Aplicación de termoterapia en el periné para reducir el dolor perineal durante el parto: ensayo clínico aleatorizado / Application of thermotherapy in the perineum to reduce perineal pain during

OBJETIVO: El objetivo general de este estudio fue evaluar la eficacia de la aplicación de termoterapia en el periné durante el periodo expulsivo de un parto normal para disminuir el dolor perineal. MÉTODO: Ensayo clínico multicéntrico, abierto, con asignación aleatoria al grupo de estudio: aplicación de calor húmedo (GCH), calor seco (GCS) y grupo control (GC). Se dirigiOBJETIVO: El objetivo general de este estudio fue evaluar la eficacia de la aplicación de termoterapia en el periné durante el periodo expulsivo de un parto normal para disminuir el dolor perineal. MÉTODO: Ensayo clínico multicéntrico, abierto, con asignación aleatoria al grupo de estudio: aplicación de calor húmedo (GCH), calor seco (GCS) y grupo control (GC). Se dirigió desde la Escuela de Enfermería de la Universidad de Barcelona y se realizó en cinco hospitales de Cataluña durante los años 2009 y 2010. La muestra fue de 198 gestantes; a todas se les aplicó el protocolo de parto natural y se asistió el expulsivo mediante el cuidado habitual. Además, en el GCH se aplicó en el periné calor húmedo mediante compresas mojadas con agua caliente, y en el GCS mediante compresas colt-hot (Nexcare®) calientes, envueltas en una compresa seca. En el GC no se aplicó calor. Durante el expulsivo se valoró el dolor en la zona perineal, mediante la escala de valoración numérica (de 0 a 10). Se realizaron pruebas de contraste estadístico utilizando un intervalo de confianza (IC) del 95% y se realizó el análisis estadístico mediante el programa PASW 17. RESULTADOS: A los 10 minutos de aplicación de termoterapia se constató una reducción del dolor estadísticamente significativa según el test de Wilcoxon: GCH, diferencia de medias de 2,14 (27%; IC del 95%: 1,65-2,62; p <0,001), y GCS, diferencia de medias de 1,45 (16,7%; IC del 95%: 8,56-24,91; p <0,001). CONCLUSIONES: La aplicación de termoterapia en el periné es eficaz para reducir el dolor durante el periodo expulsivo de parto normal

OBJECTIVE: The aim of this study was to evaluate the effectiveness of the application of heat to the perineum during the second stage of laborto reduce perineal pain. METHOD: Open multicenter clinical trial in which patients were randomized to three study groups: moist heat (MHG), dry heat (DHG) and control group (CG). The study was supervised by the School of Nursing at the University of Barcelona and was carried out at five hospitals in Catalonia between 2009 and 2010. The sample consisted of 198 pregnant women; all were assigned to a natural childbirth protocol and received standard care during labor. In both study groups, compresses were applied to the perineum: moist heat compresses in the MHG, and cold-hot compresses (Nexcare®) in the DHG. During delivery, pain in the perineal area was rated on a numerical scale from 0 to 10. Statistical tests were performed using a 95% confidence interval (CI) and statistical analyses were performed with the PASW 17.RESULTS: After 10 minutes of heat therapy a statistically significant reduction in pain was observed using the Wilcox on test: MHG, difference mean 2.14 (27%; CI 95%: 1.65-2.62; p <0.001), and DHG, difference mean 1.45 (16.7%; CI 95%: 8.56-24.91; p <0.001).CONCLUSIONS: The application of heat to the perineum is effective in reducing pain during labor

Efficacy of a videoconferencing intervention compared with standard postnatal care at primary care health centres in Catalonia.

OBJECTIVE: to evaluate the efficacy of an intervention combining videoconferencing and telephone contact compared to standard post partum care of recent mothers attending health centres in Catalonia were recorded. DESIGN: multicentre, randomised parallel controlled clinical trial. PARTICIPANTS AND SETTING: 1598 post partum women with Internet access attending eight 'Attention to Sexual and Reproductive Health' (Catalan acronym ASSIR) units at Primary Health Care centres, in Catalonia (Spain). INTERVENTION: at each of the eight ASSIR units, 100 women were randomly assigned to the intervention group (IG) and 100 to the control group (CG). Women in the IG could consult midwives by videoconference or telephone and could also receive standard care. Women in the control group received standard care from midwives at their health centres or at home. MEASURES: number and type of visits, reasons for consultation, type of feeding at six weeks and women's satisfaction with the intervention on a scale of 1 to 5. FINDINGS: 1401 women were studied (80.9% of the initial sample), 683 in the IG and 718 in the CG. Two hundred and seventy-six women (40.4%) used videoconferencing or telephone in the IG. The mean total visits, virtual and face-to-face, was higher in IG women than in controls (2.74 versus 1.22). IG women made fewer visits to the health centre (mean=1) than CG women (mean=1.17). Both differences were statistically significant, with p<0.001 and p=0.002 respectively. The prevalence of breast feeding was similar in the two groups (IG 64.5%, and CG 65.4%). The mean overall satisfaction of women with midwife care was very high in both groups (IG 4.77, CG 4.76). CONCLUSIONS AND IMPLICATIONS FOR THE PRACTICE: virtual care via videoconferencing is effective for post partum women. It reduces the number of health centre visits and allows mothers to consult health staff immediately and from their own home.

Study of response of thymic and submaxillary lymph node lymphocytes to administration of lead by different routes.

A number of studies have reported that heavy metals are not only toxic for the organism but they may modulate immune responses. In the current study, the effect of 4-week administration of 200 ppm of PbAc(2), using different routes of administration (orally and intraperitoneal injection), on lymphatic organs was evaluated. In the thymus, the number of lymphocyte cells and the cellularity diminished significantly for both routes of treatment. Regarding the submaxillary lymph nodes, no significant variations took place. Cell-mediated immune response is commonly evaluated by cell proliferation assays. Mitogens are known to induce a vigorous proliferative response in lymphoid cells from mammals. An increase in the proliferation of T lymphocytes stimulated by concanavalin A and the proliferation of B lymphocytes stimulated with lipopolysaccharides was found in thymus for both routes of administration, whereas in the lymph nodes, there was a decrease in proliferation of T lymphocytes. Furthermore, lead administration by intraperitoneal route caused an effect on B and T lymphocyte subpopulations. Thus, there was an increase in B+ cells and a decrease in T+ cells. Regarding CD4+ and CD8+ T cells, there were only variations, concretely a drop in both subpopulations, in lymph nodes when lead was administered intraperitoneally. It is important to emphasize that an increase in apoptosis was found in this tissue. At the histological level, evident alterations were described in thymus both for the oral and for the intraperitoneal route. Therefore, it is possible to show that lead administered by both routes generated effects on an immunological level.

Administración de la vacuna de la viruela / Smallpox vaccine administration

La actualidad sociopolítica mundial que vivimos ha puesto de manifiesto la necesidad de retomar y actualizar nuestros conocimientos relacionados con una enfermedad oficialmente erradicada desde el año 1980: la viruela. La vacuna antivariólica fue obligatoria en nuestro país hasta el año 1979, sin embargo, la disminución de la incidencia de la viruela desde la década de los sesenta favoreció que la cobertura real de vacunación descendiera paralelamente desde principios de los años setenta. Por esta razón, la mayoría de los profesionales sanitarios actuales, ante una potencial amenaza bioterrorista con el virus de la viruela, nos enfrentaríamos a una enfermedad que afortunadamente no hemos conocido en nuestra práctica profesional y que cuenta con una vacuna eficaz, pero que tampoco ha formado parte de nuestro entrenamiento y práctica profesional. Por tanto, resulta evidente la importancia que tiene el hecho de establecer un entrenamiento específico en la administración de esta vacuna, dirigido a los profesionales de enfermería, toda vez que se trata de una técnica sencilla pero diferente a las que tradicionalmente se utilizan para la administración del resto de las vacunas, y que utiliza una aguja poco común y poco conocida: la aguja bifurcada (AU)