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In patients with a hip fracture, anaemia has been associated with increased transfusion requirements, poor functional outcomes, prolonged hospital stays and increased mortality. While anaemia in elderly patients with hip fractures has traditionally been attributed to bleeding during or after surgery, many of these patients are anaemic on hospital admission. Thus, detecting and managing anaemia in the perioperative, postoperative and, most significantly, the preoperative period is important to avoid the need for blood transfusions and to improve patient outcomes. The protocol for this clinical trial is designed to evaluate the efficacy and safety of both combined intravenous and topical tranexamic acid (TXA) therapy, or topical administration alone, assessing its effect on blood loss and the need for blood transfusions in elderly patients undergoing hip fracture surgery.
This is a multicentre, double-blinded, randomised, placebo-controlled trial with a 1:1 allocation ratio. Patients of both sexes, aged ≥65 years, who are admitted to the emergency department and will undergo hip fracture surgery are eligible for enrolment. Eligible patients who provide their consent will be stratified according to the type of fracture (intracapsular and extracapsular) and whether or not they are suitable for intravenous TXA therapy, and they will then be randomly allocated to receive either TXA or a placebo. The primary outcome is the blood transfusion rate from patient admission to the emergency department until discharge, while the secondary outcomes include: the preoperative, perioperative and postoperative haemoglobin and haematocrit levels; the preoperative and postoperative occult and total blood loss; the mean length of hospital stay; and any adverse events assessed for up to 1 year after patient discharge.
The study was approved by the Basque Country Ethics Committee (Ref.: 2021012) and the Spanish Agency for Medicines and Healthcare Products (Agencia Española de Medicamentos y Productos Sanitarios). All participants will provide their written informed consent prior to study inclusion. The trial’s results, regardless of its outcomes, will be disseminated through presentations at scientific conferences and publication in peer-reviewed journals, and they will be made publicly available through the European Union Clinical Trials Register after the end of the clinical trial.
EudraCT Number 2020-002144-23; EUCT Number 2024-519349-31-00.
To quantify sex- and age-related differences in hypercholesterolaemia diagnosis and associated comorbidities around the menopausal transition, using a population-based real-world dataset.
Retrospective, multicentre, non-interventional observational cohort study.
Region-wide public healthcare system data (primary and secondary care) from Andalusia (Spain), 2016–2022.
All adult patients meeting inclusion criteria with a recorded diagnosis of hypercholesterolaemia between 1 January 2016 and 31 December 2022 (n=557 034; 227 834 men and 329 200 women).
None.
Primary outcomes were age- and sex-stratified patterns of hypercholesterolaemia diagnosis and comorbidity burden before and after age 50 years (proxy for post-menopausal age). Secondary outcomes included comorbidity-specific comparisons between sexes across age strata and trajectory-based analyses (OR trajectories and incidence-ratio summaries).
Women were diagnosed later than men (mean age 59.1 vs 56.0 years; mean difference 3.1 years, 95% CI 3.03 to 3.17). Hypercholesterolaemia diagnoses in women rose sharply around ages 50–55 and remained higher than in men at older ages. Comorbidity patterns differed by sex across age strata: compared with men, women aged ≥50 years had higher frequencies of osteoporosis (42 255 vs 2623), anxiety disorder (94 916 vs 31 374) and hypertension (147 538 vs 91 532), with statistically significant differences for these comparisons (p
Menopause age is a pivotal period associated with a shift towards higher hypercholesterolaemia diagnosis rates and a greater burden of specific comorbidities in women. These findings support sex-specific prevention and management strategies, particularly targeting the menopausal transition and early post-menopause.
In 2017, Lifeline Nehemiah Projects in Sierra Leone launched 2YoungLives, a mentoring initiative for vulnerable pregnant adolescents, including those living with disabilities. Drawing from the social model of disability, we aimed to investigate the exacerbated disabling barriers which prevent these girls and their babies from accessing available healthcare and develop comprehensive solutions to improve their access.
Qualitative methods were used in this study.
Participants were invited to participate in face-to-face interviews in one district in Sierra Leone.
Six pregnant or postnatal adolescents living with disability, alongside four caregivers and five stakeholders from various organisations participated in semi-structured interviews employing thematic analysis.
We identified four key themes: (1) discrimination and financial barriers within the healthcare system, despite laws ensuring free healthcare for persons living with disabilities, (2) societal stigma manifested through abandonment by families and inadequate support, (3) lack of understanding of disability issues, particularly of those with intellectual impairments, leading to stigmatisation and exclusion, and (4) infrastructural limitations which hinder accessibility to essential services, with many facilities remaining non-compliant with disability regulations.
Adolescent girls living with disability during pregnancy and after birth in Sierra Leone face barriers to accessing healthcare, including caregiver ignorance, lack of autonomy, disabling services, social stigma and ineffective policy implementation, despite existing supportive laws. These findings keep those women who are arguably the most vulnerable, adolescent and living with a disability, from accessing perinatal healthcare, exacerbating their risk and that of their babies. Solutions include the need to enforce disability-inclusive policies and infrastructure adaptations, awareness and training for healthcare providers and community advocacy to break down social stigma.
Each year, suicide claims approximately 700 000 lives worldwide and generates a significant financial burden. Integrating genomic data, exposomic factors and digital phenotypes can enhance the development of short-term predictive models. Current knowledge and available tools provide the basis for designing personalised treatment strategies that incorporate real-time interventions to prevent suicide attempt recurrence cost-effectively. This study aims to develop a predictive algorithm for suicidal behaviour integrating psychiatric assessments, genetic risk markers, digital phenotypes and exposomic data.
This protocol describes a retrospective multicentre study that will recruit participants with a clinical history of suicide across 25 hospitals across Spain with a catchment area of 8.6 million people (17.8% of Spain’s population). Our sample target is over 5000 participants, aged over 12 years old, ensuring 93.5% statistical power for genetic analysis. Eligible participants must be over 12 years old. Data collection will include psychiatric assessments, biospecimen collections (DNA, RNA, plasma and serum), Google Takeout data for digital phenotyping, and a standardised set of administrative and clinical data registered for each patient. Genotyping will be performed with the Axiom Spanish array (>750 000 markers), and genome-wide association studies (GWAS) will be performed after genetic imputation in a whole sample of >10 000 individuals (5000 suicide attempters; 5000 controls). Prescription and clinical history will also be retrospectively integrated, and codified data statistics forms will periodically be sent to the Government. Statistical analyses will combine traditional regression models and AI-based algorithms to identify predictive behavioural, genomic profiles, and digital markers of suicidal behaviour. Cost-effectiveness analyses of pharmacogenomic markers for antidepressant response will also be conducted.
By successfully implementing this project, we aim to help reduce suicide reattempts and lessen the emotional and economic burden on families and the healthcare system.
This study has been approved by the Ethics Committee of the Fundación Jiménez Díaz (PIC301-24_FJD) and complies with the Declaration of Helsinki. It adheres to the GDPR (EU Regulation 2016/679), Spain’s Organic Law 3/2018 on Personal Data Protection and Digital Rights, and Law 41/2002 on patient autonomy. All required data protection measures will be implemented, including those under Real Decreto 1718/2010 on prescriptions and treatment adherence. Underaged participants will require parental consent for participation. The results will be disseminated through publication in peer-reviewed scientific journals and presentations at psychiatric conferences.
Primary progressive aphasia (PPA) is a neurodegenerative syndrome associated with Alzheimer’s disease and frontotemporal degeneration. Non-invasive brain stimulation (NIBS) is a promising treatment, especially associated with language therapy, but comparative efficacy and long-term effects between the different techniques (transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS)) remain unknown. The present study aims to investigate the effects of non-invasive brain stimulation, alone or associated (tDCS/TMS/tDCS plus TMS) combined with language therapy delivered during a period of 6 months, in the progression of language impairment in PPA, compared with sham stimulation combined with language therapy.
The study is a randomised, double-blinded, parallel, sham-controlled clinical trial. Patients with PPA in early stages (global Clinical Dementia Rating equal to or less than 1) are eligible. They are to be randomised to one of the four treatment arms of the study (active tDCS-active TMS, active tDCS-sham TMS, sham tDCS-active TMS, sham tDCS-sham TMS). All patients will receive language therapy immediately after each session of NIBS, for 6 months. The primary outcome is the Mini-Linguistic State Examination. The secondary outcomes are naming of trained items, Addenbrooke’s Cognitive Examination, Interview for Deterioration in Daily Living Activities, Clinical Dementia Rating including behaviour and language domains, Neuropsychiatric Inventory and regional brain metabolism. Exploratory substudies will be conducted including blood biomarkers, quantitative electroencephalography and spontaneous speech assessment.
The study is registered (ClinicalTrials.gov: NCT07158216) and approved by the Ethics Committee of the Hospital Clinico San Carlos (code 25/309-IC_P_CE). Patients will be enrolled after signing an informed consent form. Study outcomes will be disseminated through presentations at scientific conferences, publications in peer-reviewed journals and other academic forums.
To describe the characteristics of paediatric postoperative patients with cognitive dysfunction and assess the prevalence of pain and associated factors.
A descriptive observational study.
Cross-sectional study in children and adolescents who had undergone surgery in the previous 72 h with cognitive dysfunction impeding verbal communication of pain. The Spanish-language version of the revised Face, Legs, Activity, Cry and Consolability scale was used to assess pain intensity.
The 51 included patients underwent 1072 pain assessments. Moderate to severe pain was detected in 12.1% of the evaluations (n = 130). Girls showed more intense pain after analgesia than boys. Higher pain intensity before analgesia was associated with neurodegenerative disease and autism spectrum disorder.
In children with cognitive dysfunction, female sex and baseline cognitive conditions seem to be associated with more intense postsurgical pain.
Hospital pain management protocols should differentiate between patients with cognitive dysfunction and patients with neurotypical development.
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This study addresses the prevalence of postsurgical pain in paediatric patients with cognitive dysfunction and associated factors
–12.1% of postsurgical evaluations showed moderate to severe pain. Female sex and baseline cognitive conditions seem to be associated with more intense postsurgical pain.
–This research will have an impact on the care of paediatric patients with cognitive dysfunction in postsurgical hospitalization units.
This study was performed according to EQUATOR GUIDELINES and the STROBE statement.
No Patient or Public Contribution.
by Sandra S. Chaves, Valérie Bosch Castells, Ainara Mira-Iglesias, Joan Puig-Barberà, F. Xavier López-Labrador, Miguel Tortajada-Girbés, Mario Carballido-Fernández, Joan Mollar-Maseres, Germán Schwarz-Chávarri, Javier Díez-Domingo, Alejandro Orrico-Sánchez, Valencia Hospital Network for the Study of Influenza and other Respiratory Viruses (VAHNSI)
BackgroundUnderstanding the burden of acute viral respiratory infection-related hospitalizations is crucial for guiding research and development. Unlike influenza, respiratory syncytial virus (RSV), or severe acute respiratory syndrome coronavirus 2, no pharmaceutical interventions exist for other respiratory viruses; therefore, their impact remains poorly characterized. This study aimed to investigate the association of current non-vaccine-preventable respiratory viruses, especially rhinovirus/enterovirus (RV/EV), on hospitalizations during the respiratory seasons.
MethodsData from a prospective study that used multiplex polymerase chain reaction to conduct long-term surveillance on respiratory viruses in Valencia, Spain were analyzed. Patients aged ≥50 years hospitalized due to respiratory illness from 2014–15–2019–20 were included.
ResultsRespiratory viruses were detected in 35.2% (3,755/10,675) of hospitalized patients with acute respiratory illness. Influenza and RSV accounted for 22.1% of hospitalizations, RV/EV for 7.6%, and other non-vaccine-preventable viruses for 5.4%. Adults ≥75 years had average seasonal hospitalization incidence rates more than twice those aged 65–74 years and eight times those aged 50–64-year-olds. No significant differences in severity markers were observed among patients with or without virus identified, those aged ≥75 years had a 2–3 times higher mortality rate compared to younger age groups.
ConclusionsThe potential impact of respiratory viruses on hospitalization rates among older adults, particularly those aged ≥75 years, highlights the need for targeted interventions to reduce healthcare system burden. Enhanced diagnostic capabilities and the development of next-generation preventive strategies, including vaccines and therapeutics, could improve patient outcomes and strengthen the resilience of the healthcare system during respiratory virus seasons.
To explore the perceptions of older female caregivers living in poverty in a high-income country regarding their health and self-care needs.
Descriptive qualitative study.
Seventeen semi-structured interviews were conducted with older female caregivers between October 2023 and March 2024. The reflexive thematic analysis method described by Braun & Clarke was followed, and ATLAS.ti 25 software was used for data analysis.
The analysis identified one main overarching theme, ‘Caring as an expected role that shapes identity and daily life’ and two interrelated themes: (1) ‘The need for a holistic approach to self-care’ and (2) ‘Caring on empty in the context of economic hardship and limited support’.
Self-care among older female caregivers living in poverty is constrained by caregiving expectations and socioeconomic disadvantage. Addressing their health needs requires nursing interventions that recognise caregiving as a central element of their lives and adopt holistic, context-sensitive approaches.
Nursing interventions should comprehensively assess older female caregivers' multidimensional health needs and enhance access to integrated support and services, addressing structural gender and socioeconomic inequities to strengthen health, dignity, and resilience.
Living in poverty exacerbates the challenges older female caregivers face in attending to their own health and self-care, increasing the risk of exhaustion, distress, and chronic illness. Recognising and addressing these needs through equitable, targeted interventions is essential to reduce health inequalities.
The study has been reported following the COREQ guidelines.
Limited patient and public involvement was incorporated, focusing on verification of their transcripts, ensuring accuracy and credibility in the interpretation of their accounts.
by Miriam Mohatar-Barba, Ángel Fernández-Aparicio, Javier S. Perona, Jacqueline Schmidt-RioValle, Carmen Enrique-Mirón, Emilio González-Jiménez
Different indirect methods have been developed to assess insulin resistance (IR), though their validation has been limited to adult populations. In this sense, the study aim is to compare the predictive capacity of the McAuley, QUICKI, SPISE indices, and glucose-insulin ratio against insulin resistance (IR) in Spanish adolescents and to establish reliable cut-off values for these indices in this population. A cross-sectional study was conducted with 981 adolescents aged 11–16 years, from Southern Spain. Anthropometric measurements and fasting biochemical parameters, were assessed. IR indices, such as HOMA-IR, QUICKI, the McAuley index, SPISE, and the glucose-insulin ratio, were calculated. The ability of each index to predict IR was evaluated using multivariate regression analysis and receiver operating characteristic (ROC) curves. Boys exhibited higher waist circumference, triglyceride levels, and fasting insulin levels, while girls had a higher percentage of body fat (p
Intensive care units (ICUs) can be a particularly challenging environment for patients who are mentally vulnerable. In addition to the physical stress associated with critical illness and its management, there are physiological and psychosocial factors that can negatively impact a patient’s mental health. Approximately half of ICU survivors will experience post-intensive care syndrome, a set of emotional, neuropsychological and physical sequelae that can significantly affect patients’ functionality and quality of life, both in the short and long term. The main objective of this study is to investigate whether the ICU Recovery Answers (ICURA) digital follow-up platform can effectively detect emotional and cognitive problems in critically ill patients and its impact on functionality and health-related quality of life during the first year after ICU discharge.
Multicentre longitudinal prospective study involving ICU adult patients, with randomised follow-up comparing a telemedicine monitoring programme versus usual medical care during 1 year after discharge. A total of 360 participants will be recruited during their ICU admission in two hospitals in Spain. Efficacy outcomes will focus on participants’ level of functioning, assessed with the WHO Short Disability Assessment Schedule, and quality of life, measured with the 12-Item Short Form Survey at 1, 6 and 12 months after ICU discharge. Emotional state and cognitive impairment will be evaluated using the Patient Health Questionnaire-9, Generalised Anxiety Disorder-7 and Treatment-Outcome Post-Traumatic Stress Disorder Scale and the Montreal Cognitive Assessment by telephone at 1, 3, 6, 9 and 12 months after ICU discharge.
The implementation of this project is expected to have a direct impact on the satisfaction of ICU survivors, improving their well-being, personalised follow-up and quality of life. Results from this study will be disseminated at various scientific conferences, national and international meetings, and will be shared with the general public and other relevant parties. The dissemination of these results will occur through scientific publications, allowing the medical and scientific community to benefit from the study’s findings. Ethics approval from the Ethics Board of Parc Taulí Foundation and Balearic Islands with reference numbers 2022/3031 and IB 5072/22 PI: Protocol version 1 of 18 November 2022.
Deficient palliative care coverage and nursing training in Ecuador warrant examining self-efficacy to inform education strategies and strengthen equitable services.
To examine Ecuadorian nurses' self-efficacy in Palliative Care.
A sequential explanatory mixed-methods study was conducted. Convenience samples of nurses completed the Self-Efficacy in Palliative Care Questionnaire and participated in online semi-structured interviews. Descriptive statistics were used for quantitative data. A side-by-side joint display supported integration.
497 nurses completed the questionnaire (90.4% female; 11.47 years of experience). Teamwork scored highest, while communication scored lowest. Eighteen nurses were interviewed (88.8% female; 11.5 years of experience). Participants reported communication difficulties related to emotions, prognosis, denial, collusion of silence and paediatric cases. They expressed strong confidence in pain management but more difficulty with agitation and dyspnoea. Spiritual care was mainly understood as facilitating access to religious figures. Although teamwork was perceived positively, tensions with physicians and an excessive focus on physical aspects were noted.
Quantitative and qualitative findings aligned overall, with dissonances regarding psychological and social communication.
Strengthening communication and comprehensive patient management competencies, as well as addressing interdisciplinary tensions, is necessary to improve and consolidate Palliative Care in Ecuador.
This study adhered to EQUATOR guidelines and used COREQ for qualitative reporting.
No patient or public contribution.
The primary barrier to maximizing the benefits of intermittently scanned continuous glucose monitoring (isCGM) is low scan frequency. Higher daily scan frequency correlates with better glycemic control.
To evaluate the effect of a nurse-led educational intervention on scan frequency and behavioral change in adults with type 1 diabetes (T1D) showing low scanning frequency.
In this 12-week quasi-experimental study, adults with T1D using isCGM and low scan frequency participated in a single, individualized, direct education session led by a diabetes nurse educator. The intervention focused on increasing daily scan frequency and supporting patient engagement in self-management.
Thirty-four patients using isCGM participated. Mean daily scan frequency increased from 3.1 to 6.1 scans/day following the intervention. This rise was associated with an 8.0% improvement in TIR. A positive correlation was observed between scan frequency and TIR, with each additional daily scan associated with a 0.51% increase in TIR.
A single, targeted educational session can significantly improve isCGM adherence and glycemic control in adults with T1D and low adherence, supporting its value as a practical strategy in routine clinical care.
The protocol was publicly registered at ClinicalTrials.gov (NCT05570162)
To assess the quality of the Spanish Triage System performed by nurses according to the triage code assigned to each patient and to examine factors associated with the need for re-evaluation after completion of triage.
Retrospective longitudinal observational study.
A retrospective analysis was conducted of patients triaged in the emergency department between 2018 and 2023. Patients triaged by other healthcare professionals and those who did not receive a triage priority level were excluded.
493,211 episodes were analysed. Most were low/intermediate acuity (Level IV 65.4%, Level III 23.9%; Level I 0.1%). Mean time-to-first physician record entry increased as acuity decreased (38 min Level I vs. 81 min Level V), yet recorded time-target compliance was lowest in Levels I–II (23.8% and 14.7%). Re-evaluation occurred more often in high-acuity levels and was independently associated with older age, male sex, lower oxygen saturation and longer emergency department length of stay; compared with Level I, Levels II–III and lower adjusted odds of re-evaluation.
Nurse-led triage demonstrated coherent clinical and operational stratification; however, the lowest recorded time-target compliance in the sickest patients suggests a gap between immediate care and electronic documentation.
Streamline documentation workflows for high-acuity cases and use re-evaluation risk profiles to prioritize monitoring and escalation.
Evidence on nurse-led Spanish Triage System performance and time-documentation quality is limited. Acuity and flow metrics showed expected gradients, but target-time compliance was lowest in Levels I–II; predictors of re-evaluation were also identified. Findings support emergency department nursing, quality improvement and potential benefits for patients attending emergency departments.
STROBE guidelines.
This study did not include patient or public involvement in its design, conduct or reporting.
Introducción. El dolor crónico en una condición multidimensional con elevada prevalencia que afecta en la calidad devida, entorno sociolaboral y predispone a enfermedades de Salud Mental. Metodología. Este estudio de metodologíamixta pretende hacer frente a la carencia de herramientas de valoración específicas en este contexto. La construcción delcuestionario se llevará a cabo mediante un proceso riguroso compuesto por un panel de expertos, grupo de discusión y prueba piloto, con el objetivo de analizar el manejo de las enfermeras. Los aspectos por evaluar serán suficiencia,claridad, coherencia y relevancia para obtener la versión definitiva del cuestionario. Con ello se busca conseguir una herramienta sólida que permite una mayor visibilización y desarrollo de las enfermeras en el manejo de esta comorbilidad.Relevancia. La importancia del estudio radica en desarrollar uno nuevo cuestionario que permita valorar los conocimientos de las enfermeras de Salud Mental respecto al dolor crónico, con el objetivo de detectar posibles áreas de mejora para proporcionar unos cuidados de mayor calidad basados en un enfoque enfermero biopsicosocial y la evidencia científica actual.
ABSTRACT
Introduction. Chronic pain is a multidimensional condition that impacts quality of life, socio- occupational environment, and predisposes individuals to mental health disorders. Methodology. This mixed-method study aims to address the lack of specific assessment tools in this context. The questionnaire was developed through a rigorous processinvolving an expert panel, a focus group, and a pilot test, with the objective of analyzing nurses' management of chronic pain. The evaluation will focus on assessing the adequacy, clarity, internal consistency, and relevance of the items in order to obtain the final version of the questionnaire. This process aims to produce a psychometrically sound instrument that contributes to enhancing the professional role and visibility of mental health nurses in the assessment and management of this comorbidity. Relevance. The relevance of this study lies in the development of a new questionnairespecifically designed to evaluate the level of knowledge that mental health nurses possess regarding chronic pain. The ultimate goal is to identify potential knowledge gaps and areas for improvement, thereby facilitating the delivery of higher-quality, evidence-based care grounded in a biopsychosocial nursing framework.
To examine how family caregivers of deceased nursing home residents scored and justified their ratings for each item on the Quality of Dying in Long-Term Care scale and to identify the consistencies and discrepancies between their perceptions and the scores assigned when assessing the residents' end-of-life experience.
A convergent mixed-methods design, comprising a cross-sectional study and a thematic analysis for quantitative and qualitative phases, respectively.
Quantitative and qualitative data were collected simultaneously between May 2018 and February 2019. The two sets of data were analysed separately. For the quantitative component, family caregivers completed the quality of dying in long-term care scale and a single-item question assessing the final month of the residents' life. Descriptive statistics, Mann–Whitney U-tests for comparative analyses and Spearman's correlations were applied to the quantitative data, while deductive thematic analysis was conducted for the qualitative data obtained through semi-structured interviews.
Sixty-nine family caregivers completed the QoD-LTC, and 11 participated in qualitative interviews. The mean overall QoD-LTC score was 39.29 (SD = 7.58). The highest-rated domain was ‘Personhood’ (M = 4.32; SD = 0.68), while the lowest was ‘Preparatory Tasks’ (M = 2.66; SD = 1.26). Interviewed family caregivers reported effective management of pain and other symptoms, satisfaction with the care provided and respectful and appropriate treatment. However, they identified significant shortcomings in communication concerning end-of-life issues, coping with death and advance care planning. Residents with cognitive impairment had significantly lower scores on the ‘closure’ (p < 0.01) and ‘preparatory tasks’ (p = 0.03) domains as well as on the overall QoD-LTC score (p = 0.01).
The findings demonstrate consistency between the quantitative and qualitative data, with high scores reported across most domains of the QoD-LTC scale, with the exception of the ‘Preparatory Tasks’ domain. Cognitive impairment among residents was associated with lower perceived quality of the dying process from the perspective of family members.
Aspects related to closure and preparatory tasks were often overlooked. Strategies to enhance end-of-life communication and advance care planning are needed.
The study adhered to the EQUATOR guidelines. The Mixed Methods Reporting in Rehabilitation & Health Sciences (MMR-RHS) checklist for mixed-methods studies, the STROBE checklist for cross-sectional studies, and the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines for qualitative studies were used for reporting.
No funding was received for the completion of this study.
To explore how older women experiencing poverty in a high-income country perceive their family caregiver role from a gender perspective.
Descriptive qualitative study.
A convenience sample of seventeen older female caregivers experiencing poverty was interviewed in-depth between October 2023 and March 2024. Reflexive thematic analysis was conducted following the phases described by Braun & Clarke. ATLAS.ti software was used for data analysis.
Three main themes were developed from the data analysis: (1) The duality of family caregiving: between informal female support and structural neglect, (2) family care in later life as a continuation of a life devoted to others, (3) older female family caregiving as a gender issue.
Older female caregivers experiencing poverty have limited formal support and unequal access to resources. Older women experiencing poverty experience both gratitude and despair in their caregiving role, which inevitably deteriorates their health.
Nursing interventions for older female caregivers experiencing poverty should include an assessment of social determinants of health, focusing on gender and socio-economic barriers. Implementing system navigation interventions, such as community-based case management, resource referral programmes, and personalised care coordination, could connect older female family caregivers to essential resources and support networks, thus addressing their mental health needs and promoting equity, which would enhance their overall well-being and dignity.
Experiencing poverty increases the vulnerability of older female caregivers, exacerbating gender inequality. These women often face mental health issues as they face the pressure of meeting their own needs and those of their care recipients with a lack of formal support. This neglect can lead to serious health problems, which emphasises the need for equitable nursing interventions.
The study is reported following the COREQ guidelines.
No patients or public were involved in the study development and implementation.
To measure and compare the temporal variations in sub-bandage pressure compression systems in the Andalusian Health System (SAS). Additional objectives included assessing the relationship between pressure and healing, analysing the influence of the healthcare professional applying the bandage, and determining bandage stiffness. This prospective observational and multicentre study included 140 patients with active VLUs in Andalusia. Sub-bandage pressures were measured at three anatomical points in the leg for 96 h, under different positions and activities. The bandage application technique was standardised through specific training provided to advanced practice nurses. The initial pressures were higher than those recommended by guidelines, but showed a notable reduction within the first 24 h, stabilising within therapeutic ranges for the remainder of the 96-h study period. Most systems showed low dynamic and static stiffness. No significant pressure differences were found attributable to the nurses or the location of the injury. The observed pressure dynamics, initially high, with a subsequent drop and final stabilisation, suggest a high material settlement or application to compensate for the expected loss. The sustained pressure stability confirms the effectiveness of the systems over 96 h.
A qualitative study was conducted in Catalonia (Spain), incorporating the views and opinions of relatives, healthcare professionals and patients on what they considered a ‘good death’. This study aimed to describe barriers, facilitators and unmet needs related to the achievement of a good death.
We recruited adult patients with advanced or chronic conditions, relatives and health and social care professionals involved in end-of-life processes of care, management or strategic planning. All participants took part in a qualitative study. The study was informed by phenomenological, hermeneutical and social constructivist perspectives and included 23 in-depth interviews and three focus group discussions with a total of 31 participants. Fieldwork was conducted between February and April 2022. Data were transcribed and analysed using qualitative thematic content and discourse analysis.
Six main themes were identified, comprising 17 subthemes. Facilitators and barriers related to achieving ‘a good death’ were categorised according to whether they occurred before death or during the dying process. Key facilitators include high-quality palliative care, open communication about death and the ability to choose the place of death. Key barriers included bureaucratic delays, inadequate resources, insufficient professional training and lack of respect for patients’ preferences and wishes.
Our study highlights the need to understand factors that facilitate or hinder the achievement of a good death and the quality of the dying process. Specifically, understanding individual preferences and unmet needs, enhancing communication, increasing awareness, reducing bureaucratic barriers and ensuring adequate resources are essential to support a more dignified end-of-life experience for patients, caregivers and healthcare professionals.
Community support for individuals with mental health problems is a global public health issue. Poor mental health literacy and high levels of stigmatising attitudes among the general population can hinder both help-seeking behaviours and limit the capacity of community members to provide support to people experiencing mental health challenges. The Mental Health First Aid (MHFA) training course was created to educate community members to provide initial help towards a person developing a mental health problem. MHFA training has spread to high-income countries, but there is relatively little research on cultural adaptation to lower-resource settings. This study aims to fill that gap and is the first cluster randomised controlled trial (cRCT) assessing the effectiveness of MHFA training in Chile and Argentina.
The study involves a two-arm wait-list cRCT with 240 participants (120 in each country). The study will be conducted in three settings in each of Chile and Argentina (eg, universities, health services and workplaces). Two clusters per setting in each country will be paired and randomly allocated to the intervention (the MHFA training for Chile and Argentina) or the wait-list control group. Participants in the intervention arm will be asked to complete questionnaires at baseline (T1), after training completion (T2) and 6 months after completion (T3), with control arm participants completing data collection at corresponding time points. The primary outcome will be intended support towards someone experiencing a mental health problem or experiencing a mental health crisis. Secondary outcome measures will include the ability to recognise depression and psychosis in vignettes; beliefs about the helpfulness of different types of interventions and helping actions, confidence in providing MHFA and stigmatising attitudes towards a person with depression or psychosis. Findings will demonstrate whether the culturally adapted MHFA training for Chile and Argentina can effectively enhance intended support, knowledge, attitudes and supportive actions towards other individuals within the community.
Ethics approval has been granted by the Human Research Ethics Committee at the University of Melbourne (Australia), Proyecto Suma (Argentina) and the University of Chile (Chile). Dissemination will be via academic publications and conference presentations. These will also be made available to participants and other interested parties on request.
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