Effectiveness of an educational group intervention in primary healthcare for continued exclusive breast-feeding: PROLACT study.

BACKGROUND: The World Health Organization leads a global strategy to promote the initiation and maintenance of breast-feeding. Existing literature shows that education and supportive interventions, both for breast-feeding mothers as well as for healthcare professionals, can increase the proportion of women that use exclusive breast-feeding, however, more evidence is needed on the effectiveness of group interventions. METHODS: This study involves a community-based cluster randomised trial conducted at Primary Healthcare Centres in the Community of Madrid (Spain). The project aims to evaluate the effectiveness of an educational group intervention performed by primary healthcare professionals in increasing the proportion of mother-infant pairs using exclusive breastfeeding at six months compared to routine practice. The number of patients required will be 432 (216 in each arm). All mother-infant pairs using exclusive breastfeeding that seek care or information at healthcare centres will be included, as long as the infant is not older than four weeks, and the mother has used exclusive breastfeeding in the last 24 h and who gives consent to participate. The main response variable is mother-infant pairs using exclusive breast-feeding at six months. Main effectiveness will be analysed by comparing the proportion of mother-infant pairs using exclusive breast-feeding at six months between the intervention group and the control group. All statistical tests will be performed with intention-to-treat. The estimation will be adjusted using an explanatory logistic regression model. A survival analysis will be used to compare the two groups using the log-rank test to assess the effect of the intervention on the duration of breastfeeding. The control of potential confounding variables will be performed through the construction of Cox regression models. DISCUSSION: We must implement strategies with scientific evidence to improve the percentage of exclusive breast-feeding at six months in our environment as established by the WHO. Group education is an instrument used by professionals in Primary Care that favours the acquisition of skills and modification of already-acquired behaviour, all making it a potential method of choice to improve rates of exclusive breast-feeding in this period. TRIAL REGISTRATION: The trial was registered with ClinicalTrials.gov under code number NCT01869920 (Date of registration: June 3, 2013).

Incidencia lesional en competición de atletismo de alto nivel de deportistas paralímpicos / Number of injuries in high athletics competition of paralympics sportsmen

El deporte paralímpico de alta competición, que tiene un desarrollo muy notable en cuanto al número de participantes y al nivel de dedicación y de competición, no ha generado amplias investigaciones respecto a su incidencia lesiona!. El presente trabajo analiza la incidencia lesional en el atletismo de deportistas paralímpicos de alta competición, concretamente en el Campeonato de Europa celebrado en Assen (Holanda) en año 2003 y en el que la Selección Española participó con un total de 34 atletas (28 varones) pertenecientes a las federaciones españolas de Deportes para Ciegos (FEDC) con 17 atletas, a la de Deportes de Minusválidos Físicos (FED MF), con 8 atletas y a la de Deportes de Paralíticos Cerebrales (FEDPC) con 9 atletas. Se describen los diagnósticos específicos, las clasificaciones de los deportistas y las pruebas en las que participaron. Se recogieron un total de 50 lesiones que afectaron a 24 de los 34 deportistas (70,58%). Todas fueron agudas ylas más frecuentes fueron las musculares (50% del total) con 6 sobrecargas de adductores, 4 sobrecargas en zona dorsolumbar, 4 en isquiotibiales y 3 en cintura escapular. Hubo 6 contracturas. Se observaron 2 roturas fibrilares y 3 tendinitis. Salvo una herida por compresión de la silla, no se encontraron lesiones específicas de los grandes discapacitados. Las lesiones afectaron preferentemente a las extremidades inferiores (64%), a las extremidades superiores (12%) yal tronco (8%). La incidencia lesional fue de 1,47 lesiones/deportista en el grupo de atletas ciegos, de 1,22 en los paralíticos cerebrales y de 0,75 en los discapacitados físicos

Paralympic sport of high competition has a very remarkable development as far as the number of participants and to the level of dedication and competition, however there are few investigations about the injuries that this kind of sport produces. The present work analyzes the number of injuries in athletics of paralympics sportsmen ofhigh competition, concretely in the Championship of Europe celebrated in Assen (Holland) in 2003, where the Spanish Selection participated with a total of 34 athletes (28 men) belongs to the Spanish federations of Sports for Blinds (FEDC) with 17 athletes, to the one of S ports of PhysicalDisabled (FED MF), with 8 athletes and to the one of Cerebral Palsy Brain (FEDPC) with 9 athletes. The specific diagnoses, the classifications of the sportsmen and the tests are described in which they participated. A total of 50 injuries took shelter that affected to 24 of the 34 sportsmen (70.58%). AlI the injuries were acute and the most frequent were the muscular ones (50% of the total) with 6 overuse of adducers, 4 overuse in back-Iumbar zone, 4 in hamstrings and 3 in shoulder joint complex. There were also 6 spasm muscle, 2 strains and 3 tendinitis. Except for a wound by compression of the chair there were not specific injuries ofhandicapped sportsmen. The injuries preferredly affected to the lower extremities (64%), upper extremities superior (12%) and trunk (8%). The injuries rate was of 1.47 injuries/sportsman in the group of blind athletes, 1.22 in cerebral palsy ones and 0.75 in the physical disabled ones