Solo hemos identificado como factor asociado al pronóstico que el nivel basal de vitamina E es factor protector de mortalidad.
Digital technologies for enhancing evacuation planning in critical care units: A quantitative, experimental simulation
(Wolters Kluwer, 2026) Luna-Iglesias, María Cristina; Camacho Vega, Juan Carlos; Gómez-Salgado, Juan; Ladisa, María; Garrido-Bueno, Miguel; Gómez-Salgado, Carlos; Fagundo-Rivera, Javier; Construcciones Arquitectónicas II; Enfermería; CTS1050: Cuidados Complejos, Cronicidad y Resultados en Salud
This study aims to evaluate evacuation performance in a high-acuity intensive care unit (ICU) by integrating building information modeling (BIM) and computational simulation and examine how different parametrizations affect the fidelity of predicted evacuation dynamics when compared with data from a real evacuation drill. A detailed BIM model of a tertiary hospital ICU was developed and imported into Pathfinder to simulate 3 protocol-based evacuation scenarios and 1 scenario calibrated with preparation times obtained from a 2024 evacuation drill. Simulations assessed occupant flow, bottlenecks, movement trajectories, and total evacuation times. Architectural constraints, behavioral rules, and patient dependency profiles were incorporated to reflect real operational conditions, including explicit geometric incompatibilities between door widths and ICU bed dimensions. Evacuation times produced with generic parameters showed a gap of up to 7 minutes 40 seconds less than the real drill duration, whereas the empirically calibrated simulation narrowed this difference to 2 minutes 30 seconds. Across all scenarios, bottlenecks consistently emerged at the main critical patient unit exit, primarily driven by architectural constraints such as insufficient door widths relative to bed size, which hindered bed maneuverability and intensified staff circulation conflicts. Flow rates peaked between 0.40 and 0.55 persons/s, with higher occupancy producing more sustained congestion. Preparatory actions for clinically complex patients significantly shaped overall evacuation performance. The integration of BIM and empirically informed simulation enhances the accuracy and operational relevance of evacuation analyses in complex clinical environments. Findings highlight the need for calibration based on real behavioral data and demonstrate how specific architectural mismatches, particularly between door geometry and bed dimensions, act as critical drivers of evacuation bottlenecks. This approach supports more robust risk assessment and emergency planning within critical socio-technical infrastructures.
Age-dependent impact of the major common genetic risk factor for COVID-19 on severity and mortality
(American Society for Clinical Investigation, 2021-10-01) Nakanishi, Tomoko; Pigazzini, Sara; Degenhardt, Frauke; Cordioli, Mattia; Butler-Laporte, Guillaume; Maya Miles, Douglas; Romero Gómez, Manuel; Ganna, Andrea; Calderón Sandubete, Enrique José; Gallego Durán, Rocío; Medrano Ortega, Francisco Javier; Ampuero Herrojo, Javier; Morilla Romero de la Osa, Rubén; Fisiología; Medicina; Enfermería; Junta de Andalucía; European Union; Consejo Superior de Investigaciones Científicas (CSIC)
Background. There is considerable variability in COVID-19 outcomes among younger adults, and some of this variation may be due to genetic predisposition. Methods. We combined individual level data from 13,888 COVID-19 patients (n = 7185 hospitalized) from 17 cohorts in 9 countries to assess the association of the major common COVID-19 genetic risk factor (chromosome 3 locus tagged by rs10490770) with mortality, COVID-19-related complications, and laboratory values. We next performed metaanalyses using FinnGen and the Columbia University COVID-19 Biobank. Results. We found that rs10490770 risk allele carriers experienced an increased risk of all-cause mortality (HR, 1.4; 95% CI, 1.2–1.7). Risk allele carriers had increased odds of several COVID-19 complications: severe respiratory failure (OR, 2.1; 95% CI, 1.6–2.6), venous thromboembolism (OR, 1.7; 95% CI, 1.2–2.4), and hepatic injury (OR, 1.5; 95% CI, 1.2–2.0). Risk allele carriers age 60 years and younger had higher odds of death or severe respiratory failure (OR, 2.7; 95% CI, 1.8–3.9) compared with those of more than 60 years (OR, 1.5; 95% CI, 1.2–1.8; interaction, P = 0.038). Among individuals 60 years and younger who died or experienced severe respiratory failure, 32.3% were risk-variant carriers compared with 13.9% of those not experiencing these outcomes. This risk variant improved the prediction of death or severe respiratory failure similarly to, or better than, most established clinical risk factors. Conclusions. The major common COVID-19 genetic risk factor is associated with increased risks of morbidity and mortality, which are more pronounced among individuals 60 years or younger. The effect was similar in magnitude and more common than most established clinical risk factors, suggesting potential implications for future clinical risk management.
Discapacidad intelectual en niños y adolescentes: influencia en la familia y la salud familiar. Revisión sistemática
(Elsevier, 2018) Lima Rodríguez, Joaquín Salvador; Baena Ariza, María Teresa; Domínguez Sánchez, Isabel; Lima Serrano, Marta; Enfermería; CTS969: Innovación en Cuidados y Determinantes Sociales en Salud
Objetivo Analizar la influencia en la unidad familiar de la existencia de un hijo en edad infantil o adolescente, con discapacidad intelectual. Método Revisión sistemática de la literatura, siguiendo las recomendaciones de la declaración PRISMA, en PubMed, Scopus, CINAHL, PsycINFO y Psicodoc. Se localizaron artículos originales, publicados en los últimos 5 años, en español, inglés, portugués, italiano o francés, con resumen y texto completo y calidad metodológica satisfactoria o buena. Dos investigadores independientes consensuaron decisiones. Resultados Generalmente el cuidado se presta en la familia, asumiendo las madres la mayor responsabilidad, presentando menor bienestar que los padres. El apoyo del cónyuge mejora su calidad de vida. El subsistema fraternal puede afectarse en la calidez de la relación, el estatus/poder y los problemas comportamentales. La salud familiar puede afectarse en todas sus dimensiones: clima y funcionamiento familiar por las mayores demandas y modificaciones en la organización y distribución de roles; resistencia y afrontamiento familiares por el aumento de gastos y disminución de recursos; la integridad familiar puede reforzarse al fortalecerse los lazos familiares. El apoyo emocional favorece la calidad de vida familiar. Conclusiones Estas familias pueden necesitar atención diferenciada por su mayor demanda de cuidados, disminución de recursos o problemas de salud familiar. Las enfermeras, desde un enfoque de atención centrado en la familia, pueden identificarlas y ayudarlas a normalizar su situación, fomentando la salud familiar y el bienestar de sus miembros.
Inteligencia artificial y desinformación en salud: la necesidad de reeducación desde la atención primaria
(Ediciones doyma S A; Elsevier BV, 2026-03) Valle Coronado-Vázquez; Allande Cussó, Regina; Rafael A. Caparrós-González; Juan Gómez-Salgado; Enfermería; CTS1050: Cuidados Complejos, Cronicidad y Resultados en Salud
El uso de la inteligencia artificial (IA) generativa está transformando la forma en que las personas acceden a la información sanitaria, ofreciendo grandes oportunidades, pero también riesgos asociados a la desinformación. Su impacto se observa especialmente entre quienes presentan baja alfabetización digital o sanitaria, lo que puede ampliar las desigualdades existentes. La revisión de la literatura reciente destaca la necesidad de un enfoque ético y crítico en el uso de la IA, impulsado desde la atención primaria como espacio clave de confianza y educación. Los profesionales sanitarios, junto con los pacientes y la comunidad, deben participar en estrategias formativas y programas que promuevan un uso responsable de estas herramientas. Aunque la IA mejora la accesibilidad y la eficiencia informativa, también exige una supervisión constante para evitar sesgos y errores. La atención primaria se posiciona como el eje central para liderar un uso ético y equitativo de esta herramienta.
Long- Term Effect of Macrolides on Helicobacter pylori Eradication: Data From the European Registry on Helicobacter pylori Management (Hp- EuReg)
(Wiley & Sons Ltd., 2026-01) Nyssen, Olga P.; Ortega, Guillermo J.; Jonaitis, Laimas; Pérez-Aisa, Ángeles; Bojan, Tepes; Lucendo, Alfredo J.; Pabón Carrasco, Manuel; Gisbert, Javier P.; Hp-EuReg Investigators; Enfermería; panish Association of Gastroenterology (AEG); CTS1050: Cuidados Complejos, Cronicidad y Resultados en Salud
Background and Aims: Previous antibiotic use influences Helicobacter pylori antibiotic resistance. This study evaluated how prior population-level macrolide (especially clarithromycin) use affects H. pylori eradication success in naïve patients. Methods: Retrospective, multicenter, ecological study. Multivariate logistic regression was performed with modified intention- to-treat effectiveness as the main outcome. Key variables included first-line clarithromycin-based treatments, therapy duration (7, 10, 14 days), proton pump inhibitor dose (low, standard, high), compliance (> 90%), and clarithromycin consumption (defined daily doses/1000 inhabitants/day, from the European Surveillance of Antimicrobial Consumption Network). Nested hierarchical models incorporated macrolide consumption, matched by year and country, and assessed the interaction between consumption and first-line empirical treatments from the European Registry on H. pylori Management (Hp-EuReg). Results: The study included 27,549 naïve patients from 23 countries with macrolide consumption data from 2013 to 2022. Higher macrolide consumption, within 0 to 8 years before treatment, was associated with reduced treatment effectiveness. The eradi- cation rate consistently decreased as macrolide consumption increased, particularly within the previous 4 years. The efficacy of triple-clarithromycin-metronidazole, triple-clarithromycin-amoxicillin, and some bismuth-quadruple therapies containing clarithromycin decreased with higher macrolide consumption. At the country level, higher population consumption of clarithro- mycin 2 years before treatment was associated with a decrease in eradication rates from 93% to 82%. Conclusion: Higher macrolide consumption in the general population negatively impacts the effectiveness of first-line H. pylori regimens. These findings support that clarithromycin should only be administered as a susceptibility-based therapy, with the strongest negative impact of prior population-level exposure observed within 5 years and diminishing thereafter.
Fungal microbiota dynamics and its geographic, age and gender variability in patients with cystic fibrosis
(Elsevier, 2022-11-09) Martínez Rodríguez, Sara; Friaza, Vicente; Girón Moreno, Rosa M.; Quintana Gallego, Esther; Salcedo Posadas, Antonio; Figuerola Mulet, Joan; Solé Jover, Amparo; Campano, Elena; Morilla Romero de la Osa, Rubén; Calderón Sandubete, Enrique José; Medrano Ortega, Francisco Javier; Horra Padilla, Carmen de la; Medicina; Enfermería; Junta de Andalucía; Gobierno de España
Objectives: In cystic fibrosis (CF), there is a predisposition to bronchial colonization by potentially pathogenic microorganisms, such as fungi. Our aims were to describe the dynamics of respiratory mycobiota in patients with CF and to evaluate the geographic, age and gender variability in its distribution. Methods: Cohort study in which 45 patients with CF from four hospitals in three Spanish cities were followed up during a 1-year period, obtaining spontaneous sputum samples every 3 to 6 months. Fungal microbiota were characterized by Internal Transcribed Spacer sequencing and Pneumocystis jirovecii was identified by nested PCR in a total of 180 samples. Results: The presence of fungi were detected in 119 (66.11%) of the 180 samples and in 44 (97.8%) of the 45 patients: 19 were positive and 1 negative throughout all follow-ups and the remaining 25 presented alternation between positive and negative results. A total of 16 different genera were identified, with Candida spp. (50/180, 27.78%) and Pneumocystis spp. (44/180, 24.44%) being the most prevalent ones. The distribution of fungal genera was different among the evaluated centres (p < 0.05), by age (non-adults aged 6–17 years vs. adults aged ≥18 years) (p < 0.05) and by gender (p < 0.05). Discussion: A high prevalence of fungal respiratory microbiota in patients with CF was observed, whose dynamics are characterized by the existence of multiple cycles of clearance and colonization, reporting the existence of geographic, age and gender variability in the distribution of fungal genera in this disease.
Availability, perceived need and satisfaction for school nurses in Spain: a cross-sectional study involving the school community
(Springer, 2025-11-04) Zafra-Agea, José Antonio; Domingo-Pérez, Tamara; Lima Serrano, Marta; Vargas Martínez, Ana Magdalena; Soler-Pardo, Engracia; Torralbas-Ortega, Jordi; Hoyos-Cillero, Itziar; Enfermería; Instituto de Biomedicina de Sevilla (IBIS); General Council of Nursing of Spain's budget; CTS969: Innovación en Cuidados y Determinantes Sociales en Salud
Background: School nursing in Spain faces crucial challenges that require immediate attention. This is the first national study developed by the School Nursing Observatory Research Group of the General Council of Nursing (GCN) in Spain on the school nurse (SN) professional profile and their availability at schools. The objective is to understand the social-labor situation, as well as the availability, perceived need, and satisfaction of the school community with the SN, as well as the factors related to these variables. Methods: Cross-sectional study using three ad hoc designed and validated questionnaires through a digital platform. Participants included 376 SNs, 1193 teachers and school principals, and 582 mothers, fathers, and representatives of parents’ associations (PAs). Descriptive and bivariate statistical analyses were conducted using SPSS v.28. Results: Most SNs work in a single school in exclusive, mainly employed by the education department or privately funded special education schools, in urban areas and schools with a high number of students. Both school staff and PAs perceive a high need of and satisfaction with SNs. According to school staff, SNs are more in private and subsidized schools and, according to PAs, in schools where a child has a disease. In schools where there are children with certain diseases, according to PAs, a greater need for a SN was perceived. And the schools staff also found SNs especially necessary in schools located in disadvantage areas. Conclusions: Despite the high level of satisfaction with the role of the school nurse, structural deficiencies remain in its implementation and territorial distribution within the Spanish educational system. These limitations hinder compliance with international quality standards, such as the nurse-to-student ratios recommended by the WHO and other European countries. It is essential to increase the allocation of school nursing professionals, particularly those working on an exclusive, full-time basis, with priority given to rural settings, publicly funded schools, and socioeconomically disadvantaged areas. Strengthening this resource would help reduce health inequities among children and adolescents, address the needs identified by the educational community, and contribute to the achievement of the Sustainable Development Goals (SDGs), particularly those related to health, equity, and quality education.
Willingness to adopt sustainable behaviors: A comparison among Spanish, Italian, and Mexican university members
(Ediciones Universidad Católica Silva Henríquez, 2025) Badanta Romero, Bárbara; Borrego Marín, María del Mar; Tarriño Concejero, Lorena; Corpus-Espinosa, Claudia; Alessia-Lopopolo, Donatella; Luchetti, Giancarlo; Diego Cordero, Rocío de; Economía Aplicada III; Enfermería
This study aims to investigate similarities and differences in opinions related to sustainability and in the willingness to adopt sustainable behaviors between university members from Spain, Italy, and Mexico. An observational, cross-sectional, and comparative study was conducted in 2022 and 2023. A total of 1,149 participants were included from 12 public universities and higher education institutes. The results indicate that the univer-sity community in the three countries demonstrates the ability to recognize and acknowledge the significance of environmental issues. However, few participants were trained or knew the initia-tives promoted by their universities. Concerning the comparison of countries, Spanish participants tend to have more knowledge and positive beliefs about sustainability as compared to the others, while Italian and Spanish participants tend to be more concerned about the deleterious effects of non-sustainable be-haviors and tend to have more positive attitudes as compared to Mexican participants.
Emotional well-being and glycemic control in people with diabetes after a multidisciplinary hybrid education
(MDPI, 2026-01-13) Ruiz-Trillo, Carmen Amelia; Pérez-Morales, Ana; Cortés-Lerena, Ana; Cruz-Álvarez, Pilar Santa; Enríquez-Macias, Mónica; Pabón Carrasco, Manuel; Garrido-Bueno, Miguel; Romero Castillo, Rocío; Bellido, Virginia; Enfermería; CTS1050: Cuidados Complejos, Cronicidad y Resultados en Salud
Background/Objectives: Multidisciplinary hybrid educational programs combined with continuous glucose monitoring may contribute to improved self-management in adults with type 1 diabetes mellitus (T1DM); however, real-world evidence remains limited. This study assessed the effects of an educational intervention integrated with continuous glucose monitoring on glycemic control and patient-reported outcomes in adults with T1DM. Methods: We conducted a single-group quasi-experimental study including 210 adults with T1DM from a public hospital. The nurse-led hybrid intervention consisted of a 2-h in-person group educational session followed by an individual telematic follow-up session. All participants used continuous glucose monitoring. The primary outcome was the change in HbA1c at 9 months. Secondary outcomes included continuous glucose monitoring metrics, diabetes-related quality of life, treatment satisfaction, and hypoglycemia awareness. Results: HbA1c showed a statistically significant but modest reduction from 7.70 ± 1.10% to 7.45 ± 0.91% following the intervention (p = 0.003). No statistically significant changes were observed in continuous glucose monitoring metrics, including time in range, time below and above range, mean glucose, glycemic variability, or sensor wear time. In terms of emotional well-being, treatment satisfaction increased significantly (8.17 ± 7.86 vs. 12.73 ± 5.49; p < 0.001), and the Clarke score showed a statistically significant but modest decrease (2.49 ± 1.90 vs. 2.12 ± 1.88; p = 0.017). Although the overall quality of life score did not change significantly, statistically significant differences were observed in several subscales, including satisfaction, impact, and diabetes-related concern. Conclusions: A multidisciplinary hybrid educational intervention integrated with continuous glucose monitoring was associated with modest improvements in HbA1c and statistically significant, though limited, enhancements in quality of life, treatment satisfaction, and hypoglycemia awareness in adults with T1DM. These findings suggest that similar educational models may have a supportive role in routine care.
The influence of spirituality in the care of patients with advanced chronic illnesses and at the end of life: an integrative review
(Springer Science and Business Media LLC, 2026-01-12) Pérez Jiménez, José Miguel; Bonilla Sierra, Patricia; Diego Cordero, Rocío de; Enfermería; CTS1149: Salud Integral y Sostenible: Enfoque Bio-Psico-Social, Cultural y Espiritual para el Desarrollo Humano
Spirituality is a central yet often overlooked component of care, particularly for people facing advanced chronic illness or approaching the end of life. This integrative review examined evidence on how spiritual care influences emotional, existential, and quality of life outcomes, and identified factors that facilitate or hinder its integration into clinical practice. We searched EMBASE, PubMed, Scopus, Web of Science, BvS, Cochrane, and gray literature for peer-reviewed studies published between 2015 and 2025. Inclusion criteria included adults (≥ 18 years) with advanced or terminal illness, as well as quantitative, qualitative, mixed-methods, and review designs, and publications in English, Spanish, or Portuguese. Twenty-four studies met eligibility criteria. Across all settings and diagnoses, higher spiritual well-being was consistently linked to lower anxiety and depression, greater hope and resilience, better health-related quality of life, and greater acceptance of death. Addressing spiritual needs, particularly meaning, belonging, reconciliation, and death preparation, reduced distress and enhanced dignity when integrated into Advance Care Planning. However, heterogeneity in spirituality definitions, limited professional training, and weak institutional support hindered consistent implementation. These findings underscore spirituality as a determinant of health that should be systematically assessed, taught, and incorporated into the care of patients with serious illness. A brief spiritual assessment, structured meaning-centered conversations with family inclusion, and Advance Care Planning that reflects patients' beliefs and values are recommended.
Psychological distress in Spanish-speaking countries during the COVID-19 pandemic: a systematic review and meta-analysis
(Lippincott Williams & Wilkins; Ovid Technologies (Wolters Kluwer Health), 2026) Escobar-Segovia, Kenny; Domínguez Salas, Sara; García-Iglesias, Juan Jesús; López-López, Daniel; Allande Cussó, Regina; Ruiz-Frutos, Carlos; Artero-García, Alejandro; Gómez Salgado, Juan; Psicología Experimental; Enfermería; Instituto de Biomedicina de Sevilla (IBIS); CTS1050: Cuidados Complejos, Cronicidad y Resultados en Salud; SEJ663: Metodología, Estadística y Psicometría Aplicada a las Ciencias del Comportamiento y de la Salud
Background: Psychological distress (PD) has increased significantly during the coronavirus disease 2019 (COVID-19) pandemic. In Spanish-speaking countries, with their cultural, social, and economic diversity, this phenomenon has become particularly relevant and has been aggravated by factors such as socioeconomic inequalities and unequal access to mental health services. The aim of this systematic review was to consolidate the available knowledge on PD in Spanish-speaking population groups by assessing both the prevalence of symptoms and the associated factors in different demographic groups and geographic contexts, during the COVID-19 pandemic. Methods: A systematic review following the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) statement was conducted in the Web of Science, PubMed, and Scopus electronic databases in January 2025. The search included studies published from the beginning of the pandemic until May 2023. The Joanna Briggs Institute’s critical assessment tool was used to evaluate the chosen studies’ methodological quality. Results: A total of 53 studies were included in the review, which involved research conducted in Spain, Peru, Chile, Ecuador, Argentina, and Colombia. The results revealed a high prevalence of PD in these countries, especially among healthcare workers, women, and young people. The assessment methods used included the General Health Questionnaire (GHQ, GHQ-12, and GHQ-28 versions), the Kessler scale (K-6 and K-10 versions), and the 90-symptom checklist questionnaire (SCL-90-R), that allowed obtaining various dimensions of PD. The studies also highlighted the importance of the sense of coherence and work engagement as protective factors. Conclusions: In the COVID-19 pandemic, PD was analyzed to be severe in Spanish-speaking countries, pointing to the need for specific and culturally adapted interventions to address this public mental health crisis. This is why public health policies must focus on the prevention and treatment of PD, with special attention to the most vulnerable groups.
“Transforming pain”: evaluation of a multicomponent workshop for the treatment of chronic pain—a quasi-experimental design with control group
(MDPI AG, 2026-01-02) Ruiz-Romero, María Victoria; Gómez-Hernández, María Begoña; Porrúa-Del Sanz, Ana; Martínez-Monrobé, María Blanca; Gutiérrez-Fernández, Natalia; Arroyo-Rodríguez, Almudena; Guerra Martín, María Dolores; Pereira-Delgado, Consuelo; Enfermería; CTS1158: Desarrollo y Evaluación de Intervenciones en Salud y en Educación
Background/Objectives: Between 20 and 30% of the global population experiences Chronic Pain (CP). A comprehensive, interdisciplinary approach incorporating nonpharmacological interventions and active patient participation is recommended. This study evaluated the short- and medium-term effectiveness of a multicomponent workshop compared with a control group. Methods: A detailed description of the workshop and a single-group before–after evaluation in 197 patients were recently published. The present study used a quasi-experimental before–after design with a three-month follow-up, comparing an intervention group (n = 64) with a contemporaneous control group that continued with usual care (n = 64). Validated scales were used to measure pain, wellbeing, quality of life (QoL), self-esteem, resilience, anxiety, and depression. Two ad hoc surveys assessed satisfaction and perceived impact on pain, medication use, habits, and mood. Results: A total of 128 patients participated (64 per group). The intervention group showed statistically significant improvements in all indicators at both short-term (end of workshop) and medium-term (three months) follow-up. Pain decreased by −1.3 (−3.0–0) [3 months: −1.0 (−3.0–−1.0)], anxiety by −3.0 (−5.0–−1.0) [3 months: −3.0 (−5.0–1.0)], and depression by −4.0 (−7.0–−2.0) [3 months: −3.0 (−6.0–0)]. Well-being increased by 3.0 (1.0–4.0) [ 3 months : 1.0 (0–4.0)]; QoL by 0.213 (0.072–0.388) [3 months: 0.185 (0.013–0.337)]; perceived health by 13.5 (0–30.0) [3 months: 10.0 (0–30.0)]; self-esteem by 4.5 (1.0–7.3) [3 months: 3.0 (−1.0–6.0)], and resilience by 1.0 (−1.0–5.0) [3 months: 1.0 (0.0–5.0)]. In the control group, resilience worsened (−1.0 [−5.0–1.0], p = 0.002) and depression increased (1.0 [−1.0–3.0], p = 0.037 ). Pain decreased in 47 participants (74.6%) at the end of the workshop [3 months: 34 (65.4%)]. Of 55 who used medication, 48 (81.4%) reduced their intake [3 months: 34; 68.0%]. Healthy habits improved in 58 (92.1%) [3 months: 40; 78.4%]. Mood improved: 26 (41.3%) described themselves as “cheerful” and 24 (38.1%) as “neutral” [3 months: 23; 44.2% and 14; 26.9%]. Overall satisfaction: 9.7 (scale 0–10). Conclusions: The workshop enabled patients to mitigate pain, actively participate in self-care, and improve quality of life, self-esteem, and emotional well-being. These effects persisted three months post-intervention.
Empowering patients: a multicomponent workshop improves self-management and quality of life in chronic pain
(MDPI, 2025-12-15) Ruiz-Romero, María Victoria; Gómez-Hernández, María Begoña; Porrúa-Del Saz, Ana; Martínez-Monrobé, María Blanca; Gutiérrez-Fernández, Natalia; Arroyo-Rodríguez, Almudena; Guerra Martín, María Dolores; Pereira-Delgado, Consuelo; Enfermería; Instituto de Biomedicina de Sevilla (IBIS); CTS1158: Desarrollo y Evaluación de Intervenciones en Salud y en Educación
Backgruond: Chronic pain is a prevalent and disabling condition, affecting 20–30% of the global population, which requires multidisciplinary approaches integrating non-pharmacological therapies and promoting patient engagement in self-management. Objective: To describe the structure, content, outcomes, and lessons learned from multicomponent workshops for chronic non-cancer pain using non-pharmacological therapies. Methods: A quasi-experimental before–after study was conducted in patients attending a chronic pain workshop at San Juan de Dios Hospital (Bormujos, Seville, Spain) between November 2021 and May 2024, with a 3-month follow-up, Validated scales and an ad hoc patient survey were administered at baseline, immediately post-workshop, and at 3-month follow-up. Furthermore, comparative analysis was conducted 4 months before and after the intervention for emergency visits and consultations, medication consumption, and employment status. Analyses employed Chi-square or Fisher’s exact tests (categorical variables); student’s t-tests or Mann–Whitney U (between-group); paired t-tests or Wilcoxon (within-group pre–post); and effect sizes (Cohen’s d, Rosenthal’s r). Significance was set at p < 0.05. Results: 197 patients completed the workshop; 178 (90.4%) were women, mean age: 55.0; 114 (57.9%) had fibromyalgia. Reductions were observed in: pain (scale 0–10) (baseline: 7.0; end of workshop: 5.0; 3 months: 5.0; p < 0.001); anxiety (13.0; 9.0; 11.0; p < 0.001); and depression (11.4; 7.2; 6.8; p < 0.001) (scales 0–21). Increases were noted in: well-being (scale 0–10) (4.0; 6.0; 5.0; p < 0.001); quality of life (scale 0–1) (0.399; 0.581; 0.556; p < 0.001); health status (scale 0–100) (40.0; 60.0; 60.0; p < 0.001); self-esteem (scale 9–36) (23.5; 27.1; 26.6; p < 0.001); and resilience (scale 6–30) (17.0; 18.0; 18.0; p = 0.002, p < 0.001). PROMs were completed by 189 patients at the end of the workshop and 110 at 3 months: pain decreased (end of workshop: 76.7%; 3 months: 80.7%); medication decreased (80.5%; 78.1%); and habits improved (87.2%; 87.6%). 40 patients (37.4%) reduced emergency visits and scheduled consultations. Overall satisfaction: 9.7. Conclusions: The workshop enhanced patients’ self-management and produced improvements in pain, quality of life, emotional well-being, and self-esteem, with effects maintained at 3 months.
Effects of continuous glucose monitoring on glycemic control, mental health and self-management in adults with type 1 diabetes: a randomized controlled trial
(MDPI, 2025-12-05) Romero Castillo, Rocío; Pabón Carrasco, Manuel; Kaknani Uttumchandani, Shakira; Ponce Blandón, José Antonio; Enfermería; CTS1050: Cuidados Complejos, Cronicidad y Resultados en Salud; CTS284: Promoción de la Salud
Background/Objectives: Adults with type 1 diabetes (T1D) often experience psychological distress that interferes with their ability to maintain optimal self-care. The purpose of this study was to evaluate the effectiveness of the Diabself-care, a nurse-led structured diabetes self-management education (DSME) intervention designed to improve glycemic control, self-care practices and mental health among adults with T1D. Methods: A total of 224 adults with type 1 diabetes were randomized and final analyses included 110 participants in the intervention group and 106 in the control group. The intervention group received the Diabself-care program, consisting of five daily 90 min sessions integrating education, skill training, self-management and coping strategies in addition to usual care. The control group received standard diabetes care. Outcomes were assessed at baseline, 1 month and 3 months. The primary measure was glycemic control and secondary outcomes including self-management, anxiety and depressive symptoms. Results: The intervention group achieved a significant increase in time in range at both 1 and 3 months. Self-management adherence improved significantly in the intervention group (p < 0.001). Anxiety and depression scores decreased significantly in the intervention group at 1 and 3 months, while they remained unchanged in controls. Regression analyses identified depressive symptoms as the strongest predictor of anxiety (OR = 4.34, 95% CI = 2.99–6.28, p < 0.001), while female sex, older age, and low self-management were predictors of depression. Belonging to the intervention group was strongly protective against depression (OR = 0.11, 95% CI = 0.05–0.24, p < 0.001). Conclusions: The Diabself-care program significantly improved glycemic control, self-management, and psychological outcomes in adults with T1D. These findings highlight the dual clinical and mental health benefits of structured nurse-led DSME, supporting its integration into routine diabetes care. The trial is registered at ClinicalTrials.gov, ID: NCT05159843.
Biopsychosocial and occupational health of emergency healthcare professionals: a systematic review and meta-analysis
(Mdpi Ag, 2025-12-04) Galindo-Herrera, Rafael; Pabón Carrasco, Manuel; Romero Castillo, Rocío; Garrido-Bueno, Miguel; Enfermería; CTS1050: Cuidados Complejos, Cronicidad y Resultados en Salud
Background/Objectives: Emergency healthcare professionals are continually exposed to high clinical and organizational demands that compromise their mental, physical, and occupational health. This systematic review and meta-analysis examined the prevalence and interrelations of biopsychosocial and work-related health outcomes among emergency personnel, providing an integrated synthesis of recent empirical evidence. Methods: A systematic search of PubMed, Scopus, Web of Science, and CINAHL identified 6214 records, of which 50 studies met inclusion criteria and were analyzed (total n = 278,000 emergency professionals). Eligible studies (2020–2025) evaluated biopsychosocial outcomes (burnout, depression, stress, resilience, sleep quality) and occupational indicators (workplace violence, job satisfaction, effort-reward imbalance, engagement, turnover intention). Meta-analyses were conducted using random-effects models (DerSimonian-Laird method), producing pooled prevalence estimates for each outcome based on the number of studies that reported the corresponding variable. Risk of bias was assessed using the Joanna Briggs Institute tools, with most studies rated as moderate-to-high quality. Results: Pooled estimates showed fair self-perceived health in 44.0%, severe burnout in 10.7%, depressive symptoms in 35.1%, moderate-to-severe stress in 74.6%, and poor sleep quality in 40.1% of staff. Workplace violence affected 76.9% of professionals. Job satisfaction averaged 68.1%, turnover intention 62.1%, and effort-reward imbalance 61.9%. Resilience was predominantly moderate (33.9%). Considerable heterogeneity was observed; however, patterns were consistent across regions and professional roles. Conclusions: Emergency healthcare personnel face substantial biopsychosocial strain and occupational risks, driven by persistent structural pressures. Health systems should implement integrated organizational strategies to reduce violence, enhance psychological support, ensure safe staffing, and protect rest and recovery. Improving staff well-being is essential for maintaining a resilient and effective emergency care workforce.
How Context Shapes Person-Centred Fundamental Care Through Nurse–Patient Relationships: Validation of the FoC Intelligence Modelling Tool and Predictive Pathway Analysis
(John Wiley & Sons Ltd., 2025-11-11) Allande Cussó, Regina; Pinero de Plaza, Maria Alejandra; Kitson, Alison; Feo, Rebecca; Conroy, Tiffany; Porcel Gálvez, Ana María; Enfermería; Instituto de Biomedicina de Sevilla (IBIS); CTS1050: Cuidados Complejos, Cronicidad y Resultados en Salud
Background: The Fundamentals of Care (FoC) Framework emphasises that care quality depends not only on clinical tasks but also on interpersonal relationships and the organisational context in which care is delivered. Although patient-reported outcome and experience measures (PROMs and PREMs) have gained relevance in capturing these aspects, tools based on the FoC Framework remain limited in non-English-speaking settings. Objectives: To psychometrically validate the Spanish version of the FoC Intelligence Modelling Tool (FoC-IMT) and explore predictive relationships among the FoC dimensions: Context, Relationship and Integration of Care. Methods: A cross-sectional study was conducted with 1053 hospitalised patients in southern Spain. Exploratory and confirmatory factor analyses (EFA and CFA) were performed, alongside a mediation analysis using partial least squares structural equation modelling (PLS-SEM) to examine directional relationships among constructs. Results: EFA and CFA supported a two-factor model—Context and Integration of Care—with excellent internal consistency (Cronbach's α and McDonald's ω = 0.97). CFA showed a moderate correlation between these factors. However, PLS-SEM mediation analysis revealed a directional model in which Context influences Relationship (β = 0.39), which in turn predicts Integration of Care (β = 0.89). Although embedded within Integration under CFA, the Relationship showed independent predictive power in PLS-SEM, validating its conceptual importance. This aligns with the foundational assumption of the FoC Framework: that caregiving quality is shaped not only by tasks or procedures but by the broader environment and interpersonal relationships in which care occurs. Conclusions: The Spanish FoC-IMT Tool is a valid, reliable instrument for assessing person-centred care. The predictive model highlights the pivotal role of therapeutic relationships in delivering integrated, high-quality care.
Editorial: The influence of flourishing and its associated factors on the mental health and well-being of individuals
(Frontiers media SA, 2025-11-06) Lucchetti, Giancarlo; Badanta Romero, Bárbara; Diego Cordero, Rocío de; Vallada, Homero; Gonçalves, Juliane Piasseschi de Bernardin; Enfermería; CTS1149: Salud Integral y Sostenible: Enfoque Bio-Psico-Social, Cultural y Espiritual para el Desarrollo Humano
Design and validation of the flipped-learning assessment scale for undergraduate nursing education
(WILEY, 2024-12-09) Urcola-Pardo, Fernando; Subiron-Valera, Ana Belen; Anton-Solanas, Isabel; Orkaizagirre-Gomara, Aintzane; Torres Enamorado, Dolores; Gonzalez-Sanz, Juan Diego; Enfermería; SEJ066: Mujeres, Bienestar y Ciudadanía
Aim: To design and validate the Flipped-Learning Assessment Scale; a tool for assessing students' experience of flipped learning. Background: Frequently, university students are introduced to new content during lectures. In contrast, active learning activities, such as Flipped Learning, are designed as an instructional method to engages students in the learning process. Design: Cross-sectional descriptive study. Methods: A cross-sectional study was carried out in three phases ((1) item selection, rephrasing and translation; (2) content analysis through expert panel and (3) confirmatory factor analysis). The final version of the scale was piloted on a sufficient sample of undergraduate student nurses from three Spanish universities. Results: A total of 455 students completed the questionnaire; 373 women and 82 men. The total Cronbach's alpha value for the complete instrument was 0.893. Cronbach alpha for each separate dimension ranged between 0.660 and 0.897. Goodness-of-fit values were acceptable, implying that the model was validated. Conclusion: The flipped learning approach has become increasingly popular in academic settings. Evaluating the students' flipped learning experience is important to analyse aspects such as acceptability and effectiveness of this methodology. The Flipped-Learning Assessment Scale is a valid and reliable tool for analysing students' experience of flipped learning. Impact: Flipped learning has been a useful pedagogical model very for cultivating student skills in problem-solving, critical thinking, teamwork and self-active learning in nursing education. A key issues, such as student satisfaction, has been explored further before implementing this teaching and learning methodology. Patient or public contribution: None.
Translation, cross-cultural adaptation and validation of the Spanish version of “Assessment of Physiotherapy Practice” (APP-S)
(Springer Science and Business Media LLC, 2025-10-14) Magni, Eleonora; Guerra Martín, María Dolores; Enfermería
Background Clinical education is a key component of the undergraduate education of physiotherapy students, as it provides the context for the development of essential clinical competencies. These competencies can be assessed in a variety of ways, with scales being one of the most widely used. Among these, the “Assessment of Physiotherapy Practice” (APP) has demonstrated robust psychometric properties and is used in several countries. The objective of this study is to translate and cross-culturally adapt the APP into Spanish (APP-S) and assess its psychometric properties (reliability, content validity, and structural validity) and edumetric properties (acceptability and feasibility). Methods This study involved 27 clinical educators (CEs) and 145 physiotherapy students (92 students in the fourth year and 53 students in the third year) from two Spanish universities. Students were assessed at the end of a clinical placement period during the last semester of the academic year. Ten CEs and 35 students evaluated content validity in terms of relevance, comprehensiveness and comprehensibility, using the Content Validity Index for each item (I-CVI) and for the entire scale (S-CVI). Structural validity was examined using exploratory factor analysis, while reliability was assessed using Cronbach’s alpha (α). Finally, eight CEs assessed acceptability and feasibility using a 12-item feedback form. Their ratings were then analysed using Aiken’s V coefficient and the percentage of agreement was calculated. Results The scale demonstrated acceptable content validity (I-CVI ≥ 0.89, S-CVI >0.95) and an excellent internal consistency (Cronbach’s α = 0.971). Exploratory factor analysis revealed a two-factor solution: dimension 1, items 6–20; dimension 2, items 1–5. CEs provided positive feedback regarding acceptability and feasibility, with Aiken’s V values ≥ 0.78 and a high percentage of agreement. Conclusions The APP-S is an appropriate tool for assessing students in clinical placement, and it was well accepted and positively rated by CEs. Further studies are needed to consolidate its psychometric properties.

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