Breastfeeding and maternal attachment: The moderating roles of maternal stress and child behavior.

PURPOSE: This study examined the effect of breastfeeding on maternal attachment, and explored the moderating role of maternal stress and child behavior in this relationship, in a sample of Spanish mothers with children aged between 2 and 7 years. DESIGN AND METHODS: A total of 432 mothers participated in a cross-sectional online survey. A three-way interaction model was used to test the moderating role of maternal stress and child behavioral problems in the relationship between breastfeeding and maternal attachment. RESULTS: The full model accounted for 19% of the variance of maternal attachment. Breastfeeding was significantly associated with mother-rated attachment, and the moderated moderation analysis confirmed the moderating effects of maternal stress and child behavior on the relationship between breastfeeding and maternal attachment. CONCLUSIONS: This study adds to the existing literature that supports the contribution that breastfeeding makes in enhancing maternal attachment, and may help to clarify the role of breastfeeding in shaping maternal attachment. Our findings suggest that breastfeeding is a factor in enhancing maternal attachment, and also identify maternal stress and child behavior as moderators of this relationship. PRACTICE IMPLICATIONS: Understanding the mechanisms by which breastfeeding affects maternal attachment will help generate recommendations to improve breastfeeding and maternal attachment.

The psychometric properties of the parenting scale for Spanish mothers with children aged between 2 and 7 years.

PURPOSE: This study aimed to evaluate the psychometric properties of the Spanish version of the Parenting Scale in a large sample of Spanish mothers. DESIGN AND METHODS: A two-stage cross-sectional study of the adaptation and cultural validation of the Parenting Scale in a Spanish-speaking environment. In Stage I, the Parenting Scale was translated and back-translated and its semantic, linguistic and contextual equivalence was assessed. In Stage II, the Spanish-language version was validated after its application to 662 Spanish mothers with healthy children aged between 2 and 7 years. Several factor structure models of the Parenting Scale were compared by confirmatory factor analysis. Convergent validity, internal consistency and test-retest reliability were also examined. RESULTS: The model of Irvine et al. (1999) presented the best fit to our data. This model demonstrated adequate reliability (internal consistency and stability). The total score and each factor of the Parenting Scale correlated positively with perceived stress in mothers, difficulties in mother-child bonding and child hyperactivity, and negatively with child prosocial behavior. CONCLUSIONS: The Spanish version of the Parenting Scale is a valid and reliable measure that can be used by healthcare professionals and scientists to assess dysfunctional parenting in Spanish mothers of children aged 2 to 7 years. PRACTICE IMPLICATIONS: This study will allow the use of the Parenting Scale in epidemiological and cross-cultural studies in a variety of applied contexts. Additionally, health professionals who work with families in Spain will have access to a valid and reliable instrument for the assessment of mothers' parenting styles.

The Maternal Attachment Inventory: Development and validation of a short form.

AIMS: To translate and adapt the Maternal Attachment Inventory (MAI) into Spanish; to develop a short form of the instrument that can be used during early childhood; and to test its psychometric properties in a large sample of Spanish mothers. DESIGN: Cross-sectional study of adaptation and cultural validation of instruments. METHODS: Data were collected between February and September 2018. In Stage I, the instrument was culturally adapted using a standardized translation and back-translation method. In Stage II, the factor structure of the Spanish version was tested in a sample of 300 mothers with children aged between 2 and 7 years, and on the basis of the findings a short form of the instrument was developed. Finally, in Stage III, in a second sample of 356 mothers, confirmatory factor analyses of first-, second-order and bi-factor structure were conducted to find the optimal factor structure of the short form of the Spanish MAI. Convergent validity, internal consistency and test-retest reliability were also examined. RESULTS: A bi-factor structure with four sub-scales and 17 items emerged from the factor analyses conducted in Stages II and III. Scores on the short form were negatively correlated with mother-to-infant bonding disorders. The short form presented adequate internal consistency and test-retest reliability. CONCLUSIONS: The Spanish MAI short form is a valid and reliable measure for assessing maternal attachment in mothers of children aged between 2 and 7 years. IMPACT: We present a short version of the MAI for healthcare professionals, adapted for application in a new age range and validated for use with Spanish mothers.

Cognitive phenotypes 1 month after ICU discharge in mechanically ventilated patients: a prospective observational cohort study.

BACKGROUND: ICU patients undergoing invasive mechanical ventilation experience cognitive decline associated with their critical illness and its management. The early detection of different cognitive phenotypes might reveal the involvement of diverse pathophysiological mechanisms and help to clarify the role of the precipitating and predisposing factors. Our main objective is to identify cognitive phenotypes in critically ill survivors 1 month after ICU discharge using an unsupervised machine learning method, and to contrast them with the classical approach of cognitive impairment assessment. For descriptive purposes, precipitating and predisposing factors for cognitive impairment were explored. METHODS: A total of 156 mechanically ventilated critically ill patients from two medical/surgical ICUs were prospectively studied. Patients with previous cognitive impairment, neurological or psychiatric diagnosis were excluded. Clinical variables were registered during ICU stay, and 100 patients were cognitively assessed 1 month after ICU discharge. The unsupervised machine learning K-means clustering algorithm was applied to detect cognitive phenotypes. Exploratory analyses were used to study precipitating and predisposing factors for cognitive impairment. RESULTS: K-means testing identified three clusters (K) of patients with different cognitive phenotypes: K1 (n = 13), severe cognitive impairment in speed of processing (92%) and executive function (85%); K2 (n = 33), moderate-to-severe deficits in learning-memory (55%), memory retrieval (67%), speed of processing (36.4%) and executive function (33.3%); and K3 (n = 46), normal cognitive profile in 89% of patients. Using the classical approach, moderate-to-severe cognitive decline was recorded in 47% of patients, while the K-means method accurately classified 85.9%. The descriptive analysis showed significant differences in days (p = 0.016) and doses (p = 0.039) with opioid treatment in K1 vs. K2 and K3. In K2, there were more women, patients were older and had more comorbidities (p = 0.001) than in K1 or K3. Cognitive reserve was significantly (p = 0.001) higher in K3 than in K1 or K2. CONCLUSION: One month after ICU discharge, three groups of patients with different cognitive phenotypes were identified through an unsupervised machine learning method. This novel approach improved the classical classification of cognitive impairment in ICU survivors. In the exploratory analysis, gender, age and the level of cognitive reserve emerged as relevant predisposing factors for cognitive impairment in ICU patients. TRIAL REGISTRATION: ClinicalTrials.gov Identifier:NCT02390024; March 17,2015.

Lipidomic profiling of endometrial fluid in women with ovarian endometriosis†.

The proteomic content of the endometrial fluid (EF) from patients with endometriosis has been investigated, but the lipidomic profile has not been analyzed yet in detail.This study is a comparative untargeted lipidomic analysis of human EF obtained from 35 patients (12 endometriosis and 23 controls). Global differential lipidomic profile was analyzed in both groups by ultrahigh performance liquid chromatography coupled to mass spectrometry. A total of 123 out of the 457 metabolites identified in the EF were found to be significantly differentially expressed between ovarian endometriosis (OE) versus controls. Univariate statistical analysis showed reduced levels of saturated diacylglycerols and saturated triacylglycerols in endometriosis patients. A predictive model was generated using the 123 differentially expressed metabolites. Using this model, we were able to correctly classify 86% of the samples. This study identified the lipidomic profile in the EF associated with OE, suggesting that EF analysis could be considered as a minimally invasive approach for the diagnosis of endometriosis. In conclusion, the lipidomic profile of the EF is different between samples from patients with OE and controls.

Predictors of repeat visits to hospital psychiatric emergency departments in Malaga (Spain) and in Lisbon (Portugal).

OBJECTIVE: This study describes the profile of people with mental disorders attending emergency departments (EDs) in two countries and to identify specific mental disorders associated with repeat emergency visits. METHODS: Retrospective analyses of 1 year of EDs data from two hospitals with psychiatric departments, one in Amadora/Sintra (Lisbon, Portugal, 2008) and the other in Malaga (Spain, 2009), were carried out. To determine which mental disorders were associated with repeat visits in each setting, negative binomial models were calculated. RESULTS: There were 5141 visits for a mental disorder made by 3667 patients. Patients with affective disorder were the most frequent (32.2%). Among all mental health patients, 19.9% had at least one repeat visit during the year. For the two EDs setting combined, patients with personality disorders (incidence rate ratio (IRR)=3.79, 95% CI: 2.39 to 6.02) and psychotic disorders (IRR=1.46, 95% CI: 1.13 to 1.89) were more likely to have repeat visits compared with patients with affective disorders, whereas mental disorders due to psychoactive substance use (IRR=0.52, 95% CI: 0.37 to 0.73) was associated with lower likelihood of repeat visits. Nearly all significant differences were attributable to the Malaga sample, where patients with personality disorders were four times more likely to have repeat EDs visits compared with patients with affective disorders. However, at both sites, patients with mental disorders due to psychoactive substance use were less likely to have repeat visits. CONCLUSIONS: Certain mental disorders may be predictive of more frequent ED visits. The different results for each country suggest that further studies might focus not only on the characteristics of patients, but also on local healthcare organisation.

Breastfeeding and the quality of the sibling relationship.

OBJECTIVE: To examine the association between the type of breastfeeding practiced and the quality of the sibling relationship. DESIGN: Cross-sectional study. METHOD: Participants were recruited between July and December 2019 through parenting associations and parenting support groups. They comprised a total of 149 mothers with two children between 2 and 7 years of age, who had practiced the same type of feeding with both children. Sibling relationship quality was assessed using the conflict/rivalry and warmth dimensions of the Parents' Expectations and Perceptions of Sibling Relationships with their Children (PEPC-SRQ) questionnaire. Analyses of covariance were used to identify any differences in these two dimensions of the PEPC-SRQ between the study groups (formula feeding, breastfeeding, non-prolonged breastfeeding, prolonged breastfeeding and tandem breastfeeding). RESULTS: No significant differences were observed between any of the groups regarding the conflict/rivalry dimension; in contrast, significant differences were found in the warmth dimension between the breastfeeding and formula feeding groups. CONCLUSIONS: Breastfeeding, regardless of its duration and simultaneity, was associated with higher scores in the dimension of warmth of the sibling relationship. IMPLICATIONS FOR PRACTICE: This information should be considered by healthcare professionals when providing advice on breastfeeding.

[Fournier's gangrene, a battle won. Traditional cures versus a polyhexanide solution]. / Gangrena de Fournier una batalla ganada. Curas tradicionales versus solución de polihexanida. III Premio Científico Prontosan 2008.

This article won the top place in the Third Prontosan Scientific Prize in 2008. Fournier's Gangrene is a rare process having an unknown origin which affects soft tissue in the genital and perirectal area. The authors describe the case of a 61 year old patient suffering from this disease, the recommended treatment by the Nurses' Consulting Office for Bed Sores, or Decubitus Ulcers, and Chronic Skin Ulcerations, and the patient's evolution. The medical team carried out a complete evaluation of this patient and his/her injury and took a sample to make a surface culture from. After this initial evaluation, the medical team's first recommendation was to apply treatment consisting of using polyhexanide combined with a calcic alginate dressing to control oozing; the objective of this treatment is to clean and decontaminate the wound and to provide the optimum conditions for a correct cicatrisation process in the least time possible. After 58 days undergoing treatment, the affected area did not show any sign nor symptom of infection and was practically finished with the cicatrisation process. The use of polyhexanide, in this case, proved to be the ideal therapeutic option to clean, decontaminate and maintain the conditions optimum for a correct cicatrisation of this wound.

Implantación de una Unidad de Enlace Centralizada de Vacunación contra la COVID-19 gestionada por farmacéuticos-farmacólogos de Atención Primaria / Implementation of a Centralized COVID-19 Vaccination Liaison Unit managed by Primary Care pharmacist-pharmacologists

Introducción: La Unidad de Enlace Centralizada de Vacunación contra la COVID19 (UECeV) de la Dirección de Atención Primaria Metropolitana Nord del Institut Català de la Salut se creó para resolver las consultas de usuarios y/o profesionales sa-nitarios relacionadas con la vacunación contra el virus SARS-CoV-2. El objetivo principal del presente análisis fue describir la actividad de la UECeV.Método: Realizamos un estudio observacional retrospectivo a partir del registro de consultas aten-didas desde la UECeV entre 31 de abril y 31 de oc-tubre de 2021. Población de referencia: 1.139.411 habitantes adultos asignados. La UECeV se creó en tres sedes territoriales atendidas cada una por dos farmacéuticos/farmacólogos de Atención Primaria (FAP) y un administrativo. La atención telefónica fue a jornada completa adaptable según actividad. Variable principal del análisis: número y tipos de consultas atendidas. Se calculó valores absolutos y porcentajes, medianas y desviación estándar para las variables cuantitativas y para las variables cuali-tativas se realizó un análisis descriptivo.Resultados: 3.103 consultas gestionadas de 3.030 usuarios; 2.180 (70,25%) contestadas por el FAP. Consulta más frecuente: compatibilidad vacuna según patología/medicación de base 1.008 (32,5%). 2.830 (93,4%) usuarios se vacunaron después de la intervención (2.210 consultaron antes de la primera dosis y 618 antes de la segunda). La vacuna mayo-ritaria fue la Comirnaty®. Conclusiones: Las UECeV coordinadas por el FAP con atención directa a los usuarios y/o profesiona-les sanitarios constituyen un elemento de apoyo a los equipos de vacunación de atención primaria para la gestión experta de las consultas de vacuna-ción contra la COVID19. (AU)

Introduction: The North Metropolitan Primary Care Direction of the Institut Català de la Salut crea-ted the Centralized Liaison Unit for anti-COVID19 vaccination (UECeV) to solve queries from users and/or health professionals related to vaccination against the SARS-CoV-2 virus. The main objective of the present analysis was to describe the activity of UECeV.Method: We carried out a retrospective observa-tional study based on the registry of consultations attended from the UECeV between April 31st and October 31, 2021. We have an equal or above 18 years old reference population of 1,139,411 inha-bitants. The UECeV was set up in three territorial offices, each attended by two Primary Care phar-macists/pharmacologists (FAP) and one adminis-trative staff member. The telephone service was full-time and could be adapted according to activity. The main variable of the analysis was the number and types of queries attended. Absolute values and percentages, medians and standard deviation were calculated for the quantitative variables and a descriptive analysis was performed for qualitative variables.Results: 3,103 queries were managed out of 3,030 users; 2,180 (70.25%) were answered by the FAP. Most frequent consultation was: vaccine compa-tibility according to pathology/basic medication 1,008 (32.5%). 2,830 (93.4%) users were vaccinated after the consultation (2,210 consulted before the first dose and 618 before the second). The majority vaccine was Comirnaty® Conclusions: The UECeV coordinated by the FAP with direct attention to users and/or health profes-sionals constitutes a support element for primary care vaccination teams for the expert management of AntiCOVID19 vaccination consultations. (AU)

Riesgo de depresión materna perinatal tras una pérdida gestacional: prevalencia y factores asociados. Un estudio exploratorio / Risk of perinatal maternal depression after pregnancy loss: prevalence and associated factors. An exploratory study

Objetivo: Evaluar la prevalencia del riesgo de depresión materna en el periodo perinatal, y los factores asociados a la misma, en las mujeres atendidas en Parc Taulí Hospital Universitari de Sabadell (Barcelona) que han tenido una pérdida gestacional de más de 13 semanas de gestación. Material y método: Se diseñó un estudio observacional de tipo analítico. Las variables estudiadas fueron: el riesgo de depresión materna perinatal, el tiempo transcurrido entre el diagnóstico y la expulsión, las pérdidas gestacionales previas, la viabilidad fetal, ver y sostener al bebé, la obtención de huellas y fotografías de recuerdo, y percibir contradicciones profesionales. El riesgo de depresión posparto fue evaluado mediante la Escala de Edimburgo. Se realizó un análisis de regresión múltiple por pasos para evaluar el efecto de las variables de estudio sobre la depresión posparto al alta. Resultados: Participaron 29 mujeres entre julio de 2018 y diciembre de 2020. El 37,9 % (n= 11/29) de las participantes al alta y el 26,7 % (n= 4/15) al mes presentaban puntuaciones superiores a 13 en la Escala de Edimburgo. La ecuación de la regresión fue estadísticamente significativa (F(4,23)= 7,31, p <0,001), llegando a explicar el 48,3 % (R2 ajustada) de la varianza de la depresión posparto al alta. El tiempo transcurrido entre el diagnóstico y la expulsión superior a 24 horas (B= 4,91; IC del 95 %= 0,83-8,99), así como las pérdidas gestacionales previas (B= 5,99; IC del 95 %= 1,92-10,06) se asociaron con una mayor puntuación en la Escala de Edimburgo, mientras que ver al hijo/a (B= –5,84; IC del 95 % = –11,55 a –0,12) se asoció con una disminución de la puntuación. (AU)

Objective: To evaluate the prevalence of the risk of maternal depression in the perinatal period and the factors associated with it, in women treated at Hospital Parc Taulí Hospital Universitari of Sabadell (Barcelona), who have had a gestational loss of more than 13 weeks of gestation. Material and method: An analytical observational study was designed. The variables studied were: the risk of perinatal maternal depression, the time elapsed between diagnosis and expulsion, previous pregnancy losses, fetal viability, seeing and holding the baby, obtaining footprints and souvenir photographs, and perceiving professional contradictions. The risk of postpartum depression was assessed using the Edinburgh Scale. A stepwise multiple regression analysis was performed to evaluate the effect of the study variables on postpartum depression at discharge. Results: 29 women participated between July 2018 and December 2020. 37.9% (n= 11/29) of the participants at discharge and 26.7% (n= 4/15) at one month had scores higher than 13 on the Edinburgh Scale. The regression equation was statistically significant (F(4,23)= 7.31, p <0.001) explaining 48.3% (R2 Adjusted) of the variance of postpartum depression at discharge. The time elapsed between diagnosis and expulsion greater than 24 hours (B = 4.91; 95% CI = 0.83 – 8.99), as well as previous pregnancy losses (B = 5.99; 95% CI = 1.92 – 10.06) were associated with a higher score on the Edinburgh Scale, while seeing the child (B = -5.84; 95% CI = -11.55 – -0.12 ) was associated with a decrease in score. (AU)

Diseño y validación de un cuestionario de calidad de los cuidados de Enfermería del Trabajo en los Servicios de Prevención / Design of a questionnaire on the quality of occupational health nursing at the safety management services

Origen y objetivos: El objetivo principal de este trabajo será elaborar un cuestionario que nos permita conocer la percepción de los trabajadores sobre las actividades que realiza la enfermería del trabajo en los diferentes Servicios de Prevención. Método: El cuestionario se divide en tres partes: 1) Variables sociodemográficas, formadas por 4 items; 2) Opinión sobre el servicio de prevención, formado por 15 items; 3) Opinión de los trabajadores sobre la atención de enfermería, formado por 23 items. Se analizó el comportamiento métrico del cuestionario respecto a la validez de constructo, de criterio y la consistencia interna, para lo cual, se opta por hacerlo según los criterios básicos de Moriyama y el cálculo de índice ∂ de Conbrach. Para ello se repartieron 55 cuestionarios de control en los diferentes servicios de prevención de la Comunidad de Cantabria y se trataron los datos con el programa SPSS v.15 de análisis estadístico. Resultados: Se superó el criterio de validación establecido, con resultados superiores al 80% en la valoración de los expertos. Encontramos una buena consistencia interna, evidenciada por un Alfa de Cronbach de 0.837 en cada sección. Conclusión: El cuestionario reúne suficientes propiedades psicométricas para ser considerado una herramienta útil y fiable capaz de medir con objetividad la satisfacción de los trabajadores con los cuidados de la enfermería del trabajo (AU)

Introduction and Aim: The main aim of this study is to draw up a "Questionnaire on Satisfaction with Occupational Health Nursing" (Cuestionario de satisfacción con los cuidados de la enfermería del trabajo - CUSACET), which will enable us to gauge users’ perceptions with regard to the occupational health nursing work carried out by the various safety management services. Materials and Method: The questionnaire is designed to encompass three dimensions :a. Sociodemographic: consisting of four items. b. Opinion of the safety management services: consisting of fifteen items. c. Opinion of care received from the nursing staff at the safety management service, measured by twenty-three items. We opted to do the validation according to the basic criteria of Moriyama and by applying Cronbach’s Alpha index. To this end, 55 control questionnaires were given out at various safety management services in Cantabria. The questionnaires were collected and the data recorded onto the statistical analysis program SPSS v.15.Results: The criterion established for validity was exceeded, with results above 80% in assessment by experts in accordance with Moriyama’s basic criteria. We encountered good internal consistency, as evidenced by a Cronbach Alpha coefficient of 0.837 in each section. Conclusions: This paper presents a new instrument, specifically designed to measure the quality of occupational health nursing care through the perceptions of the users who receive it which is reliable and easy to use (AU)

Corioangioma placentario gigante / Giant placental chorioangioma

El corioangioma es el tumor benigno de la placenta más frecuente. Cuando esta lesión es mayor de 5cm puede causar diversas complicaciones maternofetales, por lo que es importante realizar su diagnóstico prenatal. Presentamos el caso de un coriangioma placentario gigante de 12 x 8cm(AU)

The chorioangioma is the most common benign tumour of the placenta. Lesions larger than 5cm may cause various foetal and maternal complications. Prenatal diagnosis is very important. We report a case of a giant placental chorioangioma measuring 12 x 8cm(AU)

Gangrena de Fournier. Una batalla ganada. Curas tradicionales versus Solución de Polihexanida / Fournier’s gangrene. A battle won. Traditional cures versus a polyhexanide solution

Primer galardonado en el III Premio Científico Prontosan® 2008. La gangrena de Fournier es un proceso poco común de causa desconocida que afecta a los tejidos blandos de la región genital y perirrectal. Presentamos el caso de un paciente de 61 años afectado por dicha dolencia, el tratamiento recomendado por la Consulta de UPP y Heridas, y su evolución. Se realizó una valoración integral del paciente y de la herida y se tomó una muestra para un cultivo de superficie. Tras la valoración inicial se realizó una primera recomendación de tratamiento consistente en el uso de polihexanida combinado con un apósito de alginato cálcico para el control del exudado, con el objetivo de limpiar y descontaminar la herida y proporcionar las condiciones óptimas para un correcto proceso de cicatrización en el menor tiempo posible. Tras 58 días de evolución, la zona no presentaba ningún signo ni síntoma de infección y estaba prácticamente cicatrizada. El uso de polihexanida, en este caso, fue la opción terapéutica ideal para el lavado, descontaminación y mantenimiento de las condiciones óptimas para una correcta cicatrización de la herida(AU)

This article won the top place in the Third Prontosan® Scientific Prize in 2008. Fournier’s Gangrene is a rare process having an unknown origin which affects soft tissue in the genital and perirectal area. The authors describe the case of a 61 year old patient suffering from this disease, the recommended treatment by the Nurses’ Consulting Office for Bed Sores, or Decubitus Ulcers, and Chronic Skin Ulcerations, and the patient’s evolution. The medical team carried out a complete evaluation of this patient and his/her injury and took a sample to make a surface culture from. After this initial evaluation, the medical team’s first recommendation was to apply treatment consisting of using polyhexanide combined with a calcic alginate dressing to control oozing; the objective of this treatment is to clean and decontaminate the wound and to provide the optimum conditions for a correct cicatrisation process in the least time possible. After 58 days undergoing treatment, the affected area did not show any sign nor symptom of infection and was practically finished with the cicatrisation process. The use of polyhexanide, in this case, proved to be the ideal therapeutic option to clean, decontaminate and maintain the conditions optimum for a correct cicatrisation of this wound(AU)