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.Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Acknowledgments: We are grateful to all participating institutions and students

Design of the EBE-ST questionnaire among nursing students: mnulticenter 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 student

Indoor dampness and mould in primary schools and respiratory health in children

Several studies have showed that the occupants of damp or mouldy buildings have an increased risk of respiratory symptoms, respiratory infections and exacerbation of asthma. However, information on the school environment in this context is limited and hence more studies are needed. These dampness-related health effects may be associated with different indoor pollutants, but the causal mechanisms and aetiological agents are still largely unknown. Included in the HITEA project, this thesis aims to assess the occurrence of moisture problems in school buildings in three European countries from different climatic regions and to study the respiratory health effects associated with dampness and mould in schoolchildren. A questionnaire survey and school inspection visits were conducted to assess moisture damage, dampness problems and other indoor air quality issues in primary schools in the three countries under study. Following, we carried out an extensive questionnaire survey on respiratory health of pupils aged 6-12 years, in at least eight moisture-damaged and eight non-damaged schools per country. Our results showed that moisture problems were relatively common in schools in all three climatic regions across Europe. Spanish school buildings had the highest prevalence of these problems, followed by The Netherlands and Finland. Moreover dampness and mould in schools were associated with adverse respiratory symptoms in pupils, especially in Finland. In conclusion, Dampness and mould in schools may have respiratory adverse health effects in children. Finnish school children seem to be at higher risk, possibly due to quantitative and/or qualitative differences in exposure, due to variations in climate and building characteristics. Thus, prevention and remediation measures should be considered to reduce dampness and mould problems in school buildings to protect pupils’ health.Diversos estudios han observado que los ocupantes de edificios con problemas de humedad o moho tienen más riesgo de padecer síntomas respiratorios, infecciones respiratorias y exacerbación asmática. Aún así, la información sobre el entorno escolar en este contexto es limitada y por ello más estudios son necesarios. Los efectos en la salud relacionados con la humedad en los edificios pueden estar asociados con diferentes contaminantes interiores, pero los mecanismos causales y los factores etiológicos siguen siendo desconocidos. Incluida en el proyecto HITEA, esta tesis pretende evaluar cualitativa y cuantitativamente la prevalencia de edificios escolares con problemas de humedad en tres países europeos de tres regiones climáticas distintas y estudiar los efectos en la salud asociados a la humedad y el moho en sus alumnos. Se realizaron cuestionarios e inspecciones en los colegios de los tres países a estudio, para evaluar los posibles daños y problemas relacionados con la humedad y otros factores asociados con la calidad del aire interior. A continuación, se llevó a cabo un amplio cuestionario sobre salud respiratoria en los alumnos de entre 6 y 12 años, en al menos 8 escuelas con problemas de humedad y 8 escuelas sin problemas. Los resultados mostraron que los problemas de humedad en los edificios escolares eran relativamente comunes en las 3 regiones climáticas europeas. Las escuelas españolas presentaron una mayor prevalencia de problemas de humedad, seguidas de Holanda y Finlandia. Además, los problemas de humedad y moho en los edificios escolares se asociaron con síntomas respiratorios adversos en los alumnos, especialmente en Finlandia. En conclusión, los problemas de humedad y moho en los edificios escolares podrían tener efectos adversos en la salud respiratoria de los niños. Los alumnos finlandeses parecen tener más riesgo, posiblemente debido a diferencias cuantitativas y/o cualitativas en la exposición. Esto podría estar relacionado con las diferentes características de los edificios y con la variabilidad climática. Así pues, para proteger la salud de los alumnos se deberían considerar diversas medidas de prevención y reparación de los problemas de humedad y moho en los edificios escolares

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.The research of DM is funded by COV20/00115 (Insituto de Salud Carlos III, Spain). The research of JP is funded by grants 2017SGR1049 (Agència de Gestió d’Ajuts Universitaris i de Recerca, Catalonia) and: PGC2018-098676-B-100 (Ministerio de Ciencia, Innovación y Universidades, Spain). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Autonomy, power dynamics and antibiotic use in primary healthcare : A qualitative study

Antibiotic resistance is a global health concern. Although numerous strategies have tried to reduce inadequate antibiotic prescribing, antibiotics are still prescribed in 60% of acute lower respiratory tract infections (ALRTIs) cases in Catalonia (Spain). This study aims to explore service users' experiences of ALRTIs, the quality and access to healthcare services, and health education. Selective purposive sampling was carried out, based on a prior definition of participant characteristics. These were sex, age, ethnicity, date of the last ALRTI, number of ALRTIs in the last year, and treatments received. Participants with a previous diagnosis of ALRTIs were recruited from three primary health care centres in Barcelona and one in Tarragona. Twenty-nine interviews were conducted between April and June 2019. A content thematic analysis was performed. Three themes were identified: 1) risk perceptions and help-seeking; 2) treatment preferences and antibiotic use; and 3) relationship dynamics and communication with healthcare professionals. Accounts of service users' sense of autonomy towards their health and power dynamics within the healthcare system were apparent. Supporting service users to become reliable, subjective and agentic experts of their health and bodies could help them to voice their healthcare agendas. Power structures embedded within healthcare, political and economic institutions should be challenged so that healthcare services can be co-developed (with service users) and based on service users' autonomy and horizontal relationships. Special consideration should be paid to the intersection of social vulnerabilities. A concordance approach to prescribing could be key to improve the responsible use of antibiotics and to contribute to the prevention of AMR in primary healthcare. The marketisation of health, and the increased demands of private healthcare in Spain due to the financial pressures on public healthcare as a consequence of the financial crisis of 2008 and the COVID-19 pandemic, are a risk for promoting adequate antibiotic prescribing and use. Trial registration The ISAAC-CAT study has been registered in the NCT registry, ID:

A Co-Design Process to Elaborate Educational Materials to Promote Appropriate Use of Antibiotics for Acute Lower Respiratory Tract Infections in Primary Healthcare in Catalonia (Spain)

Co-design processes with patients allow developing health education materials, that are adapted to the population's knowledge and use of language, to reduce inappropriate antibiotic use. This study presents a co-design process of educational material with patients (over 18 years old) with a previous diagnosis of acute lower respiratory tract infection. The co-design was framed within a qualitative study (Phase I, interviews; Phase II, focus group) conducted in Barcelona between April and September 2019. Twenty-nine semi-structured interviews were conducted. Six people participated in the focus group. Based on participants' narratives, educational materials can be useful to support healthcare consultations. Materials should be designed to be accessible in terms of the content and language used. The co-design of educational materials is essential for health promotion. This study presents an example of how materials can be co-developed with patients. The material elaborated in this study is being used for the ISAAC-CAT project and may be useful for future research, practice in health services and health policy

Early life microbial exposure and fractional exhaled nitric oxide in school-age children: a prospective birth cohort study

BACKGROUND: Inflammation is a key factor in the pathogenesis of respiratory diseases. Early life exposure to microbial agents may have an effect on the development of the immune system and on respiratory health later in life.In the present work we aimed to evaluate the associations between early life microbial exposures, and fractional exhaled nitric oxide (FeNO) at school age. METHODS: Endotoxin, extracellular polysaccharides (EPS) and β(1,3)-D-glucan were measured in living room dust collected at 2-3 months of age in homes of participants of three prospective European birth cohorts (LISA, n = 182; PIAMA, n = 244; and INMA, n = 355). Home dampness and pet ownership were periodically reported by the parents through questionnaires. FeNO was measured at age 8 for PIAMA and at age 10/11 for LISA and INMA. Cohort-specific associations between the indoor microbial exposures and FeNO were evaluated using multivariable regression analyses. Estimates were combined using random-effects meta-analyses. RESULTS: FeNO at school age was lower in children exposed to endotoxin at age 2-3 months (β -0.05, 95% confidence interval (CI) -0.10;-0.01) and in children with reported dog ownership during the first two years of life (GM ratio 0.82, CI 0.70-0.96). FeNO was not significantly associated with early life exposure to EPS, β(1,3)-D-glucan, indoor dampness and cat ownership. CONCLUSION: Early life exposure to bacterial endotoxin and early life dog ownership are associated with lower FeNO at school age. Further studies are needed to confirm our results and to unravel the underlying mechanisms and possible clinical relevance of this finding.This work was supported by the European Commission as part of HITEA (Health Effects of Indoor Pollutants: Integrating microbial, toxicological and epidemiological approaches), Grant agreement no. 211488 under the Seventh Framework Programme, Topic ENV.2007.1.2.1.1. “Indoor air pollution in Europe: An emerging environmental health issue”. The LISAplus study was funded by the BMBF (Federal Ministry of Education and Research), the Helmholtz Center Munich and the UFZ Leipzig. The PIAMA study is supported by The Netherlands Organization for Health Research and Development; The Netherlands Organization for Scientific Research; The Netherlands Asthma Fund; The Netherlands Ministry of Spatial Planning, Housing, and the Environment; and The Netherlands Ministry of Health, Welfare, and Sport. The INMA-Menorca study was funded by Fondo de Investigacion Sanitaria, ISCIII, Ministerio de Sanidad y Servicios Sociales, Spain (Grants 97/0588, 00/0021-2, G03/176, PI061756 and PS0901958), EC Contract QLK4-CT-2000-00263 and Fundacio Roger Torne (Barcelona, Spain)