Impact of the COVID pandemic on vascular access creation for haemodialysis in 16 Spanish haemodialysis centres.

Background: The coronavirus disease (COVID) pandemic has resulted in a major disruption in healthcare that has affected several medical and surgical specialties. European and American Vascular Societies have proposed deferring the creation of an elective vascular access (VA) [autologous or prosthetic arteriovenous fistula (AVF) or arteriovenous graft (AVG)] in incident patients on haemodialysis (HD) in the era of the COVID pandemic. The aim of this study is to examine the impact of the COVID pandemic on VA creation and the central venous catheter (CVC)-related hospitalizations and complications in HD patients dialyzed in 16 Spanish HD units of three different regions. Methods: We compared retrospectively two periods of time: the pre-COVID (1 January 2019-11 March 2020) and the COVID era (12 March 2020-30 June 2021) in all HD patients (prevalent and incident) dialyzed in our 16 HD centres. The variables analysed were type of VA (CVC, AVF and AVG) created, percentage of CVC in incident and prevalent HD patients, CVC-related hospitalizations and complications (infection, extrusion, disfunction, catheter removal) and percentage of CVC HD sessions that did not reach the goal of Kt (>45) as a marker of HD adequacy. Results: A total of 1791 VAs for HD were created and 905 patients started HD during the study period. Patients who underwent vascular access surgery during the COVID period compared with pre-COVID period were significantly younger, with a significant decrease in surgical activity to create AVFs and AVGs in older HD patients (>75 and >85 years of age). There was a significant increase in CVC placement (from 59.7% to 69.5%; P < 0.001) from the pre-COVID to the COVID period. During the COVID pandemic, a significantly higher number of patients started HD through a CVC (80.3% versus 69.1%; P < 0.001). The percentage of CVC in prevalent HD patients has not decreased in the 19 months since the start of the pandemic [414 CVC/1058 prevalent patients (39.4%)]. No significant changes were detected in CVC-related hospitalizations between the pre-COVID and COVID periods. In the COVID period, a significant increase in catheter replacement and the percentage of HD session that did not reach the HD dose objective (Kt > 45) was observed. Conclusions: COVID has presented a public health system crisis that has influenced VA for HD, with an increase in CVCs relative to AVFs. A decrease in HD sessions that did not reach the HD dose objective was observed in the COVID period compared with a pre-COVID period.

Intradialytic Exercise: One Size Doesn't Fit All.

Purpose: Hemodialysis patients commonly have impaired physical performance and mental health. We studied the effects of an intradialytic exercise program on these variables. Methods: 27 patients (33% women; 68 ± 13 years) were enrolled in a 14-week intradialytic endurance-resistance training program ('exercise' group, 40 programmed sessions per patient); 40 hemodialysis patients (28% women; 68 ± 11 years) performing no exercise during the same time length were used as controls. Endpoints included physical performance (6-min walk test [6MWT], 10-repetition sit to stand [STS-10] and handgrip strength), emotional status (Beck's depression inventory and State-Trait Anxiety Inventory), and mental and physical component scores of the short-from (SF)-12 Health Survey. Results: There were no differences (p> 0.05) between groups at baseline for sex distribution, or mean age, body mass index and time spent on dialysis. Exercise benefits were observed for 6MWT (11 and -3% for the exercise and control groups, respectively; p < 0.001), STS-10 performance time (-22 and 6%; p < 0.001) and handgrip strength (4 and -4%; p < 0.02). No significant benefits (p> 0.05) were observed for emotional status endpoints or SF-12 component scores. Despite significant benefits on physical performance, the proportion of clinically meaningful responders was low (<50%). Responsiveness was dependent on baseline physical performance (p < 0.05) but not on age or sex (p > 0.05). Conclusion: A 14-week intradialytic training program induced significant improvements on physical performance. However, the rate of clinically meaningful responders observed in the present study was low, being the level of responsiveness dependent on baseline physical status. Efforts to individualize exercise prescription are needed in clinical practice.

Immediate effect of ultrasound and ischemic compression techniques for the treatment of trapezius latent myofascial trigger points in healthy subjects: a randomized controlled study.

OBJECTIVE: The purpose of this study was to determine immediate effects of ischemic compression (IC) and ultrasound (US) for the treatment of myofascial trigger points (MTrPs) in the trapezius muscle. METHODS: Sixty-six volunteers, all CEU-Cardenal Herrera University, Valencia, Spain, personnel, participated in this study. Subjects were healthy individuals, diagnosed with latent MTrPs in the trapezius muscle. Subjects were randomly placed into 3 groups: G1, which received IC treatment for MTrPs; G2, which received US; and G3 (control), which received sham US. The following data were recorded before and after each treatment: active range of motion (AROM) of cervical rachis measured with a cervical range of motion instrument, basal electrical activity (BEA) of muscle trapezius measured with surface electromyography, and pressure tolerance of MTrP measured with visual analogue scale assessing local pain evoked by the application of 2.5 kg/cm(2) of pressure using a pressure analog algometer. RESULTS: The results showed an immediate decrease in BEA of the trapezius muscle and a reduction of MTrP sensitivity after treatment with both therapeutic modalities. In the case of IC, an improvement of AROM of cervical rachis was also been obtained. CONCLUSION: In this group of participants, both treatments were shown to have an immediate effect on latent MTrPs. The results show a relation among AROM of cervical rachis, BEA of the trapezius muscle, and MTrP sensitivity of the trapezius muscle gaining short-term positive effects with use of IC.

Creímos en la lactancia materna. Una aproximación de la experiencia en tres generaciones / We believed in breast feeding. An approach to the experience of three generations

Los cambios en la sociedad conducen a que los bebés no se alimenten con leche materna, por lo que se están llevando a cabo proyectos de concienciación e investigación sobre los beneficios de la leche materna y los factores que conducen a las madres a elegir una u otra opción. Objetivo: Analizar el significado, a través de tres generaciones, de ciertas prácticas y creencias mediante sus experiencias vividas. Metodología: Estudio cualitativo, entrevista semidirigida. Muestreo intencionado (círculo de familiares y amistades). En 12 mujeres con edades comprendidas entre 21 años y 81 años. Resultados: La media de crianza de la primera generación estuvo entre 18 y 24 meses. Actualmente la mantienen hasta los seis o siete meses. El rol de las nodrizas ha contribuido a idealizar la lactancia materna y a fomentar lazos afectivos. La decisión de amamantar está muy influida por las creencias sociales adquiridas y el apoyo del entorno. El trabajo de la mujer constituye una dificultad si se quiere prolongar la lactancia. Conclusión: Los cambios socio-culturales y sanitarios no han sido obstáculo para seguir manteniendo su práctica. El amamantamiento se considera un proceso natural y la relación emocional no puede ser reemplazada con la lactancia artificial

Our changing society is not encouraging breastfeeding, thus research and awareness projects are being carried out regarding the benefits of breastfeeding and the factors influencing mothers’ decision. Objective: To analyze the meaning, through three generations, of certain practices and beliefs by their living experiences. Methodology: Qualitative study, semi-supervised interviews. Deliberate sampling (family and friends) of 12 women between 21 and 81 years old. Results: The average breastfeeding of first baby used to be 18-24 months. Presently it is maintained for 6- 7 months. The role of wet nurses has contributed to the idealisation of breastfeeding and the reinforcement of affective bonds. The decision of breastfeeding is highly influenced by the acquired social beliefs and the social support network. Women's jobs constitute a difficulty towards prolonging breastfeeding. Conclusion: Socio-cultural changes and health issues have not been an obstacle to the maintenance of breastfeeding. Breastfeeding is considered a natural process and the emotional relationship cannot be replaced with artificial feeding (AU)