Beatriz Rodríguez-Martín

Objective: To examine the reliability, construct validity, and discriminative capacity of the Spanish version of the Economic Living Standards Index Short Form (ELSI_SF) in a sample of older adults in Spain. Methods: This analysis was conducted using baseline data from 133 participants (mean age = 66.2 years, SD = 5.6; 53.8% women) recruited from community health and social centers in the provinces of Cuenca, Albacete, and Toledo within the PEPE cohort. Participants completed the ELSI_SF (25 items), sociodemographic measures, the SF-12 Health Survey, and the International Fitness Scale (IFIS). Internal consistency was assessed using Cronbach’s alpha. Convergent validity was examined through correlations between ELSI_SF scores and education, occupation, physical and mental health, and perceived fitness. Discriminative ability for health-related variables was analyzed using ANOVA and partial η². The internal structure was explored using exploratory factor analysis (EFA) and subsequently examined against the original four-factor theoretical model using confirmatory factor analysis (CFA), based on polychoric correlations and estimation methods appropriate for ordinal data. Results: The mean ELSI_SF score was 23.0 ± 3.9, with most participants classified as having comfortable or good living standards. Internal consistency was acceptable for the total scale (α = 0.779), whereas the ownership restrictions (α = 0.441) and self-rating (α = 0.319) subscales showed low reliability. Significant associations were observed between the ELSI_SF total score and selected socioeconomic and health-related measures. Factor-analytic findings provided only partial support for the original four-domain structure. Although CFA showed favorable CFI, TLI, and RMSEA values, the elevated SRMR and instability of the self-rating factor warrant cautious interpretation of the factorial solution. Conclusions: The Spanish ELSI_SF provides preliminary psychometric evidence supporting the use of its total score among relatively socioeconomically advantaged older adults. However, limitations in subscale reliability, factorial stability, and the restricted socioeconomic variability of the sample preclude definitive validation across the full spectrum of material living standards. Further evaluation in larger, independent, and more socioeconomically heterogeneous samples, particularly including older adults experiencing material deprivation, is required.

Background: Despite advances in wearable mobile health (mHealth) technologies and their associated apps designed to promote physical activity, and the importance of adapting them to users, little is known about older adults’ perceptions of these technologies. Objective: This review aimed to synthesize and analyze qualitative evidence exploring the perceptions of adults aged 50 years and older regarding areas to improve, barriers to, and facilitators of wearable mHealth technologies (activity trackers and companion apps) to promote physical activity. Methods: A qualitative systematic review and meta-ethnography was conducted. Comprehensive searches were performed across 8 databases (MEDLINE, Scopus, Web of Science, CINAHL, The Cochrane Library Plus, PsycINFO, ProQuest, and ÍnDICEs-CSIC) for articles published in English or Spanish between January 2013 and January 2024. The synthesis followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and ENTREQ (Enhancing Transparency in Reporting the Synthesis of Qualitative Research) guidelines. Results: Ten articles met the inclusion criteria and were synthesized using meta-ethnography. Three main themes emerged: (1) barriers to promoting physical activity caused by wearable mHealth technologies: personal barriers (physical aspects, perceptions about technology, and personal preferences), technological barriers (functionality, content, design, alarms, availability, and accessibility), and environmental barriers (season of the year); (2) personal facilitators (consideration that these apps improve health, perceptions about technology, and personal preferences), technological facilitators (functionality, content, and design), relational facilitators (technological and social support), environmental facilitators (seasonal variations), and health care professionals (support and monitoring by health care services); and (3) personal areas (perceptions about technology and personal preferences), technological areas (functionality, content, and design), and relational areas (technological support). Conclusions: Although older adults acknowledge the potential of wearable mHealth technologies to promote physical activity, their effective engagement is hindered by distinct personal, technological, and environmental barriers. Bridging the digital divide requires designers to prioritize user-centered, age-friendly interfaces that are integrated with continuous support from health care professionals. To promote genuine health equity, future research must rigorously report intersectional demographics to ensure that mHealth interventions mitigate, rather than inadvertently exacerbate, existing disparities.

Background/Objectives: Individualized nursing care is a fundamental component of high-quality healthcare, particularly in geriatric populations. However, its consistent implementation remains challenging, a situation further exacerbated by the COVID-19 pandemic due to increased workloads and resource constraints. This study aimed to assess nurses’ perceptions of individualized care for older adults in Spain and to examine the influence of the workplace ethical climate on these perceptions. Methods: A cross-sectional observational study was conducted using two validated instruments: the Individualized Care Scale–Nurse version (ICS-Nurse) and the Hospital Ethical Climate Survey (HECS). Descriptive and inferential analyses were performed to assess individualized care, ethical workplace climate, and the associations between both constructs. Results: A total of 96 nursing professionals participated in the study. Participants reported an overall favorable perception of individualized care. The highest scores were observed in the clinical situation dimension, whereas lower scores were reported for aspects related to hygiene organization and the incorporation of patients’ preferences. A moderate, positive, and statistically significant association was observed between ethical workplace climate and individualized care, particularly in dimensions related to patients and physicians. Participants working in hospital settings reported higher recent-experience individualized care scores than those working in nursing homes. Conclusions: These results highlight the critical role of an ethical workplace climate in supporting nurses’ capacity to deliver individualized care. They also underscore the need for targeted strategies to strengthen organizational support, enhance interprofessional collaboration—particularly with physicians—and promote training in individualized care practices. Addressing these factors may facilitate more consistent and comprehensive individualized care, especially in long-term care settings where structural challenges persist.

Background: Childhood and adolescent hearing loss affects not only communication and cognitive development but also motor skills and school participation. Consequently, it generates inequalities in learning and educational inclusion. Nevertheless, no systematic review has yet analyzed these differences from an inclusive education perspective. Methods: A systematic review with meta-analysis was conducted following PRISMA guidelines and registered in PROSPERO. Observational studies comparing physical fitness between children and adolescents with hearing loss and their hearing peers were included. Methodological quality was assessed using the Newcastle–Ottawa Scale, and standardized effect sizes were calculated with a random-effects model. Results: Five studies ( n = 404) were analyzed. Findings revealed significant differences in strength, agility, speed, and balance. Moreover, the meta-analysis showed a large standardized effect favoring hearing children (ES = −2.35; 95% CI: −3.34 to −1.37). Conclusions: Children and adolescents with hearing loss present significantly lower physical fitness, which may affect the planning of physical education activities if their capacities are misinterpreted. Implementing inclusive and adapted strategies within the school curriculum is essential to ensure equal opportunities, improve physical fitness, and promote educational equity.

Electronic devices are increasingly used to support self‐management in adults with type 1 diabetes (T1DM). However, understanding patient perceptions and lived experiences is essential to ensure effectiveness, equitable accessibility, and sustained acceptance. This qualitative evidence synthesis explored how adults with T1DM perceive and experience electronic devices for self‐management, focusing on benefits, barriers, and contextual factors influencing use. A systematic search across six databases was conducted using the Cochrane Qualitative and Implementation Methods Group approach. Qualitative studies published up to December 2024 were included. Data were analyzed using descriptive thematic synthesis and reported, following PRISMA and ENTREQ guidelines. Twenty‐seven studies encompassing 522 participants were included. Eight key review findings emerged: Digital devices foster empowerment, encourage positive lifestyle changes, and could improve interactions with healthcare professionals. However, sustained use and engagement were shaped by contextual and emotional factors. Significant barriers include financial constraints, technical and usability problems, and limited continuous psychological and clinical support. Social support and integration into healthcare systems also influenced engagement. Electronic devices for T1DM self‐management are complex socio‐technical interventions whose potential depends on truly person‐centered, equitable, supportive care. Trial Registration: PROSPERO: CRD42024572860

Objective: To examine qualitative evidence on the barriers and facilitators perceived by Primary Health Care professionals in prescribing physical activity, using the Social Ecological Model as the analytical framework. Methods: A qualitative systematic review using a meta‐ethnographic approach was conducted. Searches were performed between 2013 and 2024 in Medline, Scopus, Web of Science, ProQuest, and The Cochrane Library Plus. Two independent reviewers screened studies, applied eligibility criteria, and coded findings according to the Social Ecological Model. Methodological quality was assessed using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. Results: Barriers and facilitators to physical activity prescription were identified across all five domains of the Social Ecological Model. Key barriers included time constraints, insufficient training, lack of organizational and policy support, and limited referral pathways. Facilitators included professionals’ willingness, interdisciplinary collaboration, community partnerships, and the availability of structured guidelines. Conclusions: Barriers to implementing physical activity prescription remain more prominent than facilitators. Effective implementation requires a comprehensive, system‐level strategy involving healthcare organizations as well as local, regional, and national structures to support both the management and prevention of noncommunicable diseases. Trial Registration: PROSPERO under the number CRD42024613298. https://www.crd.york.ac.uk/prospero/

Background/Objectives: Although prescribing physical activity (PA) is a well-established preventive strategy in primary health care (PHC), its ethical implications remain under-researched. This study examines how general practitioners (GPs) and nurses experience, interpret, and manage ethical tensions in PAP. Methods: A qualitative study was conducted with 28 PHC professionals (13 GPs, 15 nurses) from rural and urban centers in Toledo, Spain (M = 18.4 years of experience). Data were collected through semi-structured interviews and analyzed using reflexive thematic analysis. Beauchamp and Childress’ four-principles framework was applied abductively to synthesize ethical conflicts and coping strategies. Results: Two main themes emerged: (1) Ethical conflicts in PAP, characterized by tensions between autonomy and paternalism, and the challenge of balancing beneficence with non-maleficence under institutional pressures; and (2) Professional coping strategies, where clinicians used relational care, individualized tailoring, and interprofessional collaboration to mitigate moral distress. Results indicated that clinical codes, such as “unrealistic goals” or “institutional pressure,” often overlapped across multiple ethical principles, necessitating a nuanced, multi-dimensional approach to counseling. Conclusions: PAP is not a neutral clinical task but an ethically grounded practice constrained by structural and organizational factors. To move toward safe and equitable health promotion, PAP must be conceptualized as a relational intervention. We propose an Ethical Reflective Tool and a conceptual framework to support clinical reflection, enhance professional accountability, and guide policy-level support for preventive care in PHC.

Frailty reduces resilience to surgical stress, increasing vulnerability to adverse outcomes. While recovery efforts traditionally focus on the postoperative phase, the preoperative period offers better opportunities for lifestyle interventions. Prehabilitation aims to increase functional reserve and surgical tolerance, especially in frail older adults. This systematic review and meta-analysis of randomized controlled trials (RCTs) evaluated the effectiveness of multimodal prehabilitation on aerobic capacity—measured by the 6 min walk test (6MWT)—and the length of hospital stay (LOS). A literature search was conducted up to August 2025. Eligible RCTs reported the effects of prehabilitation on functional capacity and LOS. A pairwise meta-analysis was used to calculate pooled mean differences (p-MDs) with 95% confidence intervals (CIs). The risk of bias was assessed via the Cochrane RoB tool, and evidence quality was assessed via the GRADE system. Five studies involving 400 participants were included. The p-MD for the 6MWT showed no significant improvement at any time point: (T1–T2) 9.71 (CI: −38.92; 58.36), (T2–T3) −3.27 (CI: −71.21; 64.65), and (T1–T3) 15.01 (CI: −22.05; 52.07). The LOS was also not significantly reduced (p-MD: −0.464, CI: −0.960; 0.031). Prehabilitation did not significantly improve aerobic capacity or reduce hospital stay. Future research should explore long-term benefits and adherence.