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Crohn's disease (CD) is primarily characterised by chronic gastrointestinal inflammation; however, its systemic nature frequently leads to musculoskeletal complications. Among these, clinically significant foot pathologies can impair mobility and negatively impact patients' overall quality of life. Despite their relevance, the specific influence of podiatric manifestations on health-related quality of life in individuals with CD remains insufficiently explored, underscoring a critical gap in current disease management. The aim of this study was to assess the extent to which foot-related health issues affect the quality of life in people living with CD compared with a healthy population. This multicenter observational case–control study was conducted across five provinces in southern Spain—Málaga, Granada, Jaén, Sevilla, and Cádiz—between January 2024 and February 2025. The study included 110 participants, evenly divided between individuals diagnosed with CD (n = 55) and healthy controls (n = 55), matched for age, sex, and body mass index. All participants completed the validated Spanish version of the Foot Health Status Questionnaire (SFHSQ), which assesses four foot-specific domains and four general health domains. Due to the non-normal distribution of the data, non-parametric statistical methods were applied, with the Mann–Whitney U test used to evaluate differences between groups. Participants with CD exhibited significantly lower scores across all domains of the SFHSQ, with the exception of the Footwear domain, which showed no statistically significant difference (p = 0.406). Compared with healthy controls, individuals in the CD group reported greater impairments in foot pain, foot function, general foot health, and in broader health-related domains including general health, physical activity, and social capacity (p < 0.01 for all). CD significantly compromises foot-related QoL. These results highlight the need to include podiatric evaluations as part of comprehensive, multidisciplinary care approaches aimed at enhancing mobility, functional capacity, and general well-being in affected individuals.
Scalp follicular unit (FU) transplantation is a highly effective yet underutilised minimally invasive technique for promoting healing in chronic and recalcitrant cutaneous wounds. In this case series, five patients with long-standing nonhealing leg ulcers of mixed etiologies were treated exclusively with single FU grafts harvested from the scalp with a 0.9–1-mm punch. Complete re-epithelialization occurred in three cases by 6, 3 and 1 month, respectively, while the remaining two cases showed marked partial improvement at 6 months, with reduction in ulcer area and pain. Overall, all five patients experienced a favourable clinical outcome. Case reports suggest that the transplantation of a minimum of 4 FU grafts/cm2 is required to promote effective wound closure, with higher graft densities being associated with faster healing. However, the optimal graft density and placement, whether uniform distribution or targeting the wound edge to exploit an ‘edge effect’, require further investigation. Considered alongside prior reports, these results suggest that 1-mm single-FU grafting achieves wound healing comparable to, and often faster than, 2–3-mm punch grafts. Additionally, the technique is less invasive and causes less bleeding, overall supporting wider use as an adjunct in multidisciplinary wound care.
Level of Evidence: IV
Postoperative neurocognitive disorders, including delirium and longer-term cognitive decline, are among the most common and costly complications of surgery in older adults, yet effective preventive strategies remain limited. Insomnia and sleep–circadian disruption are highly prevalent in this population, affecting up to one-third of older adults undergoing elective surgery and represent potentially modifiable risk factors that are rarely addressed in perioperative care. Cognitive Behavioural Therapy for Insomnia (CBT-I) is the first-line, evidence-based treatment for insomnia; however, its feasibility and efficacy have not been systematically evaluated for perioperative implementation. This protocol describes a pilot randomised controlled trial designed to evaluate the feasibility and acceptability of a condensed CBT-I intervention in the perioperative setting. The study will also explore its potential effects on insomnia and postoperative outcomes.
The SLEEP-BOOST study is a single-site, randomised controlled pilot trial conducted at Massachusetts General Hospital. The study will enrol 50 older adults (≥65 years) undergoing elective orthopaedic surgery with insomnia symptoms (Insomnia Severity Index≥10). Participants will be randomised 1:1 to either a condensed CBT-I intervention or a patient contact-matched Sleep Hygiene Education control group. All participants will complete 3 weeks of preoperative actigraphy and daily sleep diaries, with follow-up assessments at 2 weeks, 1 month and 3 months after surgery. The primary outcome is feasibility, assessed through adherence metrics, protocol engagement and acceptability. Secondary outcomes will be treated as exploratory including insomnia severity, sleep quality, actigraphy-derived sleep and circadian metrics, cognitive trajectories, postoperative pain, mood, functional status and incidence of postoperative neurocognitive disorders.
This protocol has received ethics approval from Massachusetts General Hospital Institutional Review Board (Protocol #2024P000780). Dissemination is expected to include peer-reviewed journal articles, reports, conference presentations as well as websites or social media platforms of relevant sleep treatment organisations. Participants will receive a summary of the study results.
Lung cancer (LC) is the leading cause of cancer-related mortality worldwide, primarily due to diagnosis at advanced stages. Although low-dose computed tomography (LDCT) screening reduces lung cancer mortality in high-risk populations, current screening programmes are largely restricted to individuals defined by age and smoking history. This approach excludes never-smokers and individuals with non-smoking-related risk factors, limiting the equity, efficiency and scalability of lung cancer screening. The LUng Cancer risk factors and their Impact Assessment (LUCIA) project aims to overcome these limitations by developing personalised lung cancer risk prediction models and evaluating novel non-invasive technologies for early detection within a risk-adapted screening strategy.
LUCIA is a multicentre, observational, longitudinal cohort study that will recruit approximately 4000 participants across four European regions: Andalusia and the Basque Country (Spain), Liège (Belgium) and Riga (Latvia). The study population includes smokers, never-smokers and reduced smokers with low-to-moderate lung cancer risk. All participants will initially enter phase 1 (wide population screening) and may transition to phase 2 (precision screening) or phase 3 (diagnosis) based on LDCT findings, results from non-invasive screening devices and artificial intelligence-based risk prediction models. Participants will be followed up for 24 months, with assessments at baseline and at 6, 12 and 24 months. Data collection includes sociodemographic characteristics, medical history, environmental and occupational exposures, lifestyle factors, spirometry, multi-omics profiles and outputs from novel non-invasive devices, including a breath analyser, spectrometry-on-card and a skin-applied volatile organic compound sensing patch. The study will develop and validate integrated lung cancer risk prediction models and evaluate the diagnostic performance of these technologies to support population stratification and personalised screening.
The study will be conducted in accordance with the Declaration of Helsinki, Good Clinical Practice guidelines and applicable national and European regulations. Ethical approval has been obtained from the relevant ethics committees in all participating countries. Written informed consent will be obtained from all participants. Study findings will be disseminated through peer-reviewed open-access publications, scientific conferences and communication with public health stakeholders.
ClinicalTrials.gov, NCT06473870.
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 (pTo examine the conceptual ambiguity of nursing leadership, particularly in relation to management roles, and to propose a multilevel competency framework that redefines leadership as a core dimension of nursing practice. The paper introduces an innovative hybrid Iceberg–Alles model that integrates observable competencies with deeper motivational, ethical and personality-based attributes.
Integrative review.
Two-stage evidence identification process informed by theoretical reflection and existing evidence on nursing leadership and management.
A literature search was conducted in targeted databases such as PubMed, Scopus, Web of Science, CINAHL and extended to Google Scholar and grey literature.
Current understandings of nursing leadership are fragmented and often limited to managerial skills, overlooking crucial aspects such as ethical commitment, personal values, interpersonal skills and relational capacities. The hybrid Iceberg–Alles model reconceptualizes leadership as a multidimensional construct that balances visible skills with underlying drivers such as motivation, self-awareness and value alignment, offering a more comprehensive basis for leadership development.
Nursing leadership should be understood as a relational and value-based process embedded across all levels of practice, not confined to formal administrative positions. The proposed model enhances conceptual clarity and provides a transferable framework that can be adapted across diverse health systems, roles and organisational structures.
Broadening the scope of nursing leadership can reduce role ambiguity, highlight the unique contribution of nurses to healthcare systems, and strengthen the profession's influence in policy and decision-making. The hybrid model provides concrete guidance for educational programmes, competency-based curricula and organisational strategies aimed at preparing future nurse leaders to manage complexity, promote collaboration and improve patient care.
This manuscript followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines (PRISMA-ScR).
This study did not include patient or public involvement in its design, conduct or reporting.
Las Unidades de Cuidados Prolongados en Psiquiatría, los ofertan a pacientes con Trastorno Mental Grave (TMG). Supone un desafío ético, queriendo mantener su autonomía y más, en situación de crisis terminal.
Las Instrucciones Previas, en este sentido, son una herramienta valiosa que busca la autodeterminación también en este tipo de usuario. El marco jurídico la salvaguarda, incluso cuando la capacidad de decisión esté comprometida.
Para hacerlo realidad, nuestra idoneidad nos privilegia para establecer una relación terapéutica, evitando el paternalismo y fomentar la cooperación valorando las particularidades cognitivas y emocionales de cada persona.
Preguntas como: qué conocimiento de la enfermedad, aceptación de tratamiento y preferencias ante medidas de reanimación, hechas desde la sensibilidad clínica y la información comprensible, persiguen esa adaptación para un formato de conversación estructurada y respetuosa.
Por ello, para la búsqueda de estrategias que den voz a los pacientes con TMG, invitamos a reflexionar a nuestro colectivo. Para un cuidado centrado en la persona.
To assess the potential for microbial contamination of open-but-unused portions of wound dressings stored under real-life conditions in healthcare facilities, to inform safer and evidence-based wound care practices. Observational, descriptive, longitudinal, prospective study. Eleven types of non-adhesive wound dressings were sampled after opening and storage under usual clinical conditions in a hospital inpatient unit and a primary care centre in Andalusia, Spain. Samples were collected on six predefined sampling days (Days 0, 2, 3, 4, 5 and 6 after opening), cultured under standardised laboratory conditions and microorganisms were identified using mass spectrometry. Differences in contamination were examined by dressing type, healthcare setting, storage time and handling conditions. Microbial growth was frequently detected in open-but-unused dressings from the first day after opening, particularly after enrichment culture and increased with handling and time. The most frequent microorganisms were coagulase-negative staphylococci and Staphylococcus aureus. Contamination patterns were similar across settings, although microbial diversity was higher in the hospital. Silver-containing dressings showed slightly lower contamination, but not enough to indicate protection. Scissors used for cutting dressings had high microbial loads, suggesting a potential source of cross-contamination. Open-but-unused dressings may become contaminated shortly after opening under routine clinical practice conditions, across different healthcare settings and dressing types.
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.
Tuberculosis is the leading cause of death globally from a single infectious agent. Early diagnosis is critical to reducing morbimortality. In cases of negative smear microscopy or limited sputum production, bronchoalveolar lavage (BAL) samples offer an alternative for diagnosis. Culture, the gold standard, requires a high bacterial load, extensive infrastructure and is time-consuming. Xpert MTB/RIF provides faster results with a higher cost. Previous systematic reviews present substantial limitations, including significant heterogeneity. Therefore, the diagnostic utility of Xpert MTB/RIF using BAL samples in adults with negative or scant sputum for pulmonary tuberculosis (PTB) needs to be reassessed.
A systematic search of MEDLINE, Embase, LILACS and Web of Science will be conducted without language or publication date restriction. Cross-sectional diagnostic studies of negative or sputum-scarce adults with presumptive PTB who underwent bronchoscopy to obtain samples for Xpert MTB/RIF and culture will be included. Screening and data extraction will be performed independently. Methodological quality will be assessed using the QUADAS-2 tool. A bivariate hierarchical random-effects model will synthesise sensitivity and specificity. Meta-analysis will be performed using Meta-DiSc 2.0. Heterogeneity will be assessed using I2 and Cochrane thresholds. Subgroup analyses will be performed based on study design, population differences, country, culture method and risk of bias. Publication bias will be investigated using a funnel plot. The certainty of evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. There was no patient or public involvement in the development of the systematic review protocol.
Ethical approval is not required as this study will use publicly available data. Findings will be disseminated through peer-reviewed publication.
CRD42025639440.
Integrated digital diagnostics can support complex surgeries in many anatomic sites, and brain tumour surgery represents one of the most complex cases. Neurosurgeons face several challenges during brain tumour surgeries, such as differentiating critical tissue from brain tumour margins. To overcome these challenges, the STRATUM project will develop a 3D decision support tool for brain surgery guidance and diagnostics based on multimodal data processing, including hyperspectral imaging, integrated as a point-of-care computing tool in neurosurgical workflows. This paper reports the protocol for the development and technical validation of the STRATUM tool.
This international multicentre, prospective, open, observational cohort study, STRATUM-OS (study: 28 months, pre-recruitment: 2 months, recruitment: 20 months, follow-up: 6 months), with no control group, will collect data from 320 patients undergoing standard neurosurgical procedures to: (1) develop and technically validate the STRATUM tool and (2) collect the outcome measures for comparing the standard procedure versus the standard procedure plus the use of the STRATUM tool during surgery in a subsequent historically controlled non-randomised clinical trial.
The protocol was approved by the participant ethics committees. Results will be disseminated in scientific conferences and peer-reviewed journals.
RESUMEN
Se pretende describir la Enfermería del Hospital de San Hermenegildo (1455-1837), aplicar una visión enfermera actual, a la obra iconográfica de El Tránsito de San Hermenegildo y relacionar Enfermería, iconografía y musicoterapia atendiendo a la obra pictórica del extinguido Hospital de San Hermenegildo. Para realizar este trabajo se ha utilizado el método histórico descriptivo, la recogida de información se ha realizado a través de fuentes primarias y secundarias. Como resultados, resaltar la Enfermería en el Hospital de San Hermenegildo, pieza clave en la atención sanitaria, indicando sus funciones e intervenciones, así como la descripción del cuadro de “El Tránsito de San Hermenegildo”, situado en el extinguido Hospital de San Hermenegildo de Sevilla, así como aplicar una Mirada Enfermera a esta obra pictórica, resumiendo un Plan de Cuidados utilizando la nomenclatura NANDA-NIC-NOC. relacionando dicha iconografía con la Terapia Musical.
La Fundación del Hospital de San Hermenegildo en 1455, conocido popularmente como hospital del Cardenal, supuso un cambio, un avance en la Medicina, en la Enfermería, en los Cuidados, en las formas de curar, siguiendo una metodología diferente e innovadora.
Dar a conocer el extinguido hospital de San Hermenegildo, describir la Enfermería del Hospital de San Hermenegildo (1455-1837), aplicar una visión enfermera actual, a la obra iconográfica de El Tránsito de San Hermenegildo, así como relacionar Enfermería, iconografía y musicoterapia/terapia musical atendiendo a la obra pictórica del extinguido Hospital de San Hermenegildo de Sevilla.
Palabras clave: Enfermería; hospital de San Hermenegildo; Sevilla; iconografía; plan de cuidados de enfermería; musicoterapia; terapia musical; historia de la enfermería.
Cardiogenic shock (CS) is a complex syndrome characterised by primary cardiac dysfunction. Despite advances in therapeutic options such as mechanical cardiac support, it remains associated with high mortality. Although previous registries have described heterogeneous populations and outcomes across different centres, contemporary real-world data on management practices remain limited. This gap is particularly evident in low- and middle-income countries, where there is no robust registry that clearly defines the current state of CS management. Therefore, a multicentre registry is needed to better characterise current practices and outcomes. Our study aims to gain insight into current therapeutic trends in Mexico, a low- to middle-income country with a significant cardiovascular disease burden.
The Mexican Registry of Cardiogenic Shock is a quality initiative that aims to identify therapeutic trends, demographic characteristics and clinical presentations. It also aims to evaluate outcomes, including mortality and cognitive function at in-hospital and 1-year follow-ups, and to identify areas for improvement in the care process across the broad spectrum of CS.
Ethical approval for this multicentre study was obtained from the local research ethics committees of all participating institutions. The study results will be disseminated to all participating institutions in the form of summary reports and presentations on completion of the analysis.
Atrial fibrillation (AF) is the leading cause of cardioembolic stroke and is associated with increased stroke severity and fatality. Early identification of AF is essential for adequate secondary prevention but remains challenging due to its often asymptomatic or paroxysmal occurrence. Artificial intelligence (AI) offers new possibilities by integrating biomarkers, clinical phenotypes, established risk factors and imaging features to define a personalised ‘digital twin’ model. The TAILOR study aims to (1) examine prospective detection of AF using monitoring devices, (2) investigate novel prognostic MRI markers in patients with an AF-related stroke (AFRS) and (3) validate AI-based models for outcome prediction in AFRS.
This prospective multicentre observational cohort study includes patients aged 40 years and above, with neuroimaging-confirmed diagnosis of ischaemic stroke, recruited from two sites: Hospital del Mar Barcelona (Spain) and Radboud University Medical Centre (The Netherlands). For the first sub-study (n=300), patients will undergo clinical assessment at baseline, 3 months and 12 months, and patch-based or Holter cardiac monitoring. The second sub-study (n=200) involves repeated brain MRI and cognitive examination after AFRS. Finally, AI-driven ‘digital twin’ models developed on retrospective TARGET datasets will be prospectively evaluated in TAILOR using temporal and centre-stratified analyses for advanced predictive tools for AF and AFRS outcomes.
The TAILOR study was approved by local ethics boards in Barcelona (CPMP/ICH/135/95) and Medical Research Ethics Committee Oost-Nederland (NL86346.091.24). Patients will be included after providing informed consent. Study results will be presented in peer-reviewed journals and at global conferences.
by Andy Domínguez-Monterroza, Alfonso Mateos Caballero, Antonio Jiménez-Martín
Heart rate variability (HRV) is a well-established marker of autonomic regulation and undergoes profound maturation during early human development. In this study, topological data analysis (TDA) is applied to investigate the evolving geometric complexity of HRV across pediatric developmental stages. Using persistent homology in homological dimension 1, we extracted topological descriptors from time-delay embedded RR interval series of 127 individuals aged 1 month to 17 years. We identified statistically significant, age-dependent transformations in the topological structure of HRV signals. Neonates and infants exhibited a greater number and strength of persistent features, reflecting highly heterogeneous cardiac control dynamics during early autonomic maturation. In contrast, adolescents displayed reduced topological complexity and increased entropy, suggesting a shift toward more uniform and structured physiological control. Topological measures correlated with conventional HRV indices, confirming their physiological relevance. Furthermore, pairwise distances between persistence landscapes revealed an inverse relationship between intra-group topological variability and classical HRV measures. Collectively, our findings demonstrate that persistent homology provides a powerful, multiscale-aware framework to capture developmental trajectories in cardiac autonomic regulation, with potential applications in pediatric monitoring, developmental physiology, and early detection of dysautonomia.Introducción. La calidad de vida es un conjunto de dimensiones que contribuyen al bienestar del ser humano, misma que está determinada por la percepción que tiene el individuo en relación a su entorno. Objetivo: Analizar la calidad de vida percibido por las madres y cuidadoras de los pacientes hospitalizados en los servicios de pediatría y neonatología del Hospital General Isidro Ayora de Loja. Metodología. Es un estudio cuantitativo, descriptivo, transversal desarrollado en 90 mujeres madres/cuidadoras. La recolección de información se realizó a través del cuestionario SF-36 (Short Form Health Survey), un instrumento válido y confiable que evalúa la función física, social, rol físico, emocional, salud mental, dolor corporal y salud general. Además, el presente trabajo fue revisado y aprobado por el Comité de Ética de Investigación en Seres Humanos (CEISH) de la UNL. Resultados. El nivel de calidad de vida en general es promedio (42,1%), por dimensiones, las muy bajas fueron el rol físico (34,4%) y emocional (36,7%), como promedio la salud general (41,1%) y cambio de salud (45,6 %), como alto el dolor corporal (35,6%), vitalidad (43,3%), función social (36,7%) y salud mental (41,1%); y finalmente solo la función física obtuvo un nivel muy alto (24,4%). Discusión. En la actualidad, la mujer es la principal en asumir el rol de cuidadora, generando una serie de problemas de salud en sí misma, desde un desgaste en el rol físico hasta un desequilibrio emocional, debido a la angustia y el cansancio que provocada el estado de salud del niño.
ABSTRACT
Introduction. Quality of life is a set of dimensions that contribute to human well-being, which is determined by the individual's perception of their environment. Objective: To analyze the quality of life perceived by mothers and caregivers of patients hospitalized in the pediatrics and neonatology departments at Isidro Ayora General Hospital in Loja. Methodology. This is a quantitative, descriptive, cross-sectional study conducted on 90 mothers/caregivers. Information was collected using the SF-36 (Short Form Health Survey) questionnaire, a valid and reliable instrument that assesses physical function, social function, physical role, emotional role, mental health, bodily pain, and general health. In addition, this study was reviewed and approved by the Human Research Ethics Committee (CEISH) of the UNL. Results.The overall quality of life level is average (42.1%). By dimension, the very low levels were physical (34.4%) and emotional (36.7%), average levels were general health (41.1%) and health change (45.6%), high levels were bodily pain (35.6%), vitality (43.3%), social function (36.7%), and mental health (41.1%); and finally, only physical function obtained a very high level (24.4%). Discussion. Currently, women are the main caregivers, which generates a series of health problems for themselves, from physical exhaustion to emotional imbalance, due to the distress and fatigue caused by the child's health condition.
To determine common and distinct factors experienced by nurses working in acute care settings during the second year of the COVID-19 pandemic.
An online qualitative descriptive study with eight open-ended questions and a comprehensive demographic profile administered via the Qualtrics XM survey software.
Thirteen countries formed teams and led online data collection in their respective countries through various approaches. The data collection period occurred between January 1, 2021, and February 28, 2022. Descriptive thematic analysis was conducted in English (with translation), Spanish, and Korean to analyse the qualitative data. Descriptive statistics summarised the responses to the demographic profile.
Worldwide, a final sample size of n = 1814 produced 6483 qualitative data points for analysis. The results identified ongoing occupational risk factors for nurses during the pandemic's second year, including mental health issues, yet showed some improvements in access to personal protective equipment and resources. Four themes emerged from the qualitative analysis, highlighting role changes, living states, and insights into the implementation of pandemic response measures.
Despite individual occupational risks nurses described, structural factors associated with healthcare delivery produced common nursing experiences during the pandemic. Additionally, at least two distinct stages of pandemic response implementation were demarcated by treatment availability (e.g., vaccine development).
There is potential for common pandemic response policies for nurses, centered on specific factors, such as the increased provision of mental health support services by healthcare organisations.
This study helped determine the common and distinct work experiences during the second year of the COVID-19 pandemic. Nurses simultaneously experienced increased workload, role changes, perpetual fear and fatigue, daily hostility, and chaos in the implementation of pandemic responses. The results will impact nurses and those they serve along with future pandemic response policies.
We have adhered to the SRQR reporting guidelines.
This study did not include patient or public involvement in its design, conduct, or reporting.
To identify sex-specific patterns based on determinants related to sleep quality, using a representative sample of the Spanish adult population.
Cross-sectional, age-stratified and sex-stratified study.
Community-based assessments in two Spanish provinces (Salamanca and Ávila).
Adults aged 25–65 years (n=500), equally distributed by sex and five age strata, selected from the regional health-card database.
Objective sleep metrics from wrist actigraphy (time in bed, total sleep time (TST), sleep efficiency, wake after sleep onset, number/duration of awakenings, fragmentation/movement indices) and self-reported sleep quality (Pittsburgh Sleep Quality Index).
Standardised baseline assessments collected sociodemographic, clinical, mental-health and lifestyle variables using validated instruments. Actigraphy (ActiGraph GT3X+) recorded triaxial acceleration at 30 Hz over 5 days; data were aggregated in 60 s epochs (ActiLife). Sleep/wake was classified with Cole-Kripke and nocturnal episodes identified with Tudor-Locke before deriving sleep indices. Two-step cluster analysis was applied separately by sex.
Three clusters were identified for each sex, with age and educational level being the most influential factors. In men, the 65-year-old cluster with university education and lower anxious–depressive load showed the highest sleep efficiency (91.8±3.8%) and the lowest TST (351.7±74.8 min). In contrast, the 35-year-old cluster with middle or high school presented the lowest efficiency (88.3±10.0%) and higher TST (368.1±83.8 min). In women, the 55-year-old cluster with middle or high school and low emotional load showed the highest efficiency (93.6±2.8%), despite a reduced TST (352.0±79.7 min), while the 35-year-old cluster, with middle or high school and high levels of anxiety and depression, showed the worst efficiency metrics (89.5±3.9%) and a higher TST (394.8±67.3 min).
Sleep quality in Spanish adults is heterogeneous across sex-specific clusters shaped by age, education and mental-health burden. Cluster-based characterisation may support tailored public-health interventions.
Patient safety culture plays a crucial role in reducing clinical errors. By improving healthcare professionals’ and patients’ understanding of human fallibility and error attribution, patient care can be enhanced, fostering greater engagement from both groups. A Just Culture approach, which balances accountability and learning from errors, is a key factor in fostering this safety culture. The DECIDE Project aims to: (1) examine the conceptualisation of human fallibility within and beyond healthcare, (2) identify barriers and facilitators to Just Culture adoption, (3) assess the impact of psychoeducational interventions on professionals’ and social leaders’ attitudes toward clinical errors and (4) develop a roadmap for Just Culture implementation in healthcare.
A 36-month mixed-methods study including qualitative research, a survey of 1255 healthcare professionals, an experimental study with 180 participants (60 per arm) testing interventions based on cognitive dissonance and reasoned action theories and a consensus conference to develop a Just Culture roadmap. Participants include professionals from hospitals, primary care, long-term care, nursing homes and social leaders in Spain. The qualitative data collected during stages 1 and 4 will be analysed using MAXQDA software. In identifying factors related to the implementation of Just Culture during stage 2, ANOVA, t-tests and multiple linear regression will be conducted. To examine the effects of the interventions in phase 3, a linear mixed-effects model for repeated measures will be employed.
This study has received ethical approval from three institutional review boards. Findings will be disseminated through peer-reviewed publications, conference presentations and policy recommendations aimed at integrating Just Culture into national and international patient safety strategies. By promoting a constructive approach to errors, the project could enhance incident reporting, strengthen professional engagement in safety policies and foster a culture of learning and accountability. Its findings will guide policy recommendations for integrating Just Culture into national and international patient safety strategies, with potential applications beyond Spain.
To analyse the impact of a participatory process of awareness and reflection on compassion, in the face of end-of-life processes, in students aged 12–23 years in six Spanish regions, and to understand how the participatory process can transform their compassion.
Mixed sequential transformative methodology with different phases. In the first phase, a prospective quasi-experimental design with evaluation pre-post in a single group will be adopted. The second phase is the intervention under study, which will consist of a Participatory Action Research with concurrent evaluations.
In the quantitative phase, 1390 students aged 12–23 from a Public University and a Public Secondary Education Institute across six different Spanish regions will be included. A single questionnaire will be administered before and after the Participatory Action Research to contribute to the process evaluation, incorporating four scales (compassion for others' lives, Death Anxiety Scale, basic empathy modified for adolescents and self-compassion). Responses will be recorded in the Research Electronic Data Capture system. For data analysis, comparison groups, change evolution and associations between variables will be examined, along with multivariate logistic regression models. In the qualitative phase of participatory action research, a promoter group will be established in each university and secondary school in every region. Qualitative data will be analysed following the authenticity, transferability, auditability and neutrality criteria. Discourse analysis triangulation will be conducted to achieve data saturation.
Implementing participative action research in the educational environment to improve students' compassion makes them capable of founding compassion communities to help those who have a terminal illness.
This study will adhere to the relevant EQUATOR guidelines, such as the Good Reporting of a Mixed Methods Study guideline, to efficiently report its results through the different steps of this mixed-methods study.
Participatory action research is a method that enables participants to act as researchers of the phenomenon under study, facilitating the immediate application of results within the context. Although students did not participate in the writing of the proposal grant or the research design.
This study registered on Clinical Trials (NCT06310434), was initiated in January 2024, and it will continue up to December 2026.
This multicentre study will contribute to the nursing community with an overview of compassion for those at the end of their lives among young people and provide the knowledge needed to cultivate compassion at universities and schools.
Implementing compassion programmes and death education in the educational environment will empower students to create a compassionate community. The double evaluation of the process will contribute to the qualitative databases.
FreshRSS 