Effectiveness of an educational group intervention in primary healthcare for continued exclusive breast-feeding: PROLACT study.

BACKGROUND: The World Health Organization leads a global strategy to promote the initiation and maintenance of breast-feeding. Existing literature shows that education and supportive interventions, both for breast-feeding mothers as well as for healthcare professionals, can increase the proportion of women that use exclusive breast-feeding, however, more evidence is needed on the effectiveness of group interventions. METHODS: This study involves a community-based cluster randomised trial conducted at Primary Healthcare Centres in the Community of Madrid (Spain). The project aims to evaluate the effectiveness of an educational group intervention performed by primary healthcare professionals in increasing the proportion of mother-infant pairs using exclusive breastfeeding at six months compared to routine practice. The number of patients required will be 432 (216 in each arm). All mother-infant pairs using exclusive breastfeeding that seek care or information at healthcare centres will be included, as long as the infant is not older than four weeks, and the mother has used exclusive breastfeeding in the last 24 h and who gives consent to participate. The main response variable is mother-infant pairs using exclusive breast-feeding at six months. Main effectiveness will be analysed by comparing the proportion of mother-infant pairs using exclusive breast-feeding at six months between the intervention group and the control group. All statistical tests will be performed with intention-to-treat. The estimation will be adjusted using an explanatory logistic regression model. A survival analysis will be used to compare the two groups using the log-rank test to assess the effect of the intervention on the duration of breastfeeding. The control of potential confounding variables will be performed through the construction of Cox regression models. DISCUSSION: We must implement strategies with scientific evidence to improve the percentage of exclusive breast-feeding at six months in our environment as established by the WHO. Group education is an instrument used by professionals in Primary Care that favours the acquisition of skills and modification of already-acquired behaviour, all making it a potential method of choice to improve rates of exclusive breast-feeding in this period. TRIAL REGISTRATION: The trial was registered with ClinicalTrials.gov under code number NCT01869920 (Date of registration: June 3, 2013).

Daily oscillations of skin temperature in military personnel using thermography.

INTRODUCTION: The human body makes many physiological adjustments throughout the day, including adjustments to body temperature. The purpose of this study was to determine oscillations in the skin temperature (Tsk-1-Tsk-25) at 25 body regions of interest (ROIs) over 1 day using infrared thermography. METHODS: Tsk values of 31 male (age 22.9±3.0 years) Brazilian Air Force members were evaluated from five thermograms collected at 7, 11, 15, 19 and 23 h (Tsk7,11,15,19,23) by a Fluke imager. We applied one-way analysis of variance for repeated measures for the different times of the day and Tukey's post hoc test to determine significant Tsk differences between ROIs (α=0.05), and the cosinor analysis was used to determine the midline estimating statistic of rhythm, amplitude and acrophase of Tsk during the 24 h period. RESULTS: The anterior hands showed the greatest Tsk variations throughout the day. In the lower limbs, scapula, abdomen, chest and lower back, Tsk-11, Tsk-15, Tsk-19 and Tsk-23 were significantly different (p<0.05) from Tsk-7. The lowest Tsk values were obtained in the early morning, with increases in the afternoon and levelling after 15:00. CONCLUSIONS: The Tsk at all ROIs and the averaged Tsk showed oscillations throughout the day, with the lowest values in the early morning (07:00). Temperature fluctuations depended on the specific ROI, with thermal stabilisation in some regions in the afternoon and a central upward trend throughout the day in the hands.

An examination of injuries in Spanish Professional Soccer League.

AIM: Objective of the study was to examine the injury incidence in the Spanish Professional Soccer League, and to analyse differences between competition and training. METHODS: Sport injuries data from 11 out of 22 Spanish second division soccer teams (301 players) were prospectively collected during the season 2008/2009. RESULTS: A total of 891 injuries (111 recurrence injuries) were identified during 161602.7 hours of exposure. Competition injury incidence was higher than training (38.8 vs. 3.8 injuries per 1000h; P<0.05). The higher injury incidence was located at lower extremities (4.82 per 1000 h), and mainly affected muscles and tendons (3.1 per 1000 h). Two out of three injuries were due to overuse (54% during competition and 72% during training), and mainly result in players were unable to full soccer participation for less than 7 days (64%). Training injury incidence was higher during the pre-season and tended to decrease throughout the season (P<0.05), while competition injury incidence increased progressively throughout the season (P<0.05). CONCLUSION: In our best knowledge, this is the first examination of injuries in Spanish professional soccer players. The main findings of the study suggest that competition is much more injurious than training, revealing a progressive decrease of training injury incidence and a progressive increase of competition injury incidence throughout the season. These data might be considered by clubs, coaches, and medical staff in order to design new strategies that reduce injury risk in Spanish Professional Soccer League.

[Go to the health center or go to the drug store? Pharmacy offices as a primary care resource]. / Ir al centro de salud o bajar a la farmacia? Las oficinas de farmacia como recurso de atención primaria.

OBJECTIVE: To find what the pharmacy office represents socially to the population that uses it most. DESIGN: Qualitative study. Analysis of the contents of two discussion groups. PARTICIPANTS: Women from 30 to 60 years old, urban residents of the Community of Madrid. MEASUREMENTS AND MAIN RESULTS: The pharmacy offices were identified by the user as a primary care resource which was accessible--both because of its closeness and opening hours--and trustworthy. They provided health care support for treating minor ailments ("assisted self-medication") and also advised on medical technicalities and use of medication. Users with potentially serious clinical pictures were referred from the pharmacy to the doctor. The images associated with "going to the doctor" lacked the nearness and familiarity of "dropping round to the pharmacy". CONCLUSIONS: Integrating pharmacy office pharmacists into a general primary care framework would improve the health of the general population.