Intrapartum synthetic oxytocin reduce the expression of primitive reflexes associated with breastfeeding.

AIM: Several synthetic peptide manipulations during the time surrounding birth can alter the specific neurohormonal status in the newborn brain. This study is aimed at assessing whether intrapartum oxytocin administration has any effect on primitive neonatal reflexes and determining whether such an effect is dose-dependent. MATERIALS AND METHODS: A cohort prospective study was conducted at a tertiary hospital. Mother-infant dyads who received intrapartum oxytocin (n=53) were compared with mother-infant dyads who did not receive intrapartum oxytocin (n=45). Primitive neonatal reflexes (endogenous, antigravity, motor, and rhythmic reflexes) were quantified by analyzing videotaped breastfeeding sessions in a biological nurturing position. Two observers blind to the group assignment and the oxytocin dose analyzed the videotapes and assesed the newborn's state of consciousness according to the Brazelton scale. RESULTS: The release of all rhythmic reflexes (p=0.01), the antigravity reflex (p=0.04), and total primitive neonatal reflexes (p=0.02) in the group exposed to oxytocin was lower than in the group not exposed to oxytocin. No correlations were observed between the dose of oxytocin administered and the percentage of primitive neonatal reflexes released (r=0.03; p=0.82). CONCLUSIONS: Intrapartum oxytocin administration might inhibit the expression of several primitive neonatal reflexes associated with breastfeeding. This correlation does not seem to be dose-dependent.

Mode of delivery may influence neonatal responsiveness to maternal separation.

INTRODUCTION: Maternal-infant separation (MIS) is a highly stressful situation for the neonate. MATERIALS AND METHODS: A study was conducted to observe and describe the reactions of term neonates to brief maternal separation and restoration of skin contact within the first 48 h of life, and to assess whether the mode of delivery influences neonatal responsiveness. A brief maternal-infant separation situation was videotaped to observe the reactions of the newborns within the first 12-48 h of life. Characteristics observed in the newborns were: the Moro reflex, spreading out arms and feet, looking at the mother, presence/lack of crying, and some dichotomous variables (present or lacking); in mothers: adult speech, "motherese" speech, speaking to another adult present in the room, singing, clicking, tapping on the diaper, rocking, kissing the baby, touching toes, touching hands, changing position, making loving comments, calling the newborn by his/her name and touching his/her back. Crying on restoration of contact was measured. RESULTS: Ten neonates born by planned C-section and 21 neonates born by oxytocin-induced vaginal delivery were included. No behavioral differences were observed according to the mode of delivery. Neonates born by vaginal delivery took longer (64.8±8.6 s) to calm down than those born by C-section (0.9±1.4 s) (p=0.004). A correlation was observed between cortisol concentrations at birth and the time required to calm the baby down (r=0.41; p=0.02). CONCLUSION: Neonates born by a planned C-section cried much less on maternal separation, which might indicate an altered attachment behavior and altered response to stress. Further studies are needed to determine the potential long-term implications of variations in mother-infant attachment during the first days of life.

Adaptación cultural y validación al español de la escala COMFORTS de satisfacción de las mujeres con los cuidados en el parto y puerperio / Cultural adaptation and validation of the Spanish version of the COMFORTS scale of women’s satisfaction in delivery and the postnatal period

Objetivo: determinar la validez y fiabilidad de una versión adaptada culturalmente al entorno español de la Care in Obstetrics: measure for testing satisfaction (COMFORTS), una escala de medida de la satisfacción con los cuidados en el parto y el puerperio. Material y método: estudio observacional de validación realizado en una muestra de 500 puérperas con parto vaginal normal, feto único en presentación cefálica y sin factores de riesgo durante la gestación, atendidas en el servicio de Obstetricia del Hospital Universitario Puerta de Hierro de Majadahonda (Madrid). Se realizó la adaptación de la escala COMFORTS por el método de traducción-retrotraducción; estudio de validez de contenido mediante entrevistas a expertos y puérperas; consistencia interna mediante el coeficiente alfa de Cronbach; y validez de constructor mediante análisis factorial exploratorio de componentes principales. Resultados: la escala modificada y adaptada al español consta de 40 ítems agrupados en cuatro dimensiones: "Cuidados durante el periodo de parto" (13 ítems), "Cuidados en el puerperio" (11 ítems), "Cuidados del recién nacido" (10 ítems) y "Logística y entorno" (6 ítems). La muestra estuvo compuesta por 486 encuestas válidas (tasa de respuesta del 97,2%). El análisis de validez de contenido demostró que la escala adaptada es conceptualmente equivalente a la escala original. La consistencia interna fue de 0,95 para la escala total. El análisis factorial exploratorio para el modelo propuesto mostró cuatro dimensiones o factores que explicaban el 56,63% de la varianza. Conclusiones: la escala COMFORTS en versión española es una escala válida y fiable para medir la satisfacción de las mujeres con los cuidados en el parto y en el puerperio (AU)

Objective: To determine the validity and reliability of a Care in Obstetrics: measure for testing satisfaction (COMFORTS) version that has been culturally adapted to the Spanish setting. This scale measures satisfaction during delivery and the postnatal period. Material and method: Observational validation study performed on a sample of 500 women with a normal vaginal delivery, with a single foetus in cephalic presentation and without risk factors during pregnancy, treated at the department of Obstetrics of the Hospital Universitario Puerta de Hierro in Majadahonda (Madrid). The COMFORTS scale was adapted using the back-translation method, content validity study by interviewing experts and postpartum women, internal consistency was assessed using the Cronbach's alpha coefficient, and construct validity was assessed through principal components factor analysis. Results: The modified and adapted scale to Spanish consists of 40 items grouped into four dimensions: "Nursing care during labor/delivery" (13 items), "Care in the puerperium" (11 items), "Newborn care" (10 items) and "Logistics and environment" (6 items). The sample consisted of 486 valid questionnaires (response rate 97.2%). Content validity analysis showed that the modified scale is conceptually equivalent to the original scale. Internal consistency was 0.95 for the total scale. Exploratory factor analysis for the proposed model showed four dimensions or factors that explained 56.63% of the variance. Conclusions: The Spanish version of the COMFORTS scale is a valid and reliable scale to measure women’s satisfaction with the care during labour/delivery and postpartum periods (AU)

Calidad de vida de los pacientes con colostomía e ileostomía a corto y medio plazo / Quality of life of patients with short and mid-term colostomy and ileostomy

Objetivo: conocer la calidad de vida percibida a corto y medio plazo de los pacientes enterostomizados (colostomías o ileostomías). Material y método: estudio de cohorte prospectivo con enterostomizados del Hospital Universitario Puerta de Hierro (Madrid). Variables: calidad de vida, sociodemográficas y clínicas. Instrumentos: cumplimentaron el SF-36 y Stoma-QOL (mientras conservaron el estoma) en el preoperatorio, a los 15 días del alta, a los tres y seis meses de la cirugía.Análisis: análisis descriptivo. Variaciones de las puntuaciones de la calidad de vida desde la visita inicial a la final. Resultados: 44 pacientes ostomizados; 68% hombres, con edad media 66años, y 32% mujeres, con edad media 59 años, el 73% casados; 48% jubilados/incapacidad; 57% con estudios medios/superiores; 57% de cirugíaprogramada; 75% padecían cáncer colorrectal; 52% fueron colostomías.Hubo 25% cierre precoz, 36% ostomía temporal y 39% permanente.Los cambios en las puntuaciones globales a lo largo de los cuatro tiempos fueron significativos en el área funcional del SF-36. También resultaron significativos los cambios en las puntuaciones globales del Stoma-QOL al comparar los valores a los 15 días del alta-3 meses de la cirugía.Conclusiones: la percepción de calidad de vida es peor los tres primeros meses de la cirugía, que mejora y se mantiene entre los tres y seis meses posteriores. La percepción de calidad de vida fue mejor en los más jóvenes y en los sujetos con estudios medios o superiores. Los pacientescon estomas permanentes valoraron mejor su percepción de calidad de vida en el área emocional (AU)

Objective: to determine the short- and mid-term quality of life perceived by enterostomized patients (colostomies or ileostomies).Material and method: prospective cohort study with enterostomized patients of the Puerta del Hierro University Hospital (Madrid). Variables: Quality of life, sociodemographic and clinical variables. Instruments:Subjects completed the SF-36 and Stoma-QOL (while they still were stomatized)in the preoperative phase, at 15 days after discharge, and at 3and 6 months after surgery. Analysis: Descriptive analysis. Variations ofquality of life scores between the first visit and the final visit.Results: 44 ostomized patients. 68% men, mean age 66 years, and 32%women, mean age 59 years. 73% were married, 48% were retired/disabled,57% had intermediate/higher studies. 57% had a programmedsurgery. 75% had colorectal cancer. 52% were colostomies. 25% hadearly closure, 36% had a temporary ostomy and 39% had a permanentostomy. Changes in the overall scores over the four points in time assessed were significant in the functional area of the SF-36. The changes in theoverall scores of the Stoma-QOL were also significant when comparingvalues at 15 days after discharge-3 months after surgery.Conclusions: perceived quality of life is worse in the first three monthsafter surgery, and then improves and remains stable between the thirdand sixth month. Perceived quality of life was better in young people and in subjects with intermediate or higher studies. Patients with permanentstomas assessed their perceived quality of life in the emotionaldomain more positively (AU)

Valores de latencia de 248 reflejos H en 124 sujetos normales / Latency values of 248 H reflexes in 124 normal subjects

Introducción. El reflejo de Hoffmann o reflejo H es un equivalente eléctrico del reflejo miotático. En el sujeto adulto está presente al estimular el nervio tibial posterior y el nervio mediano. Es útil como complemento en la exploración neurológica de éstos; evalúa los arcos reflejos correspondientes y las vías que interactúan en ellos. Sujetos y métodos. Se han estudiado 248 reflejos H que estimulan el nervio tibial posterior en 124 sujetos normales. Resultados. Los valores de latencia obtenidos son: mínimo de 23,6 ms; máximo de 29,8 ms; media de 27,6 ± 1,41 ms. Conclusión. Se expone la técnica que hay que seguir para obtener el reflejo H y se valora además la necesidad de realizar estudios de normalidad en los valores de conducción en el propio laboratorio (AU)

Introduction. The Hoffmann reflex or H reflex is an electrical counterpart of the myotatic reflex. In normal adults is elicited with stimulating the tibial and the median nerves. It is useful as an adjunct study of neuroexamination and assesses the corresponding arc reflexes in their integrity. Subjects and methods. 248 H reflexes were studied stimulating the tibial nerve in 124 healthy subjects. Results. The latency values were: minimum 23.6 ms; maximum 29.8 ms; mean value 27.6 ± 1.41 ms. Conclusion. This work explains the technique to obtain the H reflex and discusses the need for normalized values for each neurophysiology lab (AU)

Respuesta. Análisis bibliométrico sobre enfermedades raras en España: adecuar la metodología al objetivo de estudio / Reply. Bibliometric analysis of rare diseases in Spain: need for adaptation of the methodology to the objective

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[Analysis of Spanish scientific production in rare diseases: 1990-2000]. / Análisis de la producción científica española sobre enfermedades raras: 1990-2000.

BACKGROUND AND OBJECTIVE: To analyze the Spanish scientific production in a group of rare diseases selected during the period 1990-2000. MATERIAL AND METHOD: Analysis of the following disease groups: congenital anomalies, metabolism inborn errors and primary immunodeficiencies. Bibliometric tools were used to assess and analyze the evolution of research in this area. The MEDLINE database was utilized for references search. RESULTS: Total references recovered for the study were 2978: 82.5% original articles and 17.3% reviews. The number of authors was 14,752 and the mean author/article was 4.9%. Seven types of institutions were coded with hospitals being the most productive with 78% of articles published. The Bradford nucleus was formed by 1,288 articles and 43.2% of the total had been published in 12 journals (2.1%). CONCLUSIONS: Despite rare diseases research is still scarce, important efforts have been made at a national level focused on the development and strengthening of research in this field. Nevertheless, it is necessary to join efforts in this field to facilitate an appropriate research policy making that may help improve the current status.

Análisis de la producción científica española sobre enfermedades raras: 1990-2000 / Analysis of Spanish scientific production in rare diseases: 1990-2000

Fundamento y objetivo: Análisis de la producción científica de los investigadores españoles en un grupo de enfermedades raras seleccionadas durante el período comprendido entre 1990 y 2000. Material y método: Se analizaron los siguientes grupos de enfermedades: anomalías congénitas, errores innatos del metabolismo e inmunodeficiencias primarias. Para la evaluación y análisis de la evolución de la investigación en esta área se aplicaron herramientas bibliométricas. Para la búsqueda bibliográfica se utilizó la base de datos MEDLINE. Resultados: El total de las referencias recuperadas para el estudio fue de 2.978, de las cuales el 82,5% son artículos originales y el 17,3% revisiones. El número total de autores fue de 14.752 y la media de autores por artículo de 4,9. Se codificaron 7 tipos de instituciones, de las cuales los hospitales fueron los más productivos, con un 78% de los artículos publicados. El núcleo Bradford está formado por 1.288 artículos, de los que el 43,2% está publicado en 12 revistas (2,1%). Conclusiones: A pesar de que la investigación en enfermedades raras es todavía escasa, en toda España se han llevado a cabo esfuerzos importantes encaminados al desarrollo y potenciación de la investigación en este campo. No obstante, aunar esfuerzos en este sentido facilitará diseñar políticas de investigación adecuadas que contribuyan a mejorar el panorama actual

Background and objective: To analyze the Spanish scientific production in a group of rare diseases selected during the period 1990-2000. Material and method: Analysis of the following disease groups: congenital anomalies, metabolism inborn errors and primary immunodeficiences. Bibliometric tools were used to assess and analyze the evolution of research in this area. The MEDLINE database was utilized for references search. Results: Total references recovered for the study were 2978: 82.5% original articles and 17.3% reviews. The number of authors was 14,752 and the mean author/article was 4.9%. Seven types of institutions were coded with hospitals being the most productive with 78% of articles published. The Bradford nucleus was formed by 1,288 articles and 43.2% of the total had been published in 12 journals (2.1%). Conclusions: Despite rare diseases research is still scarce, important efforts have been made at a national level focused on the development and strengthening of research in this field. Nevertheless, it is necessary to join efforts in this field to facilitate an appropriate research policy making that may help improve the current status

Programa de educación para la salud en el trasplantado de corazón. Ensayo controlado con asignación aleatoria / Health education programme in heart transplant recipients. A randomized controlled trial

Objetivo. Conocer la eficacia de un programa educativo en los pacientes trasplantados de corazón en la adquisición de conocimientos, habilidades de autocuidado y percepción de su salud. Material y método. Ensayo clínico controlado con asignación aleatoria que se aplicó en pacientes trasplantados por primera vez de corazón que fueron asignados para recibir un programa educativo o la práctica informativa habitual. A todos los pacientes del estudio se les pasó un cuestionario con 40 preguntas cerradas cuando ingresaban en el hospital para la primera revisión después del alta. Las respuestas de 20 variables, que abarcaban las áreas de conocimiento, autocuidado y percepción de salud, fueron agrupadas en 5 factores mediante análisis factorial. Resultados. El estudio se realizó con 60 pacientes, 30 en el grupo intervención y 30 en el grupo control. Los 2 grupos fueron comparables en todas las variables iniciales. Los 5 factores explicaron el 60% de la variabilidad total. El grupo intervención presentó una puntuación más alta en el factor 1, relacionado con el conocimiento y el autocuidado de la inmunodepresión, el rechazo, las infecciones, el tratamiento y los signos y síntomas de alerta (medianas de 0,54 y -0,23 para la intervención y el grupo control, respectivamente; p = 0,009). En otros 3 factores, el grupo intervención presentó puntuaciones más altas no significativas respecto al grupo control. Conclusiones. Un programa educativo mejora el nivel de conocimientos de los pacientes con trasplante de corazón con respecto al rechazo, las infecciones y los signos y síntomas de alerta y mejora el nivel de autocuidados en relación con el tratamiento inmunodepresor (AU)

Objective. To assess the effectiveness of an education programme on the acquisition of knowledge, self-care skills and health perception in heart transplant recipients. Material and method. A randomized controlled trial was conducted in patients receiving a heart transplant for the first time who were assigned to undergo an educational programme or the usual information process. All patients filled in a questionnaire with 40 closed items when they were admitted to hospital for the first follow-up visit after discharge. Using factorial analysis, the responses to 20 variables, which covered the fields of knowledge, self-care and health perception, were grouped into 5 factors. Results. Sixty patients were enrolled, 30 in the intervention group and 30 in the control group. The 2 groups were similar in all baseline characteristics. The 5 factors explained 60% of the total variability. The intervention group had higher scores for factor 1, related to knowledge and self-care of immunosuppression, rejection, infections, treatment and warning symptoms and signs (median: 0.54 and -0.23 for the intervention and control groups, respectively; p = 0.009). In 3 other factors, the intervention group had higher scores than the control group but the difference was not significant. Conclusions. The education programme improved heart transplant recipients’ knowledge of rejection, infections, and warning symptoms and signs, as well as self-care related to immunosuppressive treatment (AU)