Best practices for iatrogenic anaemia prevention in the intensive care unit: Blood-sparing techniques.

Anaemia is a common issue in patients who are admitted to intensive care units and worsens their condition throughout the stay due to the extraction of blood for diagnostic purposes. It is also well-known that an important amount of the carbon dioxide produced by health services is likely attributable to blood donation, testing and manufacture, storage or distribution of blood components. This must be taken into account to perform nursing interventions consistent with the idea of sustainable health care. In this regard, within patient blood management bundles, with the objective of minimizing the use of blood products, it is recommended to use blood-sparing techniques: small volume tubes (SVT) or closed-blood sampling devices (CBSD). Published studies before 2014 (excepting two more recent ones) have shown that by themselves, both techniques reduce drawn volume but do not decrease haemoglobin reduction and/or need of transfusion. Given the lack of cost-effectiveness studies, it may be easier to implement the use of CBSD as it does not require prior consensus on the discard volume or adaptations in the processing of laboratory tests, as is the case with SVT.

Development and Psychometric Validation of the Breast Cancer Stigma Assessment Scale for Women with Breast Cancer and Its Survivors.

BACKGROUND: The increase in breast cancer cases and breast cancer survival makes it advisable to quantify the impact of the health-related stigma of this disease. PURPOSE/OBJECTIVES: To develop and validate a breast cancer stigma scale in Spanish. METHODS: Women diagnosed with, or survivors of, breast cancer were included. The development of the Breast Cancer Stigma Assessment Scale (BCSAS) involved both a literature review and personal interviews. Content validity was assessed using a Delphi study and a pilot test; construct validity was evaluated using an exploratory factor analysis; and convergent validity was assessed using six scales. Cronbach's α internal consistency and test-retest reliability were used to determine the reliability of the scales. RESULTS: 231 women responded to the 28-item scale. The BCSAS showed good reliability, with α = 0.897. Seven factors emerged: concealment (α = 0.765), disturbance (α = 0.772), internalized stigma (α = 0.750), aesthetics (α = 0.779), course (α = 0.599), danger (α = 0.502), and origin (α = 0.350). The test-retest reliability was 0.830 (p < 0.001). Significant correlation was observed with event centrality (r = 0.701), anxiety-depression (r = 0.668), shame (r = 0.645), guilt (r = 0.524), and quality of life (r = -0.545). CONCLUSIONS: The BCSAS is a reliable and valid measure of stigma in women with breast cancer and its survivors. It could be useful for detecting stigma risk and establishing psychotherapeutic and care priorities.

Is caring for pressure ulcers in the intensive care unit in Spain still a challenge? A qualitative study on nurses' perceptions.

BACKGROUND: The incidence of pressure ulcers is an indicator of quality in intensive care units. Due to their frequency and severity, they are identified as a problem of great importance, where the well-being of patients and relatives is compromised, also generating a high healthcare cost. Nurses are primarily responsible for the care of pressure ulcers, however, the existing literature exposes a clear lack of knowledge regarding its prevention and treatment. OBJECTIVES: To explore the attitudes, knowledge and perceived barriers by intensive care nurses regarding pressure ulcers treatment and prevention in a critical care setting. DESIGN: A descriptive qualitative study has been carried out through semi-structured interviews with 22 intensive care nurses from two tertiary university hospitals in Spain. The consolidated criteria for reporting qualitative research (COREQ) guidelines were used to reinforce the methodological approach of the study. FINDINGS: From the collected data, 4 main themes emerged: "lack of specific knowledge about pressure ulcers in intensive care", "continuity of care: the main problem to solve", "teamwork and pressure ulcers: gasping for improvement" and "Skin care as another vital sign". CONCLUSION: Most intensive care nurses consider that they do not have sufficient knowledge regarding pressure ulcers. The nurses' attitudes are positive, however, an ineffective transmission of information and registration regarding ulcers is perceived. Regarding the treatment of pressure ulcers, the lack of continuity of care and updated knowledge/training have been the main barriers. In terms of prevention, the most mentioned barriers have been the clinical condition of the patient and the lack of personnel, despite the level of knowledge.

Effectiveness and safety of the Space GlucoseControl system for glycaemia control in caring for postoperative cardiac surgical patients.

BACKGROUND: Hyperglycaemia is a very common complication in post-cardiac surgical patients, and as such, it must be properly managed. For this purpose, the enhanced Model Predictive Control algorithm for glycaemia control has been implemented into a nurse-led device called Space GlucoseControl (SGC) that aims to achieve a safe and effective blood glucose control in a better way than the traditional "paper-based" protocols. PURPOSE: The aim of the study was to know the effectiveness and safety of the SGC in glycaemia control in cardiosurgical adult patients in the immediate postoperative period in the intensive care unit. METHODS: A prospective before-and-after intervention study was conducted. One hundred sixty cardiosurgical adult patients with hyperglycaemia were selected: 80 in the control group from May to November 2018 and 80 in the intervention group (use of the SGC device) from January to December 2019. The primary outcome was the percentage of time within the target range (140-180 mg/dL in the control group and 100-160 mg/dL in the intervention group). RESULTS: The percentage of time within the target range was significantly higher in the SGC group than in the control group (70.5% [58.25-80] vs 54.83% [36.09-75], p < 0.001). The range was also achieved earlier with the SGC (5 [3-6.875] hours vs 7 [4-11] hours; p < 0.05). The first blood glucose value after reaching the target range was higher in the control group, with statistical significance (p < 0.05). There were no hypoglycaemia episodes in the control group. However, during SGC treatment, six episodes of hypoglycaemia occurred, and all of them were nonsevere (mean value = 61 mg/dL). CONCLUSION: The SGC is useful to achieve a faster tight glycaemic control, with a higher percentage of time within the target range, although episodes of nonsevere hypoglycaemia could be observed.

Reporting of Perinatal Outcomes in Probiotic Randomized Controlled Trials. A Systematic Review and Meta-Analysis.

The use of probiotic microorganisms in clinical practice has increased in recent years and a significant number of pregnant women are regular consumers of these products. However, probiotics might modulate the immune system, and whether or not this modulation is beneficial for perinatal outcomes is unclear. We performed a systematic review and meta-analysis to evaluate the reporting of perinatal outcomes in randomized controlled trials including women supplemented with probiotic microorganisms during pregnancy. We also analyzed the effects that the administration of probiotic microorganisms exerts on perinatal outcomes. In the review, 46 papers were included and 25 were meta-analyzed. Reporting of perinatal outcomes was highly inconsistent across the studies. Only birth weight, cesarean section, and weeks of gestation were reported in more than 50% of the studies. Random effects meta-analysis results showed that the administration of probiotic microorganisms during pregnancy did not have any a positive or negative impact on the perinatal outcomes evaluated. Subgroup analysis results at the strain level were not significantly different from main analysis results. The administration of probiotic microorganisms does not appear to influence perinatal outcomes. Nonetheless, future probiotic studies conducted in pregnant women should report probiotic strains and perinatal outcomes in order to shed light upon probiotics' effects on pregnancy outcomes.

Intensive care nurses' experiences during the COVID-19 pandemic: A qualitative study.

BACKGROUND: Because of the COVID-19 pandemic, health care systems worldwide are working under challenging conditions. Patients, who are seriously ill, require intensive care admission. In fighting COVID-19, nurses are frontline health care workers and, as such, have a great responsibility providing needed specialized patient care in intensive care units (ICU). However, working conditions and emotional factors have an impact on the quality of the care provided. AIM: The purpose of the present study was to explore and describe the experiences and perceptions of nurses working in an ICU during the COVID-19 global pandemic. STUDY DESIGN: Qualitative research was undertaken, using an empirical approach and inductive content analysis techniques. METHODS: The selected population consisted of ICU nurses from a tertiary teaching hospital in Spain. Data were obtained via semi-structured videocall interviews from Apr 12th to Apr 30th, 2020. Subsequently, transcribed verbatims were analysed using the template analysis model of Brooks. FINDINGS: A total of 17 nurses comprised the final sample after data saturation. Four main themes emerged from the analysis and 13 subthemes: "providing nursing care," "psychosocial aspects and emotional lability," "resources management and safety" and "professional relationships and fellowship." CONCLUSION: Providing health care by intensive care nursing professionals, during the COVID-19 pandemic, has shown both strong and weak points in the health care system. Nursing care has been influenced by fear and isolation, making it hard to maintain the humanization of the health care. RELEVANCE TO CLINICAL PRACTICE: Implications for practice include optimizing resource management (human and material), providing psychological support, and adequate training for ICU nurses, as well as high-quality protocols for future emergency situations.

"Work Like a Chinese": Aspirations, Patterns of Work, and Working Conditions of the Chinese Immigrant Community in Southern Spain.

Expanding businesses was the main reason for the immigration of Chinese people in Spain, which consists the fifth largest nationality of immigrants in this country. Nevertheless, few studies have been carried out to understand the working conditions of this population. Using an ethnographic design, this study examined the work patterns and working conditions among Chinese immigrants living in southern Spain and how these factors affected their health. Observing participants, field notes, and semi-structured interviews with question script were conducted with 133 Chinese immigrants. Five main themes were defined: "Economic improvement as a migratory reason", "Conception to Work", "Labor Sector", "Work conditions", and "Occupational health". Our results showed that Chinese immigrants worked in the provision of services, with long working hours and little rest. Although they had low rates of unemployment, the working conditions had an important impact on their dietary patterns and their family life. Ergonomic and psychosocial risks also explained high rates of musculoskeletal problems and stress. In conclusion, Chinese immigrants living in southern Spain work actively in the service sector of the economy, but with many work hours. These characteristics seem to impact their health at a physical, psychological, and social level.

Chronic non-cancer pain management by nurses in specialist pain clinics.

BACKGROUND: Chronic non-cancer pain (CNCP) is one of the major causes of disability globally, and patients who suffer from it are a complex population, which makes it difficult to provide effective care. Specialist pain clinics and nursing professionals in them are the main care providers, but there is little research conducted in this field. AIM: To explore the attitudes and knowledge of nurses working in specialist pain clinics regarding care of CNCP patients. METHODS: Qualitative phenomenological approach. Sixteen semi-structured interviews were conducted in 2017 with nurses who worked in specialist pain clinics in six hospitals in southern Spain. RESULTS: Data analysis led to the formation of two categories, 'being trained and improving knowledge in CNCP' and 'the challenge of caring for patients with CNCP', and five subcategories. CONCLUSION: The need for care in CNCP is not covered by nurses in all the areas it requires. Lack of time, staffing issues, and specific training in this area makes it difficult to provide care. However, some areas for improvement are proposed, such as psychological interventions, group workshops, continuous training, and multidisciplinary teams.

Validation of the Women's Views of Birth Labor Satisfaction Questionnaire (WOMBLSQ4) in the Spanish Population.

The satisfaction of women with the birth experience has implications for the health and wellness of the women themselves and also of their newborn baby. The objectives of this study were to determine the factor structure of the Women's Views of Birth Labor Satisfaction Questionnaire (WOMBLSQ4) questionnaire on satisfaction with the attention received during birth delivery in Spanish women and to compare the level of satisfaction of pregnant women during the birth process with that in other studies that validated this instrument. A cross-sectional study using a self-completed questionnaire of 385 Spanish-speaking puerperal women who gave birth in the Public University Hospitals of Granada (Spain) was conducted. An exploratory factor analysis of the WOMBLSQ4 questionnaire was performed to identify the best fit model. Those items that showed commonalities higher than 0.50 were kept in the questionnaire. Using the principal components method, nine factors with eigenvalues greater than one were extracted after merging pain-related factors into a single item. These factors explain 90% of the global variance, indicating the high internal consistency of the full scale. In the model resulting from the WOMBLSQ4 questionnaire, its nine dimensions measure the levels of satisfaction of puerperal women with childbirth care. Average scores somewhat higher than those of the original questionnaire and close to those achieved in the study carried out in Madrid (Spain) were obtained. In clinical practice, this scale may be relevant for measuring the levels of satisfaction during childbirth of Spanish-speaking women.

[Causes and components of the metabolic syndrome in renal transplant recipients from a gender perspective]. / Causas y componentes del síndrome metabólico en receptores de trasplante renal desde una perspectiva de género.

INTRODUCTION: the appearance of metabolic syndrome (MS) among renal recipients is one of the greatest post-transplant complications and is associated with an increased risk of graft failure and high rates of obesity and new onset diabetes. OBJECTIVE: the objective of this work is to identify the relationship between the glomerular filtration rate measured by two different methods and the components of the metabolic syndrome and their combinations in kidney transplant patients according to gender. MATERIAL AND METHOD: the samples consisted of 500 kidney transplant recipients, of whom 190 had MS, 121 men and 69 women. All subjects underwent clinical evaluation and blood sampling for laboratory measurements. The MS was determined according to the criteria of the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP-III). Renal function was estimated using AMDRD equations and CrS determinations. RESULTS: the average age was 55.5 years. The prevalence of MS was significantly higher in men (23.1% < vs 9.8%). High blood pressure (HBP) was the most observed component of MS. Significant correlations (Pearson, p < 0.05) between TFG-AMDRD and TFG CrS and metabolic markers were observed more in men than in women. The body mass index (BMI) was significantly higher in women than in men. CONCLUSIONES: the decrease in renal function associated with the components of MS, HBP and obesity represent a high risk of adverse cardiovascular events and graft rejections.

INTRODUCCIÓN: la aparición del síndrome metabólico (SM) entre los receptores renales es una de las mayores complicaciones postrasplante y se asocia con un mayor riesgo de fracaso del injerto y altas tasas de obesidad y diabetes de nueva aparición. OBJETIVO: el objetivo de este trabajo es identificar la relación entre la tasa de filtración glomerular medida por dos métodos distintos y los componentes del síndrome metabólico y sus combinaciones en pacientes trasplantados renales según género. MATERIAL Y MÉTODO: la muestra estuvo formada por 500 pacientes trasplantados renales, de los cuales 190 padecían SM, 121 hombres y 69 mujeres. Todos los sujetos se sometieron a evaluación clínica y toma de muestras de sangre para mediciones de laboratorio. El SM se determinó según los criterios del National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP-III). La función renal se estimó usando ecuaciones AMDRD y determinaciones de creatinina sérica (CrS). RESULTADOS: la media de edad fue de 55,5 años. La prevalencia del SM fue significativamente mayor en hombres (23,1% < vs. 9,8%). La hipertensión arterial (HTA) fue el componente del SM más observado. Se observaron correlaciones significativas (Pearson; p < 0,05) entre TFG-AMDRD y TFG CrS y marcadores metabólicos más en hombres que en mujeres. El índice de masa corporal (IMC) fue significativamente mayor en mujeres que en hombres. CONCLUSIONES: la disminución de la función renal asociada con los componentes del SM, la HTA y la obesidad representan un riesgo elevado de eventos cardiovasculares adversos y rechazos del injerto.

Causas y componentes del síndrome metabólico en receptores de trasplante renal desde una perspectiva de género / Causes and components of the metabolic syndrome in renal transplant recipients from a gender perspective

Introducción: la aparición del síndrome metabólico (SM) entre los receptores renales es una de las mayores complicaciones postrasplante y se asocia con un mayor riesgo de fracaso del injerto y altas tasas de obesidad y diabetes de nueva aparición. Objetivo: el objetivo de este trabajo es identificar la relación entre la tasa de filtración glomerular medida por dos métodos distintos y los componentes del síndrome metabólico y sus combinaciones en pacientes trasplantados renales según género. Material y método: la muestra estuvo formada por 500 pacientes trasplantados renales, de los cuales 190 padecían SM, 121 hombres y 69 mujeres. Todos los sujetos se sometieron a evaluación clínica y toma de muestras de sangre para mediciones de laboratorio. El SM se determinó según los criterios del National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP-III). La función renal se estimó usando ecuaciones AMDRD y determinaciones de creatinina sérica (CrS).Resultados: la media de edad fue de 55,5 años. La prevalencia del SM fue significativamente mayor en hombres (23,1% < vs. 9,8%). La hipertensión arterial (HTA) fue el componente del SM más observado. Se observaron correlaciones significativas (Pearson; p < 0,05) entre TFG-AMDRD y TFG CrS y marcadores metabólicos más en hombres que en mujeres. El índice de masa corporal (IMC) fue significativamente mayor en mujeres que en hombres. Conclusiones: la disminución de la función renal asociada con los componentes del SM, la HTA y la obesidad representan un riesgo elevado de eventos cardiovasculares adversos y rechazos del injerto

Introduction: the appearance of metabolic syndrome (MS) among renal recipients is one of the greatest post-transplant complications and is associated with an increased risk of graft failure and high rates of obesity and new onset diabetes. Objective: the objective of this work is to identify the relationship between the glomerular filtration rate measured by two different methods and the components of the metabolic syndrome and their combinations in kidney transplant patients according to gender. Material and method: the samples consisted of 500 kidney transplant recipients, of whom 190 had MS, 121 men and 69 women. All subjects underwent clinical evaluation and blood sampling for laboratory measurements. The MS was determined according to the criteria of the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP-III). Renal function was estimated using AMDRD equations and CrS determinations. Results: the average age was 55.5 years. The prevalence of MS was significantly higher in men (23.1% < vs 9.8%). High blood pressure (HBP) was the most observed component of MS. Significant correlations (Pearson, p < 0.05) between TFG-AMDRD and TFG CrS and metabolic markers were observed more in men than in women. The body mass index (BMI) was significantly higher in women than in men. Conclusions: the decrease in renal function associated with the components of MS, HBP and obesity represent a high risk of adverse cardiovascular events and graft rejections

Conocimientos y creencias sobre el manejo del dolor crónico no oncológico de enfermeras de grupos de medicina familiar / Knowledge and beliefs about chronic non cancer pain management for family medicine group nurses

No disponible

Panorámica de la poliquistosis renal autosómica dominante en una región del sur de España / Overview of autosomal dominant polycystic kidney disease in the south of Spain

Introducción: La poliquistosis renal autosómica dominante es la enfermedad renal hereditaria más frecuente aunque los datos disponibles generalmente son tras el inicio del tratamiento renal sustitutivo. Objetivo: Conocer la situación global de la poliquistosis renal autosómica dominante en el ámbito sanitario de Granada. Material y métodos: Desde enero 2007 hasta diciembre 2016 hemos recogido información clínica, familiar y demográfica de todos los pacientes con poliquistosis renal autosómica dominante, estuvieran o no en tratamiento renal sustitutivo, atendidos en el área de Granada. Se han utilizado los programas informáticos SPSS 15.0 y GenoPro. Resultados: Mil ciento siete pacientes diagnosticados, el 50,6% son varones. Se han estudiado 4-6 generaciones/familia. El 99,1% de raza caucásica. Hay áreas geográficas con mayor concentración. No hay antecedentes familiares en el 2,43%. La edad media de diagnóstico es de 34±17,8 años y en el 57,7% de los casos, el diagnóstico se produce después de tener descendencia. El principal motivo de diagnóstico son los antecedentes familiares (46,4%). La edad media de entrada en técnica es de 54,2±11,05 años. El 96,3% de los fallecidos tenían algún grado de insuficiencia renal en el momento del exitus. La edad media del exitus es de 60,9±14,10 años, siendo desconocida la principal causa de muerte (33,5%) seguida de la cardiovascular (27,8%). Conclusiones: Casos y familias se concentran en algunas áreas geográficas, un número importante de individuos están sin diagnosticar, fallecen antes por causa cardiovascular y se diagnostican tarde respecto al momento reproductivo. Dado que no hay tratamiento curativo, la estrategia de prevención primaria mediante el diagnóstico genético preimplantacional adquiere protagonismo (AU)

Introduction: Although autosomal dominant polycystic kidney disease is the most common hereditary kidney disease, available data tend to be limited to after initiation of renal replacement therapy. Objective: To ascertain an overview of autosomal dominant polycystic kidney disease within the health area of Granada in southern Spain. Material and methods: From January 2007 to December 2016, we collected clinical, family and demographic information about all patients with autosomal dominant polycystic kidney disease, irrespective of whether or not they were treated with RRT, in the Granada health area. The computer software SPSS 15.0 and GenoPro were used. Results: 50.6% of the 1,107 diagnosed patients were men. 99.1% were Caucasian and 4-6 generations/family were studied. The geographical distribution was heterogeneous. There was no family history in 2.43%. The mean age of diagnosis was 34.0±17.80 years and the diagnosis was made after having offspring in 57.7% of cases. The main reason for diagnosis was family history (46.4%). The mean age of initiation of renal replacement therapy was 54.2±11.05 years. 96.3% of the deceased had some degree of renal failure at the time of death. The mean age of death was 60.9±14.10 years, the main cause of death being unknown in 33.5% of cases, followed by cardiovascular (27.8%). Conclusions: Cases and families were concentrated in certain geographical areas and a significant number of individuals were undiagnosed prior to cardiovascular death or diagnosed late after reproduction. Given that there is currently no curative treatment, the primary prevention strategy of preimplantation genetic diagnosis should play a leading role (AU)

Overview of autosomal dominant polycystic kidney disease in the south of Spain. / Panorámica de la poliquistosis renal autosómica dominante en una región del sur de España.

INTRODUCTION: Although autosomal dominant polycystic kidney disease is the most common hereditary kidney disease, available data tend to be limited to after initiation of renal replacement therapy. OBJECTIVE: To ascertain an overview of autosomal dominant polycystic kidney disease within the health area of Granada in southern Spain. MATERIAL AND METHODS: From January 2007 to December 2016, we collected clinical, family and demographic information about all patients with autosomal dominant polycystic kidney disease, irrespective of whether or not they were treated with RRT, in the Granada health area. The computer software SPSS 15.0 and GenoPro were used. RESULTS: 50.6% of the 1,107 diagnosed patients were men. 99.1% were Caucasian and 4-6 generations/family were studied. The geographical distribution was heterogeneous. There was no family history in 2.43%. The mean age of diagnosis was 34.0±17.80 years and the diagnosis was made after having offspring in 57.7% of cases. The main reason for diagnosis was family history (46.4%). The mean age of initiation of renal replacement therapy was 54.2±11.05 years. 96.3% of the deceased had some degree of renal failure at the time of death. The mean age of death was 60.9±14.10 years, the main cause of death being unknown in 33.5% of cases, followed by cardiovascular (27.8%). CONCLUSIONS: Cases and families were concentrated in certain geographical areas and a significant number of individuals were undiagnosed prior to cardiovascular death or diagnosed late after reproduction. Given that there is currently no curative treatment, the primary prevention strategy of preimplantation genetic diagnosis should play a leading role.

Competencias profesionales de las matronas suecas y españolas: un estudio cualitativo de sus percepciones / Professional skills of Swedish and Spanish midwives: a qualitative study of their perceptions

OBJETIVOS: Conocer y comparar las percepciones que poseen las matronas de España y Suecia acerca de sus competencias profesionales en la atención al parto, así como la formación académica recibida al respecto y los cuidados prestados durante el parto normal. MATERIAL Y MÉTODOS: Estudio cualitativo de corte fenomenológico con entrevistas individuales semiestructuradas realizado a 12 matronas que trabajaban en el área de partos. Se llevó a cabo un muestreo por conveniencia y en bola de nieve para acceder a las participantes. El análisis de contenido se basó en categorías analíticas preestablecidas, triangulándolas entre los investigadores y teniendo en cuenta el procedimiento clásico propuesto por Huberman y Miles. RESULTADOS: En los discursos de los participantes se observan diferencias y similitudes. Por un lado, los informantes españoles refieren tener conocimientos y desarrollos competenciales de forma parcial, por lo que requieren más formación, y realizan una atención al parto donde la comunicación y las técnicas son prioritarias. Sin embargo, las matronas suecas reflejan pocos conocimientos competenciales, y otorgan importancia al parto humanizado. CONCLUSIONES: Las matronas españolas conocen sus competencias y abogan por un despliegue total de las mismas en atención primaria y hospitalaria, donde la carencia de innovación radica en la falta de recursos humanos, materiales y formativos. Las profesionales suecas desconocen sus competencias; sin embargo, albergan un amplio campo de actuación, donde realizan intervenciones basadas en evidencias. Igualmente, manifiestan la necesidad de más formación en emergencias obstétricas

OBJECTIVES: To know and compare the perceptions that midwives' from Spain and Sweden have about their professional competences in delivery care, received education and procedures to assist a normal childbirth. MATERIALS AND METHODS: Qualitative and phenomenological study with semi structured and individual interviews performed with 12 midwives' who worked in delivery area. Convenience and snowballing sampling was performed to access the participants. Content analysis was based in pre-established analytic categories, triangulated among the researchers and taking into account the classic procedure proposed by Huberman & Miles. RESULTS: In the speeches of the participants we could observe differences and similarities. On the one hand, Spanish informants refer to know and develop their competences partially, to require more education and to assist childbirth where communication and techniques are the priority. However, Swedish midwives' do have less knowledge about their competences, giving importance to humanized childbirth. CONCLUSIONS: Spanish midwives' know their competences, claiming a total development of them in outpatient clinics and hospitals, where lack of innovation is due to the deficiency of human, educative and time resources. Swedish professionals don't know their competences, however, they have a large field of action, where they perform interventions based on evidence. Furthermore they refer the need of more education in emergency situations

[Influence of physical exercise during pregnancy on newborn weight: a randomized clinical trial]. / Influencia del ejercicio físico durante el embarazo sobre el peso del recién nacido: un ensayo clínico aleatorizado.

INTRODUCTION: Recent studies have proved that physical activity of the pregnant woman brings benefits not only for the mother but also for the fetus, given that it decreases the number of macrosomic newborns and their negative consequences in both of them. OBJECTIVE: To analyze in pregnant women the influence of a moderate physical activity program in the aquatic environment on the weight of the newborn. MATERIAL AND METHODS: A randomized clinical trial with 140 healthy pregnant women, aged between 21 and 43 years, divided into two groups, study (GE, n = 70) and control (GC, n = 70). The women were attracted at 12 weeks of gestation in the first trimester ultrasound control carried out in the different obstetrical services in Granada. They joined the program at week 20 of gestation and ended in week 37. The perinatal results were obtained from the partograph of each woman, included in the Delivery Room Services of the Complejo Hospitalario Universitario de Granada. RESULTS: The median weight of the babies of the pregnant women who participated in the intervention was 3,250 g, compared to the babies of the control group, with a median of 3,460 g. There were statistically significant differences between the two groups (p = 0.011). Among newborns, 86.8% of both groups had weights within clinical normality, that is between 2,500 and 4,000 g. Women who followed the SWEP (Study Water Exercise Pregnant) method during pregnancy had a weight gain of 8.28 kg, compared to sedentary women, who presented a 11.17 kg weight gain. However, the rate of macrosomic infants was similar, so there were no significant differences between the two groups (GC n = 7, GE n = 6). There were no significant differences in gestation time between the two groups, with an average of 279.70 days (GC) and 280.09 days (SG) (p-value > 0.05). CONCLUSION: Moderate physical activity in the aquatic environment, following the SWEP methodology, does not present risks of preterm birth and does not alter the gestation time with regard to the sedentary women during pregnancy. Physical exercise has achieved a significant decrease in the weight of the newborn and a less profit ponderal during pregnancy. These two results have not been instrumental in reducing the rate of macrosomies in our study.

INTRODUCCIÓN: los últimos estudios han demostrado que la actividad física de la mujer embarazada aporta beneficios no solo para la madre sino también para el feto, puesto que disminuye el número de recién nacidos macrosómicos y sus consecuencias negativas para los dos. OBJETIVO: analizar la influencia de un programa de actividad física de carácter moderado para la mujer gestante en el medio acuático sobre el peso del recién nacido. MATERIAL Y MÉTODOS: ensayo clínico aleatorizado con 140 mujeres gestantes sanas, con edades entre 21 y 43 años y divididas en dos grupos, estudio (GE, n = 70) y control (GC, n = 70). Las mujeres fueron captadas a las 12 semanas de gestación en el control ecográfico del primer trimestre, en los distintos servicios de obstetricia de Granada. Se incorporaron al programa en la semana 20 de gestación y terminaron en la semana 37. Los resultados perinatales se obtuvieron del partograma de cada mujer, registrado en los Servicios de Paritorio del Complejo Hospitalario Universitario de Granada. RESULTADOS: la mediana del peso de los bebes de las gestantes que participaron en la intervención fue de 3.250 g, frente a la de los bebes del grupo control, que fue de 3.460 g; existen diferencias estadísticamente significativas entre ambos grupos (p = 0,011). El 86,8% de los dos grupos presentaba pesos dentro de la normalidad clínica, esto es, entre 2.500 y 4.000 g. Las mujeres que siguieron el método SWEP (Study Water Exercise Pregnant)durante el embarazo tuvieron una ganancia ponderal de 8,28 kg, frente a las mujeres sedentarias, en las cuales fue de 11,17 kg (p < 0,001). Sin embargo, la tasa de bebés macrosómicos fue similar, por lo que no se presentan diferencias significativas entre los dos grupos (GC n = 7, GE n = 6). No hubo diferencias significativas en el tiempo de gestación entre ambos grupos, con una media de 279,70 días (GC) y 280,09 días (GE) (p-valor > 0,05). CONCLUSIÓN: La actividad física de carácter moderado en el medio acuático siguiendo la metodología SWEP no presenta riesgos de parto prematuro y no se altera el tiempo de gestación con respecto a las mujeres sedentarias durante el embarazo. El ejercicio físico ha logrado una disminución significativa del peso del recién nacido y una menor ganancia ponderal durante el embarazo. Estos dos resultados no han sido determinantes para reducir la tasa de macrosomías en nuestro estudio.

Influencia del ejercicio físico durante el embarazo sobre el peso del recién nacido: un ensayo clínico aleatorizado / Influence of physical exercise during pregnancy on newborn weight: a randomized clinical trial

Introducción: los últimos estudios han demostrado que la actividad física de la mujer embarazada aporta beneficios no solo para la madre sino también para el feto, puesto que disminuye el número de recién nacidos macrosómicos y sus consecuencias negativas para los dos. Objetivo: analizar la influencia de un programa de actividad física de carácter moderado para la mujer gestante en el medio acuático sobre el peso del recién nacido. Material y métodos: ensayo clínico aleatorizado con 140 mujeres gestantes sanas, con edades entre 21 y 43 años y divididas en dos grupos, estudio (GE, n = 70) y control (GC, n = 70). Las mujeres fueron captadas a las 12 semanas de gestación en el control ecográfico del primer trimestre, en los distintos servicios de obstetricia de Granada. Se incorporaron al programa en la semana 20 de gestación y terminaron en la semana 37. Los resultados perinatales se obtuvieron del partograma de cada mujer, registrado en los Servicios de Paritorio del Complejo Hospitalario Universitario de Granada. Resultados: la mediana del peso de los bebes de las gestantes que participaron en la intervención fue de 3.250 g, frente a la de los bebes del grupo control, que fue de 3.460 g; existen diferencias estadísticamente significativas entre ambos grupos (p = 0,011). El 86,8% de los dos grupos presentaba pesos dentro de la normalidad clínica, esto es, entre 2.500 y 4.000 g. Las mujeres que siguieron el método SWEP (Study Water Exercise Pregnant) durante el embarazo tuvieron una ganancia ponderal de 8,28 kg, frente a las mujeres sedentarias, en las cuales fue de 11,17 kg (p < 0,001). Sin embargo, la tasa de bebés macrosómicos fue similar, por lo que no se presentan diferencias significativas entre los dos grupos (GC n = 7, GE n = 6). No hubo diferencias significativas en el tiempo de gestación entre ambos grupos, con una media de 279,70 días (GC) y 280,09 días (GE) (p-valor > 0,05). Conclusión: La actividad física de carácter moderado en el medio acuático siguiendo la metodología SWEP no presenta riesgos de parto prematuro y no se altera el tiempo de gestación con respecto a las mujeres sedentarias durante el embarazo. El ejercicio físico ha logrado una disminución significativa del peso del recién nacido y una menor ganancia ponderal durante el embarazo. Estos dos resultados no han sido determinantes para reducir la tasa de macrosomías en nuestro estudio (AU)

Introduction: Recent studies have proved that physical activity of the pregnant woman brings benefits not only for the mother but also for the fetus, given that it decreases the number of macrosomic newborns and their negative consequences in both of them. Objective: To analyze in pregnant women the influence of a moderate physical activity program in the aquatic environment on the weight of the newborn. Material and methods: A randomized clinical trial with 140 healthy pregnant women, aged between 21 and 43 years, divided into two groups, study (GE, n = 70) and control (GC, n = 70). The women were attracted at 12 weeks of gestation in the first trimester ultrasound control carried out in the different obstetrical services in Granada. They joined the program at week 20 of gestation and ended in week 37. The perinatal results were obtained from the partograph of each woman, included in the Delivery Room Services of the Complejo Hospitalario Universitario de Granada. Results: The median weight of the babies of the pregnant women who participated in the intervention was 3,250 g, compared to the babies of the control group, with a median of 3,460 g. There were statistically significant differences between the two groups (p = 0.011). Among newborns, 86.8% of both groups had weights within clinical normality, that is between 2,500 and 4,000 g. Women who followed the SWEP (Study Water Exercise Pregnant) method during pregnancy had a weight gain of 8.28 kg, compared to sedentary women, who presented a 11.17 kg weight gain. However, the rate of macrosomic infants was similar, so there were no significant differences between the two groups (GC n = 7, GE n = 6). There were no significant differences in gestation time between the two groups, with an average of 279.70 days (GC) and 280.09 days (SG) (p-value > 0.05). Conclusion: Moderate physical activity in the aquatic environment, following the SWEP methodology, does not present risks of preterm birth and does not alter the gestation time with regard to the sedentary women during pregnancy. Physical exercise has achieved a significant decrease in the weight of the newborn and a less profit ponderal during pregnancy. These two results have not been instrumental in reducing the rate of macrosomies in our study (AU)