Factores condicionantes de la lactancia materna en tiempos de COVID-19 / Conditioning factors for breastfeeding in times of COVID-19

Objetivo: identificar los condicionantes del establecimiento y duración de la lactancia materna (LM) durante la COVID-19 desde la perspectiva de las matronas de la provincia de Castellón (España).Métodos: estudio cualitativo realizado en 2021 mediante la realización de cuatro grupos focales (GF) con matronas de la provincia de Castellón. La recolección de la información se hizo mediante videoconferencias con grabación de voz, que fueron transcritas para posterior análisis del discurso con el programa ATLAS.ti.Resultados: las matronas identificaron como facilitadores de la LM, la puesta en valor de la LM ante las madres y el fomento de la accesibilidad a recursos para solucionar situaciones problemáticas, entre otros. Como barreras refirieron ideas maternas sobre alimentación con fórmulas artificiales construidas desde su biografía, consideración social sesgada sobre el amamantamiento, falta de protocolos para extracción de calostro y déficit en la calidad de información en las redes sociales, principalmente. Reconocen que la pandemia COVID-19 produjo impactos positivos y negativos en la LM. Surgieron medidas para optimizar la promoción de la LM como aumentar la ratio matronas/madres gestantes, asistencia domiciliaria a las 24 h del alta, unificación de protocolos intercentros, ampliación a seis meses el tiempo de incorporación al trabajo y adaptación de la promoción de la LM en redes sociales.Conclusiones: se reportaron condicionantes de la lactancia emergentes del escenario sociosanitario español que sirven de base para diseñar acciones específicas de promoción. Los impactos de la pandemia COVID-19 sobre la LM deben considerarse en situaciones de confinamiento prolongado de la madre. (AU)

Objective: to identify the conditioning factors for implementation and duration of breastfeeding during COVID-19 from the perspective of midwives from the Castellón province (Spain).Methods: a qualitative study conducted in 2021 through four focus groups (FGs) with midwives from the Castellón province. Data collection was carried out via videoconferences with audio recording, which were transcribed for subsequent discourse analysis with the Atlas Ti program.Results: the enablers for breastfeeding identified by midwives were the promotion of breastfeeding for mothers and the development of access to resources to solve troublesome situations, among others. They reported as barriers the maternal beliefs regarding feeding with artificial formulas based on their biography, a biased social consideration on breastfeeding, lack of protocols for colostrum extraction, and deficient quality of information in social networks, mostly. They acknowledged that the COVID-19 pandemic had positive and negative impacts on breastfeeding. Some measures came up to optimize breastfeeding promotion, such as an increase in the midwife/pregnant mother ratio, home care 24 hours after discharge, unification of protocols among centres, extending to six months the time for incorporation to work, and adaptation of breastfeeding promotion in social networks.Conclusions: conditioning factors for breastfeeding were reported, originating in the Spanish sociosanitary scenario, which are useful as the basis for designing specific promotion actions. The impact of the COVID-19 pandemic on breastfeeding must be considered in situations of prolonged lockout of mothers. (AU)

Umbilical cord clamping time and maternal satisfaction.

OBJECTIVE: Clamping of the umbilical cord is part of the third stage of delivery. Delayed cord clamping (DCC) is recommended due to its contribution to prevention of anaemia. There is no evidence on the effect of DCC on maternal satisfaction. The aim of this study is to evaluate the effect of different sociodemographic and obstetric factors, including the timing of cord clamping, on maternal satisfaction with the birth experience in our healthcare system. DESIGN: Pragmatic non-drug intervention study with simple random assignment of participating mothers (Clinical Trials N°: NCT03624335). SETTING: A public, university-level hospital in Villarreal city, eastern Spain. PARTICIPANTS: Childbearing woman, gestation week between 35 and 42 weeks, with regular medical pregnancy checks, single pregnancy and vaginal delivery (N = 198, 80% of the women recruited). INTERVENTIONS: umbilical cord clamping within 60 seconds of the birth (Early cord clamping, ECC) versus umbilical cord clamping after pulsation had been ceased (Delayed cord clamping, DCC). MEASUREMENTS: Birth satisfaction was measured using the Mackey Childbirth Satisfaction Rating Scale (MCSRS). Additionally, sociodemographic data, degree of knowledge about the moment of clamping and type of breastfeeding data were recorded. The Mann-Whitney and Kruskal-Wallis tests for comparison of the mean of two, three, or more groups, respectively, and Chi-square and Spearman for comparison of two qualitative and quantitative variables, respectively, were used. To determine the weight of each factor of MCSRS, an exploratory factor analysis was carried out using the maximum likelihood method for factor extraction and the varimax method for factor rotation. The adequacy of the factor analysis was checked by mean of Kaiser-Meyer-Olkin test and Bartlett sphericity test. The level of significance was set at a p-value of < 0.05. FINDINGS: The average degree of satisfaction was 4.55/5 (SD: 0.37). No statistically significant difference was observed between mothers' satisfaction according to mother level of study or mother's place of birth, while it changed significantly with age (p = 0.0398). Within the obstetric variables, satisfaction was significantly associated with spontaneous amniorrhexis, the duration of the second stage of delivery, and the Apgar value of the newborn at the first minute of life, and was independent of the number of previous pregnancies and deliveries, use of intrapartum oxytocin, epidural analgesia, episiotomy, the weight of the child at birth and type of breastfeeding. Furthermore, there was no relationship between the time of clamping and satisfaction (p = 0.5178). KEY CONCLUSIONS: Maternal satisfaction with the birth experience varies with the age of the childbearing woman, and some intrapartum factors and the result is not influenced by the time of clamping of the umbilical cord. Therefore, this component of the physiological management of childbirth provides additional benefits for the health of the neonate, without negative consequences on the final perception of the maternal health care received. IMPLICATIONS FOR PRACTICE: If there are no reasons that justify an early umbilical cord clamping, delaying it brings benefits to the neonate, without negatively affecting the maternal assessment of the experience of childbirth.

El proyecto Pixel: una experiencia educativa de learning by doing centrada en el paciente / The Pixel Project: an educational experience of patient-centered learning by doing

La nueva manera de concebir la formación universitaria requiere de metodologías activas con el estudiante como co-creador del proceso de enseñanza-aprendizaje. Una de ellas es learning by doing (aprender-haciendo). En el ámbito sanitario, la educación de sus futuros profesionales requiere del desarrollo de habilidades claves para garantizar una adecuada relación con los pacientes. Con el objetivo de fomentar competencias profesionales esenciales en estudiantes de Enfermería y Medicina, tales como la escucha activa, el reconocimiento de la realidad de la persona, los valores en salud y la integración del paciente a la toma de decisiones, se desarrolla en las titulaciones de Enfermería y de Medicina desde el curso académico 2017-18 el proyecto Pixel, una experiencia de learning by doing centrada en el paciente. Se trabaja con estudiantes de primer y segundo curso de Enfermería, y de segundo curso de Medicina. El proyecto transcurre en cuatro fases: planificación, realización, evaluación, y transferencia y consolidación. Las actividades que abarca son: prácticas tuteladas en asociaciones de pacientes, talleres y seminarios para la elaboración de programas de salud adaptados a cada asociación de pacientes, investigación y divulgación científica sobre las patologías que afectan a sus usuarios y jornada de salud con las asociaciones participantes. Hasta la actualidad participaron de la experiencia 31 asociaciones de pacientes, 629 estudiantes y docentes de ambos grados. La enseñanza orientada a la acción, base de este proyecto, favorece el desarrollo de competencias interprofesionales y promueve la cultura de la dedicación a la sociedad en el alumnado, ofreciendo un modelo innovador y reproducible.(AU)

The new way of understanding university education requires active methodologies with the student as co-creator of the teaching-learning process. One of them is learning by doing. In the healthcare setting, the education of future professionals requires the development of key skills to guarantee an adequate relationship with patients. With the goal to encourage essential professional skills among Nursing and Medicine students, such as active listening, acknowledging the reality of the person, values in health, and the integration of patients into decision-making, the Pixel Project, which is a patient-centered learning by doing experience, has been implemented in the Nursing and Medicine grades since the 2017-18 academic term. This includes first-and second-year Nursing students, and second year Medicine students. The Project is conducted in four stages: planning, implementation, evaluation, and transfer & consolidation. The activities included are: supervised practice sessions in patient associations, workshops and seminars to prepare healthcare programs adapted to each patient association, scientific research and dissemination about the conditions suffered by their users, and a Health Day with the participating associations. So far, 31 associations have participated in this experience, as well as 629 students and professors from both grades. Active learning, which is the basis for this project, encourages the development of interprofessional skills, and promotes the culture of commitment to the society among students, by offering an innovative and reproducible model.(AU)

[Giardiasis in a paediatric population of the province of castellon. Clinical details and impact]. / Giardiosis en población pediátrica de la provincia de Castellón: clínica e impacto.

INTRODUCTION: Giardiasis is a gastrointestinal parasitosis that has a great public health impact. PATIENTS AND METHODS: Observational case study - in children under 15 years old in the Health Department 3 of the Province of Castellon (Spain), during the period 2012-2019. RESULTS: A total of 190 cases of giardiasis were recorded in children under 15 years old. The number of cases varied significantly according to age group and month of the year. There were 115 males. The most frequent symptoms were diarrhea and abdominal pain. The most commonly used treatment was standard metronidazole (80% of patients). Co-infection occurred in 13% of cases, and comorbidities in 36%, especially atopic dermatitis and lactose/fructose intolerance. Relapses and/or re-infections were recorded in 8%. All cases were diagnosed by conventional parasitological stool tests and complementary immunochromatography (63 cases). Thirty-five samples were positive for Giardia duodenalis by qPCR. The direct health cost per patient was 117€. A disease notification bias was detected between 2012-2016 at a national scale. CONCLUSIONS: Giardiasis is a current disease in Castellon, and should be considered as a probable diagnosis of gastrointestinal disease in a child under 4 years-old with diarrhea and abdominal pain. Its correct clinical and therapeutic management could reduce the possibility of worsening of the patient's condition and, additionally, would reduce the economic impact of the disease in terms of direct health costs.