Impact of Dog-Assisted Therapy for Institutionalized Patients With Dementia: A Controlled Clinical Trial.

CONTEXT: Animal-assisted interventions have been used in recent years to complement other therapies of various types for dementia patients. OBJECTIVE: The study intended to evaluate the benefits of dog-assisted interventions for the emotional, behavioral, cognitive, and functional areas of the lives of dementia patients. DESIGN: The research team designed an experimental study that used dog-assisted therapy (DAT) as the intervention. SETTING: The study was conducted at the Enoc Center, a nursing home, in Azucaica, Toledo, Spain. PARTICIPANTS: Participants were 21 residents who had been living at the center for more than one year, were over 65 years old, and had symptoms associated with dementia or affective disorders. INTERVENTION: Participants were randomly divided into three groups: the control, intervention, and healthy groups. The intervention and healthy groups attended the DAT in addition to the center's regular therapies. The control group didn't attend the DAT but did attend the center's regular therapies. The program occurred over six months, with weekly sessions of 45 minutes in both cases. OUTCOME MEASURES: Participants were evaluated at baseline and postintervention using specific scales appropriate to an area: (1) cognitive-Mini-Mental Status Examination (MMSE), (2) functional-Modified Barthel Index, (3) affective-Yesavage Geriatric Depression Scale: Short Form and (4) behavioral-Neuropsychiatric Inventory Scale (NPI). RESULTS: The study revealed significant differences between the control group and the intervention group and between the control group and the healthy group in the cognitive, affective, and behavioral areas but not in the functional area. CONCLUSIONS: The program was beneficial for elderly institutionalized patients with dementia in the emotional, behavioral, and cognitive areas.

[Impact of the duration of labor in the neonatal state measured by arterial blood gas at birth.] / Repercusión de la duración del parto en el estado neonatal medido a través de la gasometría arterial al nacimiento.

OBJECTIVE: The duration of labor has become a central axis of its clinical management, most of the studies that analyze its relationship with the neonatal state focus on indirect tests such as the Apgar test or admissions to the NICU. The aim of the study was to analyze the repercussions of the duration of labor on the condition of the neonates without added risk factors through a direct analysis test such as the umbilical artery blood gas test at birth. METHODS: An observational, analytical, retrospective, and prevalence study was conducted on a sample of 286 infants no previous risk factors obtained from the computerized clinical registry. For a confidence level of p<0.05, parametric tests such as Pearson's correlation coefficient and Chi-square were applied. RESULTS: Showed a significant negative correlation between umbilical artery pH values and delivery times (Dilation: R=-0.207; p=0.002 - Expulsive: R=-0.150; p=0.027 - Total delivery: R=-0.181; p=0.006). Presenting deliveries with times above the mean greater possibilities of fetal acidosis and hypercapnia in dilation (pH: OR=3.10; IC 1.64-5.51 - pCO2: OR=2.19; IC 1.23-3.89), the expulsive (pH: OR=2.24; IC 1.21-4.16 - pCO2: OR=1.77; IC 0.98-3.22) and the total duration (pH: OR=3.36, IC 1.84-6.13- pCO2: OR=2.53; IC 1.44-4.46). CONCLUSIONS: A significant association is was found between the prolongation of labor times and acidosis and neonatal hypercapnia.

OBJETIVO: La duración del parto se ha convertido en un eje central de su manejo clínico, la mayoría de estudios que analizan su relación con el estado neonatal se centra en pruebas indirectas como el test de Apgar o los ingresos en UCIN. El objetivo del estudio fue analizar las repercusiones de la duración del parto en el estado de los neonatos sin factores de riesgo añadidos a través de una prueba de análisis directo como es la gasometría de arteria umbilical al nacimiento. METODOS: Se diseñó un estudio observacional analítico, retrospectivo y de prevalencia realizado sobre una muestra de 286 neonatos sin factores de riesgo previos obtenida del registro clínico informático. Para un nivel de confianza de p<0,05 se aplicaron pruebas paramétricas como el coeficiente de correlación de Pearson y la Chi cuadrado. RESULTADOS: Mostraron una correlación significativa negativa entre los valores de pH de arteria umbilical y los tiempos del parto (Dilatación: R=-0,207; p=0,002 ­ Expulsivo: R=-0,150; p=0,027 - Totales de parto: R=-0,181; p=0,006). Presentando los partos con tiempos superiores a la media mayores posibilidades de acidosis fetal e hipercapnia en la dilatación (pH: OR=3,10; IC 1,64-5,51 - pCO2: OR=2,19; IC 1,23-3,89), el expulsivo (pH: OR=2,24; IC 1,21-4,16 - pCO2: OR=1,77; IC 0,98-3,22) y la duración total (pH: OR=3,36, IC 1,84-6,13- pCO2: OR=2,53; IC 1,44-4,46). CONCLUSIONES: Se constató una asociación significativa entre la prolongación de los tiempos del parto y la acidosis e hipercapnia neonatal.

Analysis of Factors Associated With Variability and Acidosis of the Umbilical Artery pH at Birth.

Background: Perinatal asphyxia is a significant contributing factor for neonatal morbidity and mortality. The aim of this study was to investigate the clinical factors associated with umbilical artery pH variability and fetal acidosis at birth. Methods: This is a single center cross-sectional study in a public regional hospital in southeastern Spain from January to December 2019. The reference population was 1.655 newborns, final sample of 312 experimental units with validated values of umbilical cord blood pH. Results: Factors such as gestational age at term ( X ¯ at - term : 7.26 ± 0.08- X ¯ no -at-term: 7.31 ± 0.05, p: 0.00), primiparity ( X ¯ primiparity : 7.24 ± 0.078- X ¯ multiparity : 7.27 ± 0.08, p: 0.01), induced labor ( X ¯ induced : 7.24 ± 0.07- X ¯ spontaneous : 7.26 ± 0.081, p: 0.02), vaginal delivery ( X ¯ vaginal :7.25 ± 0.08- X ¯ cesarean :7.27 ± 0.07, p: 0.01), and prolonged dilation duration ( X ¯ AboveAverage : 7.22 ± 0.07- X ¯ BelowAverage : 7.27 ± 0.08, p: 0.00), expulsion duration ( X ¯ AboveAverage : 7.23 ± 0.07- X ¯ BelowAverage : 7.26 ± 0.08, p: 0.01), and total labor duration ( X ¯ AboveAverage : 7.23 ± 0.07- X ¯ BelowAverage : 7.27 ± 0.08, p: 0.00) are associated with a decrease in umbilical artery pH at birth. However, only three factors are associated with acidosis pH (<7.20) of the umbilical artery at birth: the induction of labor [OR: 1.74 (95% CI: 0.98-3.10); p: 0.04], vaginal delivery [OR: 2.09 (95% CI: 0.95-4.61); p: 0.04], and total duration of labor [OR: 2.06 (95% CI: 1.18-3.57); p: 0.01]. Conclusions: Although several factors may affect the variability of umbilical artery pH at birth by decreasing their mean values (gestational age, primiparity, induced labor, vaginal delivery and prolonged: dilation duration, expulsion duration and total labor duration), only induction of labor, vaginal delivery and total duration of labor are associated with an acidosis (<7.20) of same.

Benefits of Dog-Assisted Therapy in Patients with Dementia Residing in Aged Care Centers in Spain.

(1) Background: Currently, the scientific evidence on the benefits of assisted therapy with dogs in dementia is not clear. In this study, we want to evaluate such benefits through a randomized controlled clinical trial in multiple centers across the country. (2) Methods: The participants were people over 65 years old with dementia, residing in senior centers in Spain (n = 334). The experimental group underwent assisted therapy with dogs based on the Comprehensive Cognitive Activation Program in Dementia, for 8 months, with weekly sessions of 45 min. Data were collected at the commencement, middle, and end of the program, to evaluate the aspects using the Mini-Examination Cognitive, the modified Bartell Index, the Cornell Scale for Depression in Dementia and the Neuropsychiatric Inventory. (3) Results: The results show significant improvements in the experimental group versus the control group in the affective (T1 = p 0.000; T2 = p 0.000) and behavioral (T1 = p 0.005; T2 = p 0.000) aspects, with the affective aspect displaying greater progress in participants with additional depressive (p = 0.022) or anxiety (p = 0.000) disorders, shorter institutionalization periods (r = -0.222, p = 0.004), and those undergoing complementary psychotherapy (p = 0.033) or alternative therapy (p = 0.011). (4) Conclusions: Dog therapy is effective in improving the affective and behavioral aspects of institutionalized patients with dementia.

[Mothers Talk. Part Unless Told of Voluntary Abortion]. / Hablan Las Madres. la Parte Menos Contada Del Aborto Voluntario.

The aim of the study was to investigate the experiences linked to the post-abortion syndrome in mothers who have had a voluntary abortion. A phenomenological qualitative approach to collect the experiences of mothers who had voluntarily interrupted their pregnancy was used. The research technique was the semistructured interviews with women who had contacted different association's help of the Murcia region for support after experiencing symptoms consistent with post-abortion syndrome. The testimonies show feminist or utilitarian arguments to justify the decision to abort, they talk about a system, to some extent, mercantilist that has no real intention of giving real life choices. Experience shows that far from lived as an act of female freedom is experienced traumatically, developed symptoms following the sense of loss. In this context, the resource spiritual becomes the best tool to expiate guilt. The experience of abortion does not improve the lives of women; far from it is a trauma that can be avoided with proper advice to avoid the tragedy of abortion.

Culturas cosmopolitas del parto. Contrastando sus bases antropológicas desde la perspectiva bioética / Culturas cosmopolitas do parto. Contrastando suas bases antropológicas desde uma perspectiva bioética / Cosmopolitan cultures of childbirth. Contrasting its anthropological bases from the bioethical perspective

Resumen: El objetivo del presente artículo ha sido explorar, desde la perspectiva ética, las principales características y bases antropológicas del parto, tratando de dilucidar, desde un posicionamiento personalista, qué patrones son más consecuentes con el respeto de la dignidad materna y los principios básicos de la bioética. La metodología elegida fue el análisis documental, mediante el uso de diferentes bases de datos del ámbito de las ciencias médicas, sociales y antropológicas. Los resultados muestran abordajes bioéticamente antagónicos, situándose, de una parte, dos reduccionismos ontológicos de corte biologicista: el parto medicalizado y el parto natural, y, de otra, un abordaje holístico: el parto humanizado. Los dos primeros rompen con el principio de autonomía y no maleficiencia, al quedar el destino de las madres marcado por su fisiología, naturaleza que, desde la perspectiva medicalizada, es representada desde las nociones de "riesgo" y "fragilidad", quedando las madres expuestas a múltiples intervenciones clínicas iatrogénicas; mientras que, desde la cosmovisión naturista, es percibida desde la noción de "infalibilidad", lo que las convierte en rehenes de su supuesta perfección anatómica. Conflictos éticos que no surgen en el modelo humanista, al representar éste a las madres como sujetos sociales globales, que exceden cualquier reduccionismo atomista.

Resumo: O objetivo do presente artigo foi explorar, desde uma perspectiva ética, as principais características e bases antropológicas do parto, tratando de elucidar, desde um posicionamento personalista, que padrões são mais consistentes com o respeito da dignidade materna e os princípios básicos da bioética. A metodologia eleita foi a análise documental, mediante o uso de diferentes bases de dados do âmbito das ciências médicas, sociais e antropológicas. Os resultados mostram abordagens bioeticamente antagônicas, situando-se de um lado dois reducionismos ontológicos de corte biologicista, o parto medicalizado e natural, e de outro uma abordagem holística, o parto humanizado. Os dois primeiros rompem com o princípioi da autonomia e não maleficência, ao deixar o destino das mães marcado por sua fisiologia, natureza que, desde uma perspectiva medicalizada, está representada pela noção de risco e fragilidade, ficando as mães expostas a múltiplas intervenções clínicas iatrogênicas; enquanto que, desde uma cosmovisão naturista, é percebida desde a noção de infalibilidade, o que converte as mães em reféns de sua suposta perfeição anatômica. Conflitos éticos que não surgem no modelo humanista, ao representar este às mães como um sujeito social global que excede qualquer reducionismo atomista.

Abstract: The objective of this article has been to explore, from an ethical perspective, the main anthropological characteristics and bases of childbirth, trying to elucidate, from a personalist position, which patterns are more consistent with respect for maternal dignity and basic principles of bioethics. The methodology chosen was the documentary analysis, through the use of different databases in the field of medical, social and anthropological sciences. The results show bioethically antagonistic approaches, placing, on the one hand, two ontological reductions of a biological nature: medicalized and natural birth, and, on the other, a holistic approach: humanized birth. The first two break with the principle of autonomy and non-maleficiency, as the fate of the mothers is marked by their physiology, a nature that, from a medicalized perspective, is represented from the notions of "risk" and "fragility", leaving the mothers exposed to multiple iatrogenic clinical interventions; while, from the naturist worldview, it is perceived from the notion of "infallibility", which makes them hostages of their supposed anatomical perfection. Ethical conflicts that do not arise in the humanist model, when it represents mothers as global social subjects, who exceed any atomistic reductionism.

¿Némesis obstétrica o disminución del riesgo? A debate bioético el abordaje intervencionista en los partos de bajo riesgo / Obstetric nemesis or decrease risk? A discussion bioethical the approach interventionist in low-risk deliveries / Nemesis obstétrica ou diminuição do risco? A debate bioético a abordagem intervencionista em partos de baixo risco

Resumen: Desde hace décadas el parto de bajo riesgo ha sido abordado, fundamentalmente en el ámbito clínico-hospitalario, desde una perspectiva intervencionista, caracterizada por la medicalización, tecnificación y mecanización asistencial. En este contexto se sitúa el presente estudio, cuyo objetivo ha sido explorar las limitaciones bioéticas de este paradigma asistencial intervencionista, mediante el análisis de su pragmatismo clínico frente a otros abordajes más humanistas. Para ello se ha llevado a cabo un profundo análisis documental en diferentes bases de datos del ámbito de las ciencias médicas y sociales, seleccionando tanto artículos de difusión científica como libros, declaraciones, estrategias y guías de práctica clínica. Los resultados muestran un patrón asistencial medicalizado, que parece incrementar las intervenciones no justificadas y con ello los efectos iatrogénicos en los partos de bajo riesgo. Se concluye que estamos ante una cultura del nacimiento que, en cierta medida, vulnera los principios bioéticos fundamentales, al subyugar la dignidad de la corporalidad femenina a intereses económicos contingentes e ideologías transhumanistas, biopolíticas y tayloristas cosificadoras.

Abstract: For decades in low-risk deliveries has been addressed, mainly in the clinical-hospital setting, from an interventionist perspective characterized by medicalization, mechanization and machining care. In this context the present study lies, whose aim was to explore the bioethical limitations of this interventionist paradigm of care through an analysis of its clinical pragmatism compared to other approaches more humanistic. For this it has conducted a thorough analysis of documents in different databases in the field of medical and social sciences, selecting both items of scientific diffusion as books, statements, strategies and clinical practice guidelines. The results show a medicalized care pattern appears to increase the iatrogenic effects in low-risk deliveries. We conclude that this is a culture of birth which, to some, it violates basic bioethical principles to subjugate the dignity of female corporeality to contingent economic interests and transhumanists, biopolitics and taylorist ideologies reifying.

Resumo: Por décadas o parto de baixo risco tem sido abordado, fundamentalmente no campo clinico-hospitalar, a partir de uma perspectiva intervencionista caracterizada pela medicalização, tecnificação e mecanização assitencial. Nesse contexto se situa o presente estudo, cujo objetivo tem sido explorar a limitações bioéticas desse paradigma assistencial intervencionista através da análise de seu pragmatismo clínico frente à outras abordagens mais humanistas. Para isto, fora realizada uma profunda análise documental em diferentes bases de dados no campo das ciências médicas e sociais, selecionando tanto artigos de divulgação científica como livros, declarações, estratégias e guias de prática clínica. Os resultados mostram um padrão assistencial medicalizado que parece intensificar as intervenções não justificadas e, por conseguinte, os efeitos iatrogénicos em partos de baixo risco. Conclui-se estamos diante de uma cultura de nascimento que, em certa medida, viola os princípios bioéticos fundamentais ao subjugar a dignidade da corporalidade feminina por interesses econômicos contingentes e ideologias transumanistas, biopolíticas e tayloristas reificantes.