Background: Virtual reality (VR) is used as a distraction measure during painful clinical procedures associated with the use of needles. These procedures include vaccinations, blood draws, or the administration of medications, which can cause children to feel increased levels of pain and fear. Objective: The objective of this study was to collect and analyze the current evidence regarding the effectiveness of VR as a tool to distract children from pain and fear during needle procedures as compared to that of standard techniques. Methods: A systematic review and meta-analysis was performed. We included randomized clinical trials (RCTs) or quasi-RCTs with participants younger than 21 years who underwent needle procedures in which the main distraction measure used was VR and where the main outcome measure was pain. The databases searched included the PubMed, Web of Science, Scopus, PsycINFO, CINAHL, and Cochrane libraries. In this systematic review, the studies were analyzed by applying the Critical Appraisal Skills Program guide in Spanish and the Jadad scale. In the meta-analysis, the effect size of the studies was analyzed based on the results for pain and fear in children. Results: From 665 unique search results, 21 studies were included in this systematic review, most of which reported low methodological quality. The study sample cohorts ranged from a minimum of 15 participants to a maximum of 220 participants. Ten studies were included in the meta-analysis. The global effect of using VR as a distraction measure was a significant reduction in pain (inverse variance [IV] –2.37, 95% CI –3.20 to –1.54; Z=5.58; P<.001) and fear (IV –1.26, 95% CI –1.89 to –0.63; Z=3.92; P<.001) in children in the experimental groups. Conclusions: The quality of the studies was mostly low. The main limitations were the impossibility of blinding the participants and health care personnel to the VR intervention. Nonetheless, the use of VR as a distraction measure was effective in reducing pain and fear in children during procedures involving needles.

The present study aimed to investigate the perceived changes in lifestyle behaviors among Spanish university students during COVID-19-related confinement. An observational, descriptive, and cross-sectional survey study was conducted during April 2020. Sociodemographic and anthropometric data were then obtained. The FANTASTIC questionnaire was used to assess the lifestyles of the 488 participants who took part in the study. Of the participants, 76.3% were female. Overall, the lifestyles of university students significantly deteriorated during the period of confinement caused by the COVID-19 pandemic in Spain. University female students were especially affected compared to their male fellows (p = 0.010). For women, social and family relationships (p < 0.001), personality (p < 0.001), interior (p < 0.001), and career (p < 0.001) were the aspects that worsened during confinement. For men, lack of physical exercise (p < 0.001), social and family relationships (p < 0.001), and career (p = 0.002) were affected to a greater extent. In both cases, confinement was a protective factor against the consumption of tobacco, toxins (p < 0.001), and alcohol (p < 0.001). Gender (p = 0.008) and obesity (p = 0.044) were the two factors that most affected the change in the score of the FANTASTIC questionnaire. Spanish university students’ lifestyles worsened during the lockdown caused by the COVID-19 pandemic, especially those of women, who were the most affected. Some aspects, such as those related to social and emotional behaviors, were deeply affected, while confinement could be a protective factor against previous toxic habits.

Aims and Objectives: To determine the effect of immersive virtual reality (VR) on perceived pain and fear in children during vaccination and parental satisfaction with the procedure.Background: Virtual reality can reduce the perception of pain by children but only three studies have analysed its use during vaccination to date; these had small sample sizes and imperfect methodological designs.Design: A randomised controlled clinical trial.Methods: One hundred and sixty participants from the Tres Forques Health Center were randomly assigned to the intervention group (IG) (n = 82) in which distraction with immersive VR was used during the vaccination, while standard distraction techniques were used for the control group (n = 80). The primary outcome was pain (Wong–Baker FACES). Secondary outcomes included (Children's Fear Scale) and parental satisfaction with the vaccination procedure. Chi‐squared tests were used for qualitative variables, relationships between quantitative variables were tested with Spearman correlations, and Mann–Whitney U‐ or Student t‐tests were employed to assess the relationship between quantitative and qualitative variables.Results: Compared to the controls, the children in the IG reported significantly less pain and fear, while parental satisfaction was significantly higher. Reported pain and fear did not differ according to the sex of the patient. Child age was not linked to fear but was related to pain: the younger the patient, the greater the pain they described.Conclusions: Immersive VR effectively controlled pain and fear in children during vaccination and increased parent satisfaction with the vaccination process. Patient sex did not influence the level of pain and fear but age did.Relevance to clinical practice: Improving vaccination experiences can reduce perceived pain and fear in children and increase parent satisfaction, thereby enhancing vaccination schedule adherence and improving group immunity.Reporting Method: The CONSORT Statement for non‐pharmacological randomised clinical trials were followed.

If healthcare professionals wish to provide healthcare that protects patients’ values and preferences, it is necessary to find a way to systematically implement the Advance-Care Planning process. The purpose of this article is to review the literature and present a theoretical model of Advance-Care Planning implementation through the Nursing Process.

The movement restrictions put in place as a result of the COVID-19 pandemic required modification of the population’s usual routines, including those of the most vulnerable groups such as patients with schizophrenia. This was a retrospective observational study. We used an online survey to collect information on patient adherence to the Mediterranean diet (Mediterranean Diet Adherence Screener questionnaire), physical exercise (International Physical Activity Questionnaire Short Form), and tobacco consumption and levels of anxiety and depression (Hospital Anxiety and Depression Scale) before and during the movement restrictions. A total of 102 people with schizophrenia participated in this study. During the COVID-19 pandemic lockdown the participants significantly increased the number of minutes spent sitting per day (z = −6.73; p < 0.001), decreased the time they spent walking (z = −6.32; p < 0.001), and increased their tobacco consumption (X² = 156.90; p < 0.001). These results were also accompanied by a significant increase in their reported levels of anxiety (z = −7.45; p < 0.001) and depression (z = −7.03, p < 0.001). No significant differences in patient diets during the pandemic compared to before the movement restrictions were reported. These results suggest the need to implement specific programs to improve lifestyle and reduce anxiety and depression during possible future pandemic situations.

Introduction Numerous studies support the practice of different physical exercise modalities as an effective treatment to address the problems associated with schizophrenia, reporting that they result in improvements in patient symptoms and quality of life. Given the lack of studies comparing different types of training in controlled environments, the aim of this proposed study will be to compare the effects of three physical exercise programmes (strength, aerobic and mixed) on the symptoms, body composition, level of physical activity and health-related quality of life of patients with schizophrenia. Methods and analysis A multicentre, single-blinded (evaluator), randomised, wait-list controlled (ratio 2:2:2:1) trial will be conducted with 105 patients recruited from different psychosocial care centres. The participants will be randomised into three 16-week training groups comprising 48 sessions lasting 1 hour each, or to the wait-list control group. The training groups will complete aerobic, strength or mixed (aerobic+strength) training. The participants will be assessed before, immediately after and 6 months after the end of the intervention. The patients in the wait-list control group (n=15) will receive one of the three trainings immediately after the intervention. The study variables will include positive, negative and general symptomology (Positive and Negative Syndrome Scale) as the primary outcome; as secondary outcome: body composition (by assessing body mass index, body fat mass and waist circumference), physical activity levels (International Physical Activity Questionnaire-Short Form) and quality of life (abbreviated WHO Quality of Life questionnaire). Ethics and dissemination This study was approved by the ethics committees for Biomedical Research at the CEU Cardenal Herrera University of Valencia, Spain (CEI18/215). Participants will be fully informed of the purpose and procedures of the study, and written informed consent will be obtained. The results from this study will be published in peer-reviewed journals and presented in scientific conferences. Trial registration number NCT04987151.