Actividad educativa sobre el plan de nacimiento en el control prenatal: factores relacionados / Educational activity on birth plan in prenatal care: related factors

OBJETIVOS: Determinar la prevalencia de la actividad educativa (AE) sobre el Plan de Nacimiento (PN) que realizan las matronas en el control prenatal de las gestantes y averiguar las semanas de gestación (SG) en que se efectúa, e identificar los factores asociados a la realización de la AE sobre el PN. MATERIAL Y MÉTODOS: Estudio multicéntrico, descriptivo, transversal, de asociación cruzada. La población de estudio estuvo compuesta por 3.749 gestantes atendidas en 5 unidades de Atención a la Salud Sexual y Reproductiva (ASSIR) del Instituto Catalán de la Salud (ICS) entre 2015 y 2016 en Barcelona. Las principales variables fueron la AE sobre el PN, las SG en que se efectúa y si se realiza >24 SG, según el estándar de calidad del ICS. Los datos procedían de la historia clínica informatizada; se volcaron anonimizados en una hoja Excel, se analizaron con el programa SPSS 24.0 y se efectuó un análisis descriptivo e inferencial. RESULTADOS: Se excluyeron 812 (21,7%) gestantes y se evaluaron 2.937 (78,3%). La prevalencia de entrega del PN fue del 86,9% (n= 2.551; intervalo de confianza [IC] del 95%: 85,6-88,1). La media de SG fue de 24,7 (IC del 95%: 24,3-25,2) y se realizó AE a partir de las 24 SG en el 64,5% (n= 1.598) de las gestantes. Tener un menor número de partos es un factor independiente para recibir AE sobre el PN (odds ratio [OR]= 0,90); por el contrario, tener un nivel de riesgo obstétrico «muy alto» es un factor independiente para no recibirla (OR= 0,57). Las ASSIR con mayor prevalencia de AE sobre el PN tienen menor cumplimiento del estándar de calidad del ICS. CONCLUSIONES: La prevalencia de realización de la AE sobre el PN es elevada. Cerca de dos tercios de las gestantes reciben la AE a partir de las 24 SG, pero hay una gran variabilidad según la ASSIR

OBJECTIVES: To establish the prevalence of the educational activity (EA) of birth plan (BP), that midwives perform in the prenatal control of the pregnant women, to find out gestation week (GW) in what it is carried out, and to identify the associated factors to the accomplishment of the EA in the BP. MATERIAL AND METHODS: Multicenter, descriptive, cross-sectional of crossed association study. The analyzed population was the computerized clinical records of 3,749 pregnant women in 5 units of Sexual and Reproductive Health Care (ASSIR) of the Catalan Health Institute (ICS) between 2015 and 2016 in Barcelona. The main variables were the EA on the BP, the GW in which it was carried out and if it was performed before the 24 weeks, according to the ICS quality standard. The data come from computerized clinical records. Data were introduced anonymously in an excel sheet and analyzed with the statistical package SPSS 24.0. Descriptive and inferential analysis were performed. RESULTS: We excluded 812 (21.7%) pregnant women and we evaluated 2,937 (78.3%). The prevalence of BP delivery was 86.9% (n= 2,551; 95% CI: 85.6-88.1). The mean of GW was 24.7 (CI: 95% 24.3-25.2) and was performed from 24 GW in 64.5% (n= 1,598) pregnant women. Having a lower number of births is an independent factor to receive EA about the BP ( odds ratio [OR]= 0.90); on the contrary, having a "very high" level of obstetric risk is an independent factor to not receiving it (OR= 0.57). The ASSIRS that have a higher prevalence of EA over the BP had a lower compliance with the ICS quality standard. CONCLUSIONS: The prevalence of EA on BP is high. Nearly two thirds of pregnant women receive EA from 24 GW, although results according to ASSIR show a great variability

Duloxetine in the treatment of adolescents with somatoform disorders: a report of two cases.

BACKGROUND: Our goal was to evaluate the effectiveness, safety and tolerability of duloxetine in the treatment of children and adolescents with somatoform disorder. RESULTS: We describe two cases, those of an 11-year old girl and a 17-year old boy, evaluated in our Department after being studied by a Pediatrician and Neuropediatrician due to complex physical symptoms. The evaluations to rule out medical causes were normal. We diagnosed somatoform disorder. The pharmacological treatments with antidepressants, benzodiazepines, stimulants and mood stabilizers only produced brief and partial improvement. After switching the treatment to duloxetine (30 and 60 mg/day, respectively) both patients experienced a gradual improvement that was maintained at 7 and 14 months. Conclusion. Duloxetine may be effective and well tolerated in the treatment of adolescents with somatoform disorder. Controlled trials are need.

Duloxetina en el tratamiento de adolescentes con trastornos somatomorfos: un informe de dos casos / Duloxetine in the treatment of adolescents with somatoform disorders: a report of two cases

Introducción. Nuestro objetivo fue evaluar la eficacia, seguridad y tolerabilidad de duloxetina en el tratamiento de adolescentes con trastorno somatomorfo. Resultado. Describimos dos casos (chica 11 años y varón 17 años) evaluados en nuestro Departamento después de ser valorados por Pediatra y Neuropediatría por síntomas físicos complejos. Las evaluaciónes para descartar causas médicas fueron normales. Realizamos un diagnóstico de trastorno somatomorfo. El tratamiento farmacológico con antidepresivos, benzodiacepinas, estimulantes y estabilizadores del humor sólo produjouna mejoría breve y parcial. Tras cambiar el tratamiento aduloxetina (30 y 60 mg/día respectivamente) los pacientes experimentaron una mejoría gradual y se mantuvo 7 y 14meses. Conclusión. La duloxetina puede ser eficaz y bien tolerada en adolescentes con trastorno somatomorfo. Son necesarios ensayos controlados (AU)

Background. Our goal was to evaluate the effectiveness, safety and tolerability of duloxetine in the treatment of children and adolescents with somatoform disorder. Results. We describe two cases, those of an 11-year old girl and a 17-year old boy, evaluated in our Department after being studied by a Pediatrician and Neuropediatrician due to complex physical symptoms. The evaluations to rule out medical causes were normal. We diagnosed somatoform disorder. The pharmacological treatments with antidepressants, benzodiazepines, stimulants and mood stabilizers only produced brief and partial improvement. After switching the treatment to duloxetine (30 and 60 mg/day, respectively) both patients experienced a gradual improvement that was maintained at 7 and 14 months. Conclusion. Duloxetine may be effective and well tolerated in the treatment of adolescents with somatoform disorder. Controlled trials are need (AU)