Comparative study analysing women's childbirth satisfaction and obstetric outcomes across two different models of maternity care.

OBJECTIVES: To describe the differences in obstetrical results and women's childbirth satisfaction across 2 different models of maternity care (biomedical model and humanised birth). SETTING: 2 university hospitals in south-eastern Spain from April to October 2013. DESIGN: A correlational descriptive study. PARTICIPANTS: A convenience sample of 406 women participated in the study, 204 of the biomedical model and 202 of the humanised model. RESULTS: The differences in obstetrical results were (biomedical model/humanised model): onset of labour (spontaneous 66/137, augmentation 70/1, p=0.0005), pain relief (epidural 172/132, no pain relief 9/40, p=0.0005), mode of delivery (normal vaginal 140/165, instrumental 48/23, p=0.004), length of labour (0-4 hours 69/93, >4 hours 133/108, p=0.011), condition of perineum (intact perineum or tear 94/178, episiotomy 100/24, p=0.0005). The total questionnaire score (100) gave a mean (M) of 78.33 and SD of 8.46 in the biomedical model of care and an M of 82.01 and SD of 7.97 in the humanised model of care (p=0.0005). In the analysis of the results per items, statistical differences were found in 8 of the 9 subscales. The highest scores were reached in the humanised model of maternity care. CONCLUSIONS: The humanised model of maternity care offers better obstetrical outcomes and women's satisfaction scores during the labour, birth and immediate postnatal period than does the biomedical model.

[WATSON'S MODEL OF CARING FOR A NEW PARADIGM IN NURSING CARE]. / El modelo Watson para un cambio de paradigma en los cuidados enfermeros.

Due to the fact that caring is the essence and main role of nurses, we make an historical perspective to place ourselves on the current moment. We also debate the need for adequate care, and therefore, teaching and research to a model that could give properly answers to every health/disease process. For this purpose, it is briefly described the historical stages of nursing and the situation of a man who suffers from fibromyalgia to contrast it with Jean Watson model care, the paradigm of transformation and knowledge associated to critical thinking.

Serologic diagnosis of Helicobacter pylori in endoscopy personnel

OBJECTIVE: the Helicobacter pylori entered into the medical world, particularly in the field of the Gastroenterology, revolutionizing it, and changing partially our physiopathological concepts and treatment of the gastroduodenal ulcer. This infestation results in an immune response, that is measured by means of serologic tests, which are very useful in the massive screening studies, mainly in population at risk like those who are institutionalized and the personnel of health, particularly workers of the departments of Gastroenterology. METHOD: motivated for this, we carry out a prospective study in 38 endoscopists using as controls 38 workers not related with a Gastroenterology department. Thus, we analyzed the presence of antibodies against Helicobacter pylori among the personnel of the departments of Gastroenterology of three hospitals of Havana City. These personnel filled a form designed for this purpose containing following data: age, sex, time of work as endoscopist, use of protection means, and history of gastroduodenal pathology. RESULTS: there were 24 women in each group (63,2percent). Whereas the seroprevalence among endoscopists was 39,47percent, in the control group, only three people were seropositives (7,89percent). We found a positive correlation between the time working as endoscopists and the rate of seropositivity. CONCLUSIONS: our study demonstrated that endoscopists have a significantly higher risk than the controls of contracting the infection by the Helicobacter pylori, and that the seropositive endoscopists have sintomatology more frequently than the seronegative endoscopists, although these differences were not statistically significant(AU)

Objetivo: el Helicobacter pylori irrumpió en el ámbito médico-gastroenterológico, revolucionándo la fisiopatología y el tratamientode la Ulcera Gastroduodenal. Esta infestación trae consigo una respuesta inmune, que se puede reconocer con las pruebas serológicas, las cuales son muy útiles en el reconocimiento de lainfección, sobre todo entre los grupos de riesgo, tales como son las personas institucionalizados y el personal sanitario y, entre estos, principalmente los trabajadores de los Departamentos de Gastroenterología. Método: en el presente artículo realizamos un estudio prospectivo longitudinal en 38 trabajadores de los Departamentos de Gastroenterología de tres hospitales de Ciudad de La Habana, tomandocomo controles a 38 trabajadores de un hospital que no desempeñanactividad endoscópica digestiva. Pretendemos investigar la presencia entre ellos de anticuerpos contra el H. pylori. El personal analizado completó una encuesta diseñada al efecto y se consideraron los siguientes parámetros: edad, sexo, tiempo de trabajo como endoscopista, uso de medios de protección y antecedentes de patología gastroduodenal. Resultados: nuestro grupo de investigación constaba de 38endoscopistas y 38 trabajadores de un centro asistencial, ajenos a esta actividad laboral, que presentaba las mismas características socioeconómicas que el grupo investigado. Veinticuatro en ambos grupos eran mujeres, (63,16 por ciento) y 14 eran hombres (36,84por ciento). El 39,47por ciento de los endoscopistas fueron seropositivos mientras que esto ocurrió sólo en el 7,89por ciento de los controles. Se analizó el tiempoque los endoscopistas llevaban en el trabajo y encontramos que los seropositivos llevaban más tiempo trabajando como endoscopistasque los seronegativos.......(AU)

Artritis séptica de rodilla por Granulicatella adiacens. Descripción de un caso y revisión en la bibliografía / Knee septic arthritis caused by Granulicatella adiacens: case report and literature review

Presentamos el caso de una paciente de 89 años de edad con artritis séptica de rodilla y osteomielitis femoral causada por Granulicatella adiacens aislada en cultivo de líquido sinovial Este microorganismo causa el 5% de endocarditis pero desconocemos su papel etiopatogénico en otras entidades infecciosas. La paciente fue tratada con ceftriaxona durante 4 semanas junto con gentamicina los primeros 3 días. Sólo hemos encontrado 1 caso similar de artritis séptica por Granulicatella adiacens descrito en la bibliografía. Concluimos que Granulicatella adiacens debe incluirse en el diagnóstico diferencial de la artritis séptica y ponemos énfasis en la dificultad de su crecimiento en cultivos habituales

We present the case of an 89-year-old woman with knee septic arthritis and femoral osteomyelitis caused by Granulicatella adiacens, isolated from synovial fluid culture. This microorganism causes approximately 5% of cases of endocarditis but its pathogenic role in other infectious diseases is practically unknown. The patient was treated satisfactorily with ceftriaxone for 4 weeks combined with gentamicin for the first 3 days. We were able to find only 1 similar case of Granulicatella adiacens septic arthritis previously described in the literature. We conclude that septic arthritis caused by Granulicatella adiacens should be included in the differential diagnosis of septic arthritis and emphasize the difficulty of its growth in commonly-used culture media

Quality of life, emotional status, and adherence of HIV-1-infected patients treated with efavirenz versus protease inhibitor-containing regimens.

We assessed the impact of an efavirenz-containing regimen versus a protease inhibitor-containing regimen on quality of life, emotional status, and adherence of HIV-1-infected patients. In addition, we sought to define the adverse events associated with these treatments, with a special focus on central nervous system disorders in the efavirenz treatment group. This prospective, randomized, two-arm, controlled study included 100 patients for whom initial treatment with a protease inhibitor-containing regimen failed. Patients were randomized to start treatment with two nucleoside retrotranscriptase inhibitors plus efavirenz (group 1; 51 patients) or two nucleoside retrotranscriptase inhibitors plus one or more new protease inhibitors (group 2; 49 patients). Quality of life was assessed by a five-point item adapted from the HIV questionnaire of the Medical Outcomes Study, emotional status was evaluated by the Profile of Mood State questionnaire, and patients self-reported adherence. Data were analyzed by both an as-treated method and an intention-to-treat-last observation carried forward method. Patients in group 1 reported the following findings at week 4: dizziness (66%), abnormal dreaming (48%), light-headedness (37%), and difficulty sleeping (35%). At week 24, dizziness (13%; p <.001), abnormal dreaming (18%; p =.002), light-headedness (13%; p =.01), difficulty sleeping (7%; p =.001), and nervousness (13%; p =.01) decreased in these patients. Irritability, abnormal dreaming, and nervousness persisted at week 48 in 13%, 10%, and 8% of group 1 patients, respectively. Patients in group 2 reported the following findings at week 4: light-headedness (8%), dizziness (5%), difficulty sleeping (4%), nervousness (4%), and headaches (3%). Patients in group 2 reported the following findings at week 48: difficulty sleeping (4%), nervousness (3%), headaches (3%), and light-headedness (2%). In group 1, quality of life (p <.001) and emotional status (week 48; p =.004) improved, both of which were better than those in group 2 (p =.001). Both groups maintained high levels of medication adherence, and no significant differences in the number of patients who had viral loads of <200 copies/mL at week 48 were found (78% of group 1 patients vs. 85% of group 2 patients; p = not significant). At week 48, the mean CD4 cell count +/- SD was 497 +/- 224/mm3 in group 1 and 539 +/- 298/mm3 in group 2 (p = not significant). Despite similar immunologic and virologic outcomes, a second-line efavirenz-containing regimen improved quality of life of HIV-1-infected patients compared with a second-line protease inhibitor-containing regimen. However, close follow-up of patients receiving treatment with efavirenz-based regimens is recommended, especially for those with previous emotional disturbances due to central nervous system disorders in the short term and those with persistence of a low percentage of these disorders in the long term.