Differences and Similarities in the Feet of Metatarsalgia Patients with and without Rheumatoid Arthritis in Remission.

Objectives: Metatarsalgia continues to be a problem in patients with rheumatoid arthritis (RA) in remission (remRA), as well as in the non-rheumatic population, with a mechanical origin. Identify and compare clinical, morphological, disability, synovitis (ultrasound), and radiological osteoarticular damage characteristics in two groups of patients with lesser-ray metar-tarsalgia, with remRA, and without RA. Methods: Cross-sectional study with 84 patients with remRA (mRA) and 60 patients without RA (nmRA). The study evaluated five clinical variables (pain, Foot Function Index (FFI), joint mobility, digital deformities, and foot type), a radiological variable (osteoarticular damage), and an ultrasound variable (metatarsal synovitis). The data were analysed using descriptive and correlational techniques. Results: There were no significant differences in sex, age, body mass index (BMI), or degree of pain. Both groups showed a high prevalence of limited joint mobility for the ankle and first metatarsal phalanx (DF1st MTPJ) and digital deformities, with no statistically significant differences. Similarly, there were no differences in lesser-ray synovitis. On the other hand, there were differences in mRA with greater disability and activity limitation (FFI), LDD (lesser-ray digital deformities) stiffness, first-ray deformities, radiological damage, synovitis in 1st MTPJ, and positive Doppler (five patients). Conclusions: Metatarsalgia presents similarities in both populations. Biomechanical factors may influence the symptoms and presence of synovitis in patients with RA in remission. Other characteristics are more frequent in mRA, which could be related to the disease; thus, future research should include both biomechanical and ultrasound exploration of the foot in the valuation of patients in remission.

Virtual Active Learning to Maximize Knowledge Acquisition in Nursing Students: A Comparative Study.

BACKGROUND: Nursing students need to acquire knowledge through active methods that promote critical thinking and decision making. The purpose of this study is to analyze whether there are differences in the acquisition of knowledge by nursing students between active face-to-face or virtual teaching methods. METHODS: In this comparative study, nursing students enrolled in the psychology course were divided into two groups: a face-to-face group that received active teaching methods and a virtual group. The virtual group was exposed to the Effective Learning Strategy (ELS), which included seminars based on video content through the Virtual Campus and answering questions using the H5P tool. In addition, participants engaged in reflection tasks on the content. Covariate data were collected, and knowledge tests were administered to both groups before and after the course. After three months, subjects were re-evaluated with a final exam to assess content retention. RESULTS: A total of 280 students were randomized. No differences were found in students' scores at the end of the knowledge test or in their final grades in the subject. Having study habits (b = 0.12, p = 0.03) and social support from relevant people (b = 0.09; p = 0.03) were associated with better post-intervention scores, and inversely with social support from friends (b = -0.12, p < 0.01). Final grades were inversely associated with digital safety literacy (b = -0.101, p = 0.01). No factors were associated with the scores of each group separately. CONCLUSIONS: The ELS virtual active learning model is as effective as face-to-face active learning methods for teaching psychology to first-year nursing students. This study was not registered.

Changes in the Kinematics of Midfoot and Rearfoot Joints with the Use of Lateral Wedge Insoles.

The lateral wedge insole (LWI) is a typical orthopedic treatment for medial knee osteoarthritis pain, chronic ankle instability, and peroneal tendon disorders. It is still unknown what the effects are in the most important joints of the foot when using LWIs as a treatment for knee and ankle pathologies. Objectives: The aim of this study was to determine the influence of LWIs on the position of the midfoot and rearfoot joints by measuring the changes using a tracking device. Methods: The study was carried out with a total of 69 subjects. Movement measurements for the midfoot were made on the navicular bone, and for the rearfoot on the calcaneus bone. The Polhemus system was used, with two motion sensors fixed to each bone. Subjects were compared by having them use LWIs versus being barefoot. Results: There were statistically significant differences in the varus movement when wearing a 4 mm LWI (1.23 ± 2.08°, p < 0.001) versus the barefoot condition (0.35 ± 0.95°), and in the plantarflexion movement when wearing a 4 mm LWI (3.02 ± 4.58°, p < 0.001) versus the barefoot condition (0.68 ± 1.34°), in the midfoot. There were also statistically significant differences in the valgus movement when wearing a 7 mm LWI (1.74 ± 2.61°, p < 0.001) versus the barefoot condition (0.40 ± 0.90°), and in the plantar flexion movement when wearing a 4 mm LWI (2.88 ± 4.31°, p < 0.001) versus the barefoot condition (0.35 ± 0.90°), in the rearfoot. Conclusions: In the navicular bone, a varus, an abduction, and plantar flexion movements were generated. In the calcaneus, a valgus, an adduction, and plantar flexion movements were generated with the use of LWIs.

Multidisciplinary approach in the treatment of tendinous foot involvement in rheumatoid arthritis.

INTRODUCTION: Patients with rheumatoid arthritis frequently consult for pain resulting from involvement of the tendons of the foot. This pain negatively affects foot biomechanics and quality of life. The most widely used treatment option for this condition is ultrasound-guided steroid injection, while other treatments were recommended such as heel pad, splints, and footwear. OBJECTIVE: To evaluate a joint intervention (rheumatology and podiatry) comprising an orthotic-podiatric treatment and infiltrations. We evaluated the response using ultrasound monitoring, a pain scale, functional tests, and assessment of patient satisfaction. METHODS: We performed a non-controlled blinded prospective interventional study of 96 patients with foot pain and selected those with ultrasound-confirmed tendon involvement. Patients enrolled started intervention treatment and were followed for 6 months. The outcome of the intervention was compared with the patient's baseline status. The pre-post differences in the secondary variables (pain, disability) were analyzed using the t test and contingency tables or the Mann-Whitney test. RESULTS: Using our protocol, we recorded a rapid and significant reduction in the intensity of pain, in the foot function index, and in the ultrasound parameters (grayscale and Doppler). Structural damage to the tendon improved more slowly, with significant outcomes only at the last visit with respect to baseline. Abnormal foot support was detected in 50% of patients, and 79.5% were using inappropriate footwear. CONCLUSIONS: Our multidisciplinary therapeutic protocol enabled a very significant improvement in tendon involvement. It was well-tolerated, with a high degree of satisfaction, and was easily evaluated using ultrasound. No changes in background medication were necessary. Key Points • Multidisciplinary evaluation of patients with RA is advisable because it improves the treatment management in cases of inflammatory activity and structural abnormalities of the foot. • Comprising orthopedic-podiatric treatment (heel, splints, and suitable footwear) and infiltrations, in terms of clinical, ultrasound, and functional recovery of the foot tendons. • The therapy protocol we propose led to a significant improvement in pain relief and functional recovery.

Effect of a double nutritional intervention on the nutritional status, functional capacity, and quality of life of patients with chronic heart failure: 12-month results from a randomized clinical trial.

INTRODUCTION: Introduction: malnutrition is commonly associated with, and worsens the prognosis of heart failure. The management of chronic heart failure and its complications based only on the application of pharmacologic guidelines is incomplete. The benefits of interventions to improve nutritional status may be limited by the multifactorial nature of malnutrition. The objective of the present study was to determine whether nutritional advice and nutritional supplementation can improve the nutritional status of patients with chronic heart failure. Methods: we performed a randomized clinical trial on an intention-to-treat basis with blinded observers. We divided a sample of 76 patients into 2 groups: one that received structured advice combined with nutritional supplements for 12 weeks (test group), and one that received treatment as usual (control group). The outcome measure was nutritional status as evaluated using the Subjective Global Assessment and the Mini Nutritional Assessment tools. After 12 weeks of treatment the test group received a leaflet that served as a reminder. No further interventions were applied in either group. Patients were followed for 1 year. Results: at 3 months of follow-up nutritional status improved 4-fold in the test group, whereas no change was observed in the control group. At 9 months nutritional status in the intervention group had improved 2-fold with respect to the baseline visit, whereas no differences were recorded in the control group. Differences in mortality and length of stay at 1 year did not reach statistical significance.

INTRODUCCIÓN: Introducción: la desnutrición se asocia comúnmente con la insuficiencia cardíaca y empeora su pronóstico. El tratamiento de la insuficiencia cardíaca crónica basado exclusivamente en la aplicación de las guías clínicas farmacológicas resulta insuficiente. Los beneficios de las intervenciones para mejorar el estado nutricional pueden quedar enmascarados por el carácter multifactorial de la desnutrición. El objetivo del estudio fue determinar si el asesoramiento nutricional más suplementos nutricionales puede mejorar el estado nutricional de los pacientes con insuficiencia cardiaca. Método: ensayo clínico aleatorizado basado en la intención de tratar con evaluadores sometidos a enmascaramiento. Una muestra de 76 pacientes en 2 grupos: uno que recibió asesoramiento estructurado más suplementos nutricionales durante 12 semanas (grupo de intervención) y otro que siguió el tratamiento habitual (grupo de control). El parámetro del resultado fue el estado nutricional evaluado utilizando como herramientas la Valoración Global Subjetiva y el Mini Nutritional Assesment. Después de 12 semanas de tratamiento, el grupo de intervención recibió a modo de recuerdo un folleto informativo. No se aplicaron más intervenciones en ninguno de los grupos. Se siguió a los pacientes durante 1 año. Resultados: a los 3 meses de seguimiento, el estado nutricional mejoró cuatro veces en el grupo de intervención, mientras que no se observó ningún cambio en el grupo de control. A los 9 meses, el estado nutricional en el grupo de intervención había mejorado 2 veces con respecto a la visita inicial, mientras que no se registraron diferencias en el grupo de control. Las diferencias de mortalidad y estancia hospitalaria al cabo de 1 año no alcanzaron la significación estadística.

[Prevalence of undernutrition in hospital patients with unbalanced heart failure; subjective global assessment like prognosis sign]. / Prevalencia de malnutrición en pacientes hospitalizados por descompensación de insuficiencia cardiaca crónica; valoración subjetiva global como indicador pronóstico.

INTRODUCTION: The malnutrition prevalence's studies in patients with heart failure have a great variability. The proportion depends on the used method and the evaluation moment. Malnutrition increases complications, hospital stay, mortality and hospital reentry. It is good idea to diagnose and treat these patients. OBJECTIVES: The objective was determined the prevalence of malnourished heart failure's patients in hospital at our environment and to analyze what used method was a better mortality predictor. METHOD: Observational study. The nutritional status have been evaluated by Subjective Global Assessment and Mini Nutritional Assessment the nutritional status of 377 patients joined in a high complexity hospital with decompensation of chronic heart failure. RESULTS: The mean age was 75±10. The 51,5% (n=194) were men . According to the Subjective Global Assessment, 50,7 % (45,6 %-55,7 %) were normal nutrition, 41,9 % (37,0 %-46,9 %) were on risk of malnutrition and 7,4 % (5,2 %-10,5 %) were evident malnutrition. CONCLUSION: The malnutrition prevalence's in hospital chronic heart failure patients by decompensation in our area is high. The Subjective global assessment is a good mortality predictor.

Introducción: Existe una gran variabilidad en los estudios sobre la prevalencia de malnutrición en pacientes con insuficiencia cardiaca crónica. La proporción de pacientes desnutridos depende del método de valoración utilizado y del momento en que se realice. Se ha descrito la relación entre desnutrición y aumento de las complicaciones, de la estancia hospitalaria, de la mortalidad y de reingreso hospitalario. Por lo que merece la pena señalar y tratar a estos pacientes. Objetivos: El objetivo fue aproximarnos a la prevalencia de la desnutrición, en los pacientes con insuficiencia cardiaca crónica ingresados por descompensación, en nuestro medio y analizar cuál de los dos métodos de valoración nutricional utilizados, era mejor predictor de mortalidad. Métodos: Estudio observacional, transversal, en el que se evaluaron mediante la Valoración Subjetiva Global y Mini Nutritional Assesment , el estado nutricional de 377 pacientes ingresados en un hospital terciario de alta complejidad con diagnósticos compatibles con descompensación de insuficiencia cardiaca crónica. Resultados: La edad media fue de 75±10. El 51,5%(n=194) fueron hombres. Según la Valoración Subjetiva Global, el 50,7% (45,6%-55,7%) estaban normonutridos, el 41,9% (37,0%-46,9%) presentaban riesgo o sospecha de desnutrición y el 7,4% (5,2%-10,5%) presentaban desnutrición franca. Conclusiones: La prevalencia de desnutrición de los pacientes hospitalizados por descompensación de Insuficiencia Cardiaca crónica en nuestro ámbito es alta. La Valoración Subjetiva Global es un buen predictor de la mortalidad.

Personalized orthoses as a good treatment option for Charcot neuro-osteoarthropathy of the foot.

BACKGROUND: We sought to assess the biomechanical characteristics of the feet of patients with Charcot neuro-osteoarthropathy and to determine reulceration rates before and after personalized conservative orthotic treatment. METHODS: A longitudinal prospective study was performed in 35 patients with Charcot's foot. Although some patients had a history of ulcers, at the study outset no patient had ulcers. All of the patients underwent biomechanical testing and a radiographic study. A radiophotopodogram was prepared by superimposing an imprint of the sole on a plantar radiograph. Based on the results of these tests, an orthopedic insole was prepared and therapeutic footwear prescribed for each foot. The following variables were compared between the Charcot and unaffected feet: previous ulcers and ulcer sites, reulcerations produced after treatment, type of foot (neuropathic/neuroischemic), ankle mobility, first-ray mobility, and relaxed calcaneal stance position. Treatment efficacy was determined by comparing ulcers presenting in patients in the year leading up to the study period and the year in which treatment was received. RESULTS: In a 1-year period, 70 feet received orthotic treatment, of which 41 were Charcot's feet. Ulceration rates before the study were 73.2% in feet with Charcot's and 31.0% in those without. After 1 year of wearing the customized orthoses, rates fell significantly to 9.8% in the Charcot feet and 0% in the feet without this condition. CONCLUSIONS: Conservative customized orthotic treatment was effective at preventing ulcers and the complications that often lead these patients to surgery.

[Nutritional screening in heart failure patients: 5 methods review]. / Cribado nutricional en pacientes con insuficiencia cardiaca: análisis de 5 métodos.

INTRODUCTION: Malnutrition increases mortality and hospital stay. Increasingly Sanitary institutions follow nutritional screening in order to detect early malnutrition or the risk of developing. There is not universally accepted method for nutritional assessment or screening. OBJECTIVE: Determine a fast and reliable method that doesn't require prior training, for the screening and nutritional assessment of heart failure's patients. METHOD: Observational study. The nutritional status have been evaluated by Subjective global assessment (SGA), Mini nutritional assesment (MNA) in his short form (MNA-SF) and in his evaluation form (MNA-LF), the nutritional Risk Screnning (NRS 2002), the controlling nutritional status or method Ulibarri's method(- CONUT), the Cardona's method and the Malnutrition Universal Screening Tool (MUST) the nutritional status of 242 patients joined in a high complexity hospital with decompensation of chronic heart failure. There were analyzed the sensibility, specificity, the predictive values, the reasons of verisimilitude, the odds ratio diagnoses and the kappa correlation index, of the different methods compared with the subjective global valuation, which was considered like gold standard. RESULTS: The mean age was 75±9. The 50,8%(n=123) were men. The kappa index was MNA -LF : 0,637; MNASF: 0,556; NRS =0,483; MUST =0,197; Cardona =0,188; CONUT =0,076.75. Discusion: Mini Nutritional assessment (MNA) was the method that best value offered, both in its screening stage of assessment in relation with Subjetive global assesment.

Introduccion: La malnutrición aumenta la mortalidad y la estancia hospitalaria. Cada vez más instituciones sanitarias adoptan medidas de cribado nutricional con el fin de detectar precozmente la malnutrición o el riesgo de desarrollarla. No existe un método universalmente aceptado para la valoración nutricional. Objetivo: Determinar un método rápido y fiable, que no precise de entrenamiento previo, para el cribado nutricional de pacientes con insuficiencia cardiaca. Métodos: Estudio observacional, transversal, en el que se evaluaron mediante la valoración subjetiva global (VSG), el Mini nutritional assesment (MNA) tanto en su versión abreviada o de cribado (MNA-SF) como en su versión extendida o de valoración (MNA-LF), el nutritional Risk Screnning (NRS 2002), el Conocimiento nutricional o método Ulibarri (CONUT), el método Cardona y el Malnutrition Universal Screening Tool (MUST), el estado nutricional de 242 pacientes ingresados en un hospital terciario de alta complejidad con diagnósticos compatibles con descompensación de insuficiencia cardiaca crónica. Se analizaron la sensibilidad, especificidad, los valores predictivos, las razones de verosimilitud, la odds ratio diagnostica y el índice de correlación kappa, de los distintos métodos comparados con la valoración subjetiva global, que fue considerada como prueba cierta. Resultados: La edad media fue de 75±9. El 50,8% (n=123) fueron hombres. El índice de correlación kappa de los distintos métodos de cribado con respecto a la valoración subjetiva global fueron MNA valoración =0,637; MNA cribado =0,556; NRS =0,483; MUST =0,197; Cardona =0,188; CONUT =0,076. Discusión: El Mini Nutritional Assesment fue el método que mejor relación ofreció, tanto en su etapa de cribado como en la de valoración con la Valoración subjetiva global.

[Nutritional knowledge and perception on dialysis: influence on adhesion and transgression; initial study]. / Conocimiento y percepción nutricional en diálisis: su influencia en la transgresión y adherencia; estudio inicial.

BACKGROUND: The dialysis patients have problems in maintaining proper conduct and adherence to the diet prescribed in liquid nephrology consultation. Indicate the interdialytic weight gain, serum potassium and phosphorus along with self-report instruments, markers that have been used as indicators of non-adherence to the diet. Most of the time is not counted in dialysis units with dietitians-nutritionists. Nephrologists and nurses lack the time and / or sufficient to establish and monitor adherence to an individualized diet knowledge. OBJECTIVES: The main objective is to determine adherence to dietary guidelines and hemodialysis fluids by DDFQ questionnaire and establish its relationship with the dietary habits of the patients, assessed by test dietary habits and cooking procedures. Secondary objectives are to measure adherence by DDFQ and relate the results to biochemical markers of intake and interdialytic weight gain (GID). Linking monitoring liquid diet and reported by the patient, biochemical markers of intake, interdialytic weight gain and the outcome of DDFQ. Determine membership based on sex, time on hemodialysis, have diabetes or have been transplanted once. And linking dietary habits reported by patients in the test of dietary habits and cooking procedures with patients' knowledge of the guidelines prescribed by nephrologists in consultation. METHODOLOGY: Cross-sectional pilot study. Sociodemographic variables: age and sex. Clinical variables: diabetic transplant patient ever, time on dialysis, dry weight and GID. Biochemical markers: serum potassium and phosphorus. Variables adherence to diet questionnaire measures DDFQ. STATISTICAL ANALYSIS: SPSS 20 Descriptive, Spearman correlation test, Student t test, Mann-Whitney U test and contingency table. RESULTS: 42 patients; 59.5% male, 40.5% female. Age 63.64 ± 16.17 years. Diabetics 11.9%. GID 1.96 ± 0.70 kg. Potassium 5.08 ± 0.86 meq / l phosphorus 4.71 ± 1.63 mg / dl. DDFQ Measured with 50% of patients not adhering to the diet in 2 days 14 days and 50% have no adherence to liquid in 1 day 14 days. There are correlations between adherence to diet and phosphorus (ρ= 0.304) and adherence to fluid and GID (ρ= 0.413). CONCLUSIONS: There is a lack of adherence to dietary guidelines in dialysis patients, in contrast to the accession referred by them. The review of dietary and fluid patterns is necessary in patients with CKD on dialysis. Hence the importance of training and support for nurses using simple tools to detect breaches and act with greater dietary education.

Antecedentes: Los pacientes dializados presentan problemas a la hora de mantener una conducta correcta de adherencia a la dieta y a los líquidos prescritos en la consulta nefrológica. Lo indican la ganancia de peso interdiálisis, el potasio y fósforo sérico junto con instrumentos de autoinforme, marcadores que se han utilizado como indicadores de no adherencia a la dieta. La mayor parte de las veces no se cuenta en las unidades de diálisis con dietistas-nutricionistas. Nefrólogos y enfermeros no disponen del tiempo y/o conocimientos suficientes para establecer y supervisar la adherencia a una dieta individualizada. Objetivos: El objetivo principal es determinar la adhesión a las pautas dietéticas y de fluidos en hemodiálisis mediante el cuestionario DDFQ y establecer su relación con el hábito dietético de los pacientes, valorado mediante test de hábitos dietéticos y procedimientos culinarios. Los objetivos secundarios son medir la adherencia mediante el DDFQ y relacionar los resultados con marcadores bioquímicos de ingesta y con ganancia de peso interdiálisis (GID). Establecer relaciones entre el seguimiento de la dieta y los líquidos referidos por el paciente, los marcadores bioquímicos de ingesta, la ganancia de peso interdiálisis y el resultado del DDFQ. Determinar la adhesión en base al sexo, tiempo en hemodiálisis, ser diabético o haber sido trasplantado alguna vez. Y relacionar los hábitos dietéticos manifestados por los pacientes en el test de hábitos dietéticos y procedimientos culinarios con el conocimiento de los pacientes de las pautas prescritas por los nefrólogos en consulta. Metodología: Estudio piloto descriptivo transversal. Variables sociodemográficas: edad y sexo. Variables clínicas: diabético, paciente trasplantado alguna vez, tiempo en diálisis, peso seco y GID. Marcadores bioquímicos: potasio y fósforo sérico. Variables adhesión a dieta medidas con cuestionario DDFQ. Análisis estadístico: SPSS 20. Descriptivo, pruebas correlación Spearman, prueba t-Student, prueba U Mann-Whitney y tabla contingencia. Resultados: 42 pacientes; 59,5% hombres, 40,5% mujeres. Edad 63,64 ± 16,17 años. Diabéticos 11,9%. GID 1,96 ± 0,70 Kg. Potasio 5,08 ± 0,86 meq/l y fósforo 4,71 ± 1,63 mg/dl. Medido con DDFQ el 50% de pacientes no tiene adherencia a la dieta en 2 días de los 14 días y 50 % no tiene adherencia a líquidos en 1 día de los 14 días. Existen correlaciones entre adherencia a dieta y fósforo (=0,304) y adherencia a líquidos y GID (= 0,413). Conclusiones: Existe una falta de adhesión a las pautas dietéticas en los pacientes en diálisis, en contraste con la adhesión referida por los mismos. La revisión de las pautas dietéticas y de fluidos se hace necesaria en los pacientes con ERC en diálisis. De aquí la importancia de formar y apoyar a la enfermería que con ayuda de herramientas sencillas pueda detectar incumplimientos y actuar con una mayor educación dietética.

Influence of different bed support surface covers on skin temperature.

UNLABELLED: Pressure ulcers represent an ongoing challenge, particularly in immobile patients, that must be met by all health professionals. Extrinsic influential factors involved in the development of pressure ulcers include local shear forces, skin friction, moisture, and temperature for a patient in bed. OBJECTIVES: Based on the relationship between pressure ulcers and skin temperature, we sought to study the influence of different bed support surface covers on skin temperature. The purpose of this study was to determine the influence of support surface materials and their effects on skin temperature at high risk areas of the body known to develop pressure ulcers. A quasi-experimental study with a non-probability sampling was used. A total of 31 subjects (14 males and 17 females) between 19 and 29 years old participated in this study. METHODS: The same standard foam bed cushion was used and three different types of surface protectors (also known as ticking) were chosen for comparison: no cover, cotton, or plastic. Skin temperature measurements were obtained from areas of high risk for developing pressure ulcers: sacrum, right and left scapula, right and left elbow, and right and left calcaneus. RESULTS: Upon analysis of the protective effect of different support surface coverings on the local skin temperature, we observed that temperatures were lower in all risk areas that had no support surface protector and were greater when the surfaces were in contact with protector material, with increases up to 2.13°C. CONCLUSIONS: The type of support surface protector material greatly influences skin temperature depending on the specific area of the body in contact with the surface. The protective plastic that is currently used in hospitals may increase the risk of skin lesions. Simple changes in practices could help minimize the negative impact that plastic protectors contribute to the skin. Regardless, the surface area should be covered with protective covers that do not produce an increase in local temperature and hygienically maintain their integrity.

Aconsejan dar mayor importancia a la educación nutricional durante el embarazo / Nutrition education for women of childbearing age

Objetivo: El objetivo de este trabajo es analizar las fuentes de información y el nivel de conocimiento que poseen, sobre alimentación en el embarazo, las mujeres en edad fértil, diferenciando entre mujeres con hijos o sin hijos y valorando la influencia que la edad y la profesión pueden producir. Método: estudio poblacional, descriptivo y transversal con 117 mujeres en edad fértil, entre los 18 y 50 años, residentes en el municipio de Leganés. Resultados: Sólo un 4.3 % de las encuestadas conocía qué alimento era mejor fuente de hierro durante el embarazo y un 25.6 % sabía que las espinacas constituyen una buena fuente de ácido fólico. Las mujeres con edades comprendidas entre 41-50 años poseen un mejor conocimiento de la composición de los alimentos (52.16 % ± 29,7), al igual que aquellas mujeres que desempeñan un trabajo que requiere de titulación universitaria (51,34 % ± 35,79). En cuanto a las pautas dietéticas a seguir durante esta etapa, el porcentaje de aciertos se encuentra alrededor del 50 %. Una vez más, las mujeres de entre 41 y 50 años y aquéllas que desempeñan un trabajo que requiere de titulación universitaria presentan mayores porcentajes de aciertos (50.90 % ± 20.79 y 57.1 % ±16.9 respectivamente). Las enfermedades riesgosas durante el embarazo, como la preeclampsia y la toxoplasmosis son poco conocidas, con un nivel de aciertos que no supera la mitad de la muestra (42.7 % y 45.3 %, respectivamente); por edades, el grupo de 41 a 50 años vuelve a ser el que posee el mayor porcentaje de aciertos, con 66.7 % ± 13.10 %...