Objective. To identify empirical model-based patterns of multimorbidity from chronic noncommunicable diseases in the general population, with a focus on the contribution of rheumatic and musculoskeletal diseases (RMDs), and to quantify their association with adverse health outcomes. Methods. Cross-sectional data from the Portuguese Fourth National Health Survey were analyzed (n 5 23,754). Latent class analysis was used to identify patterns of coexistence of 11 chronic noncommunicable diseases (RMDs, diabetes mellitus, hypertension, chronic obstructive pulmonary disease, stroke, depression, myocardial infarction, cancer, osteoporosis, asthma, and renal failure). Based on the Outcome Measures in Rheumatology, filter 2.0, health outcomes included life impact, pathophysiologic manifestations, and resource use. We assessed the association between patterns and adverse health outcomes, through sex-, age-, and body mass index-adjusted prevalence ratios with 95% confidence intervals, obtained using Poisson regression. Results. Four patterns of chronic noncommunicable diseases co-occurrence were identified and labeled as low disease probability, cardiometabolic conditions, respiratory conditions, and RMDs and depression. RMDs were highly prevalent in patients with chronic diseases (from 38.6% in cardiometabolic conditions to 66.7% in RMDs and depression). While negative self-rated health, short-term disability, and chronic pain were more strongly associated with cardiometabolic conditions and respiratory conditions, all multimorbidity patterns were similarly associated with long-term disability, frequent health care utilization, and out-of-pocket health care expenses. Conclusion. Our study emphasizes RMDs as a major presence in multimorbidity in the general population. All multimorbidity patterns were associated with a wide set of adverse health outcomes. Management strategies for the patient with chronic cardiometabolic, respiratory, or depressive conditions should also target RMDs.

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Health Psychology ResearchFew studies have explored the impacts of COVID-19 and lockdown on the mental health of undergraduate nursing students. This study aimed: a) to explore perceived stress among undergraduate nursing students in Portugal and Spain during the COVID-19 pandemic outbreak; and b) to analyze several COVID-19 related factors and psychological issues that may be associated with perceived stress. A cross-sectional study was conducted with a convenience sample of Portuguese and Spanish undergraduate nursing students (n=1075). The data gathered included demographic information, questions about COVID-19 related factors, and psychological issues. Data were analyzed using multiple logistic regression with a degree of significance at p<0.05. High perceived stress scores were found in 558 participants (51.9%). Students with high perceived stress most likely had a COVID-19 diagnosis in their household; their household income had been affected by the COVID-19 pandemic; experienced difficulty falling asleep or sleeping all night; consumed junk food in excess; neglected their appearance; felt headaches, stomach aches, and back pain; and lacked the patience or desire to exercise. Additionally, high perceived stress was negatively associated with life satisfaction. The results provide evidence that infectious diseases, such as COVID-19, may significantly influence mental health. Further research should explore the long-term psychological effects of the COVID-19 pandemic among nursing students.

Objective To examine the effectiveness of the FIFA 11+ in reducing injury in futsal players. Methods Ninety‐one male futsal players from six amateur futsal clubs were recruited and assessed for eligibility, and 71 were randomized to the 11+ group (n = 37, age: 27.0 ± 5.1 years) and a control group (n = 34, age: 26.0 ± 5.1 years). The 11+ program was executed twice a week for 20 weeks, separated by a 10‐week period where both groups executed their regular warm‐up. Data on match, training exposure, and injuries were recorded during the regular season. Results The players sustained a total of 58 injuries during the futsal regular season, with 24 injuries in the 11+ group and 34 injuries in the control group; the overall incidence of injuries per 1000 player‐hours was significantly higher in the control group (11.6 vs 6.5; mean difference (95% CI) −5.1 (−9.1 to −1.1), P = .014). The 11+ group had a significantly lower incidence of acute (11.2 vs 5.7; −5.5 (−9.4 to −1.6), P = .007) and lower limb (8.7 vs 4.4; −4.2 (−8.1 to −0.4), P = .032) injuries per 1000 player‐hours. Players from the control group had a higher number of days injured (20.4 ± 17.3 vs 10.5 ± 9.1, P = .036). Conclusion The FIFA 11+ is an injury prevention program suited for injury reduction in amateur futsal players, as it reduces the incidence of overall, acute, and lower limb injuries during the season.