Analysis of clinical data associated with Essure® sterilization devices: An expanded case series.

OBJECTIVES: To evaluate clinical data in women who underwent Essure® hysteroscopic sterilization and to determine whether this sterilization technique plays a role in developing new-onset symptoms. STUDY DESIGN: An observational, retrospective, single-center study. It was conducted in a secondary level hospital. It included 804 women who had Essure® hysteroscopic sterilization from 2009 to 2017. Charts from these women were reviewed from June 2009 to November 2019, searching for the development of gynecological symptoms (pelvic pain and bleeding disorders) and non-gynecological symptoms (bloating, joint pain, fatigue, headache, alopecia, allergy and depression). The sample was divided into two groups depending on whether they had developed gynecological symptoms (symptomatic group) or not (asymptomatic group), and a descriptive and comparative analysis was made between them. The impact of the global social alarm in 2015 regarding adverse events attributed to the devices, the development of non-gynecological symptoms, and the treatments required, including conservative and surgical options, were also described. RESULTS: Out of 804 women who had Essure® devices placed, 541(67.29%) remained asymptomatic, 263(32.71%) developed gynecological symptoms, and 41 of these (15.5% of the total sample) requested Essure® surgical removal. Pelvic pain was the most frequent symptom and the main reason for surgical removal. Bleeding alterations were the second most frequent symptom. Up to 55.89% described the symptoms after the social alarm. Non-gynecological symptoms were statistically significantly more frequent in the symptomatic group. CONCLUSIONS: More than a half of the women who underwent Essure® sterilization remained asymptomatic. The new-onset symptoms attributed to the devices are the minority and causality is difficult to establish. IMPLICATIONS STATEMENT: Our research provides new follow-up data about Essure® hysteroscopic sterilization. Association between gynecological symptoms and Essure® devices is difficult to demonstrate and some confounding factors may be implicated. The results we described, may guide and counsel medical-patient decisions for the treatment of symptoms related to the devices, including surgical removal.

Impact of Housing First on Psychiatric Symptoms, Substance Use, and Everyday Life Skills Among People Experiencing Homelessness.

The current unblinded, randomized controlled trial analyzed psychiatric symptoms, substance use, and life skills outcomes in participants after 21 months in the Housing First (HF) program. The HF group (intervention) comprised 46 participants and the treatment-as-usual (TAU) group (control) comprised 41 participants. Quantitative outcome measures were collected at baseline and 8 and 21 months. Primary outcomes were mental health and substance use. Secondary outcomes were everyday life skills. Descriptive and comparative analyses and linear regression models are presented. At 21 months, the HF group presented significantly better outcomes regarding alcohol and cannabis use than the TAU group. Moreover, the subgroup of HF participants with severe mental illness had significant improvements in psychotic symptoms, anxiety, depression, social relations, and cannabis use compared to TAU participants. [Journal of Psychosocial Nursing and Mental Health Services, 60(9), 46-55.].

Cervical adenocarcinoma in situ during pregnancy and subsequent fertility-sparing therapy challenge.

OBJECTIVE: Adenocarcinoma in situ (AIS) of the cervix is a premalignant lesion, and a precursor of invasive disease. It is less frequent than its squamous counterpart. During pregnancy, AIS is a scarcely described scenario, whose diagnosis barely differs from non-pregnant patients. Its management is challenging with hysterectomy being the definitive treatment. However, its high incidence in young patients makes fertility-sparing management an approachable option for selected patients. The objective of this study is twofold. Firstly, we describe a case of a patient with AIS during pregnancy and the postpartum period. Secondly, the available literature is reviewed. METHODS: Retrospective medical record review of a single case and a medical literature search in Pubmed of AIS cases in pregnant women. RESULTS: A 31-year-old woman with cervical AIS diagnosed during pregnancy underwent serial fertility-sparing surgeries including a loop electrosurgical excision procedure and endocervical curettage during the second trimester, and a re-conization and a simple traquelectomy during the postpartum period, until negative margins were achieved. Upon reviewing the literature from 1965 to 2020, 23 other cases were found. CONCLUSION: Surgical management of cervical AIS during pregnancy is a safe procedure. Subsequent conservative surgeries imply a real challenge to preserve fertility.

One-Step Nucleic Acid Amplification (OSNA) of Sentinel Lymph Node in Early-Stage Endometrial Cancer: Spanish Multicenter Study (ENDO-OSNA).

The objective of this study was to evaluate the efficacy of one-step nucleic acid amplification (OSNA) for the detection of sentinel lymph node (SLN) metastasis compared to standard pathological ultrastaging in patients with early-stage endometrial cancer (EC). A total of 526 SLNs from 191 patients with EC were included in the study, and 379 SLNs (147 patients) were evaluated by both methods, OSNA and standard pathological ultrastaging. The central 1 mm portion of each lymph node was subjected to semi-serial sectioning at 200 µm intervals and examined by hematoxylin-eosin and immunohistochemistry with CK19; the remaining tissue was analyzed by OSNA for CK19 mRNA. The OSNA assay detected metastases in 19.7% of patients (14.9% micrometastasis and 4.8% macrometastasis), whereas pathological ultrastaging detected metastasis in 8.8% of patients (3.4% micrometastasis and 5.4% macrometastasis). Using the established cut-off value for detecting SLN metastasis by OSNA in EC (250 copies/µL), the sensitivity of the OSNA assay was 92%, specificity was 82%, diagnostic accuracy was 83%, and the negative predictive value was 99%. Discordant results between both methods were recorded in 20 patients (13.6%). OSNA resulted in an upstaging in 12 patients (8.2%). OSNA could aid in the identification of patients requiring adjuvant treatment at the time of diagnosis.

Effectiveness of a structured group intervention based on pain neuroscience education for patients with fibromyalgia in primary care: A multicentre randomized open-label controlled trial.

BACKGROUND: There has been increased interest in pain neuroscience education (PNE) as a therapeutic approach for the management of fibromyalgia (FM). METHODS: A multicentre randomized, open-label, controlled trial was conducted to assess the effectiveness of a structured group intervention based on PNE in patients with FM. A total of 139 patients were included in the study and randomized to the intervention group (7 group sessions of education in neurobiology of pain) or to the control group (treatment as usual only). The primary outcome was the improvement of functional status and pain measured with the Fibromyalgia Impact Questionnaire (FIQ), and secondary outcomes were the reduction in the impact of pain and other symptoms (catastrophizing, anxiety and depression) and number of patients reaching no worse than moderate functional impairment (FIQ score <39). Differences between groups were calculated by linear mixed-effects (intention-to-treat approach) and mediational models through path analyses. RESULTS: At 1 year, improvements in FIQ scores were higher in the intervention group with moderate or high effect size, and decreases of ≥20% in 69.1% of patients (20.9% in the control group) and of ≥50% in 39.7% (4.5% in the control group). Also, 52.9% of patients had a FIQ <39 points (13.4% in the control group). CONCLUSIONS: In this sample of patients with FM, the improvement in quality of life and control of symptoms obtained by adding a PNE intervention showed promising results, equalling or surpassing previously reported outcomes. SIGNIFICANCE: A structured group intervention based on pain neuroscience education for 1 year in patients with fibromyalgia was associated with significant amelioration of the impact of the disease on scores of the Fibromyalgia Impact Questionnaire, the Health Assessment Questionnaire, the Hospital Anxiety and Depression Scale, the Pain Catastrophizing Scale and the Polysymptomatic Distress Scale as compared with only treatment as usual. These findings are clinically relevant considering the challenges posed by fibromyalgia to clinicians and patients alike.

Efecto de la educación en neurociencia del dolor en pacientes con fibromialgia: intervención grupal estructurada en atención primaria / Effectiveness of pain neuroscience education in patients with fibromyalgia: Structured group intervention in Primary Care

OBJETIVO: Evaluar la efectividad de una intervención grupal en atención primaria en pacientes con fibromialgia (FM), basada en la educación en neurociencia del dolor (Pain Neuroscience Education, PNE). DISEÑO: Estudio de intervención antes-después. EMPLAZAMIENTO: Centro de Salud urbano de Bilbao. PARTICIPANTES: Pacientes con FM (criterios diagnósticos 2010 del American College of Rheumatology), ≥ 18 años. INTERVENCIÓN: Cinco sesiones semanales (2h cada una), y una sesión de recuerdo un mes después. Mediciones principales: Cumplimiento de criterios de FM, mediante los cuestionarios WPI (número de áreas de dolor) y SS (gravedad de los síntomas), e impacto de la FM sobre la capacidad funcional (FIQ: reducción ≥ 20% y ≥ 50% sobre la puntuación basal, y proporción de pacientes con FIQ < 39 al final del estudio). Se hicieron evaluaciones al inicio, al mes de la 5.a sesión, 6 y 12 meses después. RESULTADOS: Completaron todas las evaluaciones del estudio 85/98 pacientes. Se objetivó una mejoría estadísticamente significativa en las 3 categorías estudiadas (WPI, SS y FIQ) desde la primera visita, mantenida hasta la visita final (12 meses después). Cuarenta y cinco pacientes (53%, IC: 42-63%) más que al inicio tuvieron una puntuación en el FIQ < 39 (impacto funcional no grave). Al mes de finalizar la 5.a sesión había 44 (52%, IC: 41-62%) que ya no cumplían criterios de FM y al final del seguimiento 56 (66%, IC: 55-75%). CONCLUSIONES: Una intervención basada en PNE ha mostrado ser factible en atención primaria, con resultados en el rango superior de los publicados con otros tratamientos para FM

OBJECTIVE: To evaluate the effectiveness of a group intervention in Primary Care in patients with fibromyalgia (FM) based on pain neuroscience education (PNE). DESIGN: Pre-post study. LOCATION: Urban Primary Health Centre in Bilbao. PARTICIPANTS: Patients with FM (2010 American College of Rheumatology Diagnostic Criteria for fibromyalgia), ≥ 18 years. Intervention: 5 weekly sessions (2hours each), and a reminder session one month later. MAIN MEASUREMENTS: Compliance with FM criteria, assessed using the WPI (Widespread Pain Index, number of pain areas) and the SS (severity of symptoms) questionnaires. An assessment was also made on the impact of FM on functional capacity (FIQ: ≥ 20% and ≥ 50% reduction in the FIQ total score from baseline to after treatment, and proportion of patients with FIQ < 39 at the end of the study). Assessments were made at baseline, one month following the 5th session, and during the 6- and 12-month follow-up. RESULTS: All the study evaluations were completed by 85/98 patients. A statistically significant improvement was observed in the 3 studied categories (WPI, SS, and FIQ) since the first visit, and was maintained until the final visit (12 months later). A total of 45 patients (53%, 95% CI: 42%-63%), more than those at baseline, scored FIQ < 39 (no worse than mild functional impairment). One month following the 5th session there were 44 patients (52%, 95% CI: 41%-62%) that no longer met FM criteria and, at the end of follow-up, there were 56 patients (66%, 95% CI: 55%-75%). CONCLUSIONS: An intervention based on PNE has shown to be feasible in Primary Care, with results in the upper range of those published with other treatments for FM

[Effectiveness of pain neuroscience education in patients with fibromyalgia: Structured group intervention in Primary Care]. / Efecto de la educación en neurociencia del dolor en pacientes con fibromialgia: intervención grupal estructurada en atención primaria.

OBJECTIVE: To evaluate the effectiveness of a group intervention in Primary Care in patients with fibromyalgia (FM) based on pain neuroscience education (PNE). DESIGN: Pre-post study. LOCATION: Urban Primary Health Centre in Bilbao. PARTICIPANTS: Patients with FM (2010 American College of Rheumatology Diagnostic Criteria for fibromyalgia), ≥18 years. INTERVENTION: 5 weekly sessions (2hours each), and a reminder session one month later. MAIN MEASUREMENTS: Compliance with FM criteria, assessed using the WPI (Widespread Pain Index, number of pain areas) and the SS (severity of symptoms) questionnaires. An assessment was also made on the impact of FM on functional capacity (FIQ:≥20% and ≥50% reduction in the FIQ total score from baseline to after treatment, and proportion of patients with FIQ<39 at the end of the study). Assessments were made at baseline, one month following the 5th session, and during the 6- and 12-month follow-up. RESULTS: All the study evaluations were completed by 85/98 patients. A statistically significant improvement was observed in the 3 studied categories (WPI, SS, and FIQ) since the first visit, and was maintained until the final visit (12 months later). A total of 45 patients (53%, 95% CI: 42%-63%), more than those at baseline, scored FIQ<39 (no worse than mild functional impairment). One month following the 5th session there were 44 patients (52%, 95% CI: 41%-62%) that no longer met FM criteria and, at the end of follow-up, there were 56 patients (66%, 95% CI: 55%-75%). CONCLUSIONS: An intervention based on PNE has shown to be feasible in Primary Care, with results in the upper range of those published with other treatments for FM.

Loneliness in Homeless Participants of a Housing First Program: Outcomes of a Randomized Controlled Trial.

People who are homeless are likely to experience loneliness. Housing First (HF) is a program aimed at providing home placement to homeless people who also have mental health and/or substance use-related problems. The current study was performed to assess feelings of loneliness among participants of a HF program. A randomized controlled trial was performed comparing participants in two groups, HF (n = 46) and treatment as usual (n = 41). No significant differences regarding loneliness between groups were noted at baseline (p = 0.841), 8-month follow up (p = 0.509), or 21-month follow up (p = 0.833); however, participants with severe mental illness reported higher feelings of loneliness at the 8-month assessment than at baseline. This increase was higher in HF participants. These findings are partially consistent with previous research and are of relevance for providers, policy makers, and teams working with HF programs. Findings indicate the need to address feelings of loneliness in this population. Further research is needed to ascertain the effectiveness of HF programs on loneliness. [Journal of Psychosocial Nursing and Mental Health Services, 59(3), 44-51.].

Borderline personality disorder in a community setting: service users' experiences of the therapeutic relationship with mental health nurses.

People with borderline personality disorder (BPD) suffer from severe symptoms and crises that put their lives at risk. BPD's symptoms make it difficult for nurses to establish good therapeutic relationships with people who suffer from it, thus hindering their recovery and contributing to stigma. We explored the experiences of people with BPD who were under the care of mental health nurses at a community mental health centre and who reported a reduction in distress. Our goal was to identify the actions and psychotherapeutic factors of the therapeutic relationship that people with BPD considered to be useful in their recovery. Our qualitative approach made it possible for us to learn about individual experiences and meanings and describe the perception of participants. Our sample included 12 participants. Data consisted of qualitative interviews with all participants and nursing records for six of the participants. We conducted an inductive thematic content analysis, resulting in a hierarchical system of subthemes and themes. We found that participants considered the following psychotherapeutic actions to be useful in recovery: learning about the disorder, building trust, and being empowered through validation.

Metabolic Syndrome Screening in People With Severe Mental Illness: Results From Two Spanish Community Mental Health Centers.

BACKGROUND: The excess of mortality in people with severe mental illness is due to unnatural causes such as accidents or suicides and natural causes such as metabolic syndrome. The presence of modifiable risk factors like tobacco consumption increases cardiovascular and metabolic risk. AIMS: The purpose of this study was to identify the prevalence of metabolic syndrome and other cardiovascular risk factors in people with severe mental illness. This study also aimed to identify the prevalence of patients receiving treatment for any metabolic syndrome risk factor. METHOD: A cross-sectional descriptive study was performed. A total of 125 participants from two community mental health centers in Spain were recruited. RESULTS: More than half of the participants (58.4%) were active smokers. The prevalence of metabolic syndrome was 60%. A total of 16.8% received previous treatment for hypertension, 17.6% for hypertriglyceridemia, and 11.2% for diabetes. No differences were found between centers (22.7% vs. 18.7%, p = .9). CONCLUSIONS: The findings underscore the importance of monitoring the physical health of patients on antipsychotic therapy. The identification and management of cardiovascular and metabolic risks factors is an essential part of nursing care for people with severe mental illness. Mental health nurses are ideally positioned to carry out this task by performing physical health screening, health education, and lifestyle interventions.

Adolescent males in the City of Buenos Aires: gender-based barriers to health care and prevention. / Varones adolescentes en la Ciudad de Buenos Aires: barreras de género en la prevención y atención de la salud.

This study is based on our previous work, in which we found evidence of the difficulties in including the experiences and needs of adolescent males in the design of clinical models aimed at that age group. We identified a need to explore the subjective dimension of gender in the practices of the healthcare sector directed at adolescent males, in order to determine if they constituted barriers to advancement in this field. Semi-structured interviews were conducted with 21 professionals from different disciplines who made up healthcare teams, as well as 14 adolescent males using healthcare services in the City of Buenos Aires. Additionally, group techniques were employed with adolescent male secondary school students, and in-depth interviews were conducted with key informants. We were able to determine that institutional dynamics do not adequately respond to the risks faced by adolescent males - for whom hegemonic constructions of gender play an important role - given that they are based on exclusionary biopolitical paradigms.

La presente investigación surge a partir de identificar la dificultad para incluir las experiencias y necesidades de los varones adolescentes en el diseño de los modelos clínicos dirigidos a esa franja etaria y etapa vital. Por tal motivo, se decidió indagar la dimensión subjetiva de género en las prácticas que el sector salud dirige a la prevención y atención de la salud de los varones adolescentes, con el objetivo de visibilizar si estas se convierten en barreras para el avance en este campo. Para ello, se realizaron entrevistas semiestructuradas a 21 profesionales de distintas disciplinas integrantes de equipos de salud y a 14 varones adolescentes usuarios del sistema de salud de la Ciudad Autónoma de Buenos Aires; además se implementaron dispositivos grupales de indagación a adolescentes varones estudiantes de escuela secundaria, y se realizaron entrevistas en profundidad a informantes claves. Se ha identificado que las propias dinámicas institucionales no responden de modo adecuado a los riesgos que enfrentan los varones adolescentes -dentro de los cuales las construcciones hegemónicas de género cumplen un importante papel- ya que están ancladas en paradigmas biopolíticos de exclusión.

Varones adolescentes en la Ciudad de Buenos Aires: barreras de género en la prevención y atención de la salud / Adolescent males in the City of Buenos Aires: gender-based barriers to health care and prevention

RESUMEN La presente investigación surge a partir de identificar la dificultad para incluir las experiencias y necesidades de los varones adolescentes en el diseño de los modelos clínicos dirigidos a esa franja etaria y etapa vital. Por tal motivo, se decidió indagar la dimensión subjetiva de género en las prácticas que el sector salud dirige a la prevención y atención de la salud de los varones adolescentes, con el objetivo de visibilizar si estas se convierten en barreras para el avance en este campo. Para ello, se realizaron entrevistas semiestructuradas a 21 profesionales de distintas disciplinas integrantes de equipos de salud y a 14 varones adolescentes usuarios del sistema de salud de la Ciudad Autónoma de Buenos Aires; además se implementaron dispositivos grupales de indagación a adolescentes varones estudiantes de escuela secundaria, y se realizaron entrevistas en profundidad a informantes claves. Se ha identificado que las propias dinámicas institucionales no responden de modo adecuado a los riesgos que enfrentan los varones adolescentes -dentro de los cuales las construcciones hegemónicas de género cumplen un importante papel- ya que están ancladas en paradigmas biopolíticos de exclusión.

ABSTRACT This study is based on our previous work, in which we found evidence of the difficulties in including the experiences and needs of adolescent males in the design of clinical models aimed at that age group. We identified a need to explore the subjective dimension of gender in the practices of the healthcare sector directed at adolescent males, in order to determine if they constituted barriers to advancement in this field. Semi-structured interviews were conducted with 21 professionals from different disciplines who made up healthcare teams, as well as 14 adolescent males using healthcare services in the City of Buenos Aires. Additionally, group techniques were employed with adolescent male secondary school students, and in-depth interviews were conducted with key informants. We were able to determine that institutional dynamics do not adequately respond to the risks faced by adolescent males - for whom hegemonic constructions of gender play an important role - given that they are based on exclusionary biopolitical paradigms.

Scale for the study of nursing students' perception of intimate partner violence: Adaptation and validation.

BACKGROUND: Intimate partner violence (IPV) is one of the most important challenges facing today's society. Health professionals, and nurses in particular, play a leading role in addressing this problem. Having an instrument to study Nursing students' perception of this type of violence may enable appropriate and necessary educational strategies for their pre-service training and help them identify and address IPV in their future careers. OBJECTIVES: To adapt and validate the IPV scale of Beccaria et al. (2011) in order to study nursing students' perception of IPV. METHOD: The original instrument (63 items) underwent back-translation. Statistical and metrical analysis in a sample of 1064 students of the four-year Nursing degree program at four public universities in Catalonia (Spain) were based on their responses to the Spanish version. RESULTS: The results of the exploratory factorial analysis and subsequent confirmatory analysis showed that the data had an adequate fit for a four-factor model. The reliability analysis showed adequate internal consistency for each subscale in the instrument: Education (0.83); Identification of the Victim (0.72); Nursing Role and Values (0.78), and Identification of the Perpetrator (0.66). CONCLUSION: The translation, cultural adaptation and validation process of the original IPV scale resulted in a Spanish-language instrument (IPV scale Spanish version) with 32 items in four subscales. We concluded that the Spanish version of the instrument is reliable and valid, and that its implementation would enable the assessment of nursing students' perception of IPV situations.

Should We Perform the Intraoperative Sentinel Lymph Node Biopsy in Breast Cancer?

INTRODUCTION: The purpose of this study was to evaluate the utility of performing a selective intraoperative sentinel lymph node biopsy (SLNB) in breast cancer patients. PATIENTS AND METHODS: Patients in this prospective study were women with breast cancer seen at our hospital in 2014. These patients were divided into 2 groups on the basis of the clinical criteria age, tumor size, and molecular subtype: (1) Group A: women with clinical criteria indicative of the need to perform an intraoperative analysis of the sentinel lymph node (SLN); and (2) Group B: women in whom postoperative analysis of the SLN was performed. The final anatomopathologic findings obtained for the SLNs were analyzed and the sensitivity, specificity, positive predictive value, and negative predictive value of the clinical criteria used to decide between intraoperative or postoperative analysis of the SLN were estimated. RESULTS: A total of 170 patients were included: 106 in group A and 64 in group B. The number of positive SLNs was 29 (22 in group A and 7 in group B; P = .09). The sensitivity of our clinical criteria for establishing the indication to perform an axillary SLNB was 75.86% (95% confidence interval [CI], 56.05%-88.98%), the specificity was 40.43% (95% CI, 32.35%-49.03%), the positive predictive value was 20.75% (95% CI, 13.73%-29.95%), and the negative predictive value was 89.06% (95% CI, 78.16%-95.12%). CONCLUSIONS: The clinical findings used to decide whether or not to perform an SLNB exhibit low sensitivity and specificity and must therefore not be used to decide the need for an intraoperative SLNB.

Tratamiento quirúrgico del cáncer de endometrio: ¿qué pasaría si no realizamos biopsia intraoperatoria? / Surgical treatment of endometrial cancer. What would it happen if intraoperative biopsy were not performed?

Objetivo. Analizar las discordancias entre la estadificación pre- y posquirúrgica en los cánceres de endometrio operados en nuestro servicio. Material y método. Estudio retrospectivo de los cánceres de endometrio operados por vía laparoscópica entre el 1 de enero de 2005 y el 31 de agosto de 2014. Se han calculado la sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo de la resonancia nuclear magnética y la biopsia de endometrio realizadas antes de la intervención quirúrgica, así como el porcentaje de mujeres que podrían haber sido infra- y sobretratadas en el caso de no haber realizado biopsia intraoperatoria de la pieza de histerectomía. Resultados. Hemos operado 174 cánceres de endometrio. La sensibilidad de la resonancia nuclear magnética para el diagnóstico de tumores en estadio I fue del 95,09%, la especificidad de 63,33%, el valor predictivo positivo de 93,37% y el valor predictivo negativo de 70,37%. Para la biopsia preoperatoria la sensibilidad para detectar tumores de grado 1 fue del 90,91%, la especificidad del 65,38%, el valor predictivo positivo de 74,77% y el valor predictivo negativo de 86,44. De no haber realizado biopsia intraoperatoria 21 mujeres (12,65%) de las 166 en estadio I hubiesen sido infratratadas y un 3,61% hubiesen sido sobretratadas. Conclusión. En los estadios iniciales del cáncer de endometrio la biopsia intraoperatoria de la pieza quirúrgica resulta imprescindible para evitar sobre e infratratamientos (AU)

Objectives. To analyse differences between preoperative and postoperative staging in a series of patients with endometrial cancer who underwent surgery in our department. Material and methods. We conducted a retrospective study of malignant endometrial tumours treated by laparoscopic surgery between January 1st 2005 and August 31st 2014. We calculated the sensitivity, specificity, positive predictive value and negative predictive value of magnetic resonance imaging and biopsy performed before the intervention. We estimated the percentage of women at risk of over- and under-treatment if intraoperative biopsy had not been performed. Results. We included 174 malignant endometrial tumours. The sensitivity, specificity, positive predictive value and negative predictive value of magnetic resonance imaging was 95.09, 63.33, 93.37 and 70.37%, respectively. For preoperative biopsy, the results were sensitivity (90.91%), specificity (65.38%), positive predictive value (74.77%) and negative predictive value. (86.44%). If intraoperative biopsy had not been performed, 12 of 166 (12.65%) women in stage 1 would have been undertreated and 3.61% would have been overtreated. Conclusion. Intraoperative biopsy should be mandatory in the early the stages of endometrial cancer to avoid under- and over-treatment (AU)

Language skills and nonverbal cognitive processes associated with reading comprehension in deaf children.

The main aim of this study was to examine the relationship between language skills (vocabulary knowledge and phonological awareness), nonverbal cognitive processes (attention, memory and executive functions) and reading comprehension in deaf children. Participants were thirty prelingually deaf children (10.7 ± 1.6 years old; 18 boys, 12 girls), who were classified as either good readers or poor readers by their scores on two reading comprehension tasks. The children were administered a rhyme judgment task and seven computerized neuropsychological tasks specifically designed and adapted for deaf children to evaluate vocabulary knowledge, attention, memory and executive functions in deaf children. A correlational approach was also used to assess the association between variables. Although the two groups did not show differences in phonological awareness, good readers showed better vocabulary and performed significantly better than poor readers on attention, memory and executive functions measures. Significant correlations were found between better scores in reading comprehension and better scores on tasks of vocabulary and non-verbal cognitive processes. The results suggest that in deaf children, vocabulary knowledge and nonverbal cognitive processes such as selective attention, visuo-spatial memory, abstract reasoning and sequential processing may be especially relevant for the development of reading comprehension.

Male and female involvement in the birth and child-rearing process.

AIMS AND OBJECTIVES: To know the male involvement during pregnancy and childbirth, with special attention to their participation in public services of perinatal health and the impact that this participation has on their subsequent involvement in child-rearing, to compare the male and female involvement in child-rearing and to identify the factors associated with a greater male involvement. BACKGROUND: Most of the research on male involvement in birth and child-rearing comes from Anglo-Saxon and Scandinavian countries. These studies show a lower involvement of men in relation to women, even in countries with instruments to promote gender shared responsibility. The Spanish Ministry of Health has developed strategies to improve the male involvement in the public services of perinatal health to advance in gender equality. This is a suitable context to contribute to the lack of information about fatherhood and the gender inequalities in the Spanish context. DESIGN: Transversal design. METHODS: A questionnaire was administered to 150 fathers and 157 mothers residing in Granada, with at least one biological child aged 2 months to 3 years. RESULTS: A minority of the men attended the childbirth education whereas most of them attended pregnancy check-ups and were present at birth. Women spent more time with their children and took charge of tasks of child-rearing to a larger extent. The profile of an involved father is a man with a higher level of education, not married, his partner has a full-time employment, born in Spain and attended to the childbirth education classes. CONCLUSION: This study shows gender inequalities in the reproductive field beyond the biological conditions. RELEVANCE TO CLINICAL PRACTICE: The challenge of the health services is to promote social change and identify areas for improvement to include the father figure in public services of perinatal health.

Equidad de género en la calidad de atención de niños y niñas: parte 2 / Gender equity in children health care quality: part 2

En nuestro país existen muchos avances en la incorporación de los aspectos psicológicos y sociales en la atención de la salud en la infancia. Sin embargo, estos avances no han aún incluido de manera significativa la perspectiva de género en la atención, tal como lo promueven y sugieren los/as expertos/as en los documentos de los organismos internacionales (Sen, G. Östlin P, 2007), (Irwin LG y col. 2007). Con el in de medir el grado en el cual estos avances han sido incorporados en las prácticas, esta investigación intenta identificar el modo en el cual los/as profesionales de la salud que atienden niños/as,han incorporado este bagaje en su práctica cotidiana. De este modo, se indagarán cuáles son los aspectos que pudieran afectar la equidad de género en la calidad de atención en esa etapa de la vida.

In our country there are many advances in the integration of social and psychological aspects of health care in childhood. However, these advances have not yet significantly included the gender perspective in health, as suggested by experts in documents of international organizations (Sen, G. Östl inP, 2007), (IrwinLGet al.2007) To measure the degree in which these advances have been incorporated into actual practices, this research attempts to identify ways in which health professionals who treat children consider them. The aspects that could affect gender equality in this life period will be researched.

Equidad de género en la calidad de atención de niños y niñas: parte 2 / Gender equity in children health care quality: part 2

En nuestro país existen muchos avances en la incorporación de los aspectos psicológicos y sociales en la atención de la salud en la infancia. Sin embargo, estos avances no han aún incluido de manera significativa la perspectiva de género en la atención, tal como lo promueven y sugieren los/as expertos/as en los documentos de los organismos internacionales (Sen, G. Istlin P, 2007), (Irwin LG y col. 2007). Con el in de medir el grado en el cual estos avances han sido incorporados en las prácticas, esta investigación intenta identificar el modo en el cual los/as profesionales de la salud que atienden niños/as,han incorporado este bagaje en su práctica cotidiana. De este modo, se indagarán cuáles son los aspectos que pudieran afectar la equidad de género en la calidad de atención en esa etapa de la vida.(AU)

In our country there are many advances in the integration of social and psychological aspects of health care in childhood. However, these advances have not yet significantly included the gender perspective in health, as suggested by experts in documents of international organizations (Sen, G. Istl inP, 2007), (IrwinLGet al.2007) To measure the degree in which these advances have been incorporated into actual practices, this research attempts to identify ways in which health professionals who treat children consider them. The aspects that could affect gender equality in this life period will be researched.(AU)

Equidad de género en la calidad de atención de niños y niñas / Gender equity in children health care quality

Esta investigación intenta avanzar en la identificación de sesgos de género en la toma de decisiones diagnósticas y terapéuticas de los/as miembros/as del equipo de salud que atienden niños/as, que pudieran tener impactos negativos en la calidad de atención. Para ello, se realizará un análisis de los componentes profesional/niño/a/familia en la toma de decisiones diagnósticas y terapéuticas, con el propósito de poder contribuir al logro de una mejor calidad de atención de los niños y niñas. Esto puede ser posible, mediante la utilización de dicha información en la elaboración de un modelo educativo para la capacitación en servicio, que permita la reflexión del personal de salud acerca de este aspecto de su práctica cotidiana. Se trata de una investigación de carácter exploratorio-descriptivo, en la que se utiliza metodología cualitativa para la recolección y el análisis de la información.

This research tries to identify gender bias in the process of decision making and therapeutic interventions of the health professionals who work with children, which could have a negative impact in health care quality. To this end, an analysis will be done in the professional / child / family components, regarding the diagnostic and therapeutic decisions, in order to contribute to achieving a better health care quality for children. This may be possible through the use of such information in developing an educational model for training in service, al lowing heal th staf f thought about this aspect of their daily practice. This is an exploratory and descriptive research, which used qualitative methodology to collect and analyze information.