Usability and value of a digital learning resource in nursing education across European countries: a cross-sectional exploration.

BACKGROUND: Higher education is responsible for providing education that meets international benchmarks relevant to the needs of the international community. Due to the increase of digital tools in higher education, the possibility of sharing learning resources across nations has expanded. In the current project, a Norwegian university invited universities in Spain and the United Kingdom to adapt and translate e-learning resources originally developed for Norwegian nursing students for use within their respective Bachelor in Nursing programmes. AIM: The aim of the current study was to gain insights into the usability and value for learning of e-compendiums shared and implemented across three European universities. METHODS: The study adopted a descriptive cross-sectional design and included nursing students from the University of Nottingham, Valencia Catholic University, and the University of Stavanger. Data were collected in Autumn 2017 through a questionnaire adapted from the validated "Centre for Excellence in Teaching and Learning Reusable Learning Object evaluation questionnaire" The questionnaire consisted of 19 items that included two aspects: e-compendiums' value for learning and e-compendiums' usability. The different study sites were compared using a binary logistic regression analysis. Subgroups of students were compared based on their gender and age. RESULTS: A total of 480 nursing students participated in the study. The e -compendiums were overall positively rated, especially for reinforcing and retaining knowledge. Compared to the students from the University of Stavanger, students from Valencia Catholic University rated the e-compendiums more positively in most aspects of learning. Students from University of Nottingham found the e-compendiums to be more important for learning engagement compared to students at the Norwegian study site, and no differences were found in any other aspects of learning. Younger students rated the interactivity and visual components as more important compared to older students. CONCLUSIONS: Students from the University of Nottingham and Valencia Catholic University seem to accept the e-compendiums despite the fact that they were originally developed for use in another country. We argue that, when sharing e-learning resources across countries, an adaptation and translation process that includes a multicultural and multidisciplinary perspective should be carried out.

Drivers for human papillomavirus vaccination in Valencia (Spain) / Factores asociados a la vacunación contra el virus del papiloma humano en Valencia (España)

Objective: To describe the drivers associated with HPV vaccination in adolescent girls and their parent's opinion on the vaccine. Methods: We conducted an observational and cross-sectional study on adolescent girls and their parents in Valencia (Spain), between September 2011 and June 2012. A consultation was made at a random sample of schools of the 14-year-old girls that should have received the vaccine in the free vaccination programme. We ran a personal survey on knowledge and attitudes regarding HPV infection and the vaccine. A binary logistic regression model was performed to determine which factors were most associated with vaccination. Results: The survey was run on a binomial of 1,278 girls/mothers in 31 schools, to which 833 girls and their mothers responded (64.0%). The factors associated with vaccination were: country of origin of the families (adjusted OR [aOR]: 0.49; 95% confidence interval [95%CI]: 0.24-0.98), civil status of the parents (aOR: 0.33; 95%CI: 0.13-0.81), knowledge/beliefs about the vaccine when the source of information was the nurse (aOR: 1.83; 95%CI: 1.01-3.35), information source about the vaccine (aOR: 2.32; 95%CI: 1.37-3.92), preventive health centre visits (aOR: 2.1; 95%CI: 1.10-4.07), and nurse advice (aOR: 6.6; 95%CI: 3.19-13.56). Conclusions: The main factor associated with HPV vaccination was the advice of health professionals. Therefore, the most effective interventions to improve vaccination coverage should focus on health professionals

Objetivo: Describir qué factores se asocian a la vacunación contra el virus del papiloma humano (VPH) en adolescentes y la opinión de sus padres/madres sobre dicha vacuna. Métodos: Se llevó a cabo un estudio observacional y transversal en chicas adolescentes y sus progenitores en Valencia (España), entre septiembre de 2011 y junio de 2012. Se realizaron consultas a las niñas de 14 años que tendrían que haber sido vacunadas dentro del programa de vacunación gratuita, en una muestra aleatoria de colegios. Se preguntó sobre conocimientos y actitud respecto a la infección por el VPH y la vacuna, mediante entrevista personal. Se llevó a cabo un modelo de regresión logística binaria para determinar qué factores estaban más asociados con la vacunación. Resultados: Se entrevistó a 1278 binomios chica/madre, con una tasa de respuesta del 64,0% (833). Los factores asociados a la vacunación fueron el país de origen de las familias (odds ratio ajustada [ORa]: 0,49; intervalo de confianza del 95% [IC95%]: 0,24-0,98), el estado civil de los progenitores (ORa: 0,33; IC95%: 0,13-0,81), los conocimientos/creencias sobre la vacuna cuando la principal fuente de información fue la enfermera (ORa: 1,83; IC95%: 1,01-3,35), la fuente de información sobre la vacuna (ORa: 2,32; IC95%: 1,37-3,92), las visitas preventivas al centro de salud (ORa: 2,12; IC95%: 1,10-4,07) y el consejo de la enfermera (ORa: 6,57; IC95%: 3,19-13,56). Conclusiones: El principal factor asociado a la vacuna del VPH fue el consejo del personal sanitario, por lo que las intervenciones para aumentar la cobertura vacunal deben centrarse en este colectivo

Drivers for human papillomavirus vaccination in Valencia (Spain).

OBJECTIVE: To describe the drivers associated with HPV vaccination in adolescent girls and their parent's opinion on the vaccine. METHODS: We conducted an observational and cross-sectional study on adolescent girls and their parents in Valencia (Spain), between September 2011 and June 2012. A consultation was made at a random sample of schools of the 14-year-old girls that should have received the vaccine in the free vaccination programme. We ran a personal survey on knowledge and attitudes regarding HPV infection and the vaccine. A binary logistic regression model was performed to determine which factors were most associated with vaccination. RESULTS: The survey was run on a binomial of 1,278 girls/mothers in 31 schools, to which 833 girls and their mothers responded (64.0%). The factors associated with vaccination were: country of origin of the families (adjusted OR [aOR]: 0.49; 95% confidence interval [95%CI]: 0.24-0.98), civil status of the parents (aOR: 0.33; 95%CI: 0.13-0.81), knowledge/beliefs about the vaccine when the source of information was the nurse (aOR: 1.83; 95%CI: 1.01-3.35), information source about the vaccine (aOR: 2.32; 95%CI: 1.37-3.92), preventive health centre visits (aOR: 2.1; 95%CI: 1.10-4.07), and nurse advice (aOR: 6.6; 95%CI: 3.19-13.56). CONCLUSIONS: The main factor associated with HPV vaccination was the advice of health professionals. Therefore, the most effective interventions to improve vaccination coverage should focus on health professionals.

Moral assessment of frozen human embryo adoption in the light of the Magisterium of the Catholic Church / Evaluación moral de la adopción de embriones humanos congelados a la luz del Magisterio de la Iglesia Católica / Avaliação moral de adoção de embriões humanos congelados, em consideração ao Magistério da Igreja Católica

As the number of frozen human embryos continues to rise daily, with numbers not expected to fall, an answer must be found to this dilemma. Four possible solutions have been suggested: a) thaw the embryos and allow them to perish; b) thaw them and donate them for biomedical research; c) thaw them and donate them in adoption; and d) leave them frozen indefinitely. This paper will evaluate the morality of these four possible solutions, particularly frozen human embryo adoption in the light of the Magisterium of the Catholic Church, which in its Instruction Dignitas Personae, appears to have opted to consider this practice as illicit. We also review the various stances of expert moralists in favour of or against frozen human embryo adoption, and we reflect on the extent to which the doctrine contained in Dignitas Personae can bind the moral conscience of the Catholic faithful. Finally, we make a personal evaluation of frozen human embryo adoption, in an attempt to find moral reasons that substantiate the negative opinion manifested by the Catholic Magisterium on this matter. In conclusion, we suggest that the moral assessment of frozen human embryo adoption as set forth in Dignitas Personae might not be considered as settled. Therefore, we are of the opinion that there is no impediment to further research on the moral foundation of this adoptive practice; however, insofar as this occurs, we believe that the best attitude of the Catholic faithful is to follow the moral criteria presented in Dignitas Personae with respect to the adoption of frozen human embryos.

Cada día aumenta el número de embriones humanos congelados y no se prevé que su número disminuya, por lo que parece necesario buscar una solución a este problema. Se han planteado cuatro posibles: a) descongelarlos y dejarlos morir; b) descongelarlos y donarlos para investigaciones biomédicas; c) descongelarlos y donarlos en adopción; y d) dejarlos congelados indefinidamente. En este trabajo se evalúa la moralidad de estas cuatro posibles soluciones, y espacialmente de la adopción de los embriones humanos congelados a la luz del Magisterio de la Iglesia Católica, que en su Instrucción Dignitas Personae, se decanta por la ilicitud de dicha práctica. También se revisan distintas posturas de moralistas expertos favorables o no a la adopción de embriones humanos congelados. Igualmente se reflexiona sobre en qué medida la doctrina contenida en Dignitas Personae puede obligar a la conciencia moral de los fieles católicos. Finalmente se realiza una evaluación personal de la adopción de embriones humanos congelados tratando de buscar razones morales que fundamenten el porqué del juicio negativo manifestado por el Magisterio Católico. Los autores sostienen que la ilicitud ética de la adopción de embriones humanos congelados puede radicar en la ilicitud moral de la subrogación, que hace ilícito todo el proceso procreativo, constituido por: acto conyugal, fecundación del óvulo e implantación del embrión producido en el útero en su madre biológica. Finalmente se plantea que lo expuesto en Dignitas Personae posiblemente no da por zanjada la valoración moral de la adopción de embriones humanos congelados, por lo que somos de la opinión de que no existe impedimento alguno para poder seguir investigando sobre la fundamentación moral de esta práctica adoptiva; pero que, en tanto en cuanto ello se produzca, nos parece que la mejor actitud de los fieles católicos es seguir los criterios morales de Dignitas Personae, expone con respecto a la adopción de embriones humanos congelados.

Cada dia aumenta o número de embriões humanos congelados e não se espera o número diminua, portanto parece necessário encontrar uma solução para este problema. Foram levantadas quatro possíveis: a) descongelá-los e deixá-los morrer; (b) descongelá-los e doá-los para pesquisa biomédica; (c) descongelada-los e doá-los para adoção; e (d) deixá-los congelados indefinidamente. Nesse trabalho se avalia a moralidade dessas quatro possíveis soluções e especialmente a adoção de embriões humanos congelados à luz do Magistério da Igreja Católica, que em sua instrução Dignitas Personae, opta pela ilegalidade da prática. Também se revisam posturas diferentes dos moralistas especialistas favoráveis ou não à adoção de embriões humanos congelados. Igualmente, reflete-se sobre como a doutrina contida na Dignitas Personae pode obrigar a consciência moral dos fiéis católicos.Finalmente se realiza uma avaliação pessoal da adoção de embriões humanos congelados pretendendo buscar razões morais que fundamentem o porquê do juízo negativo manifestado pelo magistério católico. Os autores argumentam que a ilegalidade ética da adoção de embriões humanos congelados pode resultar na ilicitude moral de sub-rogação, tornando ilícito todo o processoprocriador, constiuído por: ato conjugal, fertilização do óvulo e implantação do embrião produzido no útero de sua mãe biológica. Finalmente, apresenta-se que o exposto no Dignitas Personae, possivelmente, não dá por resolvida a valoração moral da adopção de embriões humanos congelados, portanto somos da opinião de que não há nenhum impedimento para seguir pesquisando sobre o fundamentação moral desta prática adotiva; Porém, porquanto ele se produza, parece-nos que a melhor atitude dos fiéis católicos será seguir os critérios morais de Dignitas Personae, expostos no que se refere a adoção de embriões humanos congelados.

Effectiveness of HPV vaccines against genital warts in women from Valencia, Spain.

OBJECTIVES: To assess the effectiveness of the HPV vaccines in preventing genital warts in young women. DESIGN: Population-based study using health databases. SETTING: Valencian Community (Spain). PARTICIPANTS: All girls and women aged 14-19years who were registered in the Valencian Community between January 2009 and December 2014 (n=279,787). MAIN OUTCOME MEASURES: Incident cases of genital warts were defined as the first activation of diagnosis code ICD-9-CM 078.11 (Condyloma acuminatum) in primary care and outpatient clinics during the study period. RESULTS: There were 612 cases of genital warts. The overall incidence rate was 75.8/100,000 person-years (95% CrI 69.7-81.8). There was a decrease in genital warts when female candidates to be vaccinated with quadrivalent HPV vaccine reached the age of 18 (in 2012), compared to previous years. Incidence of genital warts in unvaccinated women and those who received the bivalent vaccine was higher than in girls and women who received the quadrivalent HPV vaccine. The effectiveness of a three-dose regimen of the quadrivalent HPV vaccine was 77% (95 CrI: 66-85%), whereas that of a single dose was 61% (95 CrI: 20-87%). No effectiveness was seen with a full vaccination course with the bivalent HPV vaccine. CONCLUSIONS: Three doses of the quadrivalent HPV vaccine were effective against genital warts in our population. Moreover, with low vaccine coverage the incidence of genital warts decreased only in the vaccinated.

¿Están preparados nuestros profesionales sanitarios para responder ante una reanimación cardiopulmonar en mujeres embarazadas? / Are healthcare staff trained to perform cardiopulmonary resuscitation on pregnant women?

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[Relationship between maternal body mass index, gestational weight gain and birth weight; prospective study in a health department]. / Asociación entre el índice de masa corporal materno, la ganancia de peso gestacional y el peso al nacer; estudio prospectivo en un departamento de salud.

OBJECTIVES: To ascertain the relationship between maternal weight gain and birth weight, in every pre-gestational body mass index (BMI) category. MATERIAL AND METHODS: A two-stage sampling observational and descriptive study was carried out in the health department of La Ribera (Valencia, Spain). The sample was divided into four groups according to pre-gestational BMI. FINDINGS: 140 pregnant women were studied. We observed rising pre-gestational weight gain (PWG) and trimestral gradients. There was a higher increase from the first to the second trimester than from the second to the third trimester in every pre-gestational BMI category. According to the international recommendations of Institute of Medicine, 16.4% of women had an inferior gestational weight gain (GWG), 38.6% were within the recommendations and 45% were above them. The pre-gestational BMI, categorized by the WHO, is related to the birth weight, showing a statistical significance (F=6.636 and and p<0.001). Obese mothers with a higher weight gain than the recommended have newborns with higher birth weight (4,353 ± 821.924 g) and, underweight mothers with a lower weight gain than the recommended, have newborns with lower birth weights (2,900 ± 381.83 g) than the rest of the groups. CONCLUSIONS: The absolute gestational weight gain did not show a statistical significance compared to the birthweight in any of the pre-gestational BMI categories and, as an isolated indicator, is not an added value to the prenatal quality control.

Objetivo: Contrastar la relación que existe entre la ganancia de peso gestacional y el peso del recién nacido, entre cada categoría de IMC pregestacional. Material y Métodos: Estudio observacional y descriptivo con muestreo bietápico en el Departamento de Salud de la Ribera (Valencia, España). Se clasificaron en cuatro grupos dependiendo del índice de masa corporal (IMC) pregestacional. Resultados: Se estudiaron 140 gestantes. La evolución de la ganancia de peso gestacional (GPG) y de sus gradientes trimestrales fue ascendente. Se produjo un mayor incremento del primer al segundo trimestre que del segundo al tercero para todas las categorías de IMC pregestacional. Según las recomendaciones internacionales de GPG el 16,4% de la muestra tuvo una ganancia de peso inferior a la recomendada, el 38,6% una ganancia de peso igual y el 45% una ganancia de peso superior. El IMC pregestacional categorizado por la OMS, está relacionado con el peso al nacer, mostrando significación estadística (F=6,636 y p<0,001). Las obesas con una ganancia de peso mayor de la recomendada tienen recién nacidos con mayor peso (4.353±821,924 g) y las de bajo-peso con ganancia menor de la recomendada, tienen recién nacidos con pesos menores (2.900±381,83 g) que el resto de grupos. Conclusiones: La GPG de forma absoluta no mostró significación estadística con el peso al nacer con ninguna categoría materna de IMC pregestacional y, como indicador aislado, no es un valor añadido a la calidad del control prenatal.

¿Podemos mejorar la predicción del peso al nacer? Modelo multivariante en mujeres en normopeso / Can we improve prediction of birth weight? A multivariate model in women with normal body mass index

Objetivo. Construir un modelo predictivo que mejore la estimación del peso del recién nacido. Material y métodos. Estudio observacional y descriptivo sobre 140 gestantes seleccionadas con muestreo bietápico en el Departamento de Salud de La Ribera (Valencia). Se clasificaron en 4 grupos dependiendo del índice de masa corporal (IMC) pregestacional. El peso fetal fue estimado por ecografía en la semana 35 a 40 de gestación por un ginecólogo. Resultados. Las variables que se relacionaron estadísticamente con el peso al nacer para la categoría de IMC pregestacional de normopeso fueron: altura uterina medida entre la semana 35-40 de gestación, peso proyectado a la semana 40 por la ecografía del tercer trimestre (PP40s), edad gestacional, ferritina sérica del tercer trimestre y cigarrillos consumidos en el tercer trimestre (p < 0,001; p < 0,001; p < 0,001; p = 0,007; p = 0,006, respectivamente). Se construyó un modelo multivariante para la categoría de normopeso para estimar el peso al nacer (PErm) obteniendo una R2 = 0,72 (F = 47,32; p < 0,001). Las diferencias de las medias obtenidas entre PP40s y PErm, con el peso del recién nacido, fueron significativas (p < 0,001). El modelo multivariante infravalora el peso al nacer en 0,07 g (error medio 0,54%) y la PP40s lo sobrestima en 300,89 g (error medio 10,75%). Conclusiones. El modelo multivariante construido, para la categoría de normopeso, mejora la precisión de la ecografía (AU)

Objectives. To construct a predictive model that improves birthweight estimation. Material and methods. A comparative, descriptive study was carried out in 140 pregnant women selected through two-stage sampling in the health department of La Ribera (Spain). The women were classified in 4 groups depending on their pre-gestational body mass index (BMI). Fetal weight was estimated by ultrasound at 35-40 weeks by a gynecologist. Results. The variables significantly related to birth weight in women with a normal pregestational BMI were, symphysis fundal height between 35-40 weeks, projected birth weight estimated at 40 weeks by ultrasound, gestational age, ferritin level in the third trimester, and the number of cigarettes smoked in the third trimester (P<.001, P<.001, P<.001, P<.007, P<.006, respectively). A multivariate model was created for the normal weight group to estimate birth weight, resulting in R2=.72 (F=47.32, P<.001). The differences in the means for fetal weight at week 40 and projected birth weight estimated by ultrasound at 35-40 weeks with birth weight were significant (P<.001). Birth weight was underestimated by 0.07 g in the multivariate model (mean error 0.54%) and overestimated by 300.89 g by projected birth weight estimated at 35-40 weeks (mean error 10.75%). Conclusions. The multivariate model created for the normal weight group improves the accuracy of ultrasound (AU)

"Knowledge and attitudes of Spanish adolescent girls towards human papillomavirus infection: where to intervene to improve vaccination coverage".

BACKGROUND: HPV vaccine coverage is far from ideal in Valencia, Spain, and this could be partially related to the low knowledge about the disease and the vaccine, therefore we assessed these, as well as the attitude towards vaccination in adolescent girls, and tried to identify independently associated factors that could potentially be modified by an intervention in order to increase vaccine coverage. METHODS: A cross sectional study was conducted in a random selection of schools of the Spanish region of Valencia. We asked mothers of 1278 girls, who should have been vaccinated in the 2011 campaign, for informed consent. Those that accepted their daughters' participation, a questionnaire regarding the Knowledge of HPV infection and vaccine was passed to the girls in the school. RESULTS: 833 mothers (65.1%) accepted participation. All their daughters' responded the questionnaire. Of those, 89.9% had heard about HPV and they associated it to cervical cancer. Only 14% related it to other problems like genital warts. The knowledge score of the girls who had heard about HPV was 6.1/10. Knowledge was unrelated to the number of contacts with the health system (Pediatrician or nurse), and positively correlated with the discussions with classmates about the vaccine. Adolescents Spanish in origin or with an older sister vaccinated, had higher punctuation. 67% of the girls thought that the vaccine prevented cancer, and 22.6% felt that although prevented cancer the vaccine had important safety problems. 6.4% of the girls rejected the vaccine for safety problems or for not considering themselves at risk of infection. 71.5% of the girls had received at least one vaccine dose. Vaccinated girls scored higher knowledge (p = 0.05). CONCLUSION: Knowledge about HPV infection and vaccine was fair in adolescents of Valencia, and is independent to the number of contacts with the health system, it is however correlated to the conversations about the vaccine with their peers and the vaccination status. An action to improve HPV knowledge through health providers might increase vaccine coverage in the adolescents.

Ethical considerations of universal vaccination against human papilloma virus.

BACKGROUND: From an epidemiological perspective, the practice of universal vaccination of girls and young women in order to prevent human papilloma virus (HPV) infection and potential development of cervical cancer is widely accepted even though it may lead to the neglect of other preventive strategies against cervical cancer. DISCUSSION: It is argued that removing the deterrent effect--the fear of developing cancer--could encourage teenage sex. This paper reflects on the ethical legitimacy of the universal vaccination of girls and young women against HPV infection, especially regarding safety issues, the need to vaccinate people who have opted to abstain from sex, the presumption of early onset of sexual relations, the commercial interests of the companies that manufacture the vaccine, and the recommendation of universal vaccination in males. SUMMARY: Based on the aforementioned information, we believe that the universal vaccination against HPV in young women is acceptable from an ethical point of view, given the medical advantages it presents.