Cultural influence on the expression of labour-associated pain.

BACKGROUND: Every woman expresses pain differently during birth since it depends on a multitude of predictive factors. The medical care received, companionship during birth, cultural background and language barriers of the women in labour can influence on the expression of pain. This study aims to evaluate the expression of pain during birth and its associated factors in women treated in a Spanish border town. METHODS: The study included 246 women in labour. The expression of pain during labour was evaluated using the validated ESVADOPA scale. A descriptive analysis and association study were performed between cultural identity and dimensions of the scale. Multiple linear regression models were performed to assess the association between cultural identity, origin, language barrier, and companionship during labour. RESULTS: The women included in the study comprised 68.7% Berbers, 71.5% Muslims and 82.1% were accompanied during labour. An association between cultural identity and greater body expression of pain (p = 0.020; Cramer's V = 0.163) in addition to its verbal expression was found during the latent phase of labour, (p = 0.028; Cramer's V = 0.159). During the active phase of labour, cultural identity was associated with pain expression through greater body response, verbal expression, expression of the facial muscles, anxiety, inability to relax and vegetative symptoms. The different factors studied that had a predictive value were companionship (p = 0.027) during the latent phase of labour and Berber origin (p = 0.000), language barrier (p = 0.014) and companionship (p = 0.005) during the active phase of labour. The models designed predict pain expression in the latent phase by companionship and type of companionship (ß = 1.483; 95%CI = 0.459-2.506, ß = 0.238; 95%CI = 0.029-0. 448, respectively), and in the active phase by background, language barrier and companionship (ß = 0.728; 95%CI = 0.258-1.198, ß = 0.738; 95%CI = 0.150-1.326, ß = 1.888; 95%CI = 0.984-2.791, respectively). CONCLUSION: Culture, origin, language barrier and companionship during labour influences the manner in which women in labour express their pain. An understanding of this may help midwives correctly interpret the signs of pain expression and be able to offer the appropriate assistance depending on a woman's particular characteristics. There is a clear need for new models of maternity care that will take the cultural and language characteristics of women in labour into consideration.

[Motor imagery: a systematic review of its effectiveness in the rehabilitation of the upper limb following a stroke]. / Imagineria motora: revision sistematica de su efectividad en la rehabilitacion de la extremidad superior tras un ictus.

INTRODUCTION: Motor imagery or mental practice of movement is a relatively new intervention that is being used on an increasingly more frequently basis in the treatment of stroke patients. It consists in the person evoking a movement or gesture in order to learn or improve its execution. Neuroimaging studies have shown that imagining movements activates neuronal patterns that are similar to those produced when they are actually performed. PATIENTS AND METHODS: A systematic review was conducted between January and June 2017 in the Web of Science, PubMed, CINHAL, PEDro and Scopus databases to select clinical trials carried out with stroke patients in whom this technique was used as rehabilitation. Thirteen randomised clinical trials were included. The characteristics of the studies and the measures of results were summarised and the evidence of their outcomes was described. RESULTS: Most of the studies found significant differences in terms of improved motor rehabilitation of the upper limb among the subjects in the experimental groups. Only one of the studies failed to show any evidence of its effectiveness in isolation. None of them made any reference to its effectiveness in improving sensory alterations. CONCLUSIONS: Motor imagery, combined with conventional therapy (physiotherapy or occupational therapy), seems to have positive effects on the motor rehabilitation of the upper limb following a stroke. Further research is needed to improve the heterogeneity of the interventions and to evaluate their effectiveness in the long term.

TITLE: Imagineria motora: revision sistematica de su efectividad en la rehabilitacion de la extremidad superior tras un ictus.Introduccion. La imagineria motora o practica mental del movimiento es una intervencion relativamente nueva, cada vez mas empleada en el tratamiento del paciente con ictus. Consiste en la evocacion, por parte de la persona, de un movimiento o gesto para aprender o mejorar su ejecucion. Estudios de neuroimagen han demostrado que la imaginacion de movimientos activa patrones neuronales similares a su ejecucion. Pacientes y metodos. Se ha realizado una revision sistematica entre enero y junio de 2017 en las bases de datos Web of Science, PubMed, CINHAL, PEDro y Scopus, seleccionando los ensayos clinicos llevados a cabo con pacientes con ictus en los que se empleara esta tecnica como intervencion rehabilitadora. Se incluyeron 13 estudios clinicos aleatorizados. Se resumieron las caracteristicas de los estudios y las medidas de resultados, y se describio la evidencia de sus resultados. Resultados. La mayor parte de los estudios encuentran diferencias de mejora significativas en la rehabilitacion motora de la extremidad superior entre los sujetos de los grupos experimentales. Solo uno de los estudios no mostro evidencia de su efectividad de forma aislada. En ninguno se hace referencia a su efectividad en la mejora de las alteraciones sensitivas. Conclusiones. La imagineria motora, combinada con terapia convencional (fisioterapia o terapia ocupacional), parece tener efectos positivos en la rehabilitacion motora de la extremidad superior tras un ictus. Se precisan mas estudios que mejoren la heterogeneidad de las intervenciones y que valoren su efectividad a largo plazo.

[Early reconstruction of congenital pseudoarthrosis of the tibia with free vascularized fibular grafts]. / Reconstrucción precoz de pseudoartrosis congénita de tibia con injerto libre vascularizado de peroné.

Congenital pseudoarthrosis of the tibia (CPT) is an uncommon disease presenting a tibial nonunion since birth and frequently associated to neurofibromatosis type 1. Surgical management by wide excision of the pseudoarthrosis and sustitution of the defect with vascularized bone in an early stage has proven to be the most effective technique in terms of bone consolidation. We present a clinical case of a 22-month-old patient with CPT treated successfully by reconstruction with a free vascularized fibula graft with an excellent functional result.

Analytical phosphorus fractionation in sewage sludge and sediment samples.

The Standards, Measurements and Testing (SMT) harmonized procedure for phosphorus fractionation in freshwater sediments (SMT protocol), which was developed within the framework of the Standards, Measurements and Testing (SMT) Programme of the European Commission, has been applied to different environmental samples such as sewage sludge, river and marine sediments. The phosphorus contents in the extracts were spectrophotometrically determined; the measurement conditions and the matrix effects were evaluated for each fraction. The partitioning patterns obtained for sewage sludge and sediment samples reveal that the distribution between inorganic and organic phosphorus forms is independent of the matrix composition of the samples. In addition, a higher available phosphorus content was found in sewage sludges due to the higher percentages of labile phosphorus forms, which suggests possible internal phosphorus release. Finally, one simplified pseudototal microwave digestion method was performed for total phosphorus determination which was validated by its application to the reference material BCR-684.

Comparison of single extraction procedures, using either conventional shaking or microwave heating, and the Tessier sequential extraction method for the fractionation of heavy metals from environmental samples.

The conventional four-step sequential extraction method and the EDTA and acetic acid single extraction procedures were applied to sewage sludge and sediment samples. The results obtained with these samples for Cu, Cr, Ni, Pb and Zn using the Tessier method were compared with those supplied by the two single extraction procedures employed. In addition, the Tessier method was also applied to a reference material, CRM 483, and these results were also compared with the certified EDTA and acetic acid values for this sample. As a result, good agreement was found between the metal contents released in the first three fractions of the Tessier method and those leached by the simpler single extraction procedures for the most of the elements studied. Subsequently, the conventional EDTA and acetic acid extraction methods were accelerated by means of microwave energy, in order to reduce the operating time. The extraction efficiency of the first three fractions of the Tessier method was compared with that obtained using the optimised microwave single extraction procedures and only in sewage sludge and CRM 483 samples were satisfactory results found for all the elements studied, except Cr and Pb. This means that the microwave single extraction procedures optimised in this work could be employed as screening methods to evaluate rapidly the easiest mobilizable heavy metals in these samples, although more samples should be analysed to determine their general applicability. The application of the accelerated single extraction procedures to a reference material, CRM 483, provided satisfactory results for all the elements studied, except for Cr in both methods and for Pb in the acetic acid extracts.

Metal fractionation in olive oil and urban sewage sludges using the three-stage BCR sequential extraction method and microwave single extractions.

The conventional three-stage BCR sequential extraction method was employed for the fractionation of heavy metals in sewage sludge samples from an urban wastewater treatment plant and from an olive oil factory. The results obtained for Cu, Cr, Ni, Pb and Zn in these samples were compared with those attained by a simplified extraction procedure based on microwave single extractions and using the same reagents as employed in each individual BCR fraction. The microwave operating conditions in the single extractions (heating time and power) were optimized for all the metals studied in order to achieve an extraction efficiency similar to that of the conventional BCR procedure. The measurement of metals in the extracts was carried out by flame atomic absorption spectrometry. The results obtained in the first and third fractions by the proposed procedure were, for all metals, in good agreement with those obtained using the BCR sequential method. Although in the reducible fraction the extraction efficiency of the accelerated procedure was inferior to that of the conventional method, the overall metals leached by both microwave single and sequential extractions were basically the same (recoveries between 90.09 and 103.7%), except for Zn in urban sewage sludges where an extraction efficiency of 87% was achieved. Chemometric analysis showed a good correlation between the results given by the two extraction methodologies compared. The application of the proposed approach to a certified reference material (CRM-601) also provided satisfactory results in the first and third fractions, as it was observed for the sludge samples analysed.

[Homozygous familial hypercholesterolemia. Response to combined cholestyramine and lovastatin therapy]. / Hipercolesterolemia familiar homocigota. Respuesta al tratamiento combinado con colestiramina y lovastatina.

Homozygous familiar hypercholesterolemia (FH) is a serious inherited disease caused by a genetic defect in the cell surface receptor that controls the degradation of low density lipoprotein (LDL). These patients often have myocardial infarction in their teens or early adulthood and are usually unresponsive to drugs. Recently it has been reported promising results using combined drugs regimens in patients with residual receptor activity. We report a new additional patient with receptor-defective homozygous FH treated with a combination of lovastatin and cholestyramine. The cholesterol levels were reduced in a 67% and there were adverse events related to treatment during a 7 month period of follow-up.

[The cardiorespirogram in the first 12 hours of life. Relation to the form of termination of labor]. / Estudio del cardiorrespirograma en las primeras doce horas de vida. Relación con la forma de terminación del parto.

Cardiorespirography is a method of monitoring which establishes a correlation between cardiac and respiratory activity. During the first twelve hours following birth cardiorespirographic parameters undergo a series of evolutionary modifications, becoming stable between the sixth and twelfth hours. Authors analyse how the manner in which birth is terminated influences parameters during first twelve hours. In the case of caesarean births they find only one instance of diminishing accelerations during the first hour, and in spontaneous births, a reduced number of instances of decelerations are registered during first and sixth hour. They believe that these findings are due to drugs administered during birth rather than to the manner in which this was achieved.

[Cardiorespirographic parameters in the first 12 hours of life. Influence of the administration of thiopental and diazepam plus thiopental on labor]. / Parámetros cardiorrespirográficos en las primeras doce horas de vida. Influencia de la administración de tiopental y diacepam más tiopental en el parto.

Cardiorespirographic parameters undergo a series of evolutionary modifications during first hours of life, becoming stable between the sixth and twelfth. The authors analyse how these parameters are influenced by the administration to the mother of thiopental and diazepam plus thiopental during birth. They observed a significant reduction, during the first hour after birth, in the range and frequency of accelerations in the newborn babies whose mothers had been administered one of the drugs. Also, they observed a greater number of cases of decelerations in the newborns who were given drugs. No significant differences were observed in other parameters, and after the twelfth hour no differences were observed at all.