Predictors of a positive birth experience in childbirth: A cross-sectional study.

Background: Recognizing predictors of positive birth experience is viewed as essential for minimizing negative experiences during childbirth that are related to current obstetric care, especially when those could be attributed to intrapartum interventions. The CEQ-E is a suitable instrument for investigating maternal birth experience within the Spanish population, highlighting the necessity to identify predictors for all its domains. This study aimed to identify predictors of positive birth experience based on socio-demographic and clinical variables, and obstetric interventions. Methods: Cross-sectional study conducted with consecutive sampling (N = 301). Quantitative data were collected by the Childbirth Experience Questionnaire (CEQ-E) and an Ad hoc questionnaire. Clinical data was obtained from participants' medical records. Descriptive, bivariant and multivariant analysis were performed. Results: The CEQ overall mean score was 3.18(SD:0.42), showing the highest score for the professional support (3.79; SD: 0.43) and the lowest for the own capacity (2.8; SD:0.57). All domains and overall score showed negative correlations with the number of intrapartum interventions (p ≤ .001). Inductions of labour, instrumental deliveries, and caesarean sections were inversely related to; overall birth experience score (p ≤ .001), perceived safety (p ≤ .001), and own capacity (p ≤ .001). Epidural analgesia was linked to worse values of birth experience (p ≤ .001). Predictors of positive birth experience were identified as having a midwife as birth attendant (p ≤ .001) and neonatal higher Apgar scores at birth (p ≤ .001), whereas higher maternal education grade (p = .04), inductions of labour (p ≤ .001) and caesarean births (p ≤ .001) had worse values on birth experience. Conclusion: Women reported a positive birth experience, and professional support was highly valued. Key predictors of lower scores in birth experience included higher maternal education, caesarean and instrumental deliveries, and neonatal intensive care unit (NICU) admission. Spontaneous labour onset predicted better capacity and safety. Epidural use decreased participation. Midwife-attended births reported better scores on birth experience, highlighting their importance in maternal care.

[Effects of a Phase III cardiac rehabilitation program on functional capacity and body composition for coronary heart disease]. / Efectos de un programa de rehabilitación cardíaca fase iii en la capacidad funcional y composición corporal en pacientes con cardiopatía isquémica.

INTRODUCTION AND OBJECTIVES: The effects of a phase III cardiac rehabilitation program (CRP) have been insufficiently studied in terms of training methods and administration. We studied the impact on functional capacity, body composition and physical activity engagement of interdisciplinary program based on aerobic and community strength therapeutic exercise after an acute coronary syndrome. TRIAL DESIGN: Randomised clinical trial. METHODS: Eighty consecutive patients with stable ischemic heart disease and preserved systolic function before phase II CRP were included. They were distributed into a control group (CG), with autonomous exercise, and an experimental group (EG), that follows supervised community program based on aerobic exercise and overload dynamic muscle strength, and an educational strategy through short messaging. Both groups underwent monthly inpatient group therapy. Results were compared after 12 months. RESULTS: Functional capacity presented higher levels in the EG and measured by the 6-min walk test (26.0±27.4m; P<.001), and maximal exercise test (0.6±2.2METs; P=.021). Home physical activity measured in minutes by IPAQ questionnaire increased more in the EG (90±78min/week) (P=.047), and the sitting time during the week decreased (-50.25±94.48min/day) (P=.001). There were no differences in body mass index, although we found a higher percentage of adipose tissue in CG after 12 months (P=.039). CONCLUSIONS: A multidisciplinary community phase III CRP based on aerobic and dynamic muscle strength therapeutic exercise combined with a short message service educational strategy was feasible. After 12 months, patients in the EG presented higher levels on functional capacity, reported higher physical activity engagement compared to the CG.

[Effects of an interdisciplinary program combining aerobic interval training and dynamic strength in acute coronary syndrome]. / Efectos de un programa interdisciplinar combinado con entrenamiento aeróbico continuo variable y fuerza dinámica en el síndrome coronario agudo.

INTRODUCTION AND OBJECTIVES: Cardiac rehabilitation has the highest level of recognition in medical guideline references, however there are still little-explored training modalities. We study the effects of an interdisciplinary program after acute coronary syndrome (ACS) in phase II secondary prevention. METHODS: Between January 2008 and December 2018, 439 patients with stable ischemic heart disease and preserved systolic function were included, as maximum 2 month after the ACS. A combined aerobic resistance training program in a variable continuous method and muscle toning with overload and/or ballast was applied, in addition to nutritional counseling and psychological-educational therapy for 12 weeks. RESULTS: 378 patients finished. The functional capacity increases in the incremental stress test (1.76 METS; CI 95%: 1.59-1.96, p < 0.001) and in the six minutes walking test (32.58 m; CI 95%: 29.24-35.92, p < 0.001). Leisure physical activity in IPAQ increased (763.27 min/week; CI 95%: 583.31-943.16, p < 0.001) and the time sitting during the week decreased (-28.85 min/day; CI 95%: -43.94 to -13.77, p < 0.001). Also, eating habits improved in PREDIMED (2.58 units; CI 95%: 1.43-3.73, p < 0.001), decreased body weight (-0.88 kg; CI 95%: -1.26 to -0.49, p < 0.001), the abdominal perimeter (1.57 cm; CI 95%: 2.23-0.90, p < 0.001) and adipose tissue (-0.80%; CI 95%: -1.10 to -0.51, p < 0.001). CONCLUSIONS: An interdisciplinary program with high intensity variable continuous training combined with dynamic muscle toning increases functional capacity, the level of physical activity, improves body composition and eating habits in ACS patients.

Efectos de un programa de rehabilitación cardíaca fase iii en la capacidad funcional y composición corporal en pacientes con cardiopatía isquémica / Effects of a Phase III cardiac rehabilitation program on functional capacity and body composition for coronary heart disease

Introducción y objetivos: Los programas de rehabilitación cardíaca (PRC) fase III han sido poco investigados tanto por los métodos de entrenamiento como por las modalidades de administración. Estudiamos los efectos en capacidad funcional, composición corporal y adherencia a la actividad física de un PRC interdisciplinar basado en ejercicio terapéutico aeróbico combinado con fuerza muscular tras síndrome coronario agudo. Diseño del estudio: Ensayo clínico aleatorizado. Métodos: Ochenta pacientes con cardiopatía isquémica estable y función sistólica preservada fueron incluidos posteriormente a un PRC fase II. Se distribuyeron en grupo control (GC), con ejercicio autónomo y grupo experimental (GE), con ejercicio aeróbico combinado con fuerza muscular comunitaria, además de estrategia educativa de mensajería telefónica instantánea. Ambos grupos realizaron terapia grupal hospitalaria. Se compararon los resultados de capacidad funcional, composición corporal y nivel de actividad física tras 12 meses. Resultados: La capacidad funcional presentó niveles más altos en el GE en la prueba de marcha de 6min, 26,03m (DE: 27,4; p<0,001), y en la ergometría incremental convencional, 0,6METs (DE: 2,2; p=0,021). El nivel de actividad física domiciliaria medido con el cuestionario IPAQ en el GE incrementó 90,38min/semana (DE: 79,7; (p=0,047), y disminuyó el tiempo sedentario entresemana −50,3min/día (DE: 94,5; p=0,001). Ambos grupos aumentaron el tejido adiposo, sobre todo el GC 1,4% (DE: 3,1; p=0,039). Conclusiones: Los pacientes con síndrome coronario agudo que realizaron un PRC fase III comunitario durante 12 meses, mediante ejercicio terapéutico aeróbico combinado con fuerza muscular y estrategias educativas de mensajería telefónica instantánea, presentaron niveles más altos en capacidad funcional y actividad física reportada.(AU)

Introduction and objectives: The effects of a phase III cardiac rehabilitation program (CRP) have been insufficiently studied in terms of training methods and administration. We studied the impact on functional capacity, body composition and physical activity engagement of interdisciplinary program based on aerobic and community strength therapeutic exercise after an acute coronary syndrome. Trial design: Randomised clinical trial. Methods: Eighty consecutive patients with stable ischemic heart disease and preserved systolic function before phase II CRP were included. They were distributed into a control group (CG), with autonomous exercise, and an experimental group (EG), that follows supervised community program based on aerobic exercise and overload dynamic muscle strength, and an educational strategy through short messaging. Both groups underwent monthly inpatient group therapy. Results were compared after 12 months. Results: Functional capacity presented higher levels in the EG and measured by the 6-min walk test (26.0±27.4m; P<.001), and maximal exercise test (0.6±2.2METs; P=.021). Home physical activity measured in minutes by IPAQ questionnaire increased more in the EG (90±78min/week) (P=.047), and the sitting time during the week decreased (−50.25±94.48min/day) (P=.001). There were no differences in body mass index, although we found a higher percentage of adipose tissue in CG after 12 months (P=.039). Conclusions: A multidisciplinary community phase III CRP based on aerobic and dynamic muscle strength therapeutic exercise combined with a short message service educational strategy was feasible. After 12 months, patients in the EG presented higher levels on functional capacity, reported higher physical activity engagement compared to the CG.(AU)