Study protocol for improving mental health during pregnancy: a randomized controlled low-intensity m-health intervention by midwives at primary care centers.

BACKGROUND: Pregnancy-related anxiety and depression has received considerable attention worldwide. Mental health problems in pregnant women already since early weeks of gestation may have important consequences to the fetus. The necessity for more effective health care pathways, including some early interventions that reduce the overall burden of the childbearing situation appears a key factor for a successful birth and care of the baby. The few studies focalized in interventions, are focused on delivery and postpartum, without taking into account the whole maternity process. Current literature recommends the use of interventions based on new technologies for the treatment of mood disorders, already during the prenatal period. There have been scarce well-designed intervention studies that test technological low-intensity interventions by midwives to address pregnant women's mental health, diminishing anxiety and depression during pregnancy. METHODS/DESIGN: Adult pregnant women (weeks 12-14 of gestation) will be recruited and screened from different primary care centers in Catalonia, Spain. Women who pass the initial mental screening will be randomly allocated to the relaxation virtual reality intervention or control group. The intervention aims to improve mental state of pregnant women during pregnancy, work through breathing, mindfulness and muscle relaxation techniques. Women in the control group will receive standard care offered by the public funded maternity services in Catalonia. The primary outcome measures will include the Edinburg Postnatal Depression (EPDS), State Trait Anxiety Inventory (STAI), Symptom Checklist-90 (SCL-90), and the Cambridge Worry Scale (CWS) instruments. Secondary outcome measures will include the Temperament and Character Inventory-Revised (TCI-R) and the Whooley and Generalized Anxiety Disorder-2 (GAD-2) questions. Routinary pregnancy monitoring measures will be also evaluated. DISCUSSION: This study aims to test the efficacy of a low-intensity, midwife-led e-health intervention based on new technologies to work on women's anxiety and depression during pregnancy. We hypothesize that low-intensity mental health intervention during pregnancy, using an e-health (virtual reality) as a support tool, will be effective in reducing of anxiety, depressive symptoms, and improving satisfaction with pregnancy follow-up. TRIAL REGISTRATION: Clinical Trials ID NCT05756205.

Radiological Characteristics of Carbonated Portland Cement Mortars Made with GGBFS.

The objective of this study is to assess whether the carbonation process can modify the physicochemical characteristics of the natural radionuclides of the three natural radioactive series, together with 40K. Three mortar specimens with different percentages of ground granulated blast-furnace slag (GGBFS), cured under water for 1, 3, 7, 14, or 28 days, were subjected to a natural carbonation process. Activity concentrations for the solid and ground mortars were determined by gamma spectrometry and by radiochemical separation of isotopic uranium. The novelty of this paper relies principally on the study we have carried out, for the first time, of the radiological characteristics of carbonated Portland cement mortars. It was found that the chemical properties of the 3 mortar specimens were not affected by the carbonation process, with particular attention placed on uranium (238U, 235U, and 234U), the activity concentrations of which were equivalent to the 226Ra results and ranged from 5.5 ± 1.6 Bq kg-1 to 21.4 ± 1.2 Bq kg-1 for the 238U. The average activity concentrations for the 3 types of mortars were lower than 20.1 Bq kg-1, 14.5 Bq kg-1, and 120.2 Bq kg-1 for the 226Ra, 232Th (212Pb), and 40K, respectively. Annual effective dose rates were equivalent to the natural background of 0.024 mSv. In addition, it was observed that the variation rate for the 222Rn emanation was due primarily to the Portland cement hydration and not due to the pore size redistribution as a consequence of the carbonation process. This research will provide new insights into the potential radiological risk from carbonated cement-based materials. Moreover, the assessment that is presented in this study will convey valuable information for future research that will explore the activity concentration of building materials containing NORM materials.

Emergency severity level-3 patient flow based on point-of-care testing improves patient outcomes.

BACKGROUND: Overcrowding of the Emergency Department is rapidly becoming a global challenge and a major source of concern for emergency physicians. The desire to improve Emergency Department throughput requires novel approaches to patient flow. MATERIALS AND METHODS: We conducted a prospective and cluster-randomized study, to evaluate the impact in patient outcomes of a new patient flow based on Point-of-Care Testing (POCT). A total of 380 Emergency Severity Level-3 patients were enrolled and studied in two different groups, interventional arm (laboratory analyses performed on POCT analyzers implemented in the Emergency Department) or control arm (central laboratory). The primary outcome was the Emergency Department length of stay. Secondary outcome included the time to first medical intervention, the laboratory turnaround time and the time to disposition decision. Readmission within the 7 days after discharge was also calculated. RESULTS: Length of stay significantly decreased by 88.50 min (from 247.00 to 158.50), time to disposition decision by 89.00 min (from 192.00 to 103.00) and laboratory turnaround time by 67.11 min (from 89.84 to 22.73) in the POCT group. No increase in readmission was found. CONCLUSION: Our strategy based on POCT represents a good approach to optimize patient flow in the Emergency Department and it should be seen as a starting point for further studies focusing on improving throughput.

Validity and reliability of the Spanish version of the "Wijma Delivery Expectancy/Experience Questionnaire" (W-DEQ-B).

The Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ-B) is an instrument that allows the experiences around fear of childbirth to be examined after the birth. It is currently the most widely used to measure different aspects related to the fear of childbirth and enables healthcare and additional assistance to women after birth to be adapted according to their needs. The objective of this study was to translate the W-DEQ-B into Spanish and analyse its reliability and validity. The study was carried out in two phases: (1) transcultural adaption of the questionnaire to Spanish and (2) a transversal study in a sample of 190 postpartum women from Sexual and Reproductive Health Clinics in the province of Barcelona (Spain). The psychometric properties were examined in terms of reliability (internal consistency and temporal stability) and construct validity (confirmatory factorial analysis [CFA] and exploratory factorial analysis [EFA]). The results of the CFA did not confirm unidimensionality of the W-DEQ-B questionnaire. The EFA suggested four very similar, but not identical, dimensions to those obtained in other studies in which the W-DEQ-B has been evaluated. Both the Cronbach's alpha and the omega coefficient were adequate for the total questionnaire and for each of the four dimensions. The results of this study confirm that the W-DEQ-B is multi-dimensional. In the Spanish version of the W-DEQ-B-Sp four dimensions have been identified that allow the experiences around fear of childbirth to be examined after the birth. The Spanish version of the WDEQ-B (WDEQ-B-Sp) is reliable and valid for the measurement of fear of childbirth in clinical practice and for use in future research.

Reliability and validity study of the Spanish adaptation of the "Wijma Delivery Expectancy/Experience Questionnaire" (W-DEQ-A).

The Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ-A) is an instrument that evaluates fear of childbirth through the expectations of women in relation to childbirth and their experience during the birth. The objective of this study was to translate the W-DEQ-A into Spanish and analyse its reliability and validity. The study was carried out in two phases: (1) adapting the questionnaire to Spanish and (2) a transversal study in a sample of 273 pregnant women in the Sexual and Reproductive Health centres in the Metropolitan Northern Barcelona in Catalonia (Spain). The psychometric properties were analysed in terms of reliability and construct validity. The confirmatory factorial analysis did not confirm the unidimensionality of the original structure of the WDEQ-A, as happened with the other studies in which it has previously been validated. The result of the exploratory factorial analysis suggests four factors, or dimensions, very similar but not identical to those obtained in other analysis studies of the W-DEQ-A. The Cronbach alpha and the omega scale were also adequate for all the scales and for each of the dimensions. The results of this study confirm the findings of other studies that suggest that the W-DEQ-A is multi-dimensional. In the Spanish version of the W-DEQ-A four dimensions have been identified to explore fear of childbirth in pregnant women. The Spanish version of the WDEQ-A (WDEQ-A-Sp) is reliable and valid for the measurement of fear of childbirth in clinical practice and for use in future research.

Beneficios de la pelota de partos (birth ball) en la sala de partos / Benefits of the birth ball in the birthing room

Objetivo: identificar los beneficios del uso de la pelota de partos durante el proceso de dilatación y expulsivo, en mujeres que ingresaban en curso de parto o para inducción al parto.Material y método: estudio descriptivo transversal, en la Corporació Sanitària Parc Taulí (CSPT) de Sabadell en 2008. Se incluyeron mujeres que ingresaban en curso de parto o para inducción al parto en CSPT y que aceptaban el uso de la pelota.Se utilizó un cuestionario de elaboración propia sobre el uso de la pelota que contenía: datos demográficos relacionados con el empleo de la pelota, cuestiones que hacían referencia a la analgesia peridural, posiciones adoptadas durante el proceso y el grado de satisfacción.Resultados: de 1.285 partos asistidos en el período de estudio, la pelota se ofreció a 102 mujeres, tres de las cuales la rechazaron porque querían estar de pie o en la cama. Comparando la pelota con la cama, la gran mayoría de mujeres (96,7%) encontraron la pelota muy confortable, la sensación de dolor mejoró(79,6%) así como la sensación de movimiento (97,0%).La vivencia de acompañamiento por parte de la pareja mejoró en un 73,5%. En un 94,9% las mujeres refirieron que la pelota les ayudaba a controlar mejor el dolor de la contracción.Conclusiones: los resultados apuntan claros beneficios con la utilización de la pelota durante el proceso de parto, si bien son necesarios estudios analíticos para confirmar su eficacia (AU)

Objective: to identify the benefits of using a birth ball during the dilation and pushing phases of labour, in women who were admitted while in labour or for induction of labour.Material and method: cross-sectional descriptive study conducted at the Parc Tauli Health Care Corporation of Sabadell in 2008. The sample consisted of women admitted while in labour or in order to induce labour in CSPT (Parc Tauli Health CareCorporation) who accepted the use of the birth ball. A self-elaborated questionnaire on the use of the ball was administered,containing the following: demographic data, data related with the use of the ball, peridural analgesia matters, positions adopted during the process and degree of satisfaction. Results: of the 1.285 births attended over the course of the study the ball was offered to 102 women, three of whom refused to use it because they preferred to stand or lay on the bed. When comparing the ball with the bed, the majority of women (96,7%)found the ball to be very comfortable, their pain improved (79,6%), as did the sensation of movement (97,0%). The experience of feeling accompanied by their partner improved in73,5%. 94,9% of women reported that the ball helped them manage their pain better during contractions.Conclusions: the results indicate the clear benefits of using the ball during labour, but further analytical studies are needed to confirm its efficacy (AU)