The effect of virtual reality versus standard-of-care treatment on pain perception during paediatric vaccination: A randomised controlled trial.

AIMS AND OBJECTIVES: To determine the effect of immersive virtual reality (VR) on perceived pain and fear in children during vaccination and parental satisfaction with the procedure. BACKGROUND: Virtual reality can reduce the perception of pain by children but only three studies have analysed its use during vaccination to date; these had small sample sizes and imperfect methodological designs. DESIGN: A randomised controlled clinical trial. METHODS: One hundred and sixty participants from the Tres Forques Health Center were randomly assigned to the intervention group (IG) (n = 82) in which distraction with immersive VR was used during the vaccination, while standard distraction techniques were used for the control group (n = 80). The primary outcome was pain (Wong-Baker FACES). Secondary outcomes included (Children's Fear Scale) and parental satisfaction with the vaccination procedure. Chi-squared tests were used for qualitative variables, relationships between quantitative variables were tested with Spearman correlations, and Mann-Whitney U- or Student t-tests were employed to assess the relationship between quantitative and qualitative variables. RESULTS: Compared to the controls, the children in the IG reported significantly less pain and fear, while parental satisfaction was significantly higher. Reported pain and fear did not differ according to the sex of the patient. Child age was not linked to fear but was related to pain: the younger the patient, the greater the pain they described. CONCLUSIONS: Immersive VR effectively controlled pain and fear in children during vaccination and increased parent satisfaction with the vaccination process. Patient sex did not influence the level of pain and fear but age did. RELEVANCE TO CLINICAL PRACTICE: Improving vaccination experiences can reduce perceived pain and fear in children and increase parent satisfaction, thereby enhancing vaccination schedule adherence and improving group immunity. REPORTING METHOD: The CONSORT Statement for non-pharmacological randomised clinical trials were followed.

The short and long-term effects of aerobic, strength, or mixed exercise programs on schizophrenia symptomatology.

The purpose of this study was to compare the effects of three different physical exercise programs on the symptomatology, body composition, physical activity, physical fitness, and quality of life of individuals with schizophrenia. A total of 432 patients were assessed for eligibility and 86 were randomized into the aerobic (n = 28), strength (n = 29) or mixed (n = 29) groups. Positive, negative, and general symptoms of psychosis, body mass index (BMI), physical activity (IPAQ-SF), physical fitness (6-min walk test [6MWT] and hand-grip strength [HGS]), and quality of life (WHOQUOL-BREF) were assessed at baseline, post-intervention (16 weeks), and at 10-months. Our results at 16 weeks showed significant improvements in all three groups in the negative, general, and total symptoms with moderate to large effect sizes (P < 0.01, ηp2 > 0.11), no change in the BMI, 6MWT or IPAQ-SF, and a significant improvement in the HGS test in the strength and mixed groups (P ≤ 0.05, ηp2 > 0.08). Nonetheless, all the improvements had disappeared at 10 months. We concluded that 3 weekly sessions of a moderate to vigorous progressive exercise program for 16 weeks improved the symptomatology of individuals with schizophrenia in all three groups, with no differences between them. However, the effects had declined to baseline levels by the 10-month follow-up, suggesting that exercise interventions should be maintained over time.

Asociación entre el duelo por muerte intrauterina y la interacción con los/as profesionales sanitarios en una muestra de mujeres españolas / Association between grief due to intrauterine death and interaction with healthcare professionals in a sample of Spanish women

Objetivos: Describir el apoyo emocional y la competencia profesional percibida por las mujeres que han sufrido una pérdida por muerte intrauterina, y analizar la asociación entre la relación paciente-profesional y la intensidad del duelo y otras variables relacionadas con la pérdida. Por otra parte, se pretende conocer la existencia de variables predictoras del duelo por muerte intrauterina. Metodología: Estudio observacional, descriptivo y retrospectivo, en el que han participado 95 mujeres que tuvieron una o más pérdidas espontáneas del embarazo en los últimos 5 años. Se analizó la intensidad del duelo (adaptación española validada de la escala de duelo Perinatal Grief Scale, con puntuaciones de 16 a 80: a mayor puntuación, mayor intensidad del duelo) y la interacción con los profesionales sanitarios durante la pérdida (encuesta validada de la calidad de la atención en muerte intrauterina, con puntuaciones de 13 a 65: a mayor puntuación, mayor calidad en la atención percibida). Resultados: Un 90,5% de las mujeres presenta un duelo activo, y la media de intensidad de duelo es de 38,8 ± 9,8. La media obtenida en la interacción con los profesionales sanitarios fue de 39,2 ± 10,2. El duelo fue predicho por la interacción con el personal sanitario (R2 ajustado= 0,281), por la semana de la pérdida (R2 ajustado= 0,38) y por el tiempo transcurrido desde la pérdida (R2 ajustado= 0,409). Conclusiones: Existe una relación inversa entre la calidad de la atención percibida por las participantes durante la pérdida y la intensidad del duelo, que es la principal variable predictora del duelo en las mujeres de esta muestra. (AU)

Objectives: To describe the emotional support and professional competence perceived by women who have suffered a loss due to intrauterine death, and to analyze the association between the patient-professional relationship and the intensity of grief and other variables related to the loss. On the other hand, it is intended to know the existence of predictors of intrauterine death grief. Methodology: Retrospective descriptive observational study involving 95 women who had one or more spontaneous pregnancy losses in the last 5 years. Grief intensity was analyzed (validated Spanish adaptation of the Perinatal Grief Scale, with scores from 16 to 80 points: the higher the score, the greater the intensity of grief); and the interaction with health professionals during loss (validated survey of the quality of care in intrauterine death, with scores from 13 to 65 points: the higher the score, the higher the quality of perceived care). Results: 90,5% of the women have active grief (average grief intensity of 38.8 ± 9.8). The mean obtained in the interaction with health professionals was 39.2 ± 10.2. Grief was predicted by interaction with healthcare professionals (adjusted R2 = 0.281), by the gestational week of the loss (adjusted R2 = 0.38) and by the time elapsed since the loss (adjusted R2 = 0.409). Conclusions: There is an inverse relationship between the quality of care perceived by the participants during the loss and the intensity of grief, being this relationship the main predictor of grief in the women in this sample. (AU)

Autopercepción del estado de salud como indicador de la calidad de vida de los pacientes con deterioro cognitivo en función de su lugar de residencia: domicilio versus centro sociosanitario / Self-perception of health status as an indicator of the quality of life in patients with cognitive dysfunction based on the residence: home care versus nursing home

OBJETIVO: analizar la relación entre las variables sociodemográficas y clínicas en pacientes con deterioro cognitivo en función del lugar de residencia (domicilio familiar frente a instituciones), comparándola con la autopercepción del estado de salud de ambos grupos. MATERIAL Y MÉTODOS: estudio comparativo observacional transversal. La muestra estuvo formada por 71 sujetos, de los cuales 44 recibían cuidado informal en su domicilio y asistían a un centro de día (Valencia, España), y 27 que residían en un centro sociosanitario (Teruel, Valencia), ambos situados en zona rural. Los participantes fueron evaluados mediante el índice de comorbilidad de Charlson, Mini-Mental Test de Folstein (MMSE), test de fluidez verbal, autopercepción del estado de salud mediante escala visual analógica del Euro-Qol y variables sociodemográficas que incluyeron: sexo, edad, nivel de estudios, estado civil y número de hijos. RESULTADOS: los principales resultados apuntan a que pese a que los pacientes que residen en sus hogares tienen un peor estado cognitivo en relación con el MMSE (diferencia de 3,09 puntos; p = 0,003) y la fluidez verbal (diferencia de 3,05 puntos 5,32; p = 0,000), su autopercepción del estado de salud es superior frente a aquellos que viven en un centro sociosanitario (diferencia de 21,22 puntos; p = 0,000). CONCLUSIONES: los sujetos que residen en el domicilio presentan una autopercepción de su estado de salud mejor que aquellos que residen en el centro sociosanitario, pese a que su estado cognitivo muestra peores resultados. Este aspecto contribuye a la mejora de la utilización de los recursos necesarios hacia los ámbitos donde los cuidados sean más eficaces

OBJECTIVE: analyze the relationship between sociodemographic and clinical variables in patients with cognitive impairment regarding to the place of residence (family home versus institutions), compare their self-perception of health status. MATERIAL AND METHOD: observational comparative study. The sample was formed by 71 participants; 44 of them were living in their homes and attended to a day center and 27 of them resided in a Social Health Center. Participants were evaluated using the Charlson comorbidity index, Folstein Mini Mental Test (MMSE), verbal fluency test, self-perception of health status using Euro-Qol visual analogue scale and sociodemographic variables included: sex, age, level of studies, marital status and number of children. RESULTS: the main results suggest that patients residing in their homes have a worse cognitive state compared to those who lived in Social Health Centers in relation to the MMSE (difference of 3,09 points, p = 0,003) and verbal fluency (difference of 3,05 points 5,32, p = 0,000). However, their self-perception of health status was higher (difference of 21,22 points, p = 0,000). CONCLUSIONS: patients with cognitive dysfunction who reside in their homes have a better self-perception of their health status compared to those who reside in the Social Health Center. This aspect is of relevance to the improvement of the development of cost-effective strategies that encourage the health of patients with cognitive diseases

Estados hipertensivos: perfil materno y papel de la matrona en el Departamento de Salud de Gandía / Hypertensive disorders of pregnancy: maternal profile and role of the midwife in the Department of Health of Gandía

Objetivos: Describir el perfil de las mujeres con estados hipertensivos del embarazo, su relación con los distintos trastornos y el papel de la matrona en el seguimiento de la presión arterial y la derivación de la gestante. Metodología: Estudio de cohortes retrospectivo, que incluye a todas las gestantes derivadas a la Unidad de Hipertensión Arterial del Hospital Francisco de Borja durante el periodo 2009-2015. Resultados: El total de participantes fue de 79. Los trastornos descritos fueron los siguientes: preeclampsia (35/79; 44,3%), hipertensión crónica (31/79; 39,2%), preeclampsia sobreañadida (8/79; 10,1%) e hipertensión gestacional (5/79; 6,3%). Los estados hipertensivos se relacionaron significativamente con el nivel de estudios (p= 0,022), los antecedentes de hipertensión (p= 0,000), obesidad (p= 0,015) y estado hipertensivo en una gestación anterior (p= 0,000). La matrona realizó 6,8 mediciones de presión arterial por gestante, derivó a urgencias a 15 mujeres y a la consulta del nefrólogo a 2. Conclusiones: El perfil de las participantes es similar al referido para las gestantes con estados hipertensivos del embarazo por otros estudios. El subgrupo de hipertensión crónica se asocia con estudios primarios, antecedentes de hipertensión arterial, obesidad y estado hipertensivo en un embarazo anterior. El subgrupo de preeclampsia sobreañadida se asocia a antecedentes de hipertensión arterial. Las primíparas presentan con más frecuencia preeclampsia y las secundíparas o multíparas hipertensión crónica. El mayor seguimiento de la presión arterial se realiza por la matrona, que es la que más deriva al servicio de urgencias y, en menor medida, a la consulta de nefrología

Objectives: To describe the profile of women with hypertensive disorders of pregnany, their relationship between the different disorders and the role of the midwife in monitoring blood pressure and the referral of the woman. Methods: Retrospective cohort study, which includes all the pregnant women referred to the Hypertension Unit of Hospital Francisco de Borja in 2009-2015. Results: The total number of participants was 79. Hypertensive disorders were preeclampsia (44.3%), chronic hypertension (39.2%), superimposed preeclampsia (10.1%) and gestational hypertension (6.3%). Level of studies (p= 0.022), history of hypertension (p= 0.000), of obesity (p= 0.015) and history of hypertensive disorder of pregnany (p= 0.000) were significantly related to the type of hypertensive disorders. The midwife performed 6.8 blood pressure measurements per pregnant woman, and referred 15 women to the emergency hospital unit and two to the nephrologist's office. Conclusions: The profile of the participants is similar to that reported for pregnant women with hypertensive disorders of pregnany by other studies. Chronic hypertension group is related to primary studies, chronic hypertension, obesity and history of hypertensive disorder. Superimposed preeclampsia group is related to history of hypertensive disorder. Primiparous women had more frequently preeclampsia, and secondary or multiparous women had more frequently chronic hypertension. The best follow-up of blood pressure is performed by the midwife, being the one that leads to the emergency unit and to a lesser extent to the nephrologist's office

Perfil perinatal asociado a los estados hipertensivos del embarazo / Perinatal profile associated with hypertensive disorders of pregnancy

Introducción: Los estados hipertensivos del embarazo son un conjunto de trastornos que acontecen en gestantes, siendo una de las principales causas de morbimortalidad materna y perinatal. Se clasifican en: hipertensión crónica, hipertensión gestacional, preeclampsia e hipertensión crónica con preclampsia sobreañadida. El adecuado control de la presión arterial es clave para su seguimiento. Objetivos: describir el perfil de los recién nacidos fruto de una gestación con estados hipertensivos y estudiar si existe relación con el tipo de alteración hipertensiva de la madre. Pacientes y Método: estudio de cohortes retrospectivo, que incluye a recién nacidos de gestantes con estados hipertensivos, seguidas en la unidad de hipertensión arterial, y que naciesen entre el 1 de enero de 2009 y el 31 de diciembre de 2015. Resultados: la muestra estuvo formada por 84 sujetos. La edad gestacional fue de 37,1 y el peso al nacer fue de 2.782,7 g. Las menores edades gestacionales y peso al nacer fueron en hijos de gestantes con preeclampsia o hipertensión crónica con preeclampsia sobreañadida (p<0,05). El Apgar y el sexo del RN no fue diferente en función del estado hipertensivo materno. Conclusiones: el perfil es el de un recién nacido con edad gestacional de 37,1 semanas, peso medio de 2.782,7 g, y Apgar al minuto de nacer de 8,6, y a los 5 minutos de 9,7. El peso al nacer y la edad gestacional se relacionaron significativamente con el tipo de estado hipertensivo de la madre, describiéndose peores resultados en hijos de gestantes con preeclampsia sola o sobreañadida. número de sesiones de entrenamiento (10 sesiones vs 8,7 sesiones; p=0,048)

Introduction: Pregnant women can be affected with a group of disorders called hypertensive disorders of pregnancy. These are classified as follows: chronic hypertension, gestational hypertension, mild preeclampsia, severe preeclampsia and chronic hypertension with superimposed preeclampsia. Hypertensive disorders of pregnancy are among the leading causes of maternal and perinatal morbidity and mortality. An adequate blood pressure monitoring is essential for the follow-up of this risk group. Objective: To describe a profile for new-borns delivered in pregnancies with hypertensive disorders of pregnancy, and to determine whether the profile is related to the different types of disorders. Patients and Method: Retrospective cohort study, which includes new-borns of pregnant women with hypertensive states, followed in the hypertension unit, and born between January 1, 2009 and December 31, 2015. Results: The sample consisted of 84 subjects. The gestational age was 37.1 and the birth weight was 2,782.7 g. The lowest gestational ages and birth weight were in children of pregnant women with preeclampsia or chronic hypertension with superimposed preeclampsia (p<0.05). The Apgar test and the sex of the RN was not different based on the maternal hypertensive state. Conclusions: The profile was a newborn with a gestational age of 37.1 weeks, average weight of 2,782.7 g, and an Apgar test at birth of 8.6, and at 5 minutes of 9.7. Birth weight and gestational age were significantly related to the type of hypertensive state of the mother, with worse results being reported in children of pregnant women with preeclampsia alone or in addition

Conocimientos de los profesionales sanitarios sobre la mutilación genital femenina / Knowledge of healthcare professionals about female genital mutilation

La mutilación genital femenina (MGF) es una práctica realizada en algunas culturas. El hecho de que los profesionales sanitarios traten a personas de diferentes culturas, hace que entren en contacto con prácticas culturales con repercusión en la salud y la enfermedad, como es la MGF. Objetivo: determinar el conocimiento sobre la MGF que poseen matronas, ginecólogos y pediatras de la provincia de Valencia y si estos profesionales se han formado sobre la MGF; identificar el número de casos atendidos por ellos y la actuación realizada, y conocer la percepción que tienen estos profesionales sobre la necesidad de ampliar su formación. Metodología: estudio descriptivo, longitudinal y prospectivo. En el estudio participaron matronas, pediatras y ginecólogos. Para la recogida de datos se utilizó una encuesta de elaboración propia, que fue administrada en diferentes centros de salud y hospitales públicos y privados de la provincia de Valencia. Resultados: la muestra se compuso de 110 encuestados, de los cuales 28(25,24%) eran hombres y 82 (74,54%) mujeres. La edad media era de 42años y tenían una media de 15 años de experiencia profesional. Un 57%respondió correctamente en qué consiste la MGF. El 51,8% conoce las consecuencias derivadas de esta. El 90% considera necesario ampliar su formación. La formación previa está directamente relacionada con poseer conocimientos sobre el tema (p= 0,044; p= 0,002). Existe una relación significativa(p= 4,13 e-11) entre las variables que determinan si los encuestados consideran tener suficiente información, y si consideran necesario ampliarla misma. Conclusiones: los conocimientos por parte de los profesionales sanitarios sobre la MGF no son suficientes y, por tanto, sería recomendable ampliar su formación (AU)

Female Genital Mutilation (FGM) is a practice conducted in some cultures. The fact that healthcare professionals must treat persons from different cultures brings them into contact with cultural practices which have an impact on health and disease, such as FGM. Objective: to determine the knowledge about FGM shown by midwives, gynecologists and pediatricians in the province of Valencia, and whether these professionals have been trained on FGM; to identify the number of cases managed by them and the action taken, and to understand the need to extend their training perceived by these professionals. Methodology: descriptive, longitudinal and prospective study. Midwives, pediatricians and gynecologists were included in the study. A self-prepared survey was used for data collection, and it was administered in different health centers and public and private hospitals in the province of Valencia. Results: the sample included 110 participants; 28 (25.24%) were men and82 (74.54%) were women. Their average age was 42 years, and they had an average 15 years of professional experience. 57% answered correctly to what FGM consists in. 51.8% was aware of the consequences entailed by this practice. A 90% considered it is necessary to extend their training. Previous training is directly associated with having knowledge about the subject (p= 0.044; p= 0.002). There is a significant relationship (p= 4.13e-11) between the variables determining whether participants consider they have enough training, and whether they consider it necessary to extend said training. Conclusions: the knowledge by healthcare professionals about FGM is not sufficient, and therefore, it would be advisable to extend their training (AU)