Experiences of water immersion during childbirth: a qualitative thematic synthesis.

BACKGROUND: The increasing demand for childbirth care based on physiological principles has led official bodies to encourage health centers to provide evidence-based care aimed at promoting women's participation in informed decision-making and avoiding excessive medical intervention during childbirth. One of the goals is to reduce pain and find alternative measures to epidural anesthesia to enhance women's autonomy and well-being during childbirth. Currently, water immersion is used as a non-pharmacological method for pain relief. This review aimed to identify and synthesize evidence on women's and midwives' experiences, values, and preferences regarding water immersion during childbirth. METHODS: A systematic review and thematic synthesis of qualitative evidence were conducted. Databases were searched and references were checked according to specific criteria. Studies that used qualitative data collection and analysis methods to examine the opinions of women or midwives in the hospital setting were included. Non-qualitative studies, mixed-methods studies that did not separately report qualitative results, and studies in languages other than English or Spanish were excluded. The Critical Appraisal Skills Program Qualitative Research Checklist was used to assess study quality, and results were synthesized using thematic synthesis. RESULTS: Thirteen studies met the inclusion criteria and were included in this review. The qualitative studies yielded three key themes: 1) reasons identified by women and midwives for choosing a water birth, 2) benefits experienced in water births, and 3) barriers and facilitators of water immersion during childbirth. CONCLUSIONS: The evidence from qualitative studies indicates that women report benefits associated with water birth. From the perspective of midwives, ensuring safe water births requires adequate resources, midwives training, and rigorous standardized protocols to ensure that all pregnant women can safely opt for water immersion during childbirth with satisfactory results.

The association between sleep quality, low back pain and disability: A prospective study in routine practice.

BACKGROUND: The objective of this study was to estimate the association between sleep quality (SQ) and improvements in low back pain (LBP) and disability, among patients treated for LBP in routine practice. METHODS: This prospective cohort study included 461 subacute and chronic LBP patients treated in 11 specialized centres, 14 primary care centres and eight physical therapy practices across 12 Spanish regions. LBP, leg pain, disability, catastrophizing, depression and SQ were assessed through validated questionnaires upon recruitment and 3 months later. Logistic regression models were developed to assess: (1) the association between the baseline score for SQ and improvements in LBP and disability at 3 months, and (2) the association between improvement in SQ and improvements in LBP and disability during the follow-up period. RESULTS: Seventy-three per cent of patients were subacute. Median scores at baseline were four points for both pain and disability, as assessed with a visual analog scale and the Roland-Morris Questionnaire, respectively. Regression models showed (OR [95% CI]) that baseline SQ was not associated with improvements in LBP (0.99 [0.94; 1.06]) or in disability (0.99 [0.93; 1.05]), although associations existed between 'improvement in SQ' and 'improvement in LBP' (4.34 [2.21; 8.51]), and 'improvement in SQ' and 'improvement in disability' (4.60 [2.29; 9.27]). CONCLUSIONS: Improvement in SQ is associated with improvements in LBP and in disability at 3-month follow-up, suggesting that they may reflect or be influenced by common factors. However, baseline SQ does not predict improvements in pain or disability. SIGNIFICANCE: In clinical practice, sleep quality, low back pain and disability are associated. However, sleep quality at baseline does not predict improvement in pain and disability.

Platelet-rich plasma in the conservative treatment of painful tendinopathy: a systematic review and meta-analysis of controlled studies.

BACKGROUND: Platelet-rich plasma (PRP) seeks to meet the multifaceted demand of degenerated tendons providing several molecules capable of boosting healing. AREAS TIMELY FOR DEVELOPING RESEARCH: PRP is used for managing tendinopathy, but its efficacy is controversial. SOURCES OF DATA: Electronic databases were searched for clinical studies assessing PRP efficacy. Methodological quality was evaluated using the methods described in the Cochrane Handbook for systematic reviews. AREAS OF AGREEMENT: Thirteen prospective controlled studies, comprising 886 patients and diverse tendons were included; 53.8% of studies used identical PRP protocol. AREAS OF CONTROVERSY: Sources of heterogeneity included different comparators, outcome scores, follow-up periods and diverse injection protocols, but not PRP formulation per se. GROWING POINTS: Pooling pain outcomes over time and across different tendons showed that L-PRP injections ameliorated pain in the intermediate-long term compared with control interventions, weighted mean difference (95% CI): 3 months, -0.61 (-0.97, -0.25); 1 year, -1.56 (-2.27, -0.83). However, these findings cannot be applied to the management of individual patients given low power and precision. RESEARCH: Further studies circumventing heterogeneity are needed to reach firm conclusions. Available evidence can help to overcome hurdles to future clinical research and bring forward PRP therapies.

[A pharmacoepidemiological study of antiepileptic drug consumption (1992-2004)]. / Estudio farmacoepidemiológico del consumo de fármacos antiepilépticos (1992-2004).

INTRODUCTION: Epilepsy and the epileptic syndromes are common neurological diseases and represent an important public health problem that has given rise to marked social and healthcare concerns. AIM: To analyse the changes in the consumption of antiepileptic drugs in the Basque Country Autonomous Community over a 13 year period (1992-2004). MATERIALS AND METHODS: The consumption of the N03 subgroup has been studied using data from the ECOM database of the Spanish Ministry of Health and Consumer Affairs, which records the number of drug packets dispensed on National Health Service prescription. The results are expressed as defined daily doses per 1,000 inhabitants per day (DID). RESULTS: A significant increase is observed in the consumption of antiepileptic drugs over the study period (5.53-9 DID). The most widely used drugs were phenobarbital, carbamazepine, valproic acid and phenytoin and, in recent years, the extensive use of gabapentin is of particular note. CONCLUSION: Epidemiological studies on epilepsy are difficult to perform due to a number of methodological problems which are caused fundamentally by the heterogeneity of the disease. Pharmacoepidemiological studies constitute a simple, effective, low-cost tool for estimating the prevalence of the disease, and furthermore enumerates the drugs used, thus contributing to a rational use of these drugs.

Estudio farmacoepidemiológico del consumo de fármacos antiepilépticos (1992-2004) / A pharmacoepidemiological study of antiepileptic drug consumption (1992-2004)

Las epilepsias y los síndromes epilépticos constituyen enfermedades neurológicas frecuentes y representanun importante problema de salud pública, que ha dado lugar a una gran preocupación sanitaria y social. Objetivo. Analizar la evolución del consumo de fármacos antiepilépticos en la Comunidad Autónoma del País Vasco en un período de 13 años (1992-2004). Materiales y métodos. Se ha estudiado el consumo del subgrupo N03 con datos procedentes de la base de datos ECOM del Ministerio de Sanidad y Consumo de España, que ofrece el número de envases de medicamentos dispensadosmediante recetas realizadas a cargo del Servicio Nacional de Salud. Los resultados se presentan en dosis definidas diarias por 1.000 habitantes y día (DHD). Resultados. Se ha producido un aumento significativo en la utilización de fármacos antiepilépticos en el período estudiado (5,53-9 DHD). Los fármacos más utilizados han sido el fenobarbital, la carbamacepina, el ácido valproico y la fenitoína, y destaca en los últimos años el amplio uso de la gabapentina. Conclusiones. Los estudios epidemiológicos sobre epilepsia son difíciles de realizar por diversos problemas metodológicos, que fundamentalmente parten de la heterogeneidad de la enfermedad. Los estudios farmacoepidemiológicos constituyen una herramienta eficaz, fácil y de bajo coste para estimar la prevalencia de la enfermedad, además de dar a conocer los fármacos utilizados y contribuir al uso racional de los mismos (AU)

Epilepsy and the epileptic syndromes are common neurological diseases and represent an importantpublic health problem that has given rise to marked social and healthcare concerns. Aim. To analyse the changes in the consumption of antiepileptic drugs in the Basque Country Autonomous Community over a 13 year period (1992-2004). Materials and methods. The consumption of the N03 subgroup has been studied using data from the ECOM database of theSpanish Ministry of Health and Consumer Affairs, which records the number of drug packets dispensed on National Health Service prescription. The results are expressed as defined daily doses per 1,000 inhabitants per day (DID). Results. A significant increase is observed in the consumption of antiepileptic drugs over the study period (5.53-9 DID). The most widely used drugs were phenobarbital, carbamazepine, valproic acid and phenytoin and, in recent years, the extensive use of gabapentin is of particular note. Conclusion. Epidemiological studies on epilepsy are difficult to perform due to a number of methodological problems which are caused fundamentally by the heterogeneity of the disease. Pharmacoepidemiological studies constitute a simple, effective, low-cost tool for estimating the prevalence of the disease, and furthermore enumerates the drugs used, thus contributing to a rational use of these drugs (AU)