Predictors of childbirth experience: Prospective observational study in eastern Spain.

BACKGROUND: In recent years, birth experience has been highlighted by national and international organisations as a relevant value in measuring maternal health care quality. According to a standardised tool, we aimed to assess which clinical indicators had the most significant influence on the birth experience. METHODS: This prospective observational study was carried out in fourteen hospitals in eastern Spain. 749 women consented to the collection of birth variables at discharge, and subsequently, at 1-4 months, data were collected on the birth experience as measured by the Spanish version of the Childbirth Experience Questionnaire. Next, a linear regression analysis was performed to determine which clinical birth indicators greatly influence the birth experience measure. RESULT: The study sample (n = 749) was predominantly Spanish and primipara, with 19.5% vaginal births. The predictors that emerged in the linear regression model were to have a birth companion (B = 0.250, p = 0.028), drink fluids during labour (B = 0.249, p < 0.001), have early skin-to-skin contact (B = 0.213, p < 0.001) and being transferred to a specialised room for the second stage of labour (B = 0.098, p = 0.016). The episiotomy (B = -0.100, p < 0.015) and having an operative birth (B = -0.128, p < 0.008) showed a negative influence. CONCLUSION: Our study supports that intrapartum interventions recommended according to clinical practice guidelines positively influence the mother's birth experience. Episiotomy and operative birth should not be used routinely as they negatively influence the birth experience.

A new validated international questionnaire on health professionals' knowledge of hypertension diagnosis.

INTRODUCTION: Arterial hypertension is the main factor in attributable mortality. It is therefore considered one of the most important public health problems. Health professionals require special training and skills to make a diagnosis. No studies have been found in the literature search that use a validated instrument (questionnaire) to assess health professionals' theoretical and practical knowledge in diagnosing hypertension or measuring blood pressure. AIM: To design and validate an instrument for gauging health professionals' theoretical knowledge in measuring blood pressure for the initial diagnosis of hypertension. METHODOLOGY: Design, development, and validation of a questionnaire in three languages (English, Spanish, and Catalan) to assess knowledge based on the Rasch-item response theory model. RESULTS: A questionnaire in three languages was constructed and validated. It consisted of 23 questions on the theoretical knowledge of the initial diagnosis of hypertension and was called the ARC questionnaire. It met all the Rasch-IRT model criteria: item- and person-fit measurement, unidimensionality, local independence, invariance, targeting, and reliability. CONCLUSIONS: The ARC questionnaire is a validated tool that enables objective and uniform analyses of knowledge in the initial diagnosis of hypertension among medical and nursing professionals, comparing them over time. It allows for established strategies to be developed to enhance this knowledge.

A new validated international questionnaire on health professionals’ knowledge of hypertension diagnosis

Introduction: Arterial hypertension is the main factor in attributable mortality. It is therefore considered one of the most important public health problems. Health professionals require special training and skills to make a diagnosis. No studies have been found in the literature search that use a validated instrument (questionnaire) to assess health professionals’ theoretical and practical knowledge in diagnosing hypertension or measuring blood pressure. Aim: To design and validate an instrument for gauging health professionals’ theoretical knowledge in measuring blood pressure for the initial diagnosis of hypertension. Methodology: Design, development, and validation of a questionnaire in three languages (English, Spanish, and Catalan) to assess knowledge based on the Rasch-item response theory model. Results: A questionnaire in three languages was constructed and validated. It consisted of 23 questions on the theoretical knowledge of the initial diagnosis of hypertension and was called the ARC questionnaire. It met all the Rasch-IRT model criteria: item- and person-fit measurement, unidimensionality, local independence, invariance, targeting, and reliability. Conclusions: The ARC questionnaire is a validated tool that enables objective and uniform analyses of knowledge in the initial diagnosis of hypertension among medical and nursing professionals, comparing them over time. It allows for established strategies to be developed to enhance this knowledge.(AU)

Introducción: La hipertensión arterial es el principal factor de mortalidad atribuible. Es por eso que se considera uno de los problemas de salud pública más importantes. Los profesionales de la salud necesitan una formación y unas habilidades especiales para realizar un diagnóstico. En la literatura actual no se han encontrado estudios que utilicen un instrumento validado (cuestionario) para evaluar los conocimientos teóricos y prácticos de los profesionales de la salud en el diagnóstico de la hipertensión o medición de la tensión arterial. Objetivo: Diseñar y validar un instrumento para medir los conocimientos teóricos de los profesionales de la salud en la medida de la tensión arterial para el diagnóstico inicial de la hipertensión. Metodología: Diseño, desarrollo y validación de un cuestionario en tres idiomas (inglés, español y catalán) para evaluar los conocimientos basados en el modelo de Rasch (teoría de la respuesta al ítem). Resultados: Se construyó y validó un cuestionario en tres idiomas. Constaba de 23 preguntas sobre los conocimientos teóricos en el diagnóstico inicial de hipertensión que se denominó cuestionario ARC. Cumplió con todos los criterios del modelo Rasch-IRT: medición de ajuste (fit) al ítem y a la persona, unidimensionalidad, independencia local, invarianza, targeting y fiabilidad. Conclusiones: El cuestionario ARC es una herramienta validada que permite realizar análisis objetivos y uniformes de los conocimientos en el diagnóstico inicial de la hipertensión entre profesionales de medicina y de enfermería, comparándolos en el tiempo. Permite desarrollar estrategias establecidas para potenciar este conocimiento.(AU)

Lugar de fallecimiento de las personas con enfermedades susceptibles de cuidados paliativos en las diferentes comunidades autónomas de España / Place of death of people with conditions needing palliative care in the different autonomous communities (regions) of Spain

FUNDAMENTO: Conocer el lugar de fallecimiento por causas susceptibles de cuidados paliativos de personas residentes en España de 15 o más años de edad según la comunidad autónoma (CA), y cómo influyen las causas (oncológicas y no oncológicas). MÉTODO: Estudio transversal de base poblacional con análisis de los certificados médicos de defunción entre 2012 y 2015. Los efectos ajustados de las variables sociodemográficas, la CA y las causas sobre el lugar de fallecimiento se estimaron mediante las odds de fallecimiento en hospital frente a domicilio (OH/D) y en residencia frente a domicilio (OR/D), y las odds ratio (ORH/D y ORR/D) obtenidas por regresión logística multinomial. RESULTADOS: Se produjeron 1.611.767 muertes de las que 64,8% correspondieron a la población diana. La defunción en hospital fue un 77% más frecuente que en domicilio, y en residencia un 53% menor. Sexo masculino, menor edad, bajo nivel de estudios, lugar de nacimiento fuera de España, tamaño de municipio grande y estado civil no casado se asociaron a fallecimiento en hospital, y las mismas excepto sexo femenino y mayor edad a residencia. Las OH/D ajustadas fueron > 1 en todas las CA y las OR/D < 1, excepto Cataluña. Para las causas oncológicas, las ORH/D ajustadas disminuyeron y fueron significativamente <1 en casi la mitad de CA, y todas las ORR/D permanecieron <1. CONCLUSIONES: El fallecimiento se produjo mayoritariamente en hospital y menos en residencia, aunque las causas oncológicas aumentan la probabilidad de fallecer en domicilio en vez de en hospital (efecto ajustado)

BACKGROUND: Dying at home is the most frequent preference, with the institutionalized context being the most common place of death. To determine the place of death in conditions requiring palliative care of residents in Spain aged 15 or over by Autonomous Community (AC) and to examine the relationship with oncological vs. non-oncological causes of death. METHODS: Population-based cross-sectional study analysing medical death certificates. Adjusted effects of socio-demographic variables, AC and causes on the place of death were estimated calculating odds of death in hospital vs. at home (OH/H) and in a nursing home vs. at home (ON/H), and odds ratio (ORH/H and ORN/H) by multinomial logistic regression models. RESULTS: During 2012-2015, 1,611,767 deaths were recorded, 64.8% corresponding to the target population. Death in hospital was 77% more frequent than death at home, while death in a nursing home was 53% lower. Male sex, lower age, lower academic level, place of birth other than Spain, bigger city size and civil status other than married displayed a relationship with death in hospital, while the same variables except female sex and higher age did so in a nursing home. Adjusted OH/H > 1 and ON/H < 1 were observed in all AC, except Catalonia. Oncological causes made OH/H < 1 in almost 50% of AC, while ON/H continue to be < 1. CONCLUSIONS: Most deaths were in hospital and fewer at nursing homes, despite oncological causes increasing deaths at home (adjusted effect)

[Place of death of people with conditions needing palliative care in the different regions of Spain]. / Lugar de fallecimiento de las personas con enfermedades susceptibles de cuidados paliativos en las diferentes comunidades autónomas de España.

BACKGROUND: Dying at home is the most frequent preference, with the institutionalized context being the most common place of death. To determine the place of death in conditions requiring palliative care of residents in Spain aged 15 or over by Autonomous Community (AC) and to examine the relationship with oncological vs. non-oncological causes of death. METHODS: Population-based cross-sectional study analysing medical death certificates. Adjusted effects of socio-demographic variables, AC and causes on the place of death were estimated calculating odds of death in hospital vs. at home (O-H/H) and in a nursing home vs. at home (O-N/H), and odds ratio (OR-H/H and OR-N/H) by multinomial logistic regression models. RESULTS: During 2012-2015, 1,611,767 deaths were recorded, 64.8% corresponding to the target population. Death in hospital was 77% more frequent than death at home, while death in a nursing home was 53% lower. Male sex, lower age, lower academic level, place of birth other than Spain, bigger city size and civil status other than married displayed a relationship with death in hospital, while the same variables except female sex and higher age did so in a nursing home. Adjusted O-H/H higher than 1 and O-N/H lower than 1 were observed in all AC, except Catalonia. Oncological causes made O-H/H lower than 1 in almost 50% of AC, while O-N/H continue to be lower than 1. CONCLUSIONS: Most deaths were in hospital and fewer at nursing homes, despite oncological causes increasing deaths at home (adjusted effect).

The Spanish version of the Childbirth Experience Questionnaire (CEQ-E): reliability and validity assessment.

BACKGROUND: The Childbirth Experience Questionnaire (CEQ) was originally designed to study women's perceptions of labour and birth. The main objective of our study was to adapt the CEQ to the Spanish context and determine its psychometric properties. This would provide an opportunity to evaluate women's experiences in order to improve evidence in the Spanish context as recommended by national guidelines. METHODS: The CEQ was translated into Spanish using a standard forward and back translation method (CEQ-E). A convenience sample of 364 women was recruited from 3 Spanish hospitals; all participants were able to read and write in Spanish. Mothers with high risk pregnancies or preterm deliveries were excluded from the study. A self-administered questionnaire on sociodemographic variables was completed by participants before discharge. Data on childbirth variables were obtained from maternity records. Between 1 and 3 months postpartum a postal CEQ-E questionnaire was sent. The CEQ-E structure was examined by a confirmatory factor analysis of polychoric correlations using a diagonally weighted least squares estimator. Reliability was assessed using Cronbach's alpha. Construct validity was conducted by testing differences in CEQ-E scores between known-groups (to differ on key variables). RESULTS: 226 (62.1%) of the recruited participants completed the postal questionnaire. The CEQ-E factor structure was similar to the original one. The Spanish version showed fit statistics in line with standard recommendations: CFI = 0.97; NNFI = 0.97; RMSEA = 0.066; SRMS = 0.077. The internal consistency reliability of the CEQ-E was good for the overall scale (0.88) and for all subscales (0.80, 0.90, 0.76, 0.68 for "own capacity", "professional support", "perceived safety" and "participation", respectively) and similar to the original version. Women with a labour duration ≤ 12 h, women with a labour not induced, women with a normal birth and multiparous women showed higher overall CEQ-E scores and "perceived safety" subscale scores. Women with a labour duration ≤ 12 h and those with previous experience of labour obtained higher scores for the "own capacity" and "participation" subscales. CONCLUSIONS: The results of this study indicate that the CEQ-E can be considered a valid and reliable measure of women's perceptions of labour and birth in Spain.

Revisión sistemática de las medidas de calidad de vida en cuidados paliativos en España / No disponible

Objetivo: identificar qué medidas de calidad de vida multidimensionales se emplean con los pacientes paliativos en España, en qué grado se adecuan conceptual y técnicamente y si reúnen 105 estándares adecuados de fiabilidad, validez y responsividad. Método: revisión sistemática de instrumentos de medida. Se realizaron búsquedas electrónicas utilizando 3 términos de búsqueda: cuidados paliativos (palliative care), medidas multidimensionales de calidad de vida (quality of life y atributos de calidad de los instrumentos de medida (psychometrics), en bases de datos nacionales (lME e ISOC) e internacionales (MEDLlNE. CINAHL, PsyInfo y EMBASE) en el periodo 1997-2007. También se llevaron a cabo búsquedas manuales y rastreo de referencias. Resultados: se han encontrado 18 estudios empíricos relativos a 5 instrumentos multidimensionales: el European Organization for Research and Treatment of Cancer. Quality of Life Questionnaire of Cancer 30, el Rotterdam Sympton Checklist, el Quality for Life-Cancer-Antonio Font Experimental, el Palliative Care Outcome Scale y el Hebrew Rehabilitation Centre for Aged Quality of Life Index, así como dos escalas de tipo modular: el Quality of Life Questionnaire Colorectal38 y el Quality of Life Questionnaire of Head & Neck 35. Las evidencias obtenidas con cada uno de ellos no superan los estándares mínimos recomendados para las medidas de resultados de salud basadas en el paciente. Conclusiones: el Palliative Care Outcome Scale (POS) es el instrumento que aparece con una mejor valoración global: su adecuación conceptual y aplicabilidad son adecuadas pero no reúne los estándares psicométricos (AU)

Objective: to identify which multidimensional measures for quality of life are used on palliative patients in Spain, which is their degree of conceptual and technical adequacy, and if they meet the appropriate standards of reliability, validity and responsiveness. Method: a systematic review of measuring instruments. Electronic searches were carried out with three terms: palliative care, multidimensional measures of quality of life, and quality attributes of measures (psychometrics) both in Spanish (IME and ISOC) and international databases (MEDLlNE, CINAHL, Psyclnfo and EMBASE). Manual searches and reference searches were also conducted. Results: eighteen empirical articles were found relating to 5 multidimensional measures: the European Organization for Research and Treatment of Cancer. Quality of Life Questionnaire of Cancer 30, the Rotterdam Sympton Checklist, the Quality for Life-Cancer-Antonio Font Experimental, the Palliative Care Outcome Scale, and the Hebrew Rehabilitation Centre for Aged Quality of Life Index, as well as two modular scales: the Quality of Life Questionnaire-Colorectal 38 and the Quality of Life Questionnaire of Head & Neck 35. The obtained evidences with each of them did not meet the minimum recommended standards for patient-based health outcome measures. Conclusions: the Palliative Care Outcome Scale (POS) is the measurement with the best overall evaluation: its conceptual adequacy and feasibility are good but it does not attain recommended psychometric standards (AU)

Revisión de los atributos de las medidas de resultados de salud basados en el paciente / Review of the attributes of patient-based health outcomes instruments

El estudio de la calidad y uso de instrumentos de medición de resultados de salud basados en el paciente ha sido y es un campo de interés incipiente para muchas disciplinas sanitarias, entre ellas la enfermería. En los últimos 30 años se ha multiplicado el número de instrumentos de medición, y se ha observado una enorme disparidad en sus contenidos, lo que dificulta la selección de uno de ellos para su uso en la clínica o en la investigación. El objetivo de este artículo es presentar los atributos que deben reunir los instrumentos de salud basados en el paciente antes de ser utilizados. Para ello, se presentan con detalle los atributos que, al respecto, se han consensuado, tanto en el ámbito nacional como internacional, agrupándolos en 3 grandes ejes: adecuación conceptual, aplicabilidad y propiedades psicométricas (AU)

Study of the quality and use of patient-based outcomes instruments has been and still is an area of growing interest inmany health disciplines, including nursing. In the last 30 years, the number of measures has greatly increased. However, there is enormous disparity in their contents, hampering selection of one or other of these instruments for use in clinical medicine or research. The aim of this article was to describe the quality attributes that patient-basedhealth instruments should meet before being used. For that purpose, we provide a detailed description of the attributes on which there is both national and international consensus. These instruments are grouped in 3 main axes: conceptual adequacy, applicability, and psychometric properties (AU)

[Gastrointestinal signs and symptoms during pregnancy and postpartum in a sample of Spanish women]. / Signos y síntomas gastrointestinales durante el embarazo y puerperio en una muestra de mujeres españolas.

OBJECTIVE: To describe the evolution of the signs and more frequent gastrointestinal symptoms during the pregnancy and in the two weeks later the birth. SUBJECTS: 583 pregnant women, elects in an accidental way, interviewees between the 8 and 12 weeks of gestation (n = 133), among 18 and 22 (n = 155), among 37 and 42 (n = 203) and two weeks after the childbirth (n = 92) and coming from centers of health and hospitals of the Comunidad Valenciana and Murcia. The questionnaire, answered in a voluntary way by interview, it contained a listing on the signs and more frequent gastrointestinal symptoms during the pregnancy, and she answered on the presence or not of the same ones in the two weeks previous to the moment of the interview. RESULTS: The percentage of nauseas and vomits, although higher in the first trimester, stays around the 25-30% in the third gestation trimester. The heartburn is presented in 58.6% of the pregnant women in the third trimester. The sialorrea is presented in 7.7% of all the pregnant women and she stays during the whole gestation. The constipation stays constant during the gestation above at the 25-30%. The prevalence of haemorrhoids to the beginning of the gestation is over to 8% to be located in the postpartum in 53.3%. CONCLUSIONS: The description of the evolution of the signs and symptoms of the pregnancy described in the obstetrics manuals don't come up with our data.

Signos y síntomas gastrointestinales durante el embarazo y puerperio en una muestra de mujeres españolas / Gastro-intestinal signs and symptoms during pregnancy and childbirth in a sample of spanish women

Objetivo. Describir el comportamiento de los signos y síntomas gastrointestinales más frecuentes a lo largo del embarazo y en el puerperio mediato. Material y métodos. Un total de 583 mujeres embarazadas, elegidas de modo accidental, entrevistadas a las 8-12 semanas de gestación (n = 133), 18-22 semanas (n = 155), 37-42 semanas (n = 203) y 2 semanas después del parto (n = 92), procedentes de centros de salud y hospitales de la Comunidad Valenciana y Murcia. El cuestionario, contestado de forma voluntaria, contenía un listado sobre los signos y síntomas gastrointestinales más frecuentes durante el embarazo, y se preguntaba sobre la presencia o no de aquéllos en las 2 semanas anteriores al momento de la entrevista. Resultados. Los porcentajes de náuseas y vómitos, aunque más elevados en el primer trimestre, se mantienen alrededor del 25-30 por ciento en el tercer trimestre de gestación. La pirosis se presenta en un 58,6 por ciento de las gestantes en el tercer trimestre. La sialorrea se manifiesta en un 7,7 por ciento de todas las mujeres gestantes y se mantiene durante toda la gestación. El estreñimiento se mantiene constante durante la gestación en torno al 25-30 por ciento. La prevalencia de hemorroides al inicio de la gestación se encuentra en torno al 8 por ciento para situarse en el puerperio en un 53,3 por ciento. Conclusiones. La descripción de la evolución de los signos y síntomas del embarazo descrita en los manuales de obstetricia no se corresponde con nuestros datos (AU)

[Study on health related quality of life based on information from COOP/WONCA sheets]. / Evaluación de la calidad de vida relacionada con la salud mediante las láminas COOP/WONCA.

BACKGROUND: The main objective of this study is to describe the quality of life related to health (QLRH) in primary health patients, in escorts of primary health care patients, in pregnant women, in relatives caring for Alzheimer patients, and in drug addicts. PATIENTS AND METHODS: The sample consists of 1,408 persons: primary health care patients (n = 475), escorts of primary health care patients (n = 200), in pregnant women (n = 510), in relatives caring for Alzheimer patients (n = 169), and in drug addicts (n = 68). The QLRH has been measured according to the Spanish version of the COOP/WONCA charts. The questionnaire was filled directly by the people surveyed. RESULTS: The group of pregnant women is the group less physically fit but at the same time the group with best health status, higher social support and best quality of life. At the other end, the group of addicts is the worst considered group regarding the variables of feelings, social activities and quality of life. The factor analysis shows a unifactor structure and its internal consistency is 0.79 (Cronbach's alpha). The multiple regression of COOP/WONCA charts over the variables of age, sex and study groups explains the 14% of the variance (r2 = 0.14). CONCLUSIONS: The COOP/WONCA charts allow for the establishment of distinctions in some of the groups studied (pregnant women and drug addicts), but do not establish enough differences with respect to other groups, which may be due to a certain homogeneity among them. The use of a global score for the COOP/WONCA charts would be theoretically and methodology feasible.

[Classification of written nursing records in the intensive care unit of the Alicante General Hospital]. / Categorización de los registros escritos de enfermería en la UCI del Hospital General de Alicante.

During the last few years the need to implant written Nursing registers has been transferred from Schools to the different official organisms. The Servicio Valenciano de Salud took it as an aim to achieve by 1992 and we also know the Insalud and other autonomic sanitary organisms have shown their interest for the creation of such registers, and there is also a general consensus at a theoretical level of the requirements they ought to fulfill. With this work we plan to: first, know the percentage of nurses who, in our unit, write intershift reports. Second, know the kind of event or activities which we write down in these intershift reports, and last, classify the contents of such registers. To do this we analyse 113 intershift reports, randomly chosen and without previous notice to the unit staff, of the total number of available intershift reports in different periods of time between January and November 1993. A content analysis was performed with a result of 13 categories. The later classification of the contents of the registers in this category item, by equivalence among judges, indicated the high reliability of the process. The Agreement Degree obtained was 98.08% for all the categories. The results obtained indicate: 1) only medical diagnosis are used, not nursing ones 2) the events written down are of a biomedical type 3) information from graphics is repeated 4) the percentage of written intershift reports was 94.95%. Several questions arisen from the results obtained and the bibliography used for this research are revised.