Risk factors for methicillin-resistant Staphylococcus aureus and extended-spectrum Beta-lactamase-producing Enterobacterales in patients with diabetic foot infections requiring hospital admission / Factores de riesgo de infección por Staphylococcus aureus resistente a meticilina y enterobacterias productoras de betalactamasas en infecciones de pie diabético que requieren hospitalización

OBJETIVO: Staphylococcus aureus resistente a meticilina (MRSA) y las enterobacterias productoras de betalactamasas (ESBL-E) pueden complicar el tratamiento de las infecciones del pie del diabético (DFIs). El objetivo de este estudio fue determinar los factores de riesgo de las infecciones por estos microorganismos en el pie del diabético. MATERIAL Y MÉTODOS: Estudio observacional prospectivo de 167 pacientes consecutivos con infecciones del pie del diabético. El diagnóstico y gravedad de las infecciones se basó en la guía de la Infectious Disease Society of America (IDSA). Para identificar los factores de riesgo de las infecciones por MRSA y (ESBL-E) se llevó a cabo mediante un estudio multivariante. RESULTADOS: S. aureus fue el microorganismo más aislado (n= 82; 37,9 %) seguido por Escherichia coli (n= 40; 18,5%). El 57,3% de S. aureus fueron MRSA y el 70% de Klebsiella pneumoniae y el 25% de E. coli eran productores ESBL, respetivamente. Los factores de riesgo independientes de las infecciones por MRSA fueron las úlceras profundas [OR 8,563; IC 95% (1,068-4,727)], uso previo de fluoroquinolonas [OR 2,78; IC 95% (1,156-6,685)] y la vasculopatía periférica [OR 2,47; IC 95% (1.068-4.727)], mientras que para las infecciones por (ESBL-E) lo fueron osteomielitis [OR 6,351; 95% IC 95% (1,609-25,068)] y el uso previo de cefalosporinas [OR 5,824; IC 95% (1,517-22,361)]. CONCLUSIONES: MRSA y ESBL-E han adquirido una gran relevancia clínica en las DFIs. La disponibilidad de sus factores de riesgo es muy conveniente para elegir el tratamiento empírico en las formas graves

PURPOSE: Methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum Beta-lactamase-producing Enterobacterales (ESBL-E) may complicate the treatment of diabetic foot infections (DFIs). The aim of this study was to determine the risk factors for these pathogens in DFIs. MATERIAL AND METHODS: This was a prospective observational study of 167 consecutive adult patients with DFIs. The diagnosis and severity of DFIs were based on the Infectious Disease Society of America (IDSA) classification system. Multivariate analyses were performed in order to identify risk factors for MRSA and ESBL-E infections. RESULTS: S. aureus was the most isolated pathogen (n=82, 37.9 %) followed by Escherichia coli (n= 40, 18.5%). MRSA accounted for 57.3% of all S. aureus and 70% of Klebsiella pneumoniae and 25% of E. coli were ESBL producers, respectively. Deep ulcer [OR 8,563; 95% CI (1,068-4,727)], previous use of fluoroquinolones [OR 2,78; 95% CI (1,156-6,685)] and peripheral vasculopathy [OR 2,47; 95% CI (1.068-4.727)] were the independent predictors for MRSA infections; and osteomyelitis [OR 6,351; 95% CI (1,609-25,068)] and previous use of cephalosporins [OR 5,824; 95% CI (1,517-22,361)] for ESBL-E infections. CONCLUSIONS: MRSA and ESBL-E have adquired a great clinical relevance in DFIs. The availability of their risk factors is very convenient to choose the empirical treatment in severe forms

Critical overview of current anthropometric methods in comparison with a new index to make early detection of overweight in Spanish university students: the normalized weight-adjusted index.

BACKGROUND: overweight and obesity have been increasing, and university students are an important target for prevention programs. Previous studies have reported differences in the diagnosis between different anthropometric methods, so some students can be misclassified depending on the method used. OBJECTIVE: to evaluate the efficacy of different anthropometric methods to detect those university students in a probable status of overweight, including a comparison with a new proposed method, the normalized weight-adjusted index (NWAI). METHODS: different anthropometric methods (waist circumference, waist-hip ratio, waist-height ratio, body mass index, conicity index, bioimpedance and Brozek, Siri and Heath-Carter equations) were calculated for 505 university students. By k-means cluster analysis, students with higher values according to variables involved in overweight were identified. Parameters of accuracy were calculated by operating characteristic curves. RESULTS: NWAI showed significant correlations with the most used methods. Prevalence of students with body fat excess varied from 5.9% to 48.4% for women and from 8.5% to 49.0% for men depending of the method employed, being demonstrated a great variability between the different methodologies. Body mass index for women and waist circumference for men resulted to be the most accurate methods to detect a probable situation of excess of body fat or cardiovascular risk associated. NWAI resulted also a good alternative for overweight classification. CONCLUSIONS: differences between anthropometric methods for overweight and cardiovascular disease risk classification were confirmed. Classical cut-off point may misdiagnose overweight or health risk in Spanish university students depending of the method employed.

Critical overview of current anthropometric methods in comparison with a new index to make early detection of overweight in Spanish university students: the normalized weight-adjusted index / Visión crítica de los métodos antropométricos actuales en comparación con un nuevo índice para la detección precoz de sobrepeso en estudiantes universitarios españoles: el índice normalizado ajustado al peso

Background: overweight and obesity have been increasing, and university students are an important target for prevention programs. Previous studies have reported differences in the diagnosis between different anthropometric methods, so some students can be misclassified depending on the method used. Objective: to evaluate the efficacy of different anthropometric methods to detect those university students in a probable status of overweight, including a comparison with a new proposed method, the normalized weight-adjusted index (NWAI). Methods: different anthropometric methods (waist circumference, waist-hip ratio, waist-height ratio, body mass index, conicity index, bioimpedance and Brozek, Siri and Heath-Carter equations) were calculated for 505 university students. By k-means cluster analysis, students with higher values according to variables involved in overweight were identified. Parameters of accuracy were calculated by operating characteristic curves. Results: NWAI showed significant correlations with the most used methods. Prevalence of students with body fat excess varied from 5.9% to 48.4% for women and from 8.5% to 49.0% for men depending of the method employed, being demonstrated a great variability between the different methodologies. Body mass index for women and waist circumference for men resulted to be the most accurate methods to detect a probable situation of excess of body fat or cardiovascular risk associated. NWAI resulted also a good alternative for overweight classification. Conclusions: differences between anthropometric methods for overweight and cardiovascular disease risk classification were confirmed. Classical cut-off point may misdiagnose overweight or health risk in Spanish university students depending of the method employed

Introducción: el sobrepeso y la obesidad han ido en aumento, y los estudiantes universitarios son un objetivo importante para los programas de prevención. Estudios previos demuestran diferencias en el diagnóstico según el método antropométrico utilizado. Objetivo: evaluar la eficacia de diferentes métodos antropométricos para detectar a los estudiantes universitarios en un probable estado de sobrepeso y comparar con un nuevo método, el índice normalizado ajustado al peso (INAP). Metodología: se utilizaron diferentes métodos antropométricos (circunferencia de cintura, cociente cintura cadera, relación cintura-altura, índice de masa corporal, índice de conicidad, bioimpedancia y ecuaciones de Brozek, Siri y Heath-Carter) para 505 estudiantes universitarios. Se identificaron los estudiantes con valores más altos de acuerdo a las variables involucradas en el sobrepeso y se calculó la precisión de los distintos métodos antropométricos. Resultados: el INAP mostró correlaciones significativas con los métodos más utilizados. La prevalencia de estudiantes con exceso de grasa corporal varió para las mujeres del 29,4% al 78,1% y para los varones del 12,0% al 54,0% dependiendo del método empleado. El índice de masa corporal para las mujeres y la circunferencia de cintura para los hombres fueron los métodos más precisos para detectar un probable exceso de grasa corporal o riesgo cardiovascular asociado. El INAP resultó una buena alternativa para la clasificación de sobrepeso. Conclusiones: se confirmaron las diferencias entre los métodos antropométricos para el sobrepeso y la estimación de riesgo cardiovascular. Los puntos de corte clásicos pueden diagnosticar erróneamente sobrepeso o riesgo para la salud en estudiantes universitarios españoles dependiendo del método empleado

Impact of support networks for breastfeeding: A multicentre study.

BACKGROUND: The rates of breastfeeding worldwide are slowly improving since 1996. Europe is still trailing behind the global breastfeeding incidence and prevalence rates. Thus, breastfeeding promotion, protection, prolongation and support have become an important challenge as breastfeeding sharply decreases in the first six months of life. OBJECTIVES: The aim of this project is to determine, assess and identify the real impact of breastfeeding support networks in Murcia (Spain). METHODS: After searching unsuccessfully for a validated questionnaire, a specific one was developed and validated for measuring the impact of formal and informal support networks through five dimensions: satisfaction, consultation, experience, problems and support. The questionnaire was provided to 500 mothers with experience in breastfeeding, who brought their children to baby paediatricians between 2 June and 27 November 2014. Upon completion of the survey and fieldwork, a detailed statistical analysis was conducted. RESULTS: The degree of satisfaction perceived by the users of the services of support breastfeeding networks is remarkable. In addition, mothers who clarified their doubts and discussed their problems with health professionals and/or breastfeeding support networks were more likely to breastfeed for a longer duration compared to those who did not (p=0.005). Furthermore, mothers who sought support in breastfeeding are more likely to breastfeed for more than 6 months (p<0.0005). CONCLUSION: Based on this information, we conclude that breastfeeding support networks have a positive influence in the duration of a women's decision to breastfeed.

Acoustic radiation force impulse imaging for detection of liver fibrosis in overweight and obese children.

Background Acoustic radiation force impulse (ARFI) is a non-invasive alternative to a liver biopsy for the evaluation of liver fibrosis (LF). Purpose To investigate the potential usefulness of acoustic radiation force impulse ARFI for detecting LF in overweight and obese children Material and Methods A cross-sectional study was conducted in 148 schoolchildren. A diagnosis of non-alcoholic fatty liver disease (NAFLD) and LF was based on ultrasound (US) and ARFI shear wave velocity (SWV). Results The laboratory parameters were normal in all the children. NAFLD was observed in 50 children (33.8%). The median SWV was 1.18 ± 0.28 m/s. Differences between ARFI categories and hepatic steatosis grades were observed (χ2 = 43.38, P = 0.0005). No fibrosis or insignificant fibrosis (SWV ≤ 1.60 m/s) was detected in 137 children (92.5%), and significant fibrosis (SWV > 1.60 m/s) in 11 children (7.5%), nine of whom had normal US or mild steatosis. Conclusion The present study is the first to evaluate the utility of the ARFI technique for detecting LF in overweight and obese children. The results of the study suggest that children with normal laboratory parameters such as normal liver ultrasound or mild steatosis may present with significant LF.

Influencia de la protocolización del tratamiento inicial con corticoides en la estancia y costo de las neumonías adquiridas en la comunidad. Estudio prospectivo 2015 / Influence of initial protocolized treatment with steroids in length of stay and costs of community acquired pneumonia

Objetivos. Valorar el impacto que la inclusión inicial de corticoides en el protocolo de tratamiento de un paciente con neumonía de la comunidad (NAC) puede tener en la estancia y costo de los procesos en enfermos ingresados con este diagnóstico en un hospital clínico universitario. Pacientes y métodos. Estudio prospectivo de los pacientes ingresados con el diagnóstico de NAC en los Servicios de Medicina Interna e Infecciosas durante los meses de enero a marzo de 2015; los pacientes se clasificaron en Grupo I, en caso de haber recibido esteroides desde el diagnóstico del proceso neumónico y hasta la finalización del tratamiento antibiótico y en Grupo II, si no habían recibido esteroides; la administración o no de esteroides fue realizada según la práctica clínica de cada médico responsable del paciente. Se valoró el costo según el GRD de NAC. Resultados. La edad < de 65 años es más frecuente en el grupo I que en el II, siendo el único factor diferencial entre ambas cohortes con significación estadística (p<0,05). En el análisis bivariado, las estancias medias del grupo I (5,37 vs 8,88 días) fueron significativamente menores (p<0,0005) y también lo fueron los costes (2.361 euros vs 3.907 euros) (p<0,0005). En el estudio multivariado se asociaron de forma independiente los costes altos (>3.520 euros) a los pacientes con EPOC (OR=2,602; IC95% 1,074-6,305) y al grupo II (pacientes que no habían recibido esteroides) (OR=6,2; p=0,007). Conclusiones. El no utilizar corticoides en el tratamiento de los pacientes con neumonías comunitarias se asoció, junto con el ser EPOC a un mayor coste del ingreso, valorado por el GRD/estancia diaria (AU)

Objective. The aim of the study was to analyze the impact of steroid treatment in patients with community acquired pneumonia (CAP), both in length of stay and economical cost of admission at a clinical university hospital. Patients and methods. Prospective study of admitted patients with the diagnosis of CAP, both in Internal Medicine and Infectious diseases department. The study was conducted from January to march 2015; patients receiving steroids from diagnosis to end of antibiotic treatment were classified as group I; otherwise, they were considered in group II. Administration of steroids was done according to the criteria of the responsible. Cost was stablished according to CAP Diagnostic Related Group (DRG). Results. Prevalence of patients younger than 65 year old was higher in group I (p<0.05). In bivariate analyses, mean admission time was lower in group I (5.37 vs 8.88 days) (p<0.0005) and also economical cost (2,361 euros vs 3,907 euros) (p<0.0005). In multivariate analysis, factors independently associated to higher cost (>3,520 euros) were COPD (OR=2.602; 95% CI 1.074-6.305) and group II (patients with no steroids) (OR=6.2; p=0,007). Conclusions. No administration of steroids in patients with CAP was associated, together with COPD, with higher economical cost (evaluated by DRG/length of stay) (AU)

Diseño y puesta en marcha de un protocolo de tratamiento antimicrobiano domiciliario endovenoso en atención primaria: experiencia en un hospital de segundo nivel / Design and implementation of an outpatient parenteral antimicrobial therapy program in primary care: the experience at a second level hospital

Introducción. Los programas de tratamiento antimicrobiano domiciliario endovenoso (TADE) suponen una buena opción asistencial para una gran variedad de enfermedades infecciosas. Nuestro objetivo fue diseñar e implementar un programa TADE en el área de influencia de un hospital de segundo nivel, en el que no se dispone de una Unidad de Hospitalización a domicilio (UHD), siendo necesario la estrecha colaboración entre los equipos de atención hospitalaria y primaria, describir la cohorte de pacientes, analizar las pautas de tratamiento antimicrobiano y evaluar los factores de riesgo asociados al reingreso y la mortalidad. Métodos. Estudio de cohortes prospectivo de los pacientes incluidos en el TADE entre el 1 de Enero de 2012 al 31 mayo de 2015. Resultados. Se registraron un total de 98 episodios. La edad media fue 66 años. La comorbilidad más frecuente fue la inmunosupresión (33,67%), con una media global del índice de Charlson de 5,21 ± 3,09. El foco de infección más frecuente fue el respiratorio (33,67%). Se consiguió aislamiento microbiológico en 58 pacientes (59,18%), siendo Escherichia coli el más frecuentemente aislado (25%). La media de días de administración de antimicrobianos fue 10,42 (± 6,02 DE, rango 2-40), siendo los carbapenémicos (43,48%) los más usados. Ochenta y seis pacientes (87,75%) cumplimentaron el tratamiento. Treinta y dos pacientes (32,65%) reingresaron en los siguientes 30 días al alta y siete (7,14%) fallecieron. Se encontró asociación estadísticamente significativa con el reingreso con las variables edad (p = 0,03), portador de reservorios (p = 0,04) e interrupción del tratamiento RI (p<0,05). Conclusiones. Este programa es pionero en España en la administración de TADE sin el soporte de una UHD, lo que podría permitir optimizar la red de recursos hospitalarios y de Atención Primaria disponibles. No obstante, los datos del proyecto piloto son pobres en optimización de la elección del antibiótico, secuenciación, desescalamiento y duración (AU)

Introduction. Outpatient parenteral antimicrobial therapy (OPAT) programs are a good assistance option in a wide variety of infectious diseases. Our aim was to design and implement an OPAT program in the area of influence of a second-level hospital, with no Home Hospitalization Service available, being necessary close collaboration between hospitalization and Primary Care teams, describe our cohort, analyse the antimicrobial treatment indicated and evaluate the prognostic and risk factors associated with readmission and mortality. Material and methods. Prospective study cohorts of patients admitted to the OPAT programme, from 1 January 2012 to 31 May 2015. Results. During the period of study a total of 98 episodes were recorded. The average age of the cohort was 66 years. The most frequent comorbidity was immunosuppression (33.67 %), with an overall average of Charlson index of 5.21 ± 3.09. The most common source of infection was respiratory (33.67 %). Microbiological isolation was achieved in fifty-eight patients (59.18 %) being Escherichia coli the most frequently isolated (25%). The average number of days of antibiotics administration at home was 10.42 ± 6.02 (SD), being carbapenems (43.48%) the more administered. Eighty-six patients (87.75%) completed the treatment successfully. Thirty-two patients (32.65%) were readmitted within 30 days after being discharged and seven patients (7.14%) died. A statistically significant association was only found in the readmission with variables: elderly patients (p=0.03), being carriers of Porth-a-Cath (p=0.04) and treatment termination related with infection (p<0.05). Conclusions. This is the first programme of OPAT administration not dependent on Home Hospitalization Service in Spain, which could allow to optimize the hospital and primary care resources available. Nevertheless this pilot study results are poor in terms of optimization of antibiotics choice, transition to oral administration, de-escalation and duration (AU)

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.

Prospective randomized controlled study to assess the value of a hemostatic and sealing agent for preventing seroma after axillary lymphadenectomy.

BACKGROUND AND OBJECTIVES: Postoperative seroma after axillary lymphadenectomy leads to an increased use of resources and an impaired quality of life of patients. This randomized clinical trial was designed to assess the value of a hemostatic and sealing agent for decreasing seroma occurrence after axillary lymphadenectomy. METHODS: A prospective, randomized, blind study was conducted on 91 axillary lymphadenectomies distributed into a control group (n = 47) and a test group in which a collagen sponge coated with human coagulation factors was used (n = 44). Primary end-points were number of days before removal of axillary drainage, axillary drainage output, and occurrence of seroma, wound infection, haematoma, or wound dehiscence, within 8 weeks of surgery. Bivariate and multivariate analyses on seroma occurrence were performed. RESULTS: Seroma occurred in 29 patients (31.86%). A significant direct relationship (P = 0.002) was only noted between use of the hemostatic and sealing agent and nonoccurrence of seroma. In the multivariate study, the only variable found to be significantly related to seroma occurrence was use of the above agent (P = 0.046; odds ratio: 3.365 [95%CI: 1.024-11.060]). CONCLUSIONS: Use of a collagen sponge coated with human coagulation factors following axillary lymphadenectomy was associated to a lower incidence of postoperative seroma. J. Surg. Oncol. 2016;114:423-427. © 2016 Wiley Periodicals, Inc.

Episiotomy and its relationship to various clinical variables that influence its performance.

OBJECTIVE: to understand the episiotomy rate and its relationship with various clinical variables. METHOD: a descriptive, cross-sectional, analytic study of 12,093 births in a tertiary hospital. VARIABLES: Parity, gestational age, start of labor, use of epidural analgesia, oxytocin usage, position during fetal explusion, weight of neonate, and completion of birth. The analysis was performed with SPSS 19.0. RESULTS: the global percentage of episiotomies was 50%. The clinical variables that presented a significant association were primiparity (RR=2.98), gestational age >41 weeks (RR=1.2), augmented or induced labor (RR=1.33), epidural analgesia use (RR=1,95), oxytocin use (RR=1.58), lithotomy position during fetal expulsion (RR=6.4), and instrumentation (RR=1.84). Furthermore, maternal age ≥35 years (RR=0.85) and neonatal weight <2500 g (RR=0.8) were associated with a lower incidence of episiotomy. CONCLUSIONS: episiotomy is dependent on obstetric interventions performed during labor. If we wish to reduce the episiotomy rate, it will be necessary to bear in mind these risk factors when establishing policies for reducing this procedure.

The COL1A1 SP1 polymorphism is associated with lower bone mineral density in patients treated with valproic acid.

OBJECTIVE: The aim of this study was to determine the possible relationship between the Sp1 polymorphism of gene COL1A1 and bone metabolism disorder in individuals with epilepsy. METHODS: To this end, we carried out an observational cross-sectional study on 64 patients in monotherapy with an antiepileptic drug. The patients were classified on the basis of the presence of the 's' allele of the COL1A1 Sp1 polymorphism. RESULTS: In the patients with SS, the standardized bone mineral density (sBMD) in the left femoral neck was 1024.9±206.1 mg/cm, whereas in the patients with Ss or ss, the density was significantly lower, 917±141.4 mg/cm (P=0.027), as was the femoral t-score (0.72±1.67 vs. -0.29±1.15, P=0.01). The values in the lumbar spine were equally greater in those with SS: 1219.1±236.3 versus 1090.5±142.7 mg/cm for the sBMD (P=0.018) and 0.67±1.98 versus -0.34±1.16 for the lumbar t-score (P=0.023). The bone biomarkers showed no significant differences nor did the 25-OH vitamin D and parathormone values. In the patient group treated with valproic acid (VPA), the densitometric values were significantly lower in the Ss or ss patients compared with SS homozygotes: 887.1±142.6 versus 1120.6±198.2 mg/cm for femoral sBMD (P=0.02), 990±98.1 versus 1417±251.2 mg/cm for lumbar sBMD (P=0.001). Of the patients who were carriers of the 's' allele and who were treated with VPA, 86% achieved osteopenia values. CONCLUSION: In our study, the presence of the 's' allele of the COL1A1 Sp1 polymorphism in individuals with epilepsy was related to lower bone BMD (lumbar and femoral). This relationship seemed to be further apparent in the patients undergoing treatment with VPA.

Can Clinical Assessment of Locomotive Body Function Explain Gross Motor Environmental Performance in Cerebral Palsy?

Gross Motor Function Classification System has discriminative purposes but does not assess short-term therapy goals. Locomotion Stages (LS) classify postural body functions and independent activity components. Assessing the relation between Gross Motor Function Classification System level and Locomotion Stages will make us understand if clinical assessment can explain and predict motor environmental performance in cerebral palsy. A total of 462 children were assessed with both scales. High reliability and strong negative correlation (-0.908) for Gross Motor Function Classification System and Locomotion Stages at any age was found. Sensitivity was 83%, and specificity and positive predictive value were 100% within the same age range. Regression analysis showed detailed probabilities for the realization of the Gross Motor Function Classification System depending on the Locomotion Stages and the age group. Postural body function measure with Locomotion Stages is reliable, sensitive, and specific for gross motor function and able to predict environmental performance.

Episiotomy and its relationship to various clinical variables that influence its performance / Episiotomia e sua relação com diferentes variáveis cínicas que influenciam sua realização / La episiotomía y su relación con distintas variables clínicas que influyen en su realización

Objective: to understand the episiotomy rate and its relationship with various clinical variables. Method: a descriptive, cross-sectional, analytic study of 12,093 births in a tertiary hospital. Variables: Parity, gestational age, start of labor, use of epidural analgesia, oxytocin usage, position during fetal explusion, weight of neonate, and completion of birth. The analysis was performed with SPSS 19.0. Results: the global percentage of episiotomies was 50%. The clinical variables that presented a significant association were primiparity (RR=2.98), gestational age >41 weeks (RR=1.2), augmented or induced labor (RR=1.33), epidural analgesia use (RR=1,95), oxytocin use (RR=1.58), lithotomy position during fetal expulsion (RR=6.4), and instrumentation (RR=1.84). Furthermore, maternal age ≥35 years (RR=0.85) and neonatal weight <2500 g (RR=0.8) were associated with a lower incidence of episiotomy. Conclusions: episiotomy is dependent on obstetric interventions performed during labor. If we wish to reduce the episiotomy rate, it will be necessary to bear in mind these risk factors when establishing policies for reducing this procedure.

Objetivo: conhecer a taxa de episiotomia e sua relação com diferentes variáveis clínica. Método: e Estudo descritivo, transversal e analítico de 12.093 partos em um hospital terciário. Variáveis: paridade, idade gestacional, início do parto, uso de analgesia epidural, uso de oxitocina, posição durante expulsão do feto, peso do neonato e finalização do parto. A análise foi feita com o SPSS 19.0. Resultados: a porcentagem global de episiotomias foi de 50%. As variáveis clínicas que apresentaram uma associação significativa foram: primiparidade (RR=2,98), idade gestacional > 41 semanas (RR=1,2), início do parto estimulado ou induzido (RR=1,33), uso de analgesia epidural (RR=1,95), uso de ocitocina (RR=1,58), posição de litotomia durante a expulsão fetal (RR=6,4) e instrumentação (RR=1,84). Por outro lado, idade materna ≥ 35 anos (RR=0.85) e peso do neonato < 2500 g (RR=0,8) estão associados a uma menor incidência de episiotomia. Conclusões: a episiotomia depende de intervenções obstétricas feitas durante o parto. Se desejarmos reduzir a taxa de episiotomia, será necessário manter em mente esses fatores de risco para estabelecer políticas para reduzir esse procedimento.

Objetivo: conocer la tasa de episiotomía y su relación con distintas variables clínicas. Método: estudio descriptivo, transversal y analítico, de 12.093 partos en un hospital de tercer nivel. Las variables fueron: paridad, edad gestacional, inicio del parto, uso de analgesia epidural, uso de oxitocina, posición durante la expulsión fetal, peso del recién nacido y finalización del parto. El análisis se realizó con el programa estadístico SPSS 19.0. Resultados: el porcentaje global de episiotomías fue de 50%. Las variables clínicas que presentaron una asociación significativa fueron: primiparidad (RR=2,98), edad gestacional > 41 semanas (RR=1,2), inicio del parto estimulado o inducido (RR= 1,33), uso de analgesia epidural (RR=1,95), uso de oxitocina (RR=1,58), posición de litotomía durante la expulsión fetal (RR=6,4) e instrumentación (RR=1,84). Por otra parte, la edad materna fue ≥35 años (RR=0,85) y el peso del recién nacido < 2500g. (RR=0,8), se asociaron con una menor incidencia de episiotomía. Conclusiones: la episiotomía estuvo condicionada por las intervenciones obstétricas que se realizaron durante el desarrollo del parto. Si deseamos reducir la tasa de episiotomía será necesario tener en cuenta los factores de riesgo para establecer políticas de reducción de este procedimiento.

Use of antibiotics at a University Clinic Hospital: effect of protocolized antibiotic treatment in the evolution of hospital patients with infections.

OBJECTIVES: To analyse factors associated to "failure" in patients under antibiotic (AB) treatment at a third level hospital. PATIENTS AND METHODS: All patients receiving an AB treatment along April 2012 were prospectively observed and factors associated to failure were analyzed. Failure was defined as clinical or microbiological failure, relapse or death. Statistically significance was established as p<0.05. RESULTS: 602 of 1,265 admitted patients during the study month included an AB in their medical prescriptions, being 178 considered as prophylactic AB prescriptions, 342 empirical treatments and 82 directed treatments as empiric treatments. Ceftriaxone and levofloxacin were the most used AB; choice of empirical and directed treatments were in line with protocols in 71% (242 of 342 cases) and 67% (55 of 82), respectively. Of all the patients receiving antibiotics for therapy (n=424), 402 had infection criteria (in 22 cases antibiotic treatment was deemed unnecessary since the patient showed no infectious process). Of these, 292 (72%) showed a good evolution, while the others were considered as failed therapies, either because of microbiological persistence in 49 (12.8%), relapse in 31 (7.71%) and death in en 30 (7.46%). Factors associated to "failure" were Charlson score ≥3 (OR 3.35; 95%CI 1.602-7.009); empirical and/or directed treatment not in keeping with the protocol (OR 5.68; 95%CI 2.898-11.217); and infection by ESBL and/or ciprofloxacin resistant E. coli (OR 4.43; 95%CI 1.492-13.184). CONCLUSIONS: A high rate of AB prescriptions in admitted patients correspond to empirical infection treatment, being ceftriaxone and levofloxacin the most used AB. Inadequate empirical and/or directed treatment is associated to clinical or microbiological failure and death.

Use of antibiotics at a University Clinic Hospital: effect of protocolized antibiotic treatment in the evolution of hospital patients with infections / Uso de antibióticos en un hospital clínico universitario: efecto del tratamiento antibiótico protocolizado en la evolución de pacientes hospitalizados con infección

Objectives. To analyse factors associated to 'failure' in patients under antibiotic (AB) treatment at a third level hospital. Patients and methods. All patients receiving an AB treatment along April 2012 were prospectively observed and factors associated to failure were analyzed. Failure was defined as clinical or microbiological failure, relapse or death. Statistically significance was established as p<0.05 Results. 602 of 1,265 admitted patients during the study month included an AB in their medical prescriptions, being 178 considered as prophylactic AB prescriptions, 342 empirical treatments and 82 directed treatments as empiric treatments. Ceftriaxone and levofloxacin were the most used AB; choice of empirical and directed treatments were in line with protocols in 71% (242 of 342 cases) and 67% (55 of 82), respectively. Of all the patients receiving antibiotics for therapy (n=424), 402 had infection criteria (in 22 cases antibiotic treatment was deemed unnecessary since the patient showed no infectious process). Of these, 292 (72%) showed a good evolution, while the others were considered as failed therapies, either because of microbiological persistence in 49 (12.8%), relapse in 31 (7.71%) and death in en 30 (7.46%). Factors associated to 'failure' were Charlson score ≥3 (OR 3.35; 95%CI 1.602-7.009); empirical and/or directed treatment not in keeping with the protocol (OR 5.68; 95%CI 2.898-11.217); and infection by ESBL and/or ciprofloxacin resistant E. coli (OR 4.43; 95%CI 1.492-13.184). Conclusions. A high rate of AB prescriptions in admitted patients correspond to empirical infection treatment, being ceftriaxone and levofloxacin the most used AB. Inadequate empirical and/or directed treatment is associated to clinical or microbiological failure and death (AU)

Objetivos. Analizar los factores asociados a fracaso en los pacientes que están recibiendo tratamiento antibiótico en un hospital de tercer nivel. Pacientes y métodos. Todos los pacientes que recibieron algún tratamiento antibiótico durante el mes de Abril de 2012 se siguieron de forma prospectiva y se analizaron los factores asociados a fracaso. El fracaso fue definido como clínico o microbiológico, recaída o muerte. La significación estadística fue establecida con una p<0,05. Resultados. 602 de los 1.265 pacientes ingresados durante el mes de estudio llevaban al menos un antibiótico entre sus prescripciones médicas, correspondiendo en 178 de los casos a profilaxis antibiótica, 342 a tratamientos antibióticos empíricos y 82 a tratamientos dirigidos. Los antibióticos más utilizados fueron ceftriaxona y levofloxacino; la elección del tratamiento antibiótico tanto empírico como dirigido se hizo de acuerdo a los protocolos correspondientes en el 71% (242 de 342 casos) y el 67% (55 de 82 casos), respectivamente. De todos los pacientes que recibieron antibióticos como tratamiento (n=424), 402 tenían criterios de infección (en 22 casos el tratamiento se consideró innecesario dado que el paciente no presentaba proceso infeccioso alguno). De estos, 292 (72%) evolucionaron favorablemente, mientras los otros fueron considerados fallos terapéuticos, bien por persistencia microbiológica en 49 casos (12,8%), recaída en 31 casos (7,71%) y muerte en 30 (7,46%). Los factores asociados a 'fracaso' fueron un índice de Charlson ≥3 (OR 3,35; 95%CI 1,602-7,009); el tratamiento antibiótico empírico o dirigido no ajustado a protocolo (OR 5,68; 95%CI 2,898-11,217); y la infección por E. coli BLEE y/o resistente a ciprofloxacino (OR 4,43; 95%CI 1,492-13,184). Conclusiones. Un alto porcentaje de los antibióticos prescritos en pacientes hospitalizados corresponde a tratamientos empíricos, siendo ceftriaxona y levofloxacino los antibióticos más usados. El tratamiento inadecuado, tanto empírico como dirigido, se asocia con fracaso clínico o microbiológico y con un mayor riesgo de muerte (AU)

Use and influence of Delivery and Birth Plans in the humanizing delivery process.

OBJECTIVES: get to know, analyze and describe the current situation of the Delivery and Birth Plans in our context, comparing the delivery and birth process between women who presented a Delivery and Birth Plan and those who did not. METHOD: quantitative and cross-sectional, observational, descriptive and comparative cohort study, carried out over two years. All women who gave birth during the study period were selected, including 9303 women in the study. RESULTS: 132 Delivery and Birth Plans were presented during the first year of study and 108 during the second. Among the variables analyzed, a significant difference was found in "skin to skin contact", "choice of dilation and delivery posture", "use of enema", "intake of foods or fluids", "eutocic deliveries", "late clamping of the umbilical cord" and "perineal shaving". CONCLUSIONS: the Delivery and Birth Plans positively influence the delivery process and its outcome. Health policies are needed to increase the number of Delivery and Birth Plans in our hospitals.

Toxicity of a dental adhesive compared with ionizing radiation and zoledronic acid.

BACKGROUND: To determine the toxicity of aqueous dilutions of a universal self-priming dental adhesive (DA) and comparing these with those elicited by exposure to ionizing radiation (IR), Zoledronic acid (Z) treatment and the synergic effects of the combined treatment with IR+Z. MATERIAL AND METHODS: The genotoxic effect of DA was determined by the increase in the frequency of micronuclei in cytokinesis-blocked in cultured human lymphocytes before and after exposure to 2Gy of X-rays. The cytotoxic effect was studied by using the MTT cell viability test in normal prostate cell lines (PNT2) after exposure to different X-ray doses (0Gy-20Gy). The cell lines divided into different groups and treated with different test substances: DA in presence of O2, DA in absence of O2, Z-treated and control. RESULTS: An in vitro dose-dependent and time-dependent cytotoxic effect of DA, Z and IR on PNT2 cells (p>0.001) was demonstrated. DA without-O2, following the recommendations of manufacturers, had a more pronounced effect of increasing cell death than DA with-O2 (p<0.001). In the genotoxicity assay, DA at 25% of its original concentration significantly increased chromosome damage (p<0.001). The samples studied were found to be toxic, and the samples photo-polymerized in absence of O2 showed a bigger cytotoxic effect comparable to the additive toxic effect showed by the combined treatment of IR+Z. CONCLUSIONS: Additional effort should be carried out to develop adhesives, which would reduce the release of hazardous substances; since toxic effects are similar to that reported by other agents whose clinical use is controlled by the health authorities.

Use and influence of Delivery and Birth Plans in the humanizing delivery process / Uso e influência dos Planos de Parto e Nascimento no processo de parto humanizado / Uso e influencia de los Planes de Parto y Nacimiento en el proceso de parto humanizado

get to know, analyze and describe the current situation of the Delivery and Birth Plans in our context, comparing the delivery and birth process between women who presented a Delivery and Birth Plan and those who did not.

conhecer, analisar e descrever a situação atual dos Planos de Parto e Nascimento no contexto estudado, comparando o processo de parto e sua finalização entre as mulheres que apresentaram e as que não apresentaram um Plano de Parto e Nascimento.

conocer, analizar y describir la situación actual de los Planes de Parto y Nacimiento en nuestro entorno, comparando el proceso de parto y la finalización del mismo entre las mujeres que han presentado un Plan de Parto y Nacimiento y las que no lo han hecho.

Desarrollo y validación de un instrumento diseñado para medir el impacto de las redes de apoyo a la lactancia materna / Development and validation of an instrument designed to measure the impact of networks of support for breastfeeding

Antecedentes: partimos de la hipótesis de que no existen suficientes cuestionarios validados que midan el impacto de las redes de apoyo a la lactancia materna para población hispano hablante. Objetivo: Por ese motivo, nos planteamos como objetivo general de este trabajo, elaborar y validar (a nivel de contenido y constructo) un instrumento de medida cuantitativa. Método: Se evaluó la validez de contenido sometiendo el cuestionario a un juicio de expertos en lactancia materna de la Región de Murcia. La prueba piloto se llevó a cabo entre los meses de marzo y abril de 2014. Las encuestas fueron realizadas directamente por las usuarias que acudían al grupo de apoyo a la lactancia «Lactando». Para la validez de constructo se realizó un análisis factorial con el que se determinaron las distintas dimensiones que el cuestionario podría medir. Se realizó una estadística descriptiva de cada uno de los ítems. A través del análisis de componentes principales, se obtuvo la varianza total explicada, determinando así, los factores con los elementos que los definían. Resultados: A través del análisis factorial, el cuestionario obtuvo una alta consistencia interna para sus cinco componentes (satisfacción, consultas, experiencia, problemas y apoyo), consiguiendo valores de 0,942 a 0,632. Y un porcentaje de varianza total explicada elevado (11,157%-5,093%). Conclusión: Este estudio ha servido para crear un instrumento pertinente y válido a nivel de contenido y de constructo, capaz de medir el impacto de las redes de apoyo a la lactancia a través de 5 dimensiones (AU)

Background: the hypothesis of this study is that there are not enough validated questionnaires that measure the impact of networks to support breastfeeding for the Spanish speaking population. Objective: For this reason, we ask as a general objective of this study, to develop and validate (in terms of content and construct) a quantitative instrument of measure. Method: We evaluated the content validity, subjecting the survey to a breastfeeding expert's opinion in the Region of Murcia. The pilot test was conducted between the months of March and April 2014. Surveys were carried out directly by users who attended the breast-feeding support group «Lactando». For construction validity, a factor analysis was conducted, which determined the different dimensions that the survey could measure. A description of each of the items on the statistics was conducted. Through principal component analysis, the total variance explained was obtained, determining the factors that define the elements. Results: Through factor analysis, the questionnaire has a high internal consistency for its five components (satisfaction, consultations, experience, problems and support), obtaining values from 0.942 to 0.632. And a high percentage of total variance explained (11,157%-5,093%). Conclusion: This study has served to create a relevant and valid in terms of content and construction, instrument, capable of measuring the impact of networks of support for breastfeeding through 5 dimensions (AU)

[Development and validation of an instrument designed to measure the impact of networks of support for breastfeeding]. / Desarrollo y validación de un instrumento diseñado para medir el impacto de las redes de apoyo a la lactancia materna.

BACKGROUND: the hypothesis of this study is that there are not enough validated questionnaires that measure the impact of networks to support breastfeeding for the Spanish speaking population. OBJECTIVE: For this reason, we ask as a general objective of this study, to develop and validate (in terms of content and construct) a quantitative instrument of measure. METHOD: We evaluated the content validity, subjecting the survey to a breastfeeding expert's opinion in the Region of Murcia. The pilot test was conducted between the months of March and April 2014. Surveys were carried out directly by users who attended the breast-feeding support group "Lactando". For construction validity, a factor analysis was conducted, which determined the different dimensions that the survey could measure. A description of each of the items on the statistics was conducted. Through principal component analysis, the total variance explained was obtained, determining the factors that define the elements. RESULTS: Through factor analysis, the questionnaire has a high internal consistency for its five components (satisfaction, consultations, experience, problems and support), obtaining values from 0.942 to 0.632. And a high percentage of total variance explained (11,157% - 5,093%). CONCLUSION: This study has served to create a relevant and valid in terms of content and construction, instrument, capable of measuring the impact of networks of support for breastfeeding through 5 dimensions.

Antecedentes: partimos de la hipótesis de que no existen suficientes cuestionarios validados que midan el impacto de las redes de apoyo a la lactancia materna para población hispano hablante. Objetivo: Por ese motivo, nos planteamos como objetivo general de este trabajo, elaborar y validar (a nivel de contenido y constructo) un instrumento de medida cuantitativa. Método: Se evaluó la validez de contenido sometiendo el cuestionario a un juicio de expertos en lactancia materna de la Región de Murcia. La prueba piloto se llevó a cabo entre los meses de marzo y abril de 2014. Las encuestas fueron realizadas directamente por las usuarias que acudían al grupo de apoyo a la lactancia "Lactando". Para la validez de constructo se realizó un análisis factorial con el que se determinaron las distintas dimensiones que el cuestionario podría medir. Se realizó una estadística descriptiva de cada uno de los ítems. A través del análisis de componentes principales, se obtuvo la varianza total explicada, determinando así, los factores con los elementos que los definían. Resultados: A través del análisis factorial, el cuestionario obtuvo una alta consistencia interna para sus cinco componentes (satisfacción, consultas, experiencia, problemas y apoyo), consiguiendo valores de 0,942 a 0,632. Y un porcentaje de varianza total explicada elevado (11,157% - 5,093%). Conclusión: Este estudio ha servido para crear un instrumento pertinente y válido a nivel de contenido y de constructo, capaz de medir el impacto de las redes de apoyo a la lactancia a través de 5 dimensiones.