[Factors associated with the risk of hospitalization and death related to SARS-CoV-2 infection.] / Factores asociados al riesgo de hospitalización y muerte relacionados con la infección por SARS-CoV-2.

OBJECTIVE: COVID-19 has tried out global health causing high mortality. There are some risk factors that associate greater severity and mortality from COVID-19; but their individual impact is unknown yet. There are also no fixed criteria for hospital admission. For this reason, this study aimed to analyze the factors associated with the severity of COVID-19 and create predictive models for the risk of hospitalization and death due to COVID-19. METHODS: A descriptive retrospective cohort study was made in Talavera de la Reina (Toledo, Spain). Data were collected through computerized records of Primary Care, Emergencies and Hospitalization. The sample consisted of 275 patients over eighteen years old diagnosed with COVID-19 in a centralized laboratory from March 1st to May 31st, 2020. Analysis was carried on using SPSS, creating two predictive models for the risk of hospitalization and death using linear regression. RESULTS: The probability of hospitalization increased independently with polypharmacy (OR 1.086; CI95% 1.009-1.169), the Charlson index (OR 1.613; CI95% 1.158-2.247), the history of acute myocardial infarction (AMI) (OR 4.358; 95% CI 1.114-17.051) and the presence of COVID symptoms (OR 7.001; 95% CI 2.805-17.475). The probability of death was independently associated with age, increasing 8.1% (OD 1.081; 95% CI 1.054- 1.110) for each year of the patient. CONCLUSIONS: Comorbidity, polypharmacy, history of AMI and the presence of COVID-19 symptoms predict the risk of hospitalization. The age of individuals predicts the risk of death. Detecting patients at high risk of hospitalization and death allows us to define the target population and define measures to implement.

OBJETIVO: La COVID-19 ha puesto a prueba la sanidad mundial, provocando una elevada mortalidad. Existen factores de riesgo que asocian mayor gravedad y mortalidad por COVID-19, pero se desconoce su impacto individual. Tampoco existen criterios fijos para un ingreso hospitalario. Por ello, este estudio pretendió analizar los factores asociados a la gravedad de la COVID-19 y crear modelos predictivos de riesgo de hospitalización y exitus por COVID-19. METODOS: Se realizó un estudio descriptivo de cohorte retrospectiva en Talavera de la Reina (Toledo, España). Los datos fueron recogidos mediante registros informatizados de Atención Primaria, Urgencias y Hospitalización. La muestra estuvo compuesta por 275 pacientes mayores de dieciocho años diagnosticados de COVID-19 en un laboratorio centralizado del 1 de marzo al 31 de mayo de 2020. Se ejecutó el análisis mediante SPSS, creándose sendos modelos predictivos de riesgo de hospitalización y exitus mediante regresión lineal. RESULTADOS: La probabilidad de hospitalización aumentó de forma independiente con la polifarmacia (OR 1,086; IC95% 1,009-1,169), el índice de Charlson (OR 1,613; IC95% 1,158-2,247), el antecedente de infarto agudo de miocardio (IAM) (OR 4,358; IC95% 1,114-17,051) y la presencia de síntomas COVID (OR 7,001; IC95% 2,805-17,475). La probabilidad de exitus se asoció de forma independiente con la edad, aumentando un 8,1% (OD 1,081; IC95% 1,054-1,110) por cada año del paciente. CONCLUSIONES: La comorbilidad, la polifarmacia, el antecedente de IAM y la presencia de síntomas de COVID-19 predicen un riesgo de hospitalización. La edad de los individuos predice el riesgo de exitus. Detectar los pacientes con alto riesgo de hospitalización y exitus nos permite delimitar la población diana y definir las medidas a implementar.

Factores asociados al riesgo de hospitalización y muerte relacionados con la infección por SARS-CoV-2 / Factors associated with the risk of hospitalization and death related to SARS-CoV-2 infection

FUNDAMENTOS: La COVID-19 ha puesto a prueba la sanidad mundial, provocando una elevada mortalidad. Existen factores deriesgo que asocian mayor gravedad y mortalidad por COVID-19, pero se desconoce su impacto individual. Tampoco existen criteriosfijos para un ingreso hospitalario. Por ello, este estudio pretendió analizar los factores asociados a la gravedad de la COVID-19 y crearmodelos predictivos de riesgo de hospitalización y exitus por COVID-19. MÉTODOS: Se realizó un estudio descriptivo de cohorte retrospectiva en Talavera de la Reina (Toledo, España). Los datos fueron re-cogidos mediante registros informatizados de Atención Primaria, Urgencias y Hospitalización. La muestra estuvo compuesta por 275pacientes mayores de dieciocho años diagnosticados de COVID-19 en un laboratorio centralizado del 1 de marzo al 31 de mayo de 2020. Se ejecutó el análisis medianteSPSS, creándose sendos modelos predictivos de riesgo de hospitalización y exitus mediante regresión lineal.RESULTADOS: La probabilidad de hospitalización aumentó de forma independiente con la polifarmacia (OR 1,086; IC95% 1,009-1,169), el índice de Charlson (OR 1,613; IC95% 1,158-2,247), el antecedente de infarto agudo de miocardio (IAM) (OR 4,358; IC95% 1,114-17,051) y la presencia de síntomas COVID (OR 7,001; IC95% 2,805-17,475). La probabilidad de exitus se asoció de forma independientecon la edad, aumentando un 8,1% (OD 1,081; IC95% 1,054-1,110) por cada año del paciente. CONCLUSIONES: La comorbilidad, la polifarmacia, el antecedente de IAM y la presencia de síntomas de COVID-19 predicen un ries-go de hospitalización. La edad de los individuos predice el riesgo de exitus. Detectar los pacientes con alto riesgo de hospitalizacióny exitus nos permite delimitar la población diana y definir las medidas a implementar.(AU)

BACKGROUND: COVID-19 has tried out global health causing high mortality. There are some risk factors that associate greater se-verity and mortality from COVID-19; but their individual impact is unknown yet. There are also no fixed criteria for hospital admission.For this reason, this study aimed to analyze the factors associated with the severity of COVID-19 and create predictive models for therisk of hospitalization and death due to COVID-19. METHODS: A descriptive retrospective cohort study was made in Talavera de la Reina (Toledo, Spain). Data were collected throughcomputerized records of Primary Care, Emergencies and Hospitalization. The sample consisted of 275 patients over eighteen years olddiagnosed with COVID-19 in a centralized laboratory from March 1st to May 31st, 2020. Analysis was carried on usingSPSS, creating twopredictive models for the risk of hospitalization and death using linear regression.RESULTS: The probability of hospitalization increased independently with polypharmacy (OR 1.086; CI95% 1.009-1.169), the Charlsonindex (OR 1.613; CI95% 1.158-2.247), the history of acute myocardial infarction (AMI) (OR 4.358; 95% CI 1.114-17.051) and the presence ofCOVID symptoms (OR 7.001; 95% CI 2.805-17.475). The probability of death was independently associated with age, increasing 8.1% (OD1.081; 95% CI 1.054- 1.110) for each year of the patient. CONCLUSIONS: Comorbidity, polypharmacy, history of AMI and the presence of COVID-19 symptoms predict the risk of hospitaliza-tion. The age of individuals predicts the risk of death. Detecting patients at high risk of hospitalization and death allows us to definethe target population and define measures to implement.(AU)

Lung Ultrasound as a Triage Method in Primary Care for Patients with Suspected SARS-CoV-2 Pneumonia.

Background: Currently, there are few studies that have analyzed the benefits of using lung ultrasound in the field of primary care, including in homes and nursing homes, for patients with suspected COVID-19 pneumonia and subsequent follow-ups. The aim of this study was to demonstrate that lung ultrasound is a useful technique for triaging these patients. Methods: An observational and retrospective study of individuals who presented with clinical suspicion of SARS-CoV-2 pneumonia was carried out during the months of March to June 2020 in Health Center number 2 of Ciudad Real and in homes of patients and nursing homes belonging to the Health Service of Castilla-La Mancha (Spain). Results: A total of 209 patients, of whom 86 (41.1%) were male, were included in the study. The most frequent ultrasound findings were bilateral B-lines, with a right predominance, specifically in the posterobasal region. Additionally, there was a statistical significance (p < 0.05) correlation between pathological positivity on lung ultrasound and PCR and chest X-ray positivity. When calculating the sensitivity and specificity of ultrasound and X-ray, ultrasound had a sensitivity of 93%, and X-ray had a sensitivity of 75%. Conclusion: Due to its high sensitivity and negative predictive value, lung ultrasound is very useful as a triage tool for patients with suspected SARS-CoV-2 pneumonia.

Relationship between Oral Health Knowledge and Maternal Oral Health with Obstetric Risk and Breastfeeding.

The relationship between maternal gingival health status and low birth weight or preterm delivery is controversial. The aim of this study was to analyze the association between maternal oral knowledge and the level of oral health during pregnancy with the risk of obstetric complications and breastfeeding. A descriptive cross-sectional study was conducted after an oral health educational intervention in a consecutive sample of 97 pregnant women. Data collection consisted of a validated questionnaire, oral examination, the Caries Index (CAOD) and the Simplified Oral Hygiene Index (IHOS). The participants had a mean age of 32.5 ± 5.19 years and a predominantly university education (57.1%). The level of knowledge regarding oral health was fair (12.5 ± 3.56 correct answers). Older pregnant women (33.0 ± 4.80 years) practiced breastfeeding and had a higher number of correct answers to the questionnaire. Adequate IHOS was associated with higher birth-weight newborns (3333 ± 0.3), whereas poor oral hygiene control was associated with lower birth-weight newborns (2960 ± 0.1) (p < 0.05). A lower level of academic education was associated with worse oral hygiene (p < 0.05). In addition, the greater the number of children, the higher the CAOD. Finally, among non-smoking women, the weight of infants was 437 mg higher. Maternal oral hygiene and the week of delivery were associated with newborn weight (p < 0.05) in a multiple linear regression model. Smoking was also related to low birth weight (p < 0.05). Educational interventions in pregnancy are necessary to decrease the incidence of obstetric adverse effects and improve the oral health of mothers and their children.

The Importance of Optional Practical Anatomy Courses for Undergraduate Speech Therapy Students.

An in-depth understanding of the anatomy discipline is essential for the work of healthcare professionals. In recent decades, the content and time of teaching anatomy have decreased in all health science degrees. The aim of this study was to look for alternatives for compensating the reduction of the teaching of anatomy by supplementing students with a practical training course and to know evaluations of the course given by students enrolled in the degree in Speech Therapy and its impact on their academic results. All students (100%) positively evaluated having acquired skills and attitudes for their future professional life. The majority of the students (95.8%) believed that their knowledge was acceptable; 97.2% of the students thought they would have the possibility to apply their acquired anatomical knowledge as professionals; 98.5% were satisfied with the voluntary course; and finally, the percentage of students that passed the "Anatomophysiology of language and voice organs" course increased from previous academic years. Optional (theoretical/practical) undergraduate courses can be used in parallel to overcome the devaluation of anatomical studies in new curricula. The optional undergraduate anatomy course in the Speech Therapy program has been positively evaluated because it stimulated students' motivation and appealed to their interest in anatomy. Students considered that these courses would help them in their training and they could put what they had learned into practice in their future professions. However, very little evidence for the impact of optional practical courses exists, yet it could be an efficient method to increase anatomical knowledge.

Occupational Psychosocial Factors in Primary Care Continuing Care Staff.

This involves studying the psychosocial factors among the emergencies staff of primary care and seeing if there are differences with the primary health care staff at the Primary Care of the Integrated Care Management of Talavera de la Reina (Spain). Descriptive epidemiological study of type transversal. They have participated 51 emergencies staff of primary care and 50 primary health professionals from a sample of urban and rural health centres. The F-Psico 3.1 questionnaire has been used to evaluate the nine psychosocial risk factors. The emergencies staff quantify the psychosocial factors of working time (19.6 SD 5.7) and autonomy (69.8 SD 23.2) as a higher risk situation compared to the other health care staff with 3.7 SD 4, 7 and 52.1 SD 21.8, respectively (p < 0.05). In addition, the role performance is valued as a lower risk situation by the emergencies staff of primary care (p < 0.05). The workload assessment is the only difference between the emergencies staff of primary care in urban centres (61.5 SD 17.6) and rural (45.2 SD 18.4) (p < 0.05). Women have the highest workload (p < 0.05). It is necessary to apply preventive measures and policies applicable to women who work in emergencies, especially in urban areas to reduce their workload.

Anxiety levels among health sciences students during their first visit to the dissection room.

BACKGROUND: The teaching of human anatomy is often based on practices of cadaver dissection and prosected specimens. However, exposure to human cadavers might be stressful and anxiety-inducing for students. The aim of this study is to explore the degree of satisfaction and anxiety among first-year students in the Medicine, Occupational Therapy, Speech Therapy and Nursing programmes at the Universidad de Castilla-La Mancha (Spain) who are experiencing their first dissection/prosection practice to develop stress coping strategies. METHODS: A total of 204 health sciences students participated in this study. The State-Trait Anxiety Inventory was used to evaluate anxiety. RESULTS: 'State Anxiety' (SA) decreased significantly throughout the course (p < 0.05), from 20.7 ± 19.29 to 13.7 ± 11.65 points. Statistical differences (p < 0.05) in SA were found between the different health sciences, and pre-practice SA was significantly different from post-practice SA. The students with the highest pre-practice SA levels were nursing students (31.8 ± 33.7 points), but medical students had the highest post-practice SA levels (18.4 ± 12.82 points). CONCLUSIONS: Although students were satisfied with dissection practices (96.8% of them recommended that the practices be retained for future courses), the experience can provoke stressful responses that must be addressed using advanced preparation and coping mechanisms, especially among medical and nursing students.

Long-term effect of high-intensity laser therapy for persistent shoulder pain: A case report.

BACKGROUND AND OBJECTIVE: This case report describes the long-term effect of the high-intensity laser therapy (HILT) in a patient with chronic shoulder pain refractory in comparison to other treatments. CASE DESCRIPTION: Ten sessions of HILT were applied in a thirty-one-year-old woman diagnosed with subacromial syndrome. Assessment was carried out through different tests: Shoulder Pain and Disability Index (SPADI), Numeric Pain Rating Scale (NPRS) and pressure pain threshold (PPT). All measurements were taken at four different points: at the end of the 10 sessions, after one month, three months after the intervention and nine months after the initial intervention. RESULTS: There was a clinically significant improvement in NPRS (decrease of 5 points), PPT (increase of 1.5 kg/cm2) and SPADI (decrease of 24 points) one month after the intervention. After three months, the increase of NPRS and SPADI required a 5-session intervention to support the clinical improvement. Six months after these booster sessions an increase in PPT and a decrease in NPRS and SPADI were observed. CONCLUSION: Results indicate the suitability of developing new research lines which will optimize the use of HILT.

Can exergames contribute to improving walking capacity in older adults? A systematic review and meta-analysis.

BACKGROUND: The accessibility, low cost and motivation generated by exergames has fostered its rapid expansion as a rehabilitation technique. OBJECTIVE: To estimate the effectiveness of rehabilitation programs using IVGT in improving walking capacity of people aged 60 years and over. MATERIALS AND METHODS: The electronic data research following the PRISMA Statement (Scopus, Cochrane, Web of Science, OT Seeker, National Guideline Clearinghouse, Trip Database, CSIC Spanish National Research Council) was completed in September 2018. The results of randomized clinical trials using exergames for rehabilitation of walking capacity were combined. The calculations have followed the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. The Grading of Recommendations Assessment, Development and Evaluation system was used to evaluate the quality of the evidence. RESULTS: We obtained data from 14 trials, including 11 meta-analysis studies. The size of exergames effects on walking capacity is moderate, but significant (SMD -0.56; 95 % CI: -0.90, -0.21; p = 0.002). Effectiveness was greater to recover the ability to transfer from one position or place to another (SMD -1.02; CI 95 %: -1.70, -0.35; P = 0.003). The intervention protocols, their duration and intensity varied considerably. The lack of masking, the allocation concealment, the absence of assessor blinding were the main causes of bias so the final grade of evidence has been low for walking and very low for transfers. CONCLUSIONS: Positive clinical effects of exergames have been found to improve walking capacity, but the quality of evidence to refute its effectiveness is weak with risk of bias. Further research is needed in order to know the actual magnitude of its effect.

Estado nutricional de una población escolar en España y su relación con hábitos de alimentación y actividad física / Nutritional status of a school population in Spain and its relationship to eating habits and physical activity

La obesidad infantil ha incrementado su prevalencia en España, y aunque se considera un problema multifactorial, es atribuible principalmente al aumento de la ingesta y la disminución de la actividad física por un ocio sedentario mayor. El objetivo de este estudio fue conocer la prevalencia de sobrepeso y obesidad infantil en la Zona Básica de Salud (ZBS) de Menasalbas (Toledo, España), y la influencia de los hábitos alimentarios, de actividad física y deporte, y de ocio sedentario. Se realizó un estudio transversal en la población escolarizada de 3 a 12 años de la ZBS de Menasalbas, tomando medidas de peso y talla a 725 menores, calculando su IMC y clasificando su estado ponderal según las tablas de Cole. También se recogieron datos referentes a sus hábitos alimentarios y cuestionario Kidmed de adherencia a la dieta mediterránea, y hábitos de actividad física y ocio sedentario, para estudiar su relación con el estado ponderal de los menores. La prevalencia de sobrecarga ponderal (suma de prevalencias de sobrepeso y obesidad) fue del 24,9%, con un 18,8% de sobrepeso y un 6,1% de obesidad, sin diferencias por edad y sexo. No se observaron diferencias respecto a los hábitos alimentarios, pero si una menor actividad física y un mayor ocio sedentario en aquellos con sobrecarga ponderal. La prevalencia de sobrepeso y obesidad en nuestra población es elevada, aunque menor a las de otros trabajos. La alimentación, la actividad física y el ocio sedentario influenciaron el sobrepeso y la obesidad infantil en este estudio(AU)

Childhood obesity has increased its prevalence in Spain, and although it´s considered a multifactorial problem, it is mainly attributable to increased intake and decreased physical activity due to increased sedentary leisure. The objective of this study was to know the prevalence of overweight and childhood obesity in the Basic Health Zone (ZBS) of Menasalbas (Toledo, Spain), and the influence of eating habits, physical activity and sport, and sedentary entertainment. A cross-sectional study was conducted in the school children of 3 to 12 years of age in the ZBS of Menasalbas, taking weight and height measurements for 725 minors, calculating their BMI and classifying their weight status according to Cole´s tables. Data regarding their eating habits and Kidmed questionnaire of adherence to the mediterranean diet, physical activity habits and sedentary leisure habits were also collected, to study its relationship with the weigh status of minors. The prevalence of weight overload (understood as the sum of the prevalence of overweight and obesity) was 24.9% , with 18.8% overweight and 6.1% of obesity, with no differences by age and sex. No differences were observed regarding eating habits, but less physical activity and a more sedentary leisure in those with weight overload was observed. The prevalence of overweight and obesity in our population is high, although lower than reported in other works. Diet, physical activity and sedentary leisure are confirmed as fundamental aspects in childhood overweight and obesity(AU)

[Health-related quality of life in patients diagnosed with subacromial syndrome in the Talavera Integrated Area]. / Calidad de vida relacionada con la salud en los pacientes diagnosticados de síndrome subacromial en el Área Integrada de Talavera.

OBJECTIVE: There is a high prevalence of subacromial syndrome among patients with shoulder pathology, where the pain and tendency to chronification are some of its most important characteristics. This is why it is necessary to objectively interact with the quality of life of the subject. The main goal was to determine if there are differences between subacromial patients and asymptomatic patients regarding quality of life. METHODS: Transversal study carried out in the Talavera Integrated Area during the months of November 2016 to March2017. Participated a total of 92 subjects, 46 were symptomatic mating by age and sex with an asymptomatic sample and without joint pathology of the same size and health area. In both cases, the EQ-5D questionnaire was administered. The prevalence was calculated from the waiting list of traumatology physiotherapy in the year 2015. The SPSS statistical program was used, applying the T-test and the chi-square. RESULTS: The EQ-5D questionnaire obtained a standardized mean of 0.70 in the subacromial syndrome and 0.85 in the asymptomatic population (P=0.0001). The prevalence of impingement subacromial within shoulder pathology was 39.19%. CONCLUSIONS: Subacromial syndrome has a high prevalence within the shoulder pathology in the Rehabilitation Service and significantly interferes in the quality of life related to the health of the subject.

OBJETIVO: Existe una alta prevalencia del síndrome subacromial dentro de los pacientes con patología de hombro, en el cual el dolor y la tendencia a la cronificación son alguna de sus características más importantes. Por ello es necesario objetivar su interacción con la calidad de vida del sujeto. El objetivo principal del estudio fue determinar si existían diferencias en la calidad de vida entre sujetos con síndrome subacromial y asintomáticos. METODOS: Se realizó un estudio transversal en el Área Integrada de Talavera de la Reina (Toledo), durante los meses de noviembre de 2016 a marzo de 2017. Participaron un total de 92 sujetos, de los que 46 eran sintomáticos, apareándose por edad y sexo con una muestra asintomática y sin patología articular del mismo tamaño y área de salud. En ambos casos se les administró el cuestionario EQ-5D. La prevalencia se calculó a partir de la lista de espera de fisioterapia traumatológica del año 2015. Se utilizó el programa estadístico SPSS, empleándose la prueba T y la chi-cuadrado. RESULTADOS: El cuestionario EQ-5D obtuvo una media estandarizada de 0,70 en el síndrome subacromial y de 0,85 en la población asintomática (p=0,0001). La prevalencia del impingement subacromial dentro de la patología de hombro fue del 39,19%. CONCLUSIONES: El síndrome subacromial tiene una alta prevalencia dentro de la patología de hombro en el Servicio de Rehabilitación e interfiere significativamente en la calidad de vida relacionada con la salud del sujeto.

Efficacy of high-intensity laser therapy in subacromial impingement syndrome: a three-month follow-up controlled clinical trial.

OBJECTIVES: To evaluate the effectiveness of high-intensity laser therapy on shoulder pain and function in subacromial impingement syndrome. DESIGN: Clinical controlled trial with alternate allocation. SETTING: Hospital Department of Rehabilitation. SUBJECTS: A total of 46 participants with subacromial impingement syndrome. INTERVENTION: Participants were sequence allocated to an intervention group (high-intensity laser therapy + exercise therapy) and control group (sham-laser + exercise therapy) and received 15 sessions (five days a week during three weeks). MAIN MEASURES: Patiens were evaluated at baseline, after 15 sessions, and at one month and at three months after completing the intervention. The main outcome variables were pain and functionality as measured by visual analogue scale; pressure pain threshold; Shoulder Pain and Disability Index; Constant-Murley Score; and QuickDASH. Secondary outcomes were number of sessions at discharge and drug use. RESULTS: A total of 21 patients in high-intensity laser therapy group (56.7 ± 8.9 years) and 22 patients in sham-laser group (61.3 ± 8.9 years) concluded the study. Visual analogue scale (cm) at baseline, one-month, and three-months were 6.2 ± 0.5, 3 ± 2.6, and 2.6 ± 2.4 for the control group and 5.4 ± 1.5, 3.6 ± 1.3, and 1.8 ± 1.7 for experimental group, respectively. Shoulder Pain and Disability Index (points) at baseline, one-month, and three-monts were 51.8 ± 16.1, 16.3 ± 16.1, and 13.6 ± 17.1 in the control group and 41.8 ± 20.6, 20.5 ± 19.7, 11 ± 14.5 in experimental group, respectively. No differences were found between groups ( P > 0.05). CONCLUSION: The effect of high-intensity laser therapy plus exercise is not higher than exercise alone to reduce pain and improve functionality in patients with subacromial syndrome.

Anatomical prosection practices in the Occupational Therapy degree. Student anxiety levels and academic effectiveness.

CONTEXT: The practice of anatomical dissection and/or prosection on human cadavers is an essential component of human anatomy training programmes. However, this activity can be stressful for inexperienced students when exposed to cadavers for the first time, and it may generate high anxiety levels. The aims of this study are threefold: 1) to analyse the thoughts and feelings of first-year students of the Occupational Therapy degree about prosection practices; 2) to examine their anxiety levels in relation to these practices; and 3) to evaluate how useful and effective they are as an educational tool for anatomy training. METHODS: This is a before-and-after cross-sectional study of first-year students of the Occupational Therapy degree at the Universidad de Castilla-La Mancha, Spain. These students had not previously participated in prosection practices. An anonymous questionnaire was distributed among the students before and after the practice, in order to examine their feelings and perceptions during the practice. To examine their anxiety levels, we used a State-Trait Anxiety Inventory (STAI) questionnaire. To assess their learning outcomes the students had to complete two practical tests of recognition of anatomical structures, one before attending the practice and one immediately afterwards. RESULTS: Basal anxiety levels, measured as trait anxiety (TA), remained stable and did not show significant differences during the practice (p>0.05). Their emotional anxiety, measured as state anxiety (SA), dropped from 14.7 to 10 points (p<0.05) after the practice. Before the start of the practice 11 students (19%) showed signs of anxiety, and these remained so at the end of the practical session (p>0.05). As for their academic performance, we observed that the number of students able to pass the test after attending the prosection practice increased notably (by more than 60%). Additionally, 100% of the students recommended that the practice be retained for future courses, giving it an approval rate of 9.1 out of 10. CONCLUSION: Although anatomy is usually an attractive subject for Occupational Therapy students and they value prosection practices positively, they remain a potentially complex and stressful experience. Some students find that their experiences in the dissecting room can upset their emotional balance, however, the implementation of coping mechanisms could be a very effective strategy to reduce their anxiety and also to improve their learning outcomes, helping to strengthen their practical knowledge of anatomy as we have observed in this study. The students not only value positively these practices, they also believe that they are an extremely useful tool for both teaching and learning anatomy, and they recommend their routine use as part of the training process.

Anxiety among Medical Students when Faced with the Practice of Anatomical Dissection.

Practical training in the dissection of human cadavers is a fundamental and traditional component of human anatomy education in medical schools. This practice, however, can be stressful for students and can generate a certain amount of anxiety. The aim of this study is to explore the attitudes, reactions, and anxiety levels of first-year medical students when working in the dissecting room, over a period of one year, and to relate these anxiety levels to the results of our educational program. This is a before and after descriptive study of students at the University of Castilla-La-Mancha. Questionnaires were distributed among them before and after their dissection practices in order to understand their feelings and emotions and their satisfaction about this activity. State-Trait Anxiety Inventory questionnaires were used to assess the students' 'state anxiety' (SA), which dropped significantly from 49.1% to 14% by the end of their first year. Female students started with higher levels of SA than their male counterparts but by the end of the year these had dropped to similar levels. Anxiety and fearful thoughts tended to drop (P > 0.05). In contrast, uncertainty levels showed significant changes, falling from 44.4% to 12.3%. Nonetheless, 100% of students would go through the experience again. Indeed, 98.2% considered that dissection practices were useful in reinforcing the theoretical aspects of their education, and 80.7% believed that dissecting was more useful than theoretical models. Although students were satisfied with dissection practices the experience cause stressful responses.

Calidad de vida relacionada con la salud en los pacientes diagnosticados de síndrome subacromial en el Área Integrada de Talavera / Health-related quality of life in patients diagnosed with subacromial syndrome in the Talavera Integrated Area

OBJETIVO: Existe una alta prevalencia del síndrome subacromial dentro de los pacientes con patología de hombro, en el cual el dolor y la tendencia a la cronificación son alguna de sus características más importantes. Por ello es necesario objetivar su interacción con la calidad de vida del sujeto. El objetivo principal del estudio fue determinar si existían diferencias en la calidad de vida entre sujetos con síndrome subacromial y asintomáticos. MÉTODOS: Se realizó un estudio transversal en el Área Integrada de Talavera de la Reina (Toledo), durante los meses de noviembre de 2016 a marzo de 2017. Participaron un total de 92 sujetos, de los que 46 eran sintomáticos, apareándose por edad y sexo con una muestra asintomática y sin patología articular del mismo tamaño y área de salud. En ambos casos se les administró el cuestionario EQ-5D. La prevalencia se calculó a partir de la lista de espera de fisioterapia traumatológica del año 2015. Se utilizó el programa estadístico SPSS, empleándose la prueba T y la chi-cuadrado. RESULTADOS: El cuestionario EQ-5D obtuvo una media estandarizada de 0,70 en el síndrome subacromial y de 0,85 en la población asintomática (p=0,0001). La prevalencia del impingement subacromial dentro de la patología de hombro fue del 39,19%. CONCLUSIONES: El síndrome subacromial tiene una alta prevalencia dentro de la patología de hombro en el Servicio de Rehabilitación e interfiere significativamente en la calidad de vida relacionada con la salud del sujeto

OBJECTIVE: There is a high prevalence of subacromial syndrome among patients with shoulder pathology, where the pain and tendency to chronification are some of its most important characteristics. This is why it is necessary to objectively interact with the quality of life of the subject. The main goal was to determine if there are differences between subacromial patients and asymptomatic patients regarding quality of life. METHODS: Transversal study carried out in the Talavera Integrated Area during the months of November 2016 to March2017. Participated a total of 92 subjects, 46 were symptomatic mating by age and sex with an asymptomatic sample and without joint pathology of the same size and health area. In both cases, the EQ-5D questionnaire was administered. The prevalence was calculated from the waiting list of traumatology physiotherapy in the year 2015. The SPSS statistical program was used, applying the T-test and the chi-square. RESULTS: The EQ-5D questionnaire obtained a standardized mean of 0.70 in the subacromial syndrome and 0.85 in the asymptomatic population (P=0.0001). The prevalence of impingement subacromial within shoulder pathology was 39.19%. CONCLUSIONS: Subacromial syndrome has a high prevalence within the shoulder pathology in the Rehabilitation Service and significantly interferes in the quality of life related to the health of the subject

Learning from human cadaveric prosections: Examining anxiety in speech therapy students.

Human anatomy education often utilizes the essential practices of cadaver dissection and examination of prosected specimens. However, these exposures to human cadavers and confronting death can be stressful and anxiety-inducing for students. This study aims to understand the attitudes, reactions, fears, and states of anxiety that speech therapy students experience in the dissection room. To that end, a before-and-after cross-sectional analysis was conducted with speech therapy students undertaking a dissection course for the first time. An anonymous questionnaire was administered before and after the exercise to understand students' feelings and emotions. State-Trait Anxiety Inventory questionnaires (STAI-S and STAI-T) were used to evaluate anxiety levels. The results of the study revealed that baseline anxiety levels measured using the STAI-T remained stable and unchanged during the dissection room experience (P > 0.05). Levels of emotional anxiety measured using the STAI-S decreased, from 15.3 to 11.1 points (P < 0.05). In the initial phase of the study, before any contact with the dissection room environment, 17% of students experienced anxiety, and this rate remained unchanged by end of the session (P > 0.05). A total of 63.4% of students described having thoughts about life and death. After the session, 100% of students recommended the dissection exercise, giving it a mean score of 9.1/10 points. Anatomy is an important subject for students in the health sciences, and dissection and prosection exercises frequently involve a series of uncomfortable and stressful experiences. Experiences in the dissection room may challenge some students' emotional equilibria. However, students consider the exercise to be very useful in their education and recommend it. Anat Sci Educ 10: 487-494. © 2017 American Association of Anatomists.

Bayoneta vs. 2 tiempos. El dolor del inyectable / Bayonet vs two times. The pain of the injection

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La importancia de la estimulación intrauterina: nuevos contenidos y retos en los programas de educación maternal / The importance of intrauterine stimulation: New content and challenges in maternal education programmes

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Conocimiento de la estimulación prenatal en los programas de educación maternal en Atención Primaria por parte de las mujeres gestantes / Pregnant women's knowledge of prenatal stimulation in educational programs for pregnant women in primary care

Objetivo: Estudiar el grado de conocimiento sobre la estimulación prenatal y los beneficios que se obtienen de esta en mujeres embarazadas de dos Centros de Salud de Talavera de la Reina (Toledo). Diseño del estudio: Estudio observacional transversal. Emplazamiento: Centros de Salud urbanos de Talavera de la Reina, Toledo. (C.S. La Solana y C.S. La Algodonera). Participantes: 26 mujeres gestantes (edad media de 30,92 años y 7,23 meses de gestación). Mediciones principales: Mediante muestreo consecutivo se seleccionaron gestantes del programa de preparación al parto que respondieron un cuestionario elaborado 'ad hoc' acerca del conocimiento y beneficios de la estimulación prenatal o intrauterina. También se recogieron variables sociodemográficas. Resultados: El 53,8 % (IC 95 %: 33,3-73,4) de las mujeres gestantes no había escuchado hablar de la estimulación prenatal ni conoce de la importancia de esta. Un 96,2 % (IC 95 %: 80,3-99,9) de las madres gestantes no sabe de la existencia de ningún centro especializado o centro de salud en el que se realice esta práctica. Al 76,9 % (IC 95 %: 56,3-91) de las mujeres gestantes no le han explicado lo que es la estimulación prenatal ni los beneficios, sin embargo el 96,2 % (IC 95 %: 80,3-99,9) de embarazadas cree que la estimulación prenatal ofrece beneficios a su futuro hijo/a. Conclusiones: Existe un alto porcentaje de mujeres que desconoce lo que es la estimulación prenatal, su importancia y los centros donde esta se realiza, así como una falta de información por parte de las matronas sobre la estimulación prenatal y sus beneficios (AU)

Objective: Study the level of knowledge about prenatal stimulation and its benefits of pregnant women in two primary health care centres in Talavera de la Reina (Toledo). Study Design: Observational cross-sectional study. Location: Primary health care urban centres in Talavera de la Reina, Toledo (CHC La Solana and CHC La Algodonera). Participants: 26 pregnant women with an average age of 30.92. Gestational age was 7.23 months. Main measurements: Consecutive sampling of pregnant women attending the preparation for childbirth program, who answered a questionnaire prepared 'ad hoc' about knowledge and benefits of prenatal or intrauterine stimulation. Socio-demographic variables were also collected. Results: 53.8% (CI 95%: 33.3-73.4) of pregnant women had not heard about prenatal stimulation and do not know its importance. 96.2% (CI 95%: 80.3-99.9) of pregnant mothers do not know any specialized centre or health care centre in which this practice is carried out. 76.9% (CI 95%: 56.3-91) of pregnant women have not been told about prenatal stimulation or its benefits. However, 96.2% (CI 95%: 80.3-99.9) of pregnant women believe that prenatal stimulation offers benefits to their unborn children. Conclusions: There is a high percentage of women who are ignorant of what prenatal stimulation is, its importance and the centres where it is carried out, as well as a lack of explanation of prenatal stimulation and its benefits by midwives (AU)