Best practices for iatrogenic anaemia prevention in the intensive care unit: Blood-sparing techniques.

Anaemia is a common issue in patients who are admitted to intensive care units and worsens their condition throughout the stay due to the extraction of blood for diagnostic purposes. It is also well-known that an important amount of the carbon dioxide produced by health services is likely attributable to blood donation, testing and manufacture, storage or distribution of blood components. This must be taken into account to perform nursing interventions consistent with the idea of sustainable health care. In this regard, within patient blood management bundles, with the objective of minimizing the use of blood products, it is recommended to use blood-sparing techniques: small volume tubes (SVT) or closed-blood sampling devices (CBSD). Published studies before 2014 (excepting two more recent ones) have shown that by themselves, both techniques reduce drawn volume but do not decrease haemoglobin reduction and/or need of transfusion. Given the lack of cost-effectiveness studies, it may be easier to implement the use of CBSD as it does not require prior consensus on the discard volume or adaptations in the processing of laboratory tests, as is the case with SVT.

Is caring for pressure ulcers in the intensive care unit in Spain still a challenge? A qualitative study on nurses' perceptions.

BACKGROUND: The incidence of pressure ulcers is an indicator of quality in intensive care units. Due to their frequency and severity, they are identified as a problem of great importance, where the well-being of patients and relatives is compromised, also generating a high healthcare cost. Nurses are primarily responsible for the care of pressure ulcers, however, the existing literature exposes a clear lack of knowledge regarding its prevention and treatment. OBJECTIVES: To explore the attitudes, knowledge and perceived barriers by intensive care nurses regarding pressure ulcers treatment and prevention in a critical care setting. DESIGN: A descriptive qualitative study has been carried out through semi-structured interviews with 22 intensive care nurses from two tertiary university hospitals in Spain. The consolidated criteria for reporting qualitative research (COREQ) guidelines were used to reinforce the methodological approach of the study. FINDINGS: From the collected data, 4 main themes emerged: "lack of specific knowledge about pressure ulcers in intensive care", "continuity of care: the main problem to solve", "teamwork and pressure ulcers: gasping for improvement" and "Skin care as another vital sign". CONCLUSION: Most intensive care nurses consider that they do not have sufficient knowledge regarding pressure ulcers. The nurses' attitudes are positive, however, an ineffective transmission of information and registration regarding ulcers is perceived. Regarding the treatment of pressure ulcers, the lack of continuity of care and updated knowledge/training have been the main barriers. In terms of prevention, the most mentioned barriers have been the clinical condition of the patient and the lack of personnel, despite the level of knowledge.

Effectiveness and safety of the Space GlucoseControl system for glycaemia control in caring for postoperative cardiac surgical patients.

BACKGROUND: Hyperglycaemia is a very common complication in post-cardiac surgical patients, and as such, it must be properly managed. For this purpose, the enhanced Model Predictive Control algorithm for glycaemia control has been implemented into a nurse-led device called Space GlucoseControl (SGC) that aims to achieve a safe and effective blood glucose control in a better way than the traditional "paper-based" protocols. PURPOSE: The aim of the study was to know the effectiveness and safety of the SGC in glycaemia control in cardiosurgical adult patients in the immediate postoperative period in the intensive care unit. METHODS: A prospective before-and-after intervention study was conducted. One hundred sixty cardiosurgical adult patients with hyperglycaemia were selected: 80 in the control group from May to November 2018 and 80 in the intervention group (use of the SGC device) from January to December 2019. The primary outcome was the percentage of time within the target range (140-180 mg/dL in the control group and 100-160 mg/dL in the intervention group). RESULTS: The percentage of time within the target range was significantly higher in the SGC group than in the control group (70.5% [58.25-80] vs 54.83% [36.09-75], p < 0.001). The range was also achieved earlier with the SGC (5 [3-6.875] hours vs 7 [4-11] hours; p < 0.05). The first blood glucose value after reaching the target range was higher in the control group, with statistical significance (p < 0.05). There were no hypoglycaemia episodes in the control group. However, during SGC treatment, six episodes of hypoglycaemia occurred, and all of them were nonsevere (mean value = 61 mg/dL). CONCLUSION: The SGC is useful to achieve a faster tight glycaemic control, with a higher percentage of time within the target range, although episodes of nonsevere hypoglycaemia could be observed.

Intensive care nurses' experiences during the COVID-19 pandemic: A qualitative study.

BACKGROUND: Because of the COVID-19 pandemic, health care systems worldwide are working under challenging conditions. Patients, who are seriously ill, require intensive care admission. In fighting COVID-19, nurses are frontline health care workers and, as such, have a great responsibility providing needed specialized patient care in intensive care units (ICU). However, working conditions and emotional factors have an impact on the quality of the care provided. AIM: The purpose of the present study was to explore and describe the experiences and perceptions of nurses working in an ICU during the COVID-19 global pandemic. STUDY DESIGN: Qualitative research was undertaken, using an empirical approach and inductive content analysis techniques. METHODS: The selected population consisted of ICU nurses from a tertiary teaching hospital in Spain. Data were obtained via semi-structured videocall interviews from Apr 12th to Apr 30th, 2020. Subsequently, transcribed verbatims were analysed using the template analysis model of Brooks. FINDINGS: A total of 17 nurses comprised the final sample after data saturation. Four main themes emerged from the analysis and 13 subthemes: "providing nursing care," "psychosocial aspects and emotional lability," "resources management and safety" and "professional relationships and fellowship." CONCLUSION: Providing health care by intensive care nursing professionals, during the COVID-19 pandemic, has shown both strong and weak points in the health care system. Nursing care has been influenced by fear and isolation, making it hard to maintain the humanization of the health care. RELEVANCE TO CLINICAL PRACTICE: Implications for practice include optimizing resource management (human and material), providing psychological support, and adequate training for ICU nurses, as well as high-quality protocols for future emergency situations.

Chronic non-cancer pain management by nurses in specialist pain clinics.

BACKGROUND: Chronic non-cancer pain (CNCP) is one of the major causes of disability globally, and patients who suffer from it are a complex population, which makes it difficult to provide effective care. Specialist pain clinics and nursing professionals in them are the main care providers, but there is little research conducted in this field. AIM: To explore the attitudes and knowledge of nurses working in specialist pain clinics regarding care of CNCP patients. METHODS: Qualitative phenomenological approach. Sixteen semi-structured interviews were conducted in 2017 with nurses who worked in specialist pain clinics in six hospitals in southern Spain. RESULTS: Data analysis led to the formation of two categories, 'being trained and improving knowledge in CNCP' and 'the challenge of caring for patients with CNCP', and five subcategories. CONCLUSION: The need for care in CNCP is not covered by nurses in all the areas it requires. Lack of time, staffing issues, and specific training in this area makes it difficult to provide care. However, some areas for improvement are proposed, such as psychological interventions, group workshops, continuous training, and multidisciplinary teams.

Age as a Risk Factor for Burnout Syndrome in Nursing Professionals: A Meta-Analytic Study.

Although past research has highlighted the possibility of a direct relationship between the age of nursing professionals and burnout syndrome, results have been far from conclusive. The aim of this study was to conduct a wider analysis of the influence of age on the three dimensions of burnout syndrome (emotional exhaustion, depersonalization, and personal accomplishment) in nurses. We performed a meta-analysis of 51 publications extracted from health sciences and psychology databases that fulfilled the inclusion criteria. There were 47 reports of information on emotional exhaustion in 50 samples, 39 reports on depersonalization for 42 samples, and 31 reports on personal accomplishment in 34 samples. The mean effect sizes indicated that younger age was a significant factor in the emotional exhaustion and depersonalization of nurses, although it was somewhat less influential in the dimension of personal accomplishment. Because of heterogeneity in the effect sizes, moderating variables that might explain the association between age and burnout were also analyzed. Gender, marital status, and study characteristics moderated the relationship between age and burnout and may be crucial for the identification of high-risk groups. More research is needed on other variables for which there were only a small number of studies. Identification of burnout risk factors will facilitate establishment of burnout prevention programs for nurses. © 2016 Wiley Periodicals, Inc.

[Risk factors and burnout levels in Primary Care nurses: A systematic review]. / Factores de riesgo y niveles de burnout en enfermeras de atención primaria: una revisión sistemática.

OBJECTIVE: To determine the risk factors and levels of burnout in Primary Care nurses. METHODS: A systematic review was performed. DATA SOURCES: CINAHL, CUIDEN, LILACS, PubMed, ProQuest, ScienceDirect and Scopus databases were consulted. Search equations were 'burnout AND community health nursing' and 'burnout AND primary care nursing'. The search was performed in October 2015. STUDY SELECTION: The final sample was n=12 studies. Quantitative primary studies that used Maslach Burnout Inventory for burnout assessment in Primary Care nurses were included without restriction by publication date. DATA EXTRACTION: The main variables were the mean and standard deviation of the three burnout dimensions, high, medium and low prevalence rates of each dimension, and socio-demographic, occupational and psychological variables that potentially influence burnout level. RESULTS: Studies show high prevalence rates, generally between 23% and 31%, of emotional exhaustion. The prevalence rates of high depersonalisation and low personal accomplishment show heterogeneity, varying between 8%-32% and 4%-92% of the sample, respectively. Studies show that older nurses with more seniority, anxiety and depression, among other variables, have higher burnout levels, while nurses with higher salary, high job satisfaction, organisational support, and good self-concept have less burnout. CONCLUSION: High emotional exhaustion is the main affected dimension of burnout in Primary Care nursing. There is heterogeneity in depersonalisation and personal accomplishment. Burnout must be prevented in these professionals, by increasing protective factors and monitoring its appearance in those with risk factors.

Development and Psychometric Validation of the Breast Cancer Stigma Assessment Scale for Women with Breast Cancer and Its Survivors.

BACKGROUND: The increase in breast cancer cases and breast cancer survival makes it advisable to quantify the impact of the health-related stigma of this disease. PURPOSE/OBJECTIVES: To develop and validate a breast cancer stigma scale in Spanish. METHODS: Women diagnosed with, or survivors of, breast cancer were included. The development of the Breast Cancer Stigma Assessment Scale (BCSAS) involved both a literature review and personal interviews. Content validity was assessed using a Delphi study and a pilot test; construct validity was evaluated using an exploratory factor analysis; and convergent validity was assessed using six scales. Cronbach's α internal consistency and test-retest reliability were used to determine the reliability of the scales. RESULTS: 231 women responded to the 28-item scale. The BCSAS showed good reliability, with α = 0.897. Seven factors emerged: concealment (α = 0.765), disturbance (α = 0.772), internalized stigma (α = 0.750), aesthetics (α = 0.779), course (α = 0.599), danger (α = 0.502), and origin (α = 0.350). The test-retest reliability was 0.830 (p < 0.001). Significant correlation was observed with event centrality (r = 0.701), anxiety-depression (r = 0.668), shame (r = 0.645), guilt (r = 0.524), and quality of life (r = -0.545). CONCLUSIONS: The BCSAS is a reliable and valid measure of stigma in women with breast cancer and its survivors. It could be useful for detecting stigma risk and establishing psychotherapeutic and care priorities.

[Education about healthy sexual behaviors among high school students]. / Educar en conductas sexuales saludables: una innovación docente en promoción de la salud.

BACKGROUND: The need to educate adolescents about healthy sexual behavior motivated the development of an education program on sexuality. AIM: To describe the knowledge of students about sexuality and the implementation of a sexual education project. MATERIAL AND METHODS: Sixty students aged 14 years (34 females), attending the third year of secondary education participated in dynamic workshops about healthy sexual behaviors. RESULTS: The most common reactions of students when facing situations related to sexual behavior were shame, anxiety, fear and lack of knowledge. Group dynamics improved the practical knowledge of students about sexual behavior, allowing them to make informed decisions. CONCLUSIONS: These innovative educational techniques should be expanded to other students.

[Evolution of nutritional status in hemodialysis patients during 4 years of follow]. / Evolución del estado nutricional en pacientes en hemodiálisis durante 4 años de seguimiento.

Protein-calorie malnutrition as well as systemic inflammation and metabolic disorders are common among patients with chronic renal failure undergoing renal replacement therapy (hemodialysis), which contributes to their morbidity and mortality. This work has followed 90 patients of both sexes with chronic kidney disease who were treated with hemodialysis periodically in our unit for four years. All patients were performed quarterly measurements of plasma albúmina (A1b), total cholesterol (TC), total protein (TP) and monthly transferrin (Tr), Anthropometric measurements of height and weight were taken on all patients by using a balance/stadiometer (Perperson 113481); weight was measured in kilograms and height in centimetres. BMI was calculated with this formula: weight/height2 and classified according to the WHO criteria: BMI < 18.50: Underweight; from 18.50 to 24.99: Normal range; from 25.00 to 29.99: Overweight; and BMI > or =30.00: Obese. The aim of this work was evaluate the nutritional status of these patients through the assessment of biochemical parameters and anthropometric parameters and determine if these patients suffer alterations suggesting nutritional deterioration directly related to the time on dialysis. During the 4 years all patients showed a significant decline of biochemical parameters, on the other hand the BMI did not significant changes in relation to malnutrition. Malnutrition in patients on dialysis is therefore evident, the BMI does not correspond with the biochemical parameters observed, so nutritional deterioration of these patients is mainly manifested by biochemical parameters studied.

Reporting of Perinatal Outcomes in Probiotic Randomized Controlled Trials. A Systematic Review and Meta-Analysis.

The use of probiotic microorganisms in clinical practice has increased in recent years and a significant number of pregnant women are regular consumers of these products. However, probiotics might modulate the immune system, and whether or not this modulation is beneficial for perinatal outcomes is unclear. We performed a systematic review and meta-analysis to evaluate the reporting of perinatal outcomes in randomized controlled trials including women supplemented with probiotic microorganisms during pregnancy. We also analyzed the effects that the administration of probiotic microorganisms exerts on perinatal outcomes. In the review, 46 papers were included and 25 were meta-analyzed. Reporting of perinatal outcomes was highly inconsistent across the studies. Only birth weight, cesarean section, and weeks of gestation were reported in more than 50% of the studies. Random effects meta-analysis results showed that the administration of probiotic microorganisms during pregnancy did not have any a positive or negative impact on the perinatal outcomes evaluated. Subgroup analysis results at the strain level were not significantly different from main analysis results. The administration of probiotic microorganisms does not appear to influence perinatal outcomes. Nonetheless, future probiotic studies conducted in pregnant women should report probiotic strains and perinatal outcomes in order to shed light upon probiotics' effects on pregnancy outcomes.

[Bone mineral density in patients with renal hyperparathyroidism undergoing surgery: relationship with bone parameters]. / Estudio de la densidad mineral ósea en el paciente con insuficiencia renal e hiperparatiroidismo intervenido quirúrgicamente: relación con parámetros óseos.

BACKGROUND AND OBJECTIVES: Hyperparathyroidism (HPT) in chronic kidney disease (CKD) may alter the composition and bone architecture, and cause fractures. The DEXA bone mineral density (BMD), used to predict fracture risk, measures the amount of calcium in bone. However, we do not know the relationship between BMD and bone composition. PATIENT AND METHOD: Our study, conducted in two groups of renal patients with HPT who underwent parathyroidectomy (PTX): patients on hemodialysis (HD group) and patients with renal transplant (RT group). The aims were to quantify and value the differences among groups and by gender on bone mineral density, quantify and define differences between these two groups and a control group regarding the elemental composition of bone marrow biopsy obtained and static parameters of bone histomorphometry, and define a possible relationship between bone mineral density and bone elements versus histomorphometric parameters. RESULTS: The BMD mean in femur was higher in TR group than in HD group. Linear correlation analysis performed between parameters versus BMD and bone histomorphometry elements, considering both TR and HD, only correlation between femur BMD (gr/cm2) and calcium (r=0.435, p=0.034, n=24) was observed. CONCLUSION: Hyperparathyroidism patients undergoing renal transplant had better femoral BMD than those on hemodialysis; the trabecular volume was lower in kidney transplantation, while the volume of fibrosis was higher in hemodialysis patients; the elements in bone transplant and hemodialysis were in similar proportion, while the calcium content tended to be higher in renal transplant.

"Work Like a Chinese": Aspirations, Patterns of Work, and Working Conditions of the Chinese Immigrant Community in Southern Spain.

Expanding businesses was the main reason for the immigration of Chinese people in Spain, which consists the fifth largest nationality of immigrants in this country. Nevertheless, few studies have been carried out to understand the working conditions of this population. Using an ethnographic design, this study examined the work patterns and working conditions among Chinese immigrants living in southern Spain and how these factors affected their health. Observing participants, field notes, and semi-structured interviews with question script were conducted with 133 Chinese immigrants. Five main themes were defined: "Economic improvement as a migratory reason", "Conception to Work", "Labor Sector", "Work conditions", and "Occupational health". Our results showed that Chinese immigrants worked in the provision of services, with long working hours and little rest. Although they had low rates of unemployment, the working conditions had an important impact on their dietary patterns and their family life. Ergonomic and psychosocial risks also explained high rates of musculoskeletal problems and stress. In conclusion, Chinese immigrants living in southern Spain work actively in the service sector of the economy, but with many work hours. These characteristics seem to impact their health at a physical, psychological, and social level.

Validation of the Women's Views of Birth Labor Satisfaction Questionnaire (WOMBLSQ4) in the Spanish Population.

The satisfaction of women with the birth experience has implications for the health and wellness of the women themselves and also of their newborn baby. The objectives of this study were to determine the factor structure of the Women's Views of Birth Labor Satisfaction Questionnaire (WOMBLSQ4) questionnaire on satisfaction with the attention received during birth delivery in Spanish women and to compare the level of satisfaction of pregnant women during the birth process with that in other studies that validated this instrument. A cross-sectional study using a self-completed questionnaire of 385 Spanish-speaking puerperal women who gave birth in the Public University Hospitals of Granada (Spain) was conducted. An exploratory factor analysis of the WOMBLSQ4 questionnaire was performed to identify the best fit model. Those items that showed commonalities higher than 0.50 were kept in the questionnaire. Using the principal components method, nine factors with eigenvalues greater than one were extracted after merging pain-related factors into a single item. These factors explain 90% of the global variance, indicating the high internal consistency of the full scale. In the model resulting from the WOMBLSQ4 questionnaire, its nine dimensions measure the levels of satisfaction of puerperal women with childbirth care. Average scores somewhat higher than those of the original questionnaire and close to those achieved in the study carried out in Madrid (Spain) were obtained. In clinical practice, this scale may be relevant for measuring the levels of satisfaction during childbirth of Spanish-speaking women.

[Causes and components of the metabolic syndrome in renal transplant recipients from a gender perspective]. / Causas y componentes del síndrome metabólico en receptores de trasplante renal desde una perspectiva de género.

INTRODUCTION: the appearance of metabolic syndrome (MS) among renal recipients is one of the greatest post-transplant complications and is associated with an increased risk of graft failure and high rates of obesity and new onset diabetes. OBJECTIVE: the objective of this work is to identify the relationship between the glomerular filtration rate measured by two different methods and the components of the metabolic syndrome and their combinations in kidney transplant patients according to gender. MATERIAL AND METHOD: the samples consisted of 500 kidney transplant recipients, of whom 190 had MS, 121 men and 69 women. All subjects underwent clinical evaluation and blood sampling for laboratory measurements. The MS was determined according to the criteria of the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP-III). Renal function was estimated using AMDRD equations and CrS determinations. RESULTS: the average age was 55.5 years. The prevalence of MS was significantly higher in men (23.1% < vs 9.8%). High blood pressure (HBP) was the most observed component of MS. Significant correlations (Pearson, p < 0.05) between TFG-AMDRD and TFG CrS and metabolic markers were observed more in men than in women. The body mass index (BMI) was significantly higher in women than in men. CONCLUSIONES: the decrease in renal function associated with the components of MS, HBP and obesity represent a high risk of adverse cardiovascular events and graft rejections.

INTRODUCCIÓN: la aparición del síndrome metabólico (SM) entre los receptores renales es una de las mayores complicaciones postrasplante y se asocia con un mayor riesgo de fracaso del injerto y altas tasas de obesidad y diabetes de nueva aparición. OBJETIVO: el objetivo de este trabajo es identificar la relación entre la tasa de filtración glomerular medida por dos métodos distintos y los componentes del síndrome metabólico y sus combinaciones en pacientes trasplantados renales según género. MATERIAL Y MÉTODO: la muestra estuvo formada por 500 pacientes trasplantados renales, de los cuales 190 padecían SM, 121 hombres y 69 mujeres. Todos los sujetos se sometieron a evaluación clínica y toma de muestras de sangre para mediciones de laboratorio. El SM se determinó según los criterios del National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP-III). La función renal se estimó usando ecuaciones AMDRD y determinaciones de creatinina sérica (CrS). RESULTADOS: la media de edad fue de 55,5 años. La prevalencia del SM fue significativamente mayor en hombres (23,1% < vs. 9,8%). La hipertensión arterial (HTA) fue el componente del SM más observado. Se observaron correlaciones significativas (Pearson; p < 0,05) entre TFG-AMDRD y TFG CrS y marcadores metabólicos más en hombres que en mujeres. El índice de masa corporal (IMC) fue significativamente mayor en mujeres que en hombres. CONCLUSIONES: la disminución de la función renal asociada con los componentes del SM, la HTA y la obesidad representan un riesgo elevado de eventos cardiovasculares adversos y rechazos del injerto.

Overview of autosomal dominant polycystic kidney disease in the south of Spain. / Panorámica de la poliquistosis renal autosómica dominante en una región del sur de España.

INTRODUCTION: Although autosomal dominant polycystic kidney disease is the most common hereditary kidney disease, available data tend to be limited to after initiation of renal replacement therapy. OBJECTIVE: To ascertain an overview of autosomal dominant polycystic kidney disease within the health area of Granada in southern Spain. MATERIAL AND METHODS: From January 2007 to December 2016, we collected clinical, family and demographic information about all patients with autosomal dominant polycystic kidney disease, irrespective of whether or not they were treated with RRT, in the Granada health area. The computer software SPSS 15.0 and GenoPro were used. RESULTS: 50.6% of the 1,107 diagnosed patients were men. 99.1% were Caucasian and 4-6 generations/family were studied. The geographical distribution was heterogeneous. There was no family history in 2.43%. The mean age of diagnosis was 34.0±17.80 years and the diagnosis was made after having offspring in 57.7% of cases. The main reason for diagnosis was family history (46.4%). The mean age of initiation of renal replacement therapy was 54.2±11.05 years. 96.3% of the deceased had some degree of renal failure at the time of death. The mean age of death was 60.9±14.10 years, the main cause of death being unknown in 33.5% of cases, followed by cardiovascular (27.8%). CONCLUSIONS: Cases and families were concentrated in certain geographical areas and a significant number of individuals were undiagnosed prior to cardiovascular death or diagnosed late after reproduction. Given that there is currently no curative treatment, the primary prevention strategy of preimplantation genetic diagnosis should play a leading role.

[Influence of physical exercise during pregnancy on newborn weight: a randomized clinical trial]. / Influencia del ejercicio físico durante el embarazo sobre el peso del recién nacido: un ensayo clínico aleatorizado.

INTRODUCTION: Recent studies have proved that physical activity of the pregnant woman brings benefits not only for the mother but also for the fetus, given that it decreases the number of macrosomic newborns and their negative consequences in both of them. OBJECTIVE: To analyze in pregnant women the influence of a moderate physical activity program in the aquatic environment on the weight of the newborn. MATERIAL AND METHODS: A randomized clinical trial with 140 healthy pregnant women, aged between 21 and 43 years, divided into two groups, study (GE, n = 70) and control (GC, n = 70). The women were attracted at 12 weeks of gestation in the first trimester ultrasound control carried out in the different obstetrical services in Granada. They joined the program at week 20 of gestation and ended in week 37. The perinatal results were obtained from the partograph of each woman, included in the Delivery Room Services of the Complejo Hospitalario Universitario de Granada. RESULTS: The median weight of the babies of the pregnant women who participated in the intervention was 3,250 g, compared to the babies of the control group, with a median of 3,460 g. There were statistically significant differences between the two groups (p = 0.011). Among newborns, 86.8% of both groups had weights within clinical normality, that is between 2,500 and 4,000 g. Women who followed the SWEP (Study Water Exercise Pregnant) method during pregnancy had a weight gain of 8.28 kg, compared to sedentary women, who presented a 11.17 kg weight gain. However, the rate of macrosomic infants was similar, so there were no significant differences between the two groups (GC n = 7, GE n = 6). There were no significant differences in gestation time between the two groups, with an average of 279.70 days (GC) and 280.09 days (SG) (p-value > 0.05). CONCLUSION: Moderate physical activity in the aquatic environment, following the SWEP methodology, does not present risks of preterm birth and does not alter the gestation time with regard to the sedentary women during pregnancy. Physical exercise has achieved a significant decrease in the weight of the newborn and a less profit ponderal during pregnancy. These two results have not been instrumental in reducing the rate of macrosomies in our study.

INTRODUCCIÓN: los últimos estudios han demostrado que la actividad física de la mujer embarazada aporta beneficios no solo para la madre sino también para el feto, puesto que disminuye el número de recién nacidos macrosómicos y sus consecuencias negativas para los dos. OBJETIVO: analizar la influencia de un programa de actividad física de carácter moderado para la mujer gestante en el medio acuático sobre el peso del recién nacido. MATERIAL Y MÉTODOS: ensayo clínico aleatorizado con 140 mujeres gestantes sanas, con edades entre 21 y 43 años y divididas en dos grupos, estudio (GE, n = 70) y control (GC, n = 70). Las mujeres fueron captadas a las 12 semanas de gestación en el control ecográfico del primer trimestre, en los distintos servicios de obstetricia de Granada. Se incorporaron al programa en la semana 20 de gestación y terminaron en la semana 37. Los resultados perinatales se obtuvieron del partograma de cada mujer, registrado en los Servicios de Paritorio del Complejo Hospitalario Universitario de Granada. RESULTADOS: la mediana del peso de los bebes de las gestantes que participaron en la intervención fue de 3.250 g, frente a la de los bebes del grupo control, que fue de 3.460 g; existen diferencias estadísticamente significativas entre ambos grupos (p = 0,011). El 86,8% de los dos grupos presentaba pesos dentro de la normalidad clínica, esto es, entre 2.500 y 4.000 g. Las mujeres que siguieron el método SWEP (Study Water Exercise Pregnant)durante el embarazo tuvieron una ganancia ponderal de 8,28 kg, frente a las mujeres sedentarias, en las cuales fue de 11,17 kg (p < 0,001). Sin embargo, la tasa de bebés macrosómicos fue similar, por lo que no se presentan diferencias significativas entre los dos grupos (GC n = 7, GE n = 6). No hubo diferencias significativas en el tiempo de gestación entre ambos grupos, con una media de 279,70 días (GC) y 280,09 días (GE) (p-valor > 0,05). CONCLUSIÓN: La actividad física de carácter moderado en el medio acuático siguiendo la metodología SWEP no presenta riesgos de parto prematuro y no se altera el tiempo de gestación con respecto a las mujeres sedentarias durante el embarazo. El ejercicio físico ha logrado una disminución significativa del peso del recién nacido y una menor ganancia ponderal durante el embarazo. Estos dos resultados no han sido determinantes para reducir la tasa de macrosomías en nuestro estudio.

Diets low in carbohydrates for type 2 diabetics. Systematic review / Dietas bajas en hidratos de carbono para diabéticos de tipo 2. Revisión sistemática

Introduction: In general it has been recommended to people with diabetes to follow a low-carb diet. However, diets low in carbohydrates (DLCH) seem to be, at least, just as effective as low-fat, even providing better results in some cases in terms of glycemic control, decreased body weight and improves markers of cardiovascular risk. Objetives: To analyze the effect of the DLCH with respect to a low-fat diet (LFD) or other, as to baseline blood glucose, glycated hemoglobin (HbA1c), body weight, total cholesterol, and triglycerides. Methods: Literature Search of studies published in Medline, Scopus, Cinahl, Lilacs, Dialnet, Scielo and ProQuest. We extracted data on the composition of the diets evaluated, duration, and changes with respect to baseline blood glucose, HbA1c, body weight, cholesterol, and triglycerides. Results: We included 15 studies in the review found one of them significant differences between groups in levels of fasting glucose, in 6 in terms of HbA1c and 3 in terms of body weight. With regard to the levels of blood lipid, are not found in any study, significant differences between groups in regard to total cholesterol, while it is found in three studies with regard to the levels of triglycerides. Conclusions: This review shows that the DLCH can be effective in some aspects such as the reduction of HbA1c, body weight or triglyceride, although there is sufficient evidence to support its long term use over other diets, which requires more future research.

Introducción: usualmente se ha recomendado a personas diabéticas seguir una dieta baja en grasas. Sin embargo, las dietas bajas en carbohidratos (DBCH) parecen ser, al menos, igual de efectivas que las bajas en grasas, incluso aportan mejores resultados en algunos casos en cuanto a control glicémico, disminución de peso corporal y mejora de marcadores de riesgo cardiovascular. Objetivos: analizar el efecto de las DBCH con respecto a dietas bajas en grasas (DBG) u otras, en cuanto a glucemia basal, hemoglobina glicosilada (HbA1c), peso corporal, colesterol total y triglicéridos. Métodos:búsqueda bibliográfica de estudios publicados en Medline, Scopus, Cinahl, Lilacs, Dialnet, Scielo y ProQuest. Se extrajeron datos sobre la composición de las dietas evaluadas, duración y cambios respecto a glucemia basal, HbA1c, peso corporal, colesterol y triglicéridos. Resultados: se incluyen 15 estudios en la revisión: en uno de ellos se encontraron diferencias significativas entre grupos en los niveles de glucemia basal, en 6 en cuanto a HbA1c y en 3 en cuanto a peso corporal. Con respecto a los niveles de lípidos sanguíneos, no se encuentran en ningún estudio diferencias significativas entre grupos en cuanto al colesterol total, mientras que sí se encuentran en 3 estudios respecto a los niveles de triglicéridos. Conclusiones: esta revisión muestra que las DBCH pueden ser efectivas en algunos aspectos como la reducción de HbA1c, de peso corporal o de triglicéridos, aunque no hay suficiente evidencia científica que respalde su uso a largo plazo por encima de otras dietas, por lo que se precisa de más investigaciones futuras.