Variability of clinical practice in the care of the second stage of labor among midwives in Spain.

BACKGROUND: There are recommendations based on scientific evidence on care in the second stage of labor, but it is not known to what degree the professionals comply with these recommendations. OBJECTIVE: The aim of this study is to examine the variability in clinical practices among midwives during the second stage of labor, including positions, mobility, practices, and the maximum time allowed before initiating active pushing, and to assess their adherence to clinical practice guidelines. METHODS: A cross-sectional observational study. A self-designed questionnaire was developed and distributed online through scientific societies. The main variables studied were professional and work environment characteristics, maternal positions and mobility, practices during this stage, maximum time to start active pushing and duration of the second stage of labor. Descriptive statistics were calculated using SPSS 24.0. RESULTS: Regarding the woman's position during childbirth, 80.3% (245) of midwives frequently or always allow the woman to choose her birthing position. Furthermore, 44.6% (136) of professionals prefer using side-lying positions for the mother. Regarding drinking fluids during childbirth, 51.1% (156) of midwives allowed the woman to drink the amount of liquids she wanted, whereas 11.1% (34) said that they would allow them to do so however, this was against the protocol of their hospital. When inquiring about the Kristeller maneuver, it was reported to be excessively performed in 35.1% (107) of cases for fetal bradycardia, 33.1% (101) for maternal exhaustion, and 38.4% (117) to avoid instrumental birth. Finally, a great variability was observed in the time criteria used for the initiation of active pushing and the maximum duration of the second stage of labor. CONCLUSIONS: Certain practices, such as the Kristeller maneuver, are overused among midwives, with great variability in the use of certain procedures, the waiting times to initiate pushing and completion of the second stage of labor. Further training and awareness campaigns are needed for professionals to apply evidence-based care.

Professional approach to the care of women who have suffered a perinatal loss.

To understand the experience, training, and needs of midwives in their approach to perinatal grief. A descriptive cross-sectional study was carried out using an online questionnaire with 26 questions related to institutional management and individual clinical practices in the care of a perinatal loss was developed by a team of midwives from the Hospital "La Mancha-Centro" of Alcazar de San Juan (Ciudad Real). Strobe checklist was followed. A total of 267 midwives participated. A total of 92.1% (246) of the centers had specific protocols for action, but each professional applied their own criteria. The presence of a perinatal psychology team was nonexistent according to 88% (235) of those surveyed. Regarding their training and professional experience, 16.5% (44) of the midwives had never received training. Only 4.1% (11) of the midwives felt very prepared to care for women with a perinatal loss. Among the factors associated with greater application of recommended practices in the face of perinatal death by midwives were being a woman, having prior training on care during perinatal death, and a greater perception of preparation (p < 0.05). The perception of lack of preparation on the part of midwives in the accompaniment of these families was high.

Pelvic floor dysfunction: prevalence and associated factors.

BACKGROUND: Pelvic floor dysfunction in women encompasses a wide range of clinical disorders: urinary incontinence, pelvic organ prolapse, fecal incontinence, and pelvic-perineal region pain syndrome. A literature review did not identify any articles addressing the prevalence of all pelvic floor dysfunctions. OBJECTIVE: Determine the prevalence of the group of pelvic floor disorders and the factors associated with the development of these disorders in women. MATERIAL AND METHODS: This observational study was conducted with women during 2021 and 2022 in Spain. Sociodemographic and employment data, previous medical history and health status, lifestyle and habits, obstetric history, and health problems were collected through a self-developed questionnaire. The Pelvic Floor Distress Inventory (PFDI-20) was used to assess the presence and impact of pelvic floor disorders. Pearson's Chi-Square, Odds Ratio (OR) and adjusted Odds Ratio (aOR) with their respective 95% confidence intervals (CI) were calculated. RESULTS: One thousand four hundred forty-six women participated. Urinary incontinence occurred in 55.8% (807) of the women, fecal incontinence in 10.4% (150), symptomatic uterine prolapse in 14.0% (203), and 18.7% (271) reported pain in the pelvic area. The following were identified as factors that increase the probability of urinary incontinence: menopausal status. For fecal incontinence: having had instrumental births. Factors for pelvic organ prolapse: number of vaginal births, one, two or more. Factors for pelvic pain: the existence of fetal macrosomia. CONCLUSIONS: The prevalence of pelvic floor dysfunction in women is high. Various sociodemographic factors such as age, having a gastrointestinal disease, having had vaginal births, and instrumental vaginal births are associated with a greater probability of having pelvic floor dysfunction. Health personnel must take these factors into account to prevent the appearance of these dysfunctions.

Assessment, diagnosis and treatment of peristomal skin lesions by remote imaging: An expert validation study.

BACKGROUND: Prevention and treatment of peristomal skin problems should be a priority for nurses caring for ostomates, even when the assessment of lesions must be done remotely. OBJECTIVE: To measure the level of agreement on assessment, diagnosis and care indications for peristomal skin lesions using remote imaging among nurses in Spain. DESIGN: Prospective observational multicentre study to assess the diagnostic validity and inter- and intraobserver agreement between nurses in peristomal skin lesions. Data were collected between March and October 2019. SETTINGS AND PARTICIPANTS: The research sample consisted of a group of 39 nurses with expertise in the care of ostomates. METHODS: A panel of experts established a list of 24 common signs/findings, 15 diagnostic options and 35 treatment approaches for peristomal skin lesions. Three expert stoma therapy nurses compiled the clinical cases, which they described thoroughly and documented with photographs. The 39 participating nurses evaluated the cases in two rounds to measure inter and intraobserver agreement. RESULTS: A high or very high level of agreement (κ > 0.61) was observed for the following signs: encrustation, nodules, mucocutaneous separation and varicose veins; for the following diagnoses: mucocutaneous dehiscence, allergic contact dermatitis, encrustation and varicose veins (caput medusae); for the following treatments: recommending a diet rich in vitamin C/blueberries, applying acetic acid dressings, applying cold and topical tacrolimus treatment. CONCLUSIONS: The most easily identifiable lesions were those most prevalent and with visible signs. There was a lower level of agreement in identifying lesions for which photographs required additional information (laboratory data, description of signs and symptoms, type of diet and level of self-care). It is important to train nurses caring for ostomates to correctly describe ostomy-related lesions, which is important for nursing records, continuity of care and telehealth care.

Commitment, perception and evidence-based practice training in Spanish nursing students: A multicentre cross-sectional study.

AIMS AND OBJECTIVES: To evaluate the commitment and level of self-perceived training in evidence-based practice among students of the Nursing degree of five Spanish universities. BACKGROUND: In university Health Sciences degrees, evidence-based clinical practice can directly or indirectly impact the quality of care, the cost of the service provided and the safety of clinical practice. DESIGN: Multicentre cross-sectional observational study according to STROBE guidelines. METHODS: The evidence-based skills in Practice questionnaire (CACH-PBE, for its acronym in Spanish) and the Utrecht Work Engagement Student Scale (UWES-9S) were used. The study was performed in five Spanish universities (Alicante, Castilla La Mancha, Jaen, Huelva and Seville) from October to December 2020, with 755 participants (Nursing students). RESULTS: A total mean score of 91.9 points (SD = 11.81) was observed for the CACH-PBE questionnaire and of 36.8 points (SD = 8.48 points) for the UWES-9S. In addition, the multivariate analysis predicted that variables such as sex, academia, university, intention to do a Master or Doctorate degree, the level of work engagement, and the previous training in evidence-based clinical practice were associated with a greater perception of evidence-based practice. CONCLUSION: The sample of Nursing degree students has intermediate-high levels of knowledge, skills and attitudes regarding evidence-based practice and work commitment, with differences observed between each of the universities. RELEVANCE TO CLINICAL PRACTICE: Nursing students should develop from intermediate to high levels of knowledge, skills and attitudes regarding evidence-based practice and work commitment. There are various actions to promote EBP, such as the incorporation of a specific course covering the subject into the nursing curriculum, and the selection, for clinical practices, of care units that implemented evidence-based care.

Validation of a short version of the high-fidelity simulation satisfaction scale in nursing students.

BACKGROUND: Clinical simulation provides a practical and effective learning method during the undergraduate education of health professions. Currently there is only one validated scale in Spanish to assess nursing students' satisfaction with the use of high-fidelity simulation, therefore, our objective is to validate a brief version of this scale in undergraduate nursing students with or without clinical experience. METHOD: A cross-sectional descriptive study was performed. Between 2018 and 2020, the students from all academic courses of the Fundación Jiménez Díaz nursing school completed the satisfaction scale at the end of their simulation experiences. To validate this scale, composed of 33 items and eight dimensions, exploratory factor analysis (EFA) of the principal components was performed, the internal consistency was studied using Cronbach's alpha, and the corrected item-test correlation of each of the items of the total scale was reviewed. RESULTS: 425 students completed the scale, after the exploratory factor analysis, a scale consisting of 25 items distributed into six subscales, each containing between two and six items, explained a variance of 66.5%. The KMO test (Kaiser-Meyer-Olkin) obtained a value of 0.938, Bartlett's sphericity test was < 0.01 and Goodness of Fit Index (GFI) was 0.991. CONCLUSION: The modified ESSAF scale, reduced from 33 to 25 items and divided into six subscales, is as valid and reliable as the original scale for use in nursing students of different levels, with, or without clinical experience.

The psychological impact on frontline nurses in Spain of caring for people with COVID-19.

AIM: To understand the perceptions of National Health System nurses who have been working on the frontline of the psychological impact of caring for people with COVID-19 during the first and second waves. METHODS: A qualitative study, the design and analysis of which was based on phenomenology. For data collection, a semi-structured interview was administered to a sample of nurses who worked on the frontline in public hospitals in Extremadura and Madrid, Spain. The interviews, which followed a script including various topics, were conducted between May and November 2020 so as to include the experiences of the first and second waves of the pandemic. Sample collection continued until data saturation. The data were analysed following the phenomenological method of Giorgi with the help of the Atlas-Ti software. RESULTS: Two main themes emerged from the data analysis that explained the nurses' perceptions: (i) the main psychological repercussions of being frontline carers (anxiety, fear, stress, impotence, frustration, and an increase in obsessions and obsessive behaviours) and (ii) psychological coping strategies (collapse in the face of the situation, dissociative amnesia, leaning on colleagues and working as a team, resigning oneself, perceiving the situation as a war, and being aware of psychological repercussions). DISCUSSION: Caring as the first line causes great psychological repercussions for nurses. It is necessary to implement psychological and emotional support programmes to address the post-traumatic stress that nurses can suffer.

Experiences and mediating factors in nurses' responses to electronic device alarms: A phenomenological study.

AIM: This study aims to explore the experiences and mediating factors of nurses' responses to electronic device alarms in critical care units (CCUs). BACKGROUND: Alarm fatigue occasionally has adverse consequences for patient safety. METHODS: This qualitative study was designed and analysed following Giorgi's descriptive phenomenological approach. Seventeen nurses were theoretically sampled, reaching information saturation. Semistructured interviews were used to collect the data. RESULTS: Three central themes explained nurses' experiences: general perceptions about alarms (basic equipment of the CCU), strategies to reduce false alarms (training in the configuration of monitors, customization of the alarms to fit he patient's condition. teamwork and taking advantage of the development of technology) and key elements of the response to alarms (information about patient's condition, nurses' clinical experience, type of CCU, 'cry-wolf' phenomenon and nurse/patient ratio). CONCLUSIONS: To reduce false alarms, nurses need further postgraduate training, training on monitors and customizing alarms to fit the patient's health status. The complex process of deciding to respond to an alarm includes environmental, professional variables and patient status. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers should ensure that nurses have sufficient experience and training in the CCU, improve the nurse/patient ratio, promote teamwork and ensure that the devices are the latest generation.

Obstetric factors associated with postpartum post-traumatic stress disorder after spontaneous vaginal birth.

BACKGROUND: This study aimed to determine whether there is an association between clinical practices carried out during spontaneous vaginal birth (SVB), or clinical situations that arise during vaginal birth, and the incidence of post-traumatic stress disorder (PTSD). METHODS: A cross-sectional study with 839 puerperal women in Spain was conducted. The Perinatal Post-traumatic Stress Disorder Questionnaire (PPQ) was administered online. The relationship between the risk of postpartum PTSD and various intrapartum complications was studied in addition to practices or procedures performed during the intrapartum period. RESULTS: PTSD (PPQ scores ≥19) was identified in 8.1% (68) of the women who participated. Among the risk factors for PTSD was a concerning intrapartum FHR tracing (adjusted OR: 2.24, 95% CI: 1.07-4.66). Other intrapartum practices also put women at risk of PTSD, including the administration of an enema (aOR: 7.01, 95% CI: 2.14-23.01), being required to stay lying down throughout the labor and birth (aOR: 5.75, 95% CI: 3.25-10.19), artificial amniorrhexis without consent (aOR: 2.28, 95% CI: 1.31-3.97), administration of synthetic oxytocin without consent (aOR: 2.18, 95% CI: 1.26-3.77), fundal pressure during pushing (aOR: 3.14, 95% CI: 1.72-5.73), repeated vaginal examinations performed by different people (aOR: 4.84, 95% CI: 2.77-8.47), and manual removal of the placenta without anesthesia (aOR: 3.45, 95% CI: 1.81-6.58). CONCLUSIONS: Various intrapartum clinical practices, all related to dehumanized treatment, and intrapartum complications, were associated with an increased risk of PTSD. There is a need to eradicate obstetric mistreatment and to increase access to evidence-informed, respectful care in Spain. Care practitioners need to better appreciate their roles in preventing PTSD.

Mixed-method study of women's assessment and experience of childbirth care.

AIM: To examine women's evaluations of quality of care from their perspectives. BACKGROUND: Assessing women's satisfaction with the quality of care they receive during childbirth is an important component of care quality that should be analysed. Evidence suggests that childbirth experience has an important impact on women's health. Therefore, taking into account the perceptions of women about quality is a means to improve care. However, studies examining care quality in this setting remain scarce. DESIGN: Mixed-methods explanatory sequential design. METHODS: A national survey with a sample of 1082 participants, and 15 semi-structured interviews. Data collection occurred between January 2017 and January 2019. Quantitative data were obtained through a validated scale, the Quality from the Patient's Perspective-Intrapartal questionnaire, whose score can range from 1 (minimum satisfaction) to 4 (maximum satisfaction). Semi-structured interviews were conducted for qualitative data. Descriptive statistics, group comparison and qualitative content analysis were included in data analysis. RESULTS: The mean score on the QPP-I tool was high (3.13; SD 0.74). Variables that had the most influence on the experience were type of birth, type of perineal trauma, admission of the baby, time since birth, home-birth, parity and duration of labour. Data from the qualitative interviews identified five themes that explained women's experiences with the quality of care. Previous expectations influence the emotions they have regarding the experience. Relationships with professionals and their social skills are fundamental for the evaluation of quality. The separation of the newborn appears as a factor that worsens the appreciation of women. Good pain management and continuity of care by specialists are also named as key elements of the quality of care. CONCLUSION: Findings demonstrate that experience with childbirth care is of utmost importance for women. They also show the indisputable need to listen to their opinions and assessments when lines of improvement of quality are identified. IMPACT: This study provides information that can improve the care that women receive during their childbirths. Using their opinions will make them feel an active part of the system and in this way, we will be closer to achieve excellence in our services.

Nursing students' experience and training in healthcare aid during the COVID-19 pandemic in Spain.

BACKGROUND: During the COVID-19 pandemic health crisis, in some countries such as Spain, nursing students have offered to provide health assistance, but the role they have played, their degree of preparedness to face the situation, and what must be improved in their training to be ready for these situations is unknown. OBJECTIVE: Describe the experience and perceptions of students of the Nursing university degree during their participation as health support in the COVID-19 health crisis in Spain. DESIGN: We conducted a cross-sectional survey study. METHOD: 503 students enrolled in the 4th course of the Nursing degree in Spain during the months of March and April 2020. An online questionnaire was developed, based on a pilot study and distributed through the Nursing Association, students' unions and students' associations. Variables were used to describe their participation, degree of preparedness and training needs to determine how to improve training through descriptive statistics, as well as nonparametric tests to analyse the relationship between training and degree of preparedness nursing students. Results are reported according to the STROBE Statement. RESULTS: 73.2% (368) of students offered to participate in healthcare aid, of which 225 were actively involved. 27.8% carried out nursing tasks without supervision, and 47.7% assisted COVID-19 patients as any other nurse. Only 3.4% felt very prepared to work in the field of intensive care, finding that those students who perceived a higher degree of preparedness had received previous training in personal protective equipment and mechanical ventilation (p < 0.005). The highest scores for training activities that may improve their preparedness were simulations to improve levels of anxiety and stress when managing critical patients, simulation in ventilatory support and mandatory practices in services where ventilators are used. CONCLUSIONS: Although three out of four students were willing to provide health assistance, they recognise that they were not specially prepared in the field of intensive care and demand training with simulation to improve anxiety and stress levels in the management of critical patients and simulation in ventilatory support. RELEVANCE TO CLINICAL PRACTICE: Students have been vital resources for our health system and society when they have been needed. It is now up to us, both teachers and health authorities, to share their efforts by implementing the necessary improvements in training and safety measures not only because these affects the health and safety of the patient, but because they will be essential parts in future pandemics.

Effects of cord milking in late preterm infants and full-term infants: A systematic review and meta-analysis.

BACKGROUND: Umbilical cord milking (UCM) consists of performing several milkings of the cord from the placenta to the newborn. The objective was to evaluate the effects of UCM on newborns ≥34 weeks' gestation. METHODS: Searches were conducted in MEDLINE, EMBASE, CINAHL, the Cochrane Database of Clinical Trials, and the clinicaltrails.gov database for randomized clinical trials (RCT), with no time or language restrictions, and for articles that compared UCM with other strategies. The main results were initial hemoglobin and hemoglobin after 6 weeks. The data were collected by two reviewers and the quality of the studies was assessed using the Cochrane Manual methodology. RESULTS: The sample included 1845 newborns in 10 RCTs. The use of UCM in ≥34 weeks' gestation newborns was not related to initial hemoglobin levels (pooled weighted mean difference: (PWMD = 0.40 g/L [-0.16 to 0.95]) or after 6 weeks (PWMD = 0.07 g/L [-0.29 to 0.27]). A reduction in hemoglobin levels was also observed at 6 weeks when the control group had undergone late clamping (PWDM = 0.16g/L [-0.26 to -0.06]). CONCLUSIONS: UCM produced no differences in hematologic variables for newborns with ≥34 weeks of gestation relative to controls. However, a slight decrease in hemoglobin levels is observed at 6 weeks when the control group is made up of newborns with late clamping.

Obstetric and perinatal complications associated with assisted reproductive treatment in Spain.

BACKGROUND: Although most newborns conceived through assisted reproductive treatments are healthy, there are concerns about the safety of reproductive techniques and their effect on foetal/maternal well-being. OBJECTIVE: This study aims to describe the incidence of obstetric and perinatal complications in women undergoing assisted reproductive treatments in the Spanish Health System. METHOD: This is a cross-sectional observational study aimed at women who have been mothers between 2013 and 2018 in Spain. The data was collected through an online survey of 42 items that was distributed through lactation associations and postpartum support groups. In the data analysis, crude odds ratios (OR) and adjusted odds ratios (AOR) were calculated, through a multivariate analysis with binary logistic regression and multinomial logistic regression. RESULTS: Five thousand nine hundred forty-two women participated, 2.3% (139) through artificial insemination and 8.2% (486) through in vitro fertilisation (IVF) techniques. Women who underwent IVF had a higher likelihood of suffering problems during pregnancy (OR = 1.71; 95% confidence intervals (95% CI), 1.37-2.13), delivery (OR = 1.43; 95% CI, 1.01-2.02), and postpartum (OR = 1.94; 95% CI, 1.40-2.69) than women with spontaneous pregnancy. No increased likelihood of neonatal problems was observed in this group except for twin pregnancy (OR = 9.17; 95% CI, 6.02-13.96) and prematurity (OR = 1.43; 95% CI, 1.01-2.02). No differences were observed between spontaneous pregnancies and those achieved by artificial insemination. CONCLUSIONS: Pregnancies achieved through IVF present a higher risk of complications before, during and after delivery. However, there is no increased risk of neonatal problems except for a higher likelihood of twin pregnancy and prematurity.

Experience of care through patients, family members and health professionals in an intensive care unit: a qualitative descriptive study.

BACKGROUND: A patient's stay in an intensive care unit (ICU) can lead to psychological and social alterations in patients and their nearest family circle. Healthcare staff and patients' family members strongly influence patients' stays in ICU. AIMS: To explore the perceptions about the experiences of patients in the ICU, their family members and nurses who attend them. METHODS: A descriptive phenomenological design was used to guide the research. A purposive sample of 27 male and female participated. Nine hospitalised patients, nine nurses and nine family members were interviewed in 2016 using a semi-structured, face to face interview. Steps of Giorgi phenomenological method were used to analyse the qualitative data. FINDINGS: Among the three categorised groups, there is a common point that is the constant of humanization in care and it is very clear on the part of the patient, the patient's family and the nurses whom they attend. In addition, both in the group of patients and in the group of families allude to the fear and anguish that responds to patients, this problem does not appear in the speeches of nurses, who are torn between excessive technology and the performance of their work correctly for better patient welfare. CONCLUSIONS: A stay in an ICU implies emotional expense for both patients and their families, which leads to a series of changes in their affective and social sphere, manifested by a set of requirements that must be responded by the multidisciplinary team that attends to patients. It would be fundamental to inform the health authorities about these requirements in order to modify the usual conduct habits displayed in ICU, which would help improve all levels for patients, their families and nurses.

Health-related quality of life in diabetes mellitus and its social, demographic and clinical determinants: A nationwide cross-sectional survey.

AIMS AND OBJECTIVES: To investigate health-related quality of life in a representative sample of adults with diabetes mellitus in Spain, as well as its clinical and sociodemographic determinants. BACKGROUND: Diabetes mellitus is a chronic disease causing considerable morbidity and mortality worldwide, resulting in an impaired quality of life in affected people. DESIGN: A nationwide cross-sectional study, based on an online survey and carried out between February-March 2016, was performed on diabetic subjects recruited through diabetic patients' organisations. METHODS: A validated Spanish-language version of the self-administered Diabetes Quality of Life questionnaire was used, with 0 being the worst and 100 the best QoL level. Determinant factors of health-related quality of life were assessed with the aid of multivariate analysis to control for confounding factors. RESULTS: The responses provided by 456 patients (52.4% being women) revealed an overall mean score of 66.4 ± 13.3. Social/vocational worries and diabetes-related worries were the dimensions with the highest (74.3 ± 20.1) and lowest (61.1 ± 20.6) scores, respectively. Younger age, female gender, having no studies and poor glycaemic control were all independent determinants for an impaired overall health-related quality of life, with most of these factors having a higher impact than the dimensions negative impact of therapy on daily life, satisfaction with therapy and diabetes-related worries. Married (or equivalent) subjects had better scores in the diabetes-related worries dimension. The perception of health-related quality of life progressively worsens as glycaemic control deteriorates and with an increased number of disease complications. Most of the associations did not vary significantly with the type of diabetes mellitus. CONCLUSION: Overall health-related quality of life perception in the Spanish diabetic population is moderate and depends on several sociodemographic factors. Adequate glycaemic control to avoid disease complications improves perception. RELEVANCE TO CLINICAL PRACTICE: The results can help health professionals to develop strategies to promote diabetic patient self-care, in order to improve the metabolic control of the disease and avoid its complications, as a therapeutic goal towards an improvement in health-related quality of life perception.

The Experience of Living With a Gluten-Free Diet: An Integrative Review.

Celiac disease represents a problem in our society, not only because of its interest in terms of healthcare, but also because of its increasing prevalence in recent years and the impact it has on sufferers and their families. This integrative review investigated current knowledge about the experience of living with a gluten-free diet, as well as social support and the role played by nurses and/or associations in the process. A total of 18 articles were selected. Results revealed greater family support is needed to deal with the day-to-day issues of a gluten-free diet. Furthermore, women diagnosed with celiac disease have more psychological distress than men according to some studies. Sufferers of celiac disease report that more information is needed at all levels (hotel and catering, healthcare, social), which would help generate coping strategies. The few studies retrieved that talk about this topic show that following a gluten-free diet affects the personal, family, emotional, social, and financial dimensions of sufferers of celiac disease. The nurse tends to be the person whom those coping with the illness go to for support, although celiac disease associations are also a fundamental pillar in this support. Policy makers need to adapt health services to the needs of individuals with celiac disease.

Using mixed-methods research to study the quality of life of coeliac women.

AIMS AND OBJECTIVES: To research the quality of life of Spanish women with coeliac disease. BACKGROUND: Women with coeliac disease express lower quality of life than men with coeliac disease. DESIGN: Explanatory sequential approach using mixed methods and with a gender perspective. METHODS: The research was carried out between May and July 2015. In its quantitative stage, it aimed to determine the health-related quality of life in a representative sample (n = 1097) of Spanish adult women with coeliac disease using a specific questionnaire named Coeliac Disease-Quality of Life. In its qualitative phase, it aimed to describe the life experiences of a woman with coeliac disease in a qualitative manner by means of interviews (n = 19) with a semistructured script. Quantitative data were analysed using spss version 20 and presented in descriptive statistics. Qualitative data were analysed using the directed content analysis. RESULTS: The quantitative process gave us the values on the four aspects studied: dysphoria, disease limitations, health problems and inadequate treatment. These aspects allowed us to create a qualitative process, based on which we generated an interview, from which four larger categories emerged. These categories were feelings at diagnosis, limitations in day-to-day life, social perceptions of the disease and personal meanings of coeliac disease. Thus, both phases of our project are totally connected. There was a high level of congruence between quantitative scores and narratives. CONCLUSION: This study shows us the strong points of mixed-methods strategy in health sciences. The mixed-methods strategy gave us a wider view of the experience of women living with coeliac disease. In our case, a strength and not a limitation is having performed the quality of life study in women with coeliac disease using a mixed methodology, approaching the experience of being a woman with coeliac disease in Spain in two different but complementary ways. The quantitative and qualitative data allowed us to interpret the experiences of our participants.

Health-related quality of life and determinant factors in celiac disease. A population-based analysis of adult patients in Spain.

BACKGROUND: Celiac disease (CD) has a negative impact on the health-related quality of life (HRQL) of affected patients. Although HRQL and its determinants have been examined in Spanish CD patients specifically recruited in hospital settings, these aspects of CD have not been assessed among the general Spanish population. METHODS: An observational, transversal study of a non-randomized, representative sample of adult celiac patients throughout all of Spain's Autonomous Regions. Subjects were recruited through celiac patient associations. A Spanish version of the self-administered Celiac Disease-Quality of Life (CD-QOL) questionnaire was used. Determinant factors of HRQL were assessed with the aid of multivariate analysis to control for confounding factors. RESULTS: We analyzed the responses provided by 1,230 patients, 1,092 (89.2%) of whom were women. The overall mean value for the CD-QOL index was 56.3 ± 18.27 points. The dimension that obtained the most points was dysphoria, with 81.3 ± 19.56 points, followed by limitations with 52.3 ± 23.43 points; health problems, with 51.6 ± 26.08 points, and inadequate treatment, with 36.1 ± 21.18 points. Patient age and sex, along with time to diagnosis, and length of time on a gluten-free diet were all independent determinant factors of certain dimensions of HRQL: women aged 31 to 40 expressed poorer HRQL while time to diagnosis and length of time on a gluten-free diet were determinant factors for better HRQL scores. CONCLUSIONS: The HRQL of adult Spanish celiac subjects is moderate, improving with the length of time patients remain on a gluten-free diet.

Evaluation of Knowledge and Competencies in Sexual and Reproductive Health Care Using an Escape Room with Scenario Simulations.

To determine the usefulness of combining two methodologies (OSCE and escape room) in a scenario simulation to evaluate a subject, and determine the evaluation of the students of this experience. An observational cross-sectional study was carried out with students enrolled in a sexual and reproductive health-care course as a part of their nursing degree. The students had to solve four clinical cases based on the contents of the teaching practices of the subject by solving clues that led them to carry out procedures and techniques and provide care in scenario simulators. Students evaluated the experience using the GAMEX (Gameful Experience in Gamification) scale. Mean differences were estimated with their respective 95% confidence intervals. A total of 124 students participated. Of these, 63.7% (79) solved the clinical cases with their knowledge and skills. Most (80.6%, 100) students stated that they completely remembered and applied the knowledge of the topic during the game. Almost all (98.4%, 122) would recommend this experience. The dimensions with the best rating on the GAMEX scale were "fun", with an average score of 4.7 points (0.49), followed by "critical thinking", with 4.2 (0.59). Women presented statistically better scores than men (mean difference: 1.58; 95% CI: 0.55, 2.61). The OSCE combined with an escape room using scenario simulations may be a useful tool to evaluate the subject. In addition, the students were satisfied, had fun, and recommended the experience. This study was not registered.

Midwives' approach to the prevention and repair of obstetric perineal trauma in Spain.

AIM: Different clinical practice guidelines include recommendations on how to prevent and repair obstetric perineal trauma, as well as the use of episiotomy. To evaluate the variability in midwives' professional practices for preventing and repairing perineal trauma, as well as the professional factors that may be associated with the restrictive use of episiotomy. DESIGN: Observational cross-sectional study. METHODS: Three hundred five midwives completed an anonymous questionnaire developed by the authors and distributed across various midwifery scientific societies. The main outcomes measured were the frequencies of adopting specific practices related to perineal injury prevention and repair, episiotomy technique and restrictive episiotomy use (<10%). Odds ratios (OR) and adjusted odds ratios (aOR) with 95% confidence intervals were estimated. RESULTS: Intrapartum perineal massage was not normally used by 253 (83%) of midwives, and 186 (61%) applied compresses soaked in warm water to the perineum. Regarding episiotomy, there was a great deal of variability, noting that 129 (42.3%) adopted a restrictive use of this procedure, 125 (41%) performed it between 10% and 20%, while 51 midwives (16.7%) performed it in more than 20% of cases. In addition, 165 (54.1%) midwives followed an incision angle of 60º. Concerning tears, 155 (50.8%) usually sutured first-degree tears and 273 (89.5%) always sutured second-degree tears. Midwives attending home births (aOR = 6.5; 95% CI: 2.69-15.69), working at a teaching hospital (aOR = 3.69; 95% CI: 1.39-9.84), and the ones who recently completed their professional training (aOR = 3.58; 95% CI: 1.46-8.79) were significantly more likely to adopt a restrictive use of episiotomy. CONCLUSIONS: There is a significant variability in Spanish midwives' practices for preventing and repairing perineal tears. Moreover, the restrictive use of episiotomy is associated with midwives attending home births, working in teaching hospitals and having recent professional training. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.