COVID-19 Infection among Nursing Students in Spain: The Risk Perception, Perceived Risk Factors, Coping Style, Preventive Knowledge of the Disease and Sense of Coherence as Psychological Predictor Variables: A Cross Sectional Survey.

The exploration of patterns of health beliefs about COVID-19 among nursing students may be beneficial to identify behaviors, attitudes and knowledge about contagion risk. We sought to analyze the variables of risk perception, perceived risk factors, coping style, sense of coherence and knowledge of preventive measures as possible predictors of having suffered from COVID-19. Participants were nursing students from 13 universities in Spain. Sociodemographic and health variables were collected. To test the independent variables, the Perception Risk Coping Knowledge (PRCK-COVID-19) scale was created and validated because there was no specific survey for young people adapted to the pandemic situation of COVID-19. It was validated with adequate psychometric properties. A total of 1562 students (87.5% female, mean age 21.5 ± 5.7 years) responded. The high perception of the risk of contagion, the high level of knowledge and a coping style focused on the situation were notable. Significant differences by gender were found in the coping styles, problem-focused, avoidance and knowledge scales, with women scoring higher in all categories. The multiple regression analysis was significant (F = 3.68; p < 0.001). The predictor variables were the coping styles subscale search for support and the intrinsic and extrinsic perceived risk factors. Our model predicts that nursing students with a social support-based coping style are at a higher risk of becoming infected with COVID-19, based on their own health belief model.

Surveillance of Indoor Air Concentration of Volatile Organic Compounds in Luxembourgish Households.

Exposure to air pollution is a well-known health risk. For instance, volatile and very volatile organic compounds (VOCs and VVOCs) are known to cause respiratory, haematologic or immune diseases, and even cancer. Based on the Luxembourgish indoor pollution surveillance program, we performed an exploratory analysis for the period 2014-2019, in order (1) to evaluate the prevalence of VOCs and VVOCs in households, and (2) to estimate the risks of lifelong exposure to selected VOCs on the health of the adult population. The database included 715 indoor air samples from 159 different households. Observed VOC and VVOC levels were similar to those in neighbouring countries. Our health impact assessment identified some health risks associated with the observed concentrations in Luxembourg. Furthermore, this study shows the major public health importance of having a national indoor pollution surveillance system in place. Highlights: (1) This study provides an overview of the domestic indoor pollution in Luxembourg. (2) (V)VOCs levels in Luxembourg were similar to those in neighbouring countries. (3) The results clearly show the importance of having a surveillance system in place.

A comparison between midwifery and obstetric care at birth in Spain: Across-sectional study of perinatal outcomes.

BACKGROUND: The organizational structure of maternity services determines the choice of which professionals provide care during pregnancy, birth, and the postnatal period, and it influences the kind of care they deliver and the level of continuity of care offered. There is considerable evidence that demonstrates a relationship between how care is provided and the maternal and neonatal health outcomes. Registered midwives and obstetricians provide maternity care across Spain. To date, no studies have assessed whether maternity outcomes differ between these two groups. OBJECTIVE: The aim of this study was to examine the association between the care received (midwifery care versus obstetric care) and the maternal and neonatal outcomes in women with normal, low- and medium-risk pregnancies in Spain from 2016 to 2019. DESIGN: A prospective, multicentre, cross-sectional study was carried out as part of COST Action IS1405 at 44 public hospitals in Spain in the years 2016-2019. The protocol can be accessed through the registry ISRCTN14062994. The sample size of this study was 11,537 women. The primary outcome was mode of birth. The secondary outcomes included augmentation with oxytocin, use of epidural analgesia, women's position at birth, perineal integrity, third stage of labour management, maternal and neonatal admission to intensive care, Apgar score, neonatal resuscitation, and early initiation of breastfeeding. Chi-square tests for categorical variables and independent sample t-test for continuous variables to assess differences between the midwifery and obstetric groups were calculated. Odds ratio with intervals of confidence at 95% were calculated for obstetric interventions and perinatal outcomes. A multivariate logistic regression model was applied in order to examine the effect of type of healthcare provider on perinatal outcomes. These models were adjusted for care provider, type of onset of labour, use of anaesthesia, pregnancy risk, maternal age, parity, and gestational age at birth. RESULTS: Midwifery care was associated with lower rates of operative births and severe perineal damage and had no higher adverse outcomes. No statistically significant differences were observed in the use of other obstetric interventions between the two groups. CONCLUSIONS: The findings of this study should encourage a shift in the current maternity care system towards a greater integration of midwifery-led services in order to achieve optimal birth outcomes for women and newborns. REGISTRY NUMBER: ISRCTN14062994.

Telomere Length but Not Mitochondrial DNA Copy Number Is Altered in Both Young and Old COPD.

Accelerated ageing is implicated in the pathogenesis of respiratory diseases as chronic obstructive pulmonary disease (COPD), but recent evidence indicates that the COPD can have roots early in life. Here we hypothesise that the accelerated ageing markers might have a role in the pathobiology of young COPD. The objective of this study was to compare two hallmarks of ageing, telomere length (TL), and mitochondrial DNA copy number (mtDNA-CN, as a surrogate marker of mitochondrial dysfunction) in young (≤ 50 years) and old (>50 years) smokers, with and without COPD. Both, TL and mtDNA-CN were measured in whole blood DNA by quantitative PCR [qPCR] in: (1) young ever smokers with (n = 81) or without (n = 166) COPD; and (2) old ever smokers with (n = 159) or without (n = 29) COPD. A multivariable linear regression was used to assess the association of TL and mtDNA-CN with lung function. We observed that in the entire study population, TL and mtDNA-CN decreased with age, and the former but not the latter related to FEV1/FVC (%), FEV1 (% ref.), and DLCO (% ref.). The short telomeres were found both in the young and old patients with severe COPD (FEV1 <50% ref.). In addition, we found that TL and mtDNA-CN were significantly correlated, but their relationship was positive in younger while negative in the older patients with COPD, suggesting a mitochondrial dysfunction. We conclude that TL, but not mtDNA-CN, is associated with the lung function impairment. Both young and old patients with severe COPD have evidence of accelerated ageing (shorter TL) but differ in the direction of the correlation between TL and mtDNA-CN in relation to age.

Design of the EBE-ST Questionnaire among Nursing Students: Multicenter Study from Eight Universities in Spain.

BACKGROUND: Twenty years after the degree in nursing was introduced in Spain, the subject of evidence-based nursing is still unstructured and unestablished in most faculties. Moreover, there are hardly any rigorous studies at a national level that evaluate the current state of this competence in our faculties. Understanding the starting point is essential for the curricular design to ensure that evidence-based practice is implemented among future professionals. AIM: To design and validate an evidence-based nursing competency questionnaire for fourth-year nursing students. METHODS: A specific questionnaire was developed and validated (EBE-ST). A cross-sectional survey design with psychometric validation of an instrument. Participants were 304 senior year nursing students from eight universities in Spain (2020). RESULTS: The EBE-ST questionnaire is composed of 33 items that determine eight factors. It presents adequate reliability and validity (alpha = 0.882), measuring knowledge, attitudes and the practical application of evidence-based practice. CONCLUSIONS: We have created an instrument with good psychometric properties to measure evidence-based practice competence among senior nursing students. The heterogeneity of knowledge regarding evidence-based nursing in our country suggests that further reflection is warranted on the incorporation of this topic during undergraduate training. We have designed and validated an evidence-based nursing competency questionnaire specific to nursing students.

Microbial exposures in moisture-damaged schools and associations with respiratory symptoms in students: A multi-country environmental exposure study.

Moisture-damaged buildings are associated with respiratory symptoms and underlying diseases among building occupants, but the causative agent(s) remain a mystery. We first identified specific fungal and bacterial taxa in classrooms with moisture damage in Finnish and Dutch primary schools. We then investigated associations of the identified moisture damage indicators with respiratory symptoms in more than 2700 students. Finally, we explored whether exposure to specific taxa within the indoor microbiota may explain the association between moisture damage and respiratory health. Schools were assessed for moisture damage through detailed inspections, and the microbial composition of settled dust in electrostatic dustfall collectors was determined using marker-gene analysis. In Finland, there were several positive associations between particular microbial indicators (diversity, richness, individual taxa) and a respiratory symptom score, while in the Netherlands, the associations tended to be mostly inverse and statistically non-significant. In Finland, abundance of the Sphingomonas bacterial genus and endotoxin levels partially explained the associations between moisture damage and symptom score. A few microbial taxa explained part of the associations with health, but overall, the observed associations between damage-associated individual taxa and respiratory health were limited.

SARS-CoV-2 transmission in students of public schools of Catalonia (Spain) after a month of reopening.

INTRODUCTION: SARS-CoV-2 transmission within schools and its contribution to community transmission are still a matter of debate. METHODS: A retrospective cohort study in all public schools in Catalonia was conducted using publicly available data assessing the association between the number of reported SARS-CoV-2 cases among students and staff in weeks 1-2 (Sept 14-27th, 2020) of the academic year with school SARS-CoV-2 incidence among students in weeks 4-5. A multilevel Poisson regression model adjusted for the community incidence in the corresponding basic health area (BHA) and the type of school (primary or secondary), with random effects at the sanitary region and BHA levels, was performed. RESULTS: A total of 2184 public schools opened on September 14th with 778,715 students. Multivariate analysis showed a significant association between the total number of SARS-CoV-2 cases in a centre in weeks 1-2 and the SARS-CoV-2 school incidence among students in weeks 4-5 (Risk Ratio (RR) 1.074, 95% CI 1.044-1.105, p-value <0.001). The adjusted BHA incidence in the first two weeks was associated with school incidence in weeks 4-5 (RR 1.002, 95% CI 1.002-1.003, p-value <0.001). Secondary schools showed an increased incidence in weeks 4 and 5 (RR primary vs secondary 1.709 95% CI 1.599-1.897, p-value <0.001). CONCLUSIONS: Safety measures adopted by schools were not enough to stop related-to-school transmission in students and could be improved. The safest way to keep schools open is to reduce community transmission down to a minimum.

Phenotypic characterisation of early COPD: a prospective case-control study.

The phenotypic characteristics of chronic obstructive pulmonary disease (COPD) in individuals younger than 50 years of age (early COPD) are not well defined. This prospective, multicentre, case-control study sought to describe these characteristics and compare them with those of smokers (≥10 pack-years) of similar age with normal spirometry (controls). We studied 92 cases (post-bronchodilator forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) <0.7) and 197 controls. Results were contrasted with participants with similar inclusion criteria recruited into the ECLIPSE and COPDGene cohorts. Cases had moderate airflow limitation (FEV1 71.3±20.8%) but were often symptomatic, used healthcare resources frequently, had air trapping (residual volume 150.6±55.5% ref.), had reduced diffusing capacity (84.2±20.7% ref.) and had frequent evidence of computed tomography (CT) emphysema (61%). Of note, less than half of cases (46%) had been previously diagnosed with COPD. Interestingly, they also often reported a family history of respiratory diseases and had been hospitalised because of respiratory problems before the age of 5 years more frequently than controls (12% versus 3%, p=0.009). By and large, these observations were reproduced when available in the ECLIPSE and COPDGene cohorts. These results show that early COPD is associated with substantial health impact and significant structural and functional abnormalities, albeit it is often not diagnosed (hence, treated). The fact that a sizeable proportion of patients with early COPD report a family history of respiratory diseases and/or early-life events (including hospitalisations before the age of 5 years) renders further support to the possibility of early-life origin of COPD.

Effectiveness and cost-effectiveness of Improving clinicians' diagnostic and communication Skills on Antibiotic prescribing Appropriateness in patients with acute Cough in primary care in CATalonia (the ISAAC-CAT study): study protocol for a cluster randomised controlled trial.

BACKGROUND: Despite their marginal benefit, about 60% of acute lower respiratory tract infections (ALRTIs) are currently treated with antibiotics in Catalonia. This study aims to evaluate the effectiveness and efficiency of a continuous disease-focused intervention (C-reactive protein [CRP]) and an illness-focused intervention (enhancement of communication skills to optimise doctor-patient consultations) on antibiotic prescribing in patients with ALRTIs in Catalan primary care centres. METHODS/DESIGN: A cluster randomised, factorial, controlled trial aimed at including 20 primary care centres (N = 2940 patients) with patients older than 18 years of age presenting for a first consultation with an ALRTI will be included in the study. Primary care centres will be identified on the basis of socioeconomic data and antibiotic consumption. Centres will be randomly assigned according to hierarchical clustering to any of four trial arms: usual care, CRP testing, enhanced communication skills backed up with patient leaflets, or combined interventions. A cost-effectiveness and cost-utility analysis will be performed from the societal and national healthcare system perspectives, and the time horizon of the analysis will be 1 year. Two qualitative studies (pre- and post-clinical trial) aimed to identify the expectations and concerns of patients with ALRTIs and the barriers and facilitators of each intervention arm will be run. Family doctors and nurses assigned to the interventions will participate in a 2-h training workshop before the inception of the trial and will receive a monthly intervention-tailored training module during the year of the trial period. Primary outcomes will be antibiotic use within the first 6 weeks, duration of moderate to severe cough, and the quality-adjusted life-years. Secondary outcomes will be duration of illness and severity of cough measured using a symptom diary, healthcare re-consultations, hospital admissions, and complications. Healthcare costs will be considered and expressed in 2021 euros (year foreseen to finalise the study) of the current year of the analysis. Univariate and multivariate sensitivity analyses will be carried out. DISCUSSION: The ISAAC-CAT project will contribute to evaluate the effectiveness and efficiency of different strategies for more appropriate antibiotic prescribing that are currently out of the scope of the actual clinical guidelines. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03931577.

Desarrollo de materiales educativos para pacientes crónicos y familiares / Development of educational materials for chronic patients and families

Un nivel bajo de alfabetización puede dificultar la comprensión de la información necesaria para tomar decisiones apropiadas en relación con la propia salud. Esta situación está relacionada con una peor adherencia a los tratamientos, un peor estado de bienestar y una mortalidad más elevada, sobre todo en personas de edad avanzada. Resulta esencial que la información pueda ser comprendida por el paciente y su familia. Este artículo tiene como objetivo presentar las recomendaciones internacionales existentes para el diseño y la elaboración de materiales o recursos educativos para pacientes crónicos y familiares. Se describen aspectos metodológicos que engloban la inclusión de los pacientes en distintos puntos durante el proceso de desarrollo del material, la adaptación del formato y el contenido al nivel de comprensión del paciente, así como su participación en una prueba piloto antes de la publicación de los mismos. Los materiales educativos que se han elaborado con la colaboración de los pacientes resultan más adaptados a su contexto y promueven cambios positivos en su salud

Low literacy can difficult the use of information needed to take appropriate decisions in healthcare. This situation is associated with poorer treatment adherence, lower health outcomes and higher mortality among the population and, specifically, the elderly. It is essential that information can be understood by patients and families. This article aims to present the existing international recommendations for the design and development of educational materials and resources to chronic patients and families. This process encompasses the involvement of patients at various levels during the development process of the materials, the adaptation of the format and content to the level of understanding of the patient as well as their participation in the evaluation process. Educational materials that have been developed in collaboration with patients are more adapted to their context and promote positive changes in their health

EARLY COPD: determinantes de la aparición y progresión de la enfermedad pulmonar obstructiva crónica en adultos jóvenes. Protocolo de un estudio caso-control con seguimiento / Determinants of the Appearance and Progression of Early-Onset Chronic Obstructive Pulmonary Disease in Young Adults. A Case-Control Study with Follow-up

Introducción y objetivos: Los determinantes en fases iniciales de la historia natural de la enfermedad pulmonar obstructiva crónica (EPOC) son poco conocidos. Entenderlos mejor es de capital importancia para poder diseñar intervenciones dirigidas a modificar su pronóstico. Los principales objetivos del estudio son: a) caracterizar a una población de adultos jóvenes con EPOC de forma multidimensional; b) comparar estos pacientes con sujetos fumadores con función pulmonar normal; y c) establecer una cohorte de adultos jóvenes con y sin EPOC, que pueda ser seguida a largo plazo para conocer mejor la historia natural de la enfermedad. Participantes y método: EARLY COPD es un estudio multicéntrico de casos y controles que permitirá establecer una cohorte de sujetos para su seguimiento posterior. Se seleccionaron 311 (101 casos y 210 controles) participantes reclutados en una treintena de centros de atención primaria y 12 hospitales de 8 comunidades autónomas españolas. Los participantes eran fumadores o exfumadores (>10 paquetes año) de entre 35-50 años de edad. Los casos presentaban una espirometría obstructiva con un FEV1/FVC<70% y los controles una espirometría normal con un FEV1/FVC≥70%. Las principales variables de estudio que se han determinado son las siguientes: cuestionarios de salud, síntomas, exacerbaciones y actividad física, pruebas de función respiratoria, análisis biológicos de sangre y esputo y TAC de baja radiación. Para el análisis estadístico de los resultados se describirán las características de los pacientes con EPOC y se compararán con los sujetos del grupo control mediante un modelo de regresión logística

Introduction and objectives: Determinants of chronic obstructive pulmonary disease (COPD) in the early stages of its natural history are not well known. Improving our knowledge of these factors will help to design interventions that can modify prognosis. Study objectives are: a) to characterize a COPD population of young adults aged 35-50 years from a multidimensional point of view; b) to compare these patients with smokers with normal lung function; and c) to create a cohort of young adults aged 35-50 years (smokers or former smokers), with and without COPD, who will be followed in the future to improve understanding of the natural history of the disease. Participants and method: This is a case-control multicenter study aimed at establishing a well-characterized cohort of young adults, smokers or former-smokers, with and without COPD, for subsequent follow-up. A total of 311 participants (101 cases and 210 controls) were selected from approximately 30 primary care settings and 12 hospitals in 8 Spanish regions. Subjects were smokers or former smokers (>10 pack-years) aged 35-50 years. Diagnosis of COPD was based on a post-bronchodilator result of FEV1/FVC<70%. The main study variables were: questionnaires on health, symptoms, exacerbations and daily physical activity, lung function tests, blood and sputum samples, and low-dose computed tomography. In the statistical analysis, COPD patient characteristics will be described and compared with control subjects using a logistic regression analysis

Determinants of the Appearance and Progression of Early-Onset Chronic Obstructive Pulmonary Disease in Young Adults. A Case-Control Study with Follow-up. / EARLY COPD: determinantes de la aparición y progresión de la enfermedad pulmonar obstructiva crónica en adultos jóvenes. Protocolo de un estudio caso-control con seguimiento.

INTRODUCTION AND OBJECTIVES: Determinants of chronic obstructive pulmonary disease (COPD) in the early stages of its natural history are not well known. Improving our knowledge of these factors will help to design interventions that can modify prognosis. Study objectives are: a) to characterize a COPD population of young adults aged 35-50 years from a multidimensional point of view; b) to compare these patients with smokers with normal lung function; and c) to create a cohort of young adults aged 35-50 years (smokers or former smokers), with and without COPD, who will be followed in the future to improve understanding of the natural history of the disease. PARTICIPANTS AND METHOD: This is a case-control multicenter study aimed at establishing a well-characterized cohort of young adults, smokers or former-smokers, with and without COPD, for subsequent follow-up. A total of 311 participants (101 cases and 210 controls) were selected from approximately 30 primary care settings and 12 hospitals in 8 Spanish regions. Subjects were smokers or former smokers (>10 pack-years) aged 35-50 years. Diagnosis of COPD was based on a post-bronchodilator result of FEV1/FVC<70%. The main study variables were: questionnaires on health, symptoms, exacerbations and daily physical activity, lung function tests, blood and sputum samples, and low-dose computed tomography. In the statistical analysis, COPD patient characteristics will be described and compared with control subjects using a logistic regression analysis.

Alfabetización en salud en pacientes con insuficiencia cardiaca atendidos en atención primaria / Health literacy in patients with heart failure treated in primary care

OBJETIVOS: Examinar el nivel de alfabetización en salud y los factores que la condicionan en pacientes con insuficiencia cardiaca visitados en atención primaria. DISEÑO: Estudio transversal multicéntrico. Emplazamiento. Diez centros de atención primaria del área metropolitana de Barcelona. PARTICIPANTES: Pacientes con diagnóstico de insuficiencia cardiaca. CRITERIOS DE INCLUSIÓN: visita al centro de salud en el último año, desplazarse al centro de manera autónoma y acceder a participar voluntariamente. Mediciones principales. Cuestionarios Health Literacy Survey - European Union (HLS-EU-Q) y versión española de la Escala Europea de Autocuidado en Insuficiencia Cardiaca (EHFScBS). Se analizó la relación entre ambas escalas y variables sociodemográficas y clínicas mediante el test de ANOVA y un modelo de regresión lineal múltiple. RESULTADOS: Se incluyeron 318 pacientes (51,2% mujeres), con una media de edad de 77,9±8,7 años. El índice de alfabetización en salud del 79,6% (n=253) de los participantes fue de competencia insuficiente para comprender la información de salud. Los factores que explicaron la alfabetización en salud fueron el nivel académico (p < 0,001), la clasificación funcional de insuficiencia cardiaca (p = 0,032), los autocuidados y la edad (p < 0,04). El nivel académico explicaba el 61,6% del nivel de alfabetización (IC 95% bootstrap: 44,58%; 46,75%). CONCLUSIONES: La alfabetización en salud permite explicar la actitud de los pacientes hacia el régimen terapéutico que requiere la insuficiencia cardiaca. En los pacientes con insuficiencia cardiaca, los médicos y enfermeras de atención primaria han de tener en cuenta los factores que facilitan la comprensión de la información de salud

OBJECTIVES: The level of health literacy is examined, as well as its conditioning factors in patients with heart failure who are seen routinely in a Primary Health Care Area. DESIGN: A multicentre cross-sectional study. SETTING: 10 Primary care centres from the metropolitan area of Barcelona. Participants. Patients diagnosed with heart failure. Inclusion criteria: to have visited the Primary Health Care centre in the last year, being able to arrive at the primary care setting independently, and voluntarily participation. Main measurements. Health Literacy Survey-European Union - Questionnaire (HLS-EU-Q) and Spanish version of the European Heart Failure Self-care Behaviour Scale. An analysis was made of the relationships between health literacy, self-care practices, sociodemographic, and clinical variables using ANOVA test and a multiple linear regression model. RESULTS: The study included 318 patients (51.2% women) with a mean age of 77.9±8.7 years. The index of health literacy of 79.6% (n=253) of the participants indicated problems in understanding healthcare information. Health literacy level was explained by academic level (P<.001), the extent of heart failure (P=.032), self-care, and age (P<.04).The academic level explained 61.6% of the health of literacy (95% bootstrap: 44.58%; 46.75%). CONCLUSIONS: In patients with stable heart failure, it is important to consider all factors that help patients to understand the healthcare information. Health literacy explains patient self-care attitude in heart failur

[Health literacy in patients with heart failure treated in primary care]. / Alfabetización en salud en pacientes con insuficiencia cardiaca atendidos en atención primaria.

OBJECTIVES: The level of health literacy is examined, as well as its conditioning factors in patients with heart failure who are seen routinely in a Primary Health Care Area. DESIGN: A multicentre cross-sectional study. SETTING: 10 Primary care centres from the metropolitan area of Barcelona. PARTICIPANTS: Patients diagnosed with heart failure. INCLUSION CRITERIA: to have visited the Primary Health Care centre in the last year, being able to arrive at the primary care setting independently, and voluntarily participation. MAIN MEASUREMENTS: Health Literacy Survey-European Union - Questionnaire (HLS-EU-Q) and Spanish version of the European Heart Failure Self-care Behaviour Scale. An analysis was made of the relationships between health literacy, self-care practices, sociodemographic, and clinical variables using ANOVA test and a multiple linear regression model. RESULTS: The study included 318 patients (51.2% women) with a mean age of 77.9±8.7 years. The index of health literacy of 79.6% (n=253) of the participants indicated problems in understanding healthcare information. Health literacy level was explained by academic level (P<.001), the extent of heart failure (P=.032), self-care, and age (P<.04).The academic level explained 61.6% of the health of literacy (95% bootstrap: 44.58%; 46.75%). CONCLUSIONS: In patients with stable heart failure, it is important to consider all factors that help patients to understand the healthcare information. Health literacy explains patient self-care attitude in heart failure.

Aprendizaje de las competencias de investigación en el Grado de Medicina: análisis y evaluación de las calificaciones de los estudiantes en el Trabajo de Final de Grado / Learning to perform research in the degree of medicine: analysis and evaluation of the student ratings of the final degree dissertation

La adaptación al Plan Bolonia del Grado de Medicina en España ha introducido en los planes de estudio la realización del Trabajo de Final de Grado (TFG). A continuación se presenta un modelo de TFG y se estudia la validez de un sistema de evaluación de las calificaciones para medir los resultados del aprendizaje de las competencias de investigación y pensamiento crítico. Se evaluaron 62 trabajos. Para su realización los estudiantes contaron con un equipo de tutores expertos en investigación clínica y en metodología. El trabajo fue evaluado por tres profesores, cada uno completó una rúbrica de 10 ítems. La validez del sistema de evaluación se analizó mediante el modelo de múltiples facetas de Rasch, que permite estudiar las diferencias en la severidad de los evaluadores, los resultados de los estudiantes y la dificultad de los ítems. Se calificaron los trabajos de 62 estudiantes, totalizando 186 rúbricas. El 58% de los estudiantes mostraron una habilidad superior a la severidad de los evaluadores y a la dificultad de los ítems de la rúbrica. No se observaron diferencias significativas en la severidad de los evaluadores, ni en las calificaciones finales según el tipo de evaluador. El ítem más difícil para los estudiantes fue la selección del diseño epidemiológico del protocolo. El método de análisis propuesto para el TFG es eficaz para evaluar la adquisición de las competencias relacionadas con la investigación y el pensamiento crítico en los estudiantes del último curso del Grado de Medicina

The Bologna Plan applied to the Medicine Degree in Spain has included a final degree dissertation into the coursework. In this manuscript, we analyzed the validity of a rubric and the grading criteria used to assess the students skills in research and their critical thinking. A total of 62 final degree dissertations were evaluated. Each student was supervised by a clinical or epidemiologist researcher. Each dissertation was rated by three academic assistants using a 10-item rubric. The validity of the scores and the differences in the severity of the examiners were analyzed with a multi-faceted Rasch model, which allowed examining severity within evaluators, ability of the students and difficulty of items. 62 final dissertation were evaluated with a total of 186 rubrics. 58% of the students had higher ability than the severity of the evaluators and the difficulty of the items of the evaluation rubric. No significant differences were observed within the severity of the professors, neither within the final scores. The most difficult item for students was selection of epidemiological design. This study showed that the methodology proposed to evaluate the final degree dissertation is effective to assess the skills of conducting research and critical thinking in medicine students

Associations between informal care, disease, and risk factors: A Spanish country-wide population-based study.

This population-based study using 2011-2012 Spanish National Health Survey data aimed to measure the impact of disease, health-related habits, and risk factors associated with informal caregiving. We included and matched self-reported informal caregivers [ICs] with controls (1:4) from the same survey. For each outcome, we analyzed associations between ICs and controls using linear regression or logistic regression models. ICs had 3.4 per cent more depression (OR: 1.33, 95 per cent confidence intervals [CI]:1.06, 1.68). ICs had lower social support (95 per cent CI: 1.64, 3.28), they did more housework alone (OR:3.6, 95 per cent CI:2.65, 4.89), and had greater stress (95 per cent CI:0.13, 0.83). Women ICs caring alone had more anxiety than other groups. We found no statistical association between caregivers and worse health-related habits or increased risk factors (less physical activity, smoking, drinking, and cholesterol). Our results provide evidence that health-care professionals and organizations should recognize the importance of caring for those who care.

Domestic use of bleach and infections in children: a multicentre cross-sectional study.

OBJECTIVE: To report the effects of bleach use at home on the frequency of infections in 9102 school-age children participating in the HITEA project. METHODS: Parents of pupils aged 6-12 years from schools in Barcelona province (Spain), Utrecht province (the Netherlands) and Eastern and Central Finland were administered a questionnaire including questions on the frequency of infections (influenza, tonsillitis, sinusitis, otitis, bronchitis and pneumonia) in the past 12 months and bleach use at home. We developed multivariable mixed-effects multilogistic regression models to obtain relative risk ratios (RRR) and their 95% CI per country, and combined the RRR using random-effects meta-analyses. RESULTS: Bleach use was common in Spain (72%, n=1945) and uncommon in Finland (7%, n=279). Overall, the prevalence of infections (recurrent or once) was higher among children of bleach users. Significant combined associations were shown for influenza only once (RRR=1.20, 95% CI 1.04 to 1.38), recurrent tonsillitis (RRR=1.35, 95% CI 1.07 to 1.71) and any infection (RRR=1.18, 95% CI 1.01 to 1.38). CONCLUSIONS: Passive exposure to cleaning bleach in the home may have adverse effects on school-age children's health by increasing the risk of respiratory and other infections. The high frequency of use of disinfecting irritant cleaning products may be of public health concern, also when exposure occurs during childhood.

Dampness, bacterial and fungal components in dust in primary schools and respiratory health in schoolchildren across Europe.

BACKGROUND: Respiratory health effects of damp housing are well recognised, but less is known about the effect of dampness and water damage in schools. The HITEA study previously reported a higher prevalence of respiratory symptoms in pupils from moisture damaged schools, but the role of specific microbial exposures remained unclear. OBJECTIVES: To study associations between school dampness, levels of fungal and bacterial markers, respiratory symptoms and lung function in children. METHODS: Primary schools in Spain, the Netherlands and Finland were selected on the basis of the observed presence (n=15) or absence (n=10) of moisture, dampness and/or mould. Settled dust was repeatedly sampled in 232 classrooms and levels of 14 different microbial markers and groups of microbes were determined. Parental reports of respiratory symptoms were available from 3843 children aged 6-12 years, of whom 2736 provided acceptable forced spirometry testing. Country-specific associations between exposure and respiratory health were evaluated by multilevel mixed-effects logistic and linear regression models and combined using random-effects meta-analysis. RESULTS: The prevalence of respiratory symptoms was higher in moisture damaged schools, being more pronounced in Finnish pupils. Effects on lung function were not apparent. Levels of microbial markers were generally higher in moisture damaged schools, varied by season and were lower in Finnish schools. Wheeze tended to be inversely associated with microbial levels. All other respiratory symptoms were not consistently associated with microbial marker levels. CONCLUSIONS: Health effects of moisture and microbial exposures may vary between countries, but this requires further study.

Asthma, respiratory symptoms and lung function in children living near a petrochemical site.

Residential proximity to environmental hazards has been related to adverse health outcomes. Respiratory health and allergies in children living near petrochemical sites have not been extensively studied. We evaluated the association between residential proximity to the petrochemical site of Tarragona (Catalonia, Spain) and the prevalence of asthma, respiratory symptoms and lung function in children. Children aged 6-7 (n=2672) and adolescents aged 13-14 (n=2524) residing near two large petrochemical sites and those living in a city with medium vehicular traffic were cross-sectionally compared with children from an area with low vehicular traffic and without industry. The prevalence of symptoms was measured using the International Study of Asthma and Allergies in Childhood written and video questionnaires. Lung function measurements were done in a subsample of 959 adolescents in the four areas. Multivariable analyses were done to estimate the effects of the residential area on symptoms and lung function adjusted for potential confounders. Crude prevalence of symptoms was similar across the studied areas. After adjustment, children and adolescents living near a petrochemical site had a statistically significant higher prevalence of respiratory hospitalizations in the previous year (Prevalence Ratio (PR)=1.49; 95%CI, 1.06-2.09) and of nocturnal cough (PR=1.29; 95%CI 1.05-1.57), respectively. Reduced lung function values among adolescents residing near the petrochemical areas were not observed. Although a higher prevalence of asthma in children and adolescents living near the petrochemical sites could not be demonstrated, as described in other studies, respiratory hospitalizations and nocturnal cough could be related to short-term exposures to pollutants. Other clinical and sub-clinical respiratory health effects in the petrochemical industry areas should be investigated.