The Spanish version of the Childbirth Experience Questionnaire (CEQ-E): reliability and validity assessment.

BACKGROUND: The Childbirth Experience Questionnaire (CEQ) was originally designed to study women's perceptions of labour and birth. The main objective of our study was to adapt the CEQ to the Spanish context and determine its psychometric properties. This would provide an opportunity to evaluate women's experiences in order to improve evidence in the Spanish context as recommended by national guidelines. METHODS: The CEQ was translated into Spanish using a standard forward and back translation method (CEQ-E). A convenience sample of 364 women was recruited from 3 Spanish hospitals; all participants were able to read and write in Spanish. Mothers with high risk pregnancies or preterm deliveries were excluded from the study. A self-administered questionnaire on sociodemographic variables was completed by participants before discharge. Data on childbirth variables were obtained from maternity records. Between 1 and 3 months postpartum a postal CEQ-E questionnaire was sent. The CEQ-E structure was examined by a confirmatory factor analysis of polychoric correlations using a diagonally weighted least squares estimator. Reliability was assessed using Cronbach's alpha. Construct validity was conducted by testing differences in CEQ-E scores between known-groups (to differ on key variables). RESULTS: 226 (62.1%) of the recruited participants completed the postal questionnaire. The CEQ-E factor structure was similar to the original one. The Spanish version showed fit statistics in line with standard recommendations: CFI = 0.97; NNFI = 0.97; RMSEA = 0.066; SRMS = 0.077. The internal consistency reliability of the CEQ-E was good for the overall scale (0.88) and for all subscales (0.80, 0.90, 0.76, 0.68 for "own capacity", "professional support", "perceived safety" and "participation", respectively) and similar to the original version. Women with a labour duration ≤ 12 h, women with a labour not induced, women with a normal birth and multiparous women showed higher overall CEQ-E scores and "perceived safety" subscale scores. Women with a labour duration ≤ 12 h and those with previous experience of labour obtained higher scores for the "own capacity" and "participation" subscales. CONCLUSIONS: The results of this study indicate that the CEQ-E can be considered a valid and reliable measure of women's perceptions of labour and birth in Spain.

Predictors of childbirth experience: Prospective observational study in eastern Spain.

BACKGROUND: In recent years, birth experience has been highlighted by national and international organisations as a relevant value in measuring maternal health care quality. According to a standardised tool, we aimed to assess which clinical indicators had the most significant influence on the birth experience. METHODS: This prospective observational study was carried out in fourteen hospitals in eastern Spain. 749 women consented to the collection of birth variables at discharge, and subsequently, at 1-4 months, data were collected on the birth experience as measured by the Spanish version of the Childbirth Experience Questionnaire. Next, a linear regression analysis was performed to determine which clinical birth indicators greatly influence the birth experience measure. RESULT: The study sample (n = 749) was predominantly Spanish and primipara, with 19.5% vaginal births. The predictors that emerged in the linear regression model were to have a birth companion (B = 0.250, p = 0.028), drink fluids during labour (B = 0.249, p < 0.001), have early skin-to-skin contact (B = 0.213, p < 0.001) and being transferred to a specialised room for the second stage of labour (B = 0.098, p = 0.016). The episiotomy (B = -0.100, p < 0.015) and having an operative birth (B = -0.128, p < 0.008) showed a negative influence. CONCLUSION: Our study supports that intrapartum interventions recommended according to clinical practice guidelines positively influence the mother's birth experience. Episiotomy and operative birth should not be used routinely as they negatively influence the birth experience.

A new validated international questionnaire on health professionals' knowledge of hypertension diagnosis.

INTRODUCTION: Arterial hypertension is the main factor in attributable mortality. It is therefore considered one of the most important public health problems. Health professionals require special training and skills to make a diagnosis. No studies have been found in the literature search that use a validated instrument (questionnaire) to assess health professionals' theoretical and practical knowledge in diagnosing hypertension or measuring blood pressure. AIM: To design and validate an instrument for gauging health professionals' theoretical knowledge in measuring blood pressure for the initial diagnosis of hypertension. METHODOLOGY: Design, development, and validation of a questionnaire in three languages (English, Spanish, and Catalan) to assess knowledge based on the Rasch-item response theory model. RESULTS: A questionnaire in three languages was constructed and validated. It consisted of 23 questions on the theoretical knowledge of the initial diagnosis of hypertension and was called the ARC questionnaire. It met all the Rasch-IRT model criteria: item- and person-fit measurement, unidimensionality, local independence, invariance, targeting, and reliability. CONCLUSIONS: The ARC questionnaire is a validated tool that enables objective and uniform analyses of knowledge in the initial diagnosis of hypertension among medical and nursing professionals, comparing them over time. It allows for established strategies to be developed to enhance this knowledge.

[Place of death of people with conditions needing palliative care in the different regions of Spain]. / Lugar de fallecimiento de las personas con enfermedades susceptibles de cuidados paliativos en las diferentes comunidades autónomas de España.

BACKGROUND: Dying at home is the most frequent preference, with the institutionalized context being the most common place of death. To determine the place of death in conditions requiring palliative care of residents in Spain aged 15 or over by Autonomous Community (AC) and to examine the relationship with oncological vs. non-oncological causes of death. METHODS: Population-based cross-sectional study analysing medical death certificates. Adjusted effects of socio-demographic variables, AC and causes on the place of death were estimated calculating odds of death in hospital vs. at home (O-H/H) and in a nursing home vs. at home (O-N/H), and odds ratio (OR-H/H and OR-N/H) by multinomial logistic regression models. RESULTS: During 2012-2015, 1,611,767 deaths were recorded, 64.8% corresponding to the target population. Death in hospital was 77% more frequent than death at home, while death in a nursing home was 53% lower. Male sex, lower age, lower academic level, place of birth other than Spain, bigger city size and civil status other than married displayed a relationship with death in hospital, while the same variables except female sex and higher age did so in a nursing home. Adjusted O-H/H higher than 1 and O-N/H lower than 1 were observed in all AC, except Catalonia. Oncological causes made O-H/H lower than 1 in almost 50% of AC, while O-N/H continue to be lower than 1. CONCLUSIONS: Most deaths were in hospital and fewer at nursing homes, despite oncological causes increasing deaths at home (adjusted effect).

[Study on health related quality of life based on information from COOP/WONCA sheets]. / Evaluación de la calidad de vida relacionada con la salud mediante las láminas COOP/WONCA.

BACKGROUND: The main objective of this study is to describe the quality of life related to health (QLRH) in primary health patients, in escorts of primary health care patients, in pregnant women, in relatives caring for Alzheimer patients, and in drug addicts. PATIENTS AND METHODS: The sample consists of 1,408 persons: primary health care patients (n = 475), escorts of primary health care patients (n = 200), in pregnant women (n = 510), in relatives caring for Alzheimer patients (n = 169), and in drug addicts (n = 68). The QLRH has been measured according to the Spanish version of the COOP/WONCA charts. The questionnaire was filled directly by the people surveyed. RESULTS: The group of pregnant women is the group less physically fit but at the same time the group with best health status, higher social support and best quality of life. At the other end, the group of addicts is the worst considered group regarding the variables of feelings, social activities and quality of life. The factor analysis shows a unifactor structure and its internal consistency is 0.79 (Cronbach's alpha). The multiple regression of COOP/WONCA charts over the variables of age, sex and study groups explains the 14% of the variance (r2 = 0.14). CONCLUSIONS: The COOP/WONCA charts allow for the establishment of distinctions in some of the groups studied (pregnant women and drug addicts), but do not establish enough differences with respect to other groups, which may be due to a certain homogeneity among them. The use of a global score for the COOP/WONCA charts would be theoretically and methodology feasible.

[Classification of written nursing records in the intensive care unit of the Alicante General Hospital]. / Categorización de los registros escritos de enfermería en la UCI del Hospital General de Alicante.

During the last few years the need to implant written Nursing registers has been transferred from Schools to the different official organisms. The Servicio Valenciano de Salud took it as an aim to achieve by 1992 and we also know the Insalud and other autonomic sanitary organisms have shown their interest for the creation of such registers, and there is also a general consensus at a theoretical level of the requirements they ought to fulfill. With this work we plan to: first, know the percentage of nurses who, in our unit, write intershift reports. Second, know the kind of event or activities which we write down in these intershift reports, and last, classify the contents of such registers. To do this we analyse 113 intershift reports, randomly chosen and without previous notice to the unit staff, of the total number of available intershift reports in different periods of time between January and November 1993. A content analysis was performed with a result of 13 categories. The later classification of the contents of the registers in this category item, by equivalence among judges, indicated the high reliability of the process. The Agreement Degree obtained was 98.08% for all the categories. The results obtained indicate: 1) only medical diagnosis are used, not nursing ones 2) the events written down are of a biomedical type 3) information from graphics is repeated 4) the percentage of written intershift reports was 94.95%. Several questions arisen from the results obtained and the bibliography used for this research are revised.

[Gastrointestinal signs and symptoms during pregnancy and postpartum in a sample of Spanish women]. / Signos y síntomas gastrointestinales durante el embarazo y puerperio en una muestra de mujeres españolas.

OBJECTIVE: To describe the evolution of the signs and more frequent gastrointestinal symptoms during the pregnancy and in the two weeks later the birth. SUBJECTS: 583 pregnant women, elects in an accidental way, interviewees between the 8 and 12 weeks of gestation (n = 133), among 18 and 22 (n = 155), among 37 and 42 (n = 203) and two weeks after the childbirth (n = 92) and coming from centers of health and hospitals of the Comunidad Valenciana and Murcia. The questionnaire, answered in a voluntary way by interview, it contained a listing on the signs and more frequent gastrointestinal symptoms during the pregnancy, and she answered on the presence or not of the same ones in the two weeks previous to the moment of the interview. RESULTS: The percentage of nauseas and vomits, although higher in the first trimester, stays around the 25-30% in the third gestation trimester. The heartburn is presented in 58.6% of the pregnant women in the third trimester. The sialorrea is presented in 7.7% of all the pregnant women and she stays during the whole gestation. The constipation stays constant during the gestation above at the 25-30%. The prevalence of haemorrhoids to the beginning of the gestation is over to 8% to be located in the postpartum in 53.3%. CONCLUSIONS: The description of the evolution of the signs and symptoms of the pregnancy described in the obstetrics manuals don't come up with our data.