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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) 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.
Protocolo de intervención para la de prescripción de antidepresivos en Atención Primaria: un ensayo clínico comunitario aleatorizado
(2025 Madrid Ministerio de Sanidad y Consumo, Secretaría General Técnica, 2025-10-07) Madueño-Caro, Antonio José; Chávez-Gata, Luis; Álvarez-Harana, Lidia; Gómez-Salgado, Juan; García-Iglesias, Juan Jesús; Allande Cussó, Regina; Enfermería; CTS1050: Cuidados Complejos, Cronicidad y Resultados en Salud
Fundamentos El consumo de antidepresivos ha aumentado considerablemente a nivel mundial, incluyendo España. A pesar de su eficacia en casos de depresión moderada a grave, su uso a largo plazo y en casos leves es cuestionado. Este estudio se propuso evaluar la efectividad de una intervención de deprescripción en Atención Primaria, con el objetivo de reducir el consumo innecesario de estos fármacos y mejorar la calidad de vida de los pacientes. Métodos Se llevará a cabo un ensayo clínico comunitario antes-después en una población adulta, residentes en un área urbana de Cádiz (España) y con prescripción de antidepresivos en el último año. Los participantes serán seleccionados aleatoriamente y se les realizará un seguimiento durante un período determinado previo consenso. La intervención consistirá en una evaluación integral del tratamiento antidepresivo por parte de un equipo de profesionales de la salud. Se evaluarán factores como la indicación, la dosis y la respuesta al tratamiento, y se usarán la Escala de Hamilton para ansiedad y el Inventario de Beck para depresión. En aquellos casos en los que se considere apropiado, se propondrá una reducción gradual o suspensión del fármaco, siempre bajo supervisión médica. Conclusiones Esta investigación contribuirá a generar evidencia científica sobre la seguridad y eficacia de la de deprescripción en Atención Primaria, promoviendo un uso más racional de los antidepresivos y mejorando la calidad de vida de los pacientes. Los resultados obtenidos podrían tener implicaciones importantes para la práctica clínica y para el desarrollo de guías de práctica clínica.
Transforming caring for dependent older people: A new approach for integrated socio‐healthcare
(Wiley, 2025) Porcel Gálvez, Ana María; Allande Cussó, Regina; Lima Serrano, Marta; Enfermería; Instituto de Biomedicina de Sevilla (IBIS); CTS1050: Cuidados Complejos, Cronicidad y Resultados en Salud; CTS969: Innovación en Cuidados y Determinantes Sociales en Salud
Background: The increasing ageing population and growing socioeconomic disparities in the Mediterranean region pose significant challenges to the provision of integrated socio-healthcare services. Current models often fail to address the complex needs of dependent older adults and those at risk of social exclusion, highlighting the need for a sustainable, person-centred approach. Objectives: This study aims to develop and theoretically ground the TEC-MED framework, a novel model for integrated sociohealth care that ensures holistic, ethical, and culturally responsive care for vulnerable older populations. Methods: A concept analysis following Walker and Avant's methodology was conducted, informed by prior empirical research. The framework was designed based on the nursing metaparadigm, incorporating interdisciplinary collaboration, digital health solutions, and policy integration at micro, meso, and macro levels. Results: The TEC-MED framework consists of six key dimensions (person, socio-health professionals, care context, service provision, overnance, and financing) and five transversal values (quality research, gender equity, social inclusion, ethics, and transcultural care). The model enhances interdisciplinary coordination, digital innovation, and patient-centered care, addressing disparities in access and service fragmentation. Case studies demonstrate its applicability in diverse healthcare settings. Conclusion: The TEC-MED framework offers an innovative and sustainable solution for improving socio-healthcare integration, ensuring dignified and inclusive care for dependent older adults. Its implementation has significant implications for clinical practice, policymaking, and professional training, reinforcing the humanisation of care while promoting health equity and system sustainability .
Exploring the ethical dimensions of care dependency in older people: A transpersonal view
(Wiley, 2025-10-03) Porcel Gálvez, Ana María; Enrique‐Octavio Iñiguez‐Castro; Gloria Martínez‐Lacovic; Allande Cussó, Regina; Enfermería; Instituto de Biomedicina de Sevilla (IBIS); CTS1050: Cuidados Complejos, Cronicidad y Resultados en Salud
Introduction: Care dependency in older adults is a growing global concern, driven by population ageing and the increasing prevalence of chronic conditions. Beyond its clinical implications, care dependency involves ethical, cultural, and transpersonal dimensions that shape the lived experiences of individuals and caregivers. This study aims to refine the concept of care dependency through an explicitly transpersonal and culturally sensitive lens, informing practice, education, and policy. Methods: Following Walker and Avant's concept analysis framework, a systematic review of the literature was conducted. Key attributes, antecedents, and consequences were identified through an iterative process of data synthesis and the-oretical reflection, including the development of model, borderline, and contrary cases to explicitly illustrate conceptual application. Results: The analysis identified four defining attributes: loss of autonomy; erosion of identity and self-image; biographical rupture; and negative coping. Antecedents include physiological ageing, chronic degenerative disease, cognitive decline, and psychosocial/cultural factors that constrain autonomy. Consequences extend beyond functional limitations, affecting emotional well-being and generating ethical and context-specific decisions. The cases demonstrate a continuum from full dependency to complete autonomy and make visible how context and culture shape these attributes. Conclusions: Care dependency emerges as a multidimensional, ethically situated phenomenon, shaped by relationships, culture, and context. The proposed conceptual framework offers practical guidance for applying a transpersonal approach, prioritizing mutual presence, active listening, cultural attunement, and shared decision-making to preserve dignity, meaning, and connection in daily care. Future research should explore the framework's applicability through qualitative studies in diverse settings to translate it into actionable, ethically grounded tools and interventions.
Profile of European frequent attenders in primary health care: a systematic review and meta-analysis
(Oxford University Press (OUP), 2025-10-01) Sánchez-Gómez, David; Pabón Carrasco, Manuel; Fagundo-Rivera, Javier; Romero Castillo, Rocío; Vega Escaño, Juan; Jiménez Picón, Nerea; Enfermería; CTS1050: Cuidados Complejos, Cronicidad y Resultados en Salud
Introduction Frequent attendance is a phenomenon that increases health expenses and affects the environment and development of health-related activities, reducing the quality of the assistance provided and increasing care pressure. This problem is intensified in primary health care (PHC) due to high workload and limited resources. The objective of this study is to describe the sociodemographic, clinical, psychopathological, and psychosocial profile of adult frequent attenders (FAs) of PHC centres in Europe. Methods A systematic review with meta-analysis was carried out between September 2023 and August 2024, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and consulting the PubMed, Embase, Scopus, Web of Science, and PsycINFO databases. From 1008 records, 17 studies were finally selected, with data extraction into content tables. Results FAs in PHC are typically middle-aged women with medium to high educational and socioeconomic levels, unemployed or retired, married, and living with their families. They often present chronic diseases and physical or psychological conditions, such as cardiovascular, respiratory, or locomotor issues. Depression, anxiety, and somatization are the most common psychological diagnoses. Psychosocially, they perceive their health as poorer, experience more social dysfunction, and report higher exposure to stress. The meta-analysis supports these findings but shows high heterogeneity (I² ≥ 50%) due to varying measurement tools and national contexts. Conclusion FAs in PHC are usually middle-aged women with medium-high socioeconomic status, retired or unemployed, and living with family. They often have chronic, physical, and some psychiatric conditions, with limited quantitative psychosocial assessment.
Effects of sports shoe drop on walking biomechanics: a cross-sectional observational dynamometric study
(Mdpi Ag, 2025-09-28) Fragua-Blanca, Raquel; Tovaruela Carrión, Natalia; Cobos-Moreno, Paula; Tena-León, Manuel Jesús; Escamilla Martínez, Elena; Podología; CTS601: Hermes
Sports footwear is widely used across a range of physical activities. A key factor distinguishing running shoes from other types of footwear is the “drop,” the millimeter difference between the heel and the forefoot. This study aimed to analyze the influence of different drops (0, 5, and 10 mm) on ground reaction forces during walking and to examine the effects of sex and body mass index (BMI) under these conditions. An observational, descriptive, and cross-sectional study was conducted with 117 participants (56 men and 61 women). The Dinascan/IBV® dynamometric platform (Instituto de Biomecánica de Valencia, Valencia, Spain) was used to measure ground reaction forces during walking (braking, take-off, propulsion, and swing forces), walking speed, and stance time. The descriptive analysis revealed comparable values for the left and right limbs, with slightly higher values observed in the right limb. Statistically significant differences were found in stance time, braking force, and swing force between the 0 mm and 10 mm drop conditions. Take-off force showed highly significant differences when comparing the 0–5 mm and 0–10 mm drop conditions. Sex-based differences were observed in all variables at the initial proposed drop condition of 0 mm, except for walking speed, possibly due to anatomical and physiological differences. Significant differences were found in stance time at 0 mm drop, braking force, and propulsion force. Highly significant values were obtained for take-off force and during the swing phase. A strong correlation was found between ground reaction forces and BMI with the different proposed drops in all forces studied, except for the support force, where a moderate correlation was obtained. Although shoe drop was found to influence ground reaction forces in this study, it is one of several factors that affect gait biomechanics. Other footwear characteristics, such as sole stiffness, material composition, weight, and elasticity, also play important roles in walking performance. Therefore, shoe drop should be considered an important but not exclusive parameter when selecting footwear. However, these results are limited to healthy young adults and may not be generalizable to other age groups or populations.
Application of the objective structured clinical examination in undergraduate nursing students: A systematic review with meta-synthesis
(Elsevier, 2025-09-11) Garrido-Bueno, Miguel; Romero Castillo, Rocío; Pabón Carrasco, Manuel; Enfermería; CTS1050: Cuidados Complejos, Cronicidad y Resultados en Salud
Objectives: Clinical simulation enables students to replicate healthcare scenarios in a safe setting. The Objective Structured Clinical Examination (OSCE) is the gold standard for assessing clinical competence in nursing education. This study aimed to review the characteristics and applications of OSCE with nursing students and to explore their perceptions of it. Design: Systematic review with meta-synthesis. Data sources: PubMed, Scopus, Embase, Web of Science, and CINAHL. Review methods: Studies were selected based on inclusion criteria such as nursing student focus, mention of OSCE, and discussion of competencies and perceptions. Searches were conducted from December 2024 to March 2025. Risk of bias was assessed, and data were synthesized using Microsoft Excel. Results: Twenty-five studies including 3,605 students were included. OSCE designs varied widely. Students described OSCE as objective and beneficial, though anxiety-inducing due to realism and time pressure. Conclusion: A consensus model recommends in-person OSCEs of brief duration, with debriefing and broad competency assessment. Findings support improved simulation strategies for nursing students, enhancing clinical judgment and confidence.
Measuring the Science of Caring: A Patient-Centred Predictive Model for the Caring Interaction
(WILEY, 2025-09-01) Allande Cussó, Regina; Pinero de Plaza, María Alejandra; Gómez‐Salgado, Juan; Porcel Gálvez, Ana María; Enfermería; Instituto de Salud Carlos III; CTS1050: Cuidados Complejos, Cronicidad y Resultados en Salud
Background: The nurse–patient relationship is central to quality nursing care, yet its impact remains difficult to quantify. While existing models assess caring competencies from the perspective of nursing students and professionals, there is a lack of validated instruments incorporating direct patient feedback. Objective: This study aimed to develop and validate the Nursing Interaction in Caring_Competence Assessment—Patient (NIC_CA-Patient) tool, a patient-centred instrument designed to measure caring interaction in nursing practice and establish a predictive model of its development from the patient's perspective. Methods: A cross-sectional study was conducted in eight hospitals within the Andalusian Health Care System, involving 1060 patients admitted to internal medicine units. The NIC_CA-Patient tool was adapted from the Caring Nurse–Patient Interactions (CNPI) scale and validated through exploratory factor analysis (EFA) and partial least squares structural equation modelling (PLS-SEM). Results: The final model identified three key dimensions—therapeutic relationship, problem management and adaptation—ex- plaining 79% of the variance in patient-reported experiences. The predictive model demonstrated strong reliability (Cronbach's α = 0.97) and excellent model fit indices (SRMR = 0.03, AVE > 0.7). Conclusion: The NIC_CA-Patient tool provides a quantifiable and predictive measure of caring interaction from the patient's perspective. Its implementation in clinical practice and research can enhance patient-centred care by identifying relational fac- tors that improve health outcomes and patient experience.
Satisfacción con el proceso del parto en mujeres sometidas a inducción del Parto
(Health Sciences Research Unit: Nursing, 2025) Ruiz-Moreno, Sandra; Hidalgo-Lopezosa, Pedro; Guerra Martín, María Dolores; Enfermería
Marco contextual: La inducción del parto suele ocasionar partos complicados y mayor intervencionismo, lo que puede conllevar frustración y ansiedad.Objetivo: Analizar la satisfacción del proceso de parto en mujeres sometidas a inducción. Metodología: Estudio observacional. Muestreo no probabilístico por conveniencia. Se establecieron criterios de inclusión y exclusión. La muestra fue de 46 participantes. Se utilizó un cuestionario sociodemográfico, obstétrico y la versión española de la Mackey Childbirth Satisfaction Rating Scale. Resultados: La satisfacción global fue buena. La subescala mejor valorada fue la relacionada con el recién nacido, las peor valoradas las relacionadas con las fases dilatación y expulsivo. La satisfacción del acompañante y confort de las mujeres entre 30-34 años fue mayor que en ≥ 40 años. La satisfacción global fue mayor en mujeres que recibieron información previa sobre el proceso de inducción y que habían cumplido sus expectativas. Conclusión: La satisfacción global y por subescalas fue alta. Los resultados aportan evidencia para una atención eficaz de calidad que mejore los niveles de satisfacción de mujeres inducidas.
Prognostic factors affecting return to work in cancer patients: A systematic review
(BMJ, 2025-08-12) López-Faneca, Lydia; Ruiz-Frutos, Carlos; Gómez-Salgado, Juan; Fagundo-Rivera, Javier; Palomo-Gómez, Rocío; Allande Cussó, Regina; Ruger-Navarrete, Azahara; Macías-Toronjo, Israel; García-Iglesias, Juan Jesús; Enfermería; CTS1050: Cuidados Complejos, Cronicidad y Resultados en Salud
Return-to-work rates among working-age cancer survivors present a complex challenge, varying by cancer type and individual characteristics. This study aimed to identify prognostic factors influencing return to work in cancer survivors. A systematic review was conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Searches in PubMed, Scopus and Web of Science databases in December 2024 used keywords based on the Population, Prognostic Factors, Outcomes framework to identify relevant studies. Study quality was evaluated using Joanna Briggs Institute tools and the protocol was registered in PROSPERO (CRD42024596102).Twenty studies were selected. Identified factors included sociodemographic: older age, educational level, marital status and sex; clinical: aggressive treatments, comorbidities and physical sequelae; psychological: anxiety, stress, fear of relapse and social support; occupational: flexible work schedules and tasks versus rigid conditions. Multiple factors influence return-to-work outcomes for cancer survivors.Individualised intervention programmes addressing specific patient needs and fostering adapted work environments are essential to promote successful reintegration.
Beyond Pain Management:
(2025-06-02) Guerra Martín, María Dolores; Pérez Jiménez, José Miguel; Coheña Jiménez, Manuel; Borrallo Riego, Álvaro; Luque Oliveros, Manuel; Pedro Jiménez, Domingo de; Bonilla Sierra, Patricia; Enfermería; Podología; MDPI; CTS1149: Salud Integral y Sostenible: Enfoque Bio-Psico-Social, Cultural y Espiritual para el Desarrollo Humano
Background: Postoperative pain management after a cesarean section remains a significant challenge, as inadequate control can delay maternal recovery and hinder early bonding and breastfeeding. While multimodal analgesia is the standard approach, non–pharmacological strategies like immediate skin–to–skin contact (SSC) are often underused despite their potential benefits in reducing pain, improving uterine contractions, and increasing maternal satisfaction. Objective: To evaluate the effects of immediate SSC on postoperative pain perception, uterine contraction quality, and maternal satisfaction, and to explore ways to incorporate SSC into routine post–cesarean care to promote recovery and humanized care. Method: A randomized clinical trial was conducted with 80 women undergoing elective cesarean sections, divided into two groups: SSC (40 women) and control (40 women). Postoperative pain was measured using the Visual Analog Scale (VAS) at various intervals, while uterine contraction quality and maternal satisfaction were assessed through clinical observation and a Likert scale, respectively. Results: We found that women in the SSC group experienced significantly lower pain scores (VAS2 and VAS3, p < 0.001), stronger infraumbilical uterine contractions (92.5%, p < 0.001), and higher satisfaction levels (average 9.98 vs. 6.50, p < 0.001). An inverse correlation was observed between pain intensity and satisfaction, indicating that SSC enhances both physiological and psychological recovery. Conclusions: Immediate SSC after cesarean is an effective, humanizing intervention that reduces pain, supports uterine contractions, and boosts maternal satisfaction. These findings advocate for integrating SSC into standard postoperative care, aligning with ethical principles of beneficence and autonomy. Further research with larger samples is necessary to confirm these benefits and facilitate widespread adoption in maternity protocols
Diaphragmatic breathing for referred pain after total laparoscopic hysterectomy: a randomized clinical trial
(Springer, 2025-08-18) Partida Márquez Antonio Luis; Fernández Domínguez, Juan Carlos; Martínez Fernández, José Antonio; Pabón Carrasco, Manuel; Melero Cortes Lidia; Oliva Pascual-Vaca, Ángel; Fisioterapia; Enfermería; Universidad de Sevilla; CTS1050: Cuidados Complejos, Cronicidad y Resultados en Salud; CTS1043: Salud, Fisioterapia y Actividad Física
Background: Referred cervicoscapular pain is common after laparoscopic surgery. This pain has different characteristics from incisional pain and requires a different approach. Method: A blinded, randomized, controlled trial was conducted. Women reporting referred pain with an intensity of 7 points or higher on the visual analogue scale after total laparoscopic hysterectomy (TLH) were randomly assigned to a diaphragmatic breathing group (DBG) or a neck exercise group (NEG). Both groups performed the exercises three times daily, and the usual medical care was maintained. Pain intensity and location were assessed using the McGill questionnaire. Specific self-reported questionnaires were used to assess the evolution of functional disability in the head (HIT-6), shoulder and neck (NDI), or upper limbs (QuickDASH). Follow-up was conducted weekly for 4 weeks after surgery. Results: Seventy-four women (43.7 ± 9,5 years; 26.6 ± 4.9 body mass index) were recruited. The most common area of referred pain was the shoulder and neck (n = 55), followed by the head (n = 48) and upper limbs (n = 14), with four women showing pain in all three areas and thirty-five in two areas. Both groups showed improvement over time in pain intensity and functional disability in all the locations (p < 0,001). However, DBG demonstrated a faster recovery for pain intensity, NDI, and HIT-6 (p < 0,001), while no between-group difference was found for QuickDASH (p > 0,05). No adverse effects were reported for any of the tested interventions. Conclusions: Referred pain in TLH tends to become self-limiting over time, but diaphragmatic breathing exercises resulted in a faster reduction in pain intensity and craniocervical disability when compared with gentle cervical stretching exercises. Thus, abdominodiaphragmatic breathing might be a simple and safe complementary intervention to be taught to patients suffering from referred pain after TLH.
Exploring Psychosocial Risk Factors Among Spanish Nurses: Links to Health and Professional Variables
(Wiley, 2025-08-27) Narbona-Gálvez, Ángela; Gómez‐Salgado, Juan; Allande Cussó, Regina; Ruiz‐Frutos, Carlos; Ayuso-Murillo, Diego; Fontán-Vinagre, Guadalupe; Goniewicz, Krzysztof; Fagundo-Rivera, Javier; Castaño Seiquer, Antonio Luis; Enfermería; Estomatología; CTS1050: Cuidados Complejos, Cronicidad y Resultados en Salud
Objective: To identify factors associated with the perception of psychosocial risks among practising nurses in Spain and to examine their relationship with personal, professional and health-related characteristics. Design: Observational, cross-sectional and correlational study. Participants: A total of 2765 nurses completed an online questionnaire between March and June 2023. The survey was distributed via professional networks and the General Nursing Council of Spain. Methods: Descriptive and bivariate analyses were conducted, along with a categorical regression to identify factors associated with perceived psychosocial risk (measured using the ISTAS_Enfermería scale). Model assumptions were tested and multicollinearity was assessed. The model included self-reported sociodemographic, occupational and mental health variables. Results: Female sex, being under 41 years of age, working night or rotating shifts, recent use of psychotropic medication and symptoms of anxiety or depression were all associated with higher levels of perceived psychosocial risks. These variables explained 29.6% of the variance. Due to the cross-sectional design, no causal relationships can be inferred. Conclusions: Certain professional profiles appear to be more vulnerable to perceived psychosocial risks that are associated with their personal, occupational and health characteristics. These associations are likely to be bidirectional and context-dependent. Longitudinal research is needed to better understand causal mechanisms and to guide personalised preventive interventions.
E-Cigarette Use Among University Students: A Structured Literature Review of Health Risks, Behavioral and Social Determinants, and Nursing Implications
(MDPI, 2025-08-28) Rocha-Ávila, Luis-Rodrigo; Nuñez Baila, María de los Ángeles; González López, José Rafael; Enfermería; CTS284: Promoción de la Salud
Background/Objectives: E-cigarette use has increased substantially among university students in recent years, coinciding with a broader shift in nicotine consumption patterns globally. Despite initial perceptions of e-cigarettes as harm-reduction tools, growing evidence indicates significant health risks, misinformation, and limited awareness—especially within higher education environments. This structured literature review aims to synthesize peer-reviewed evidence on the health impacts, behavioral determinants, and the role of nursing in addressing e-cigarette use among university students. Methods: A literature search was conducted across five databases (PubMed, CINAHL, Scopus, Embase, Dialnet) between February and March 2025. Eligible studies were published between January 2020 and January 2025 in English or Spanish. A total of 43 studies were included. Data were synthesized narratively, and methodological quality was assessed using Joanna Briggs Institute checklists and The Scale for the Assessment of Narrative Reviews Articles. Results: E-cigarette use among university students showed wide variability in prevalence, with higher rates among males, students in non-health disciplines, and users of disposable devices. Key behavioral and social determinants included peer influence, curiosity, stress management, and social media exposure. Despite documented health risks—such as nicotine dependence, respiratory and cardiovascular impairment, and mental health concerns—misconceptions about safety and cessation efficacy were common, even among health science students. Nursing-led interventions hold great potential for prevention but remain underdeveloped within university settings. Conclusions: The findings underscore the urgent need for evidence-based prevention strategies—particularly those led by nurses—to reduce e-cigarette use, bridge knowledge gaps, and mitigate associated health risks in higher education. Future efforts should prioritize institutional policy reinforcement, improved health communication, and the integration of vaping-related education into nursing curricula and public health campaigns targeting emerging adults.
Assessment of anxiety and fear of COVID-19 in the prison population: Psychometric properties of the AMICO_Inmates scale
(Ovid Technologies (Wolters Kluwer Health), 2025) González-Riera, Francisco Javier; Allande Cussó, Regina; López-López, Daniel; Castaño Seiquer, Antonio Luis; Macías-Toronjo, Israel; Fagundo-Rivera, Javier; Gómez‐Salgado, Juan; Enfermería; Estomatología; CTS1050: Cuidados Complejos, Cronicidad y Resultados en Salud
The COVID-19 disease has entailed a public health challenge and an increased sense of uncertainty for the prison population, who have experienced restrictions on access to social contacts, communal areas, and information for a longer and more recent period than the general population, as well as increased levels of anxiety and fear associated with the COVID-19 disease. The objective of this study was the validation of the Anxiety and Fear of COVID-19 (AMICO) Assessment Scale to measure both anxiety and fear constructs in Spanish prison inmates. A descriptive psychometric validation study was carried out. A field study was conducted to perform univariate analyses, in addition to the exploratory and confirmatory factor analysis of the scale. The study sample consisted of 711 subjects over 18 years of age, inmates in Spanish prisons, 14.1% of whom were women with a mean age of 40.35 years (SD = 2.62). The construct validity study reported 2 factors and 16 items, with a Cronbach alpha value of 0.95, confirmed by McDonald Omega coefficient, with a value of 0.951. The AMICO scale is a valid and reliable tool for assessing the level of anxiety and fear of COVID-19 in the Spanish adult prison population and shows high sensitivity.
Creencias y prácticas culturales sobre comportamientos de lactancia materna en mujeres: una Revisión Sistemática Exploratoria
(Servicio de Publicaciones, Universidad de Murcia, 2025-08) Badanta Romero, Bárbara; Suarez-Reina, Paola; Álvarez-Pérez, Isabel; Lucchetti, Giancarlo; Guerra-Martín, María Dolores; Vega-Escaño, Juan; Diego Cordero, Rocío de; Enfermería
Introducción. Las cuestiones culturales están fuertemente relacionadas con los hábitos de vida de las mujeres. Se recomienda la lactancia materna exclusiva en los primeros seis meses de vida y la lactancia materna complementaria hasta los 2 años. Según la Organización Mundial de la Salud solo 4 de cada 10 lactantes menores de 6 meses de edad han recibido lactancia materna exclusiva en el mundo. Objetivo. Explorar el papel de las creencias y prácticas culturales en las conductas de lactancia materna de las mujeres. Método. Se realizó una revisión sistemática exploratoria en seis bases de datos: PubMed, Scopus, CINAHL, PsycINFO, Web of Science y Cochrane Database of Systematic Reviews. Resultados. Se localizaron 3.078 estudios, de los cuales 37 fueron finalmente seleccionados. Se propusieron dos categorías temáticas: 1. Percepciones y creencias sobre la lactancia materna en las mujeres. 2. Influencia de las normas sociales en la lactancia materna en las mujeres. Discusión: Los resultados destacan las creencias de que el calostro se considera “leche sucia” y que la leche materna tiene un bajo valor nutricional, lo que se asocia a algunas prácticas religiosas, imposiciones familiares, barreras sociales, noticias sensacionalistas y falsas y el retorno temprano al trabajo, lo que resulta en bajas tasas de lactancia materna en todo el mundo. Conclusión. Esta revisión ha avanzado en la comprensión de que las cuestiones culturales están fuertemente asociadas con la lactancia materna entre las mujeres. Se deben ofrecer programas educativos, asesoramiento y capacitación de profesionales de la salud para aumentar la lactancia materna
Sense of coherence in Spanish-speaking countries during the COVID-19 pandemic: A systematic review
(LIPPINCOTT WILLIAMS & WILKINS, 2024) Escobar Segovia, Kenny; Domínguez Salas, Sara; García Iglesias, Juan Jesús; López López, Daniel; Allande Cussó, Regina; Romero Ruiz, Adolfo; Gómez Salgado, Juan; Psicología Experimental; Enfermería
Background: The aim of this study was to assess the sense of coherence (SOC) in the Spanish-speaking population during the 2019 coronavirus disease pandemic. Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in the PubMed, Scopus, and Web of Science electronic databases in August 2024. The methodological quality of the included studies was evaluated using the critical appraisal tools developed by the Joanna Briggs Institute. Results: A total of 25 studies were included in the review, which demonstrated that high SOC is associated with improved coping styles, a reduced incidence of mental disorders, and greater resilience to traumatic events. The findings indicated that SOC acts as a crucial protective factor in diverse population groups, including health professionals, university students, and older adults, particularly during the 2019 coronavirus disease pandemic. Conclusions: The study concludes that there are significant benefits for the mental and physical health of the population, regardless of cultural context, to be gained from strengthening the SOC. It is therefore essential that interventions which enhance the SOC are implemented in order to improve public health in times of crisis. Furthermore, it is crucial that SOC measurement instruments are validated in different cultural contexts in order to ensure the reliability and validity of the results obtained.

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