Importance Assigned to Breastfeeding by Spanish Pregnant Women and Associated Factors: A Survey-Based Multivariate Linear Correlation Study.

Breastfeeding education, across all disciplines, is often inconsistent and lacking in expertise and confidence. However, recommendations from health professionals, the sociocultural environment, and previous knowledge and experiences significantly influence women's decision to breastfeed. This study aimed to identify factors that promote the assignment of greater importance to breastfeeding and associated practical benefits. This retrospective cross-sectional study included 276 participants who completed a self-administered questionnaire. Descriptive and bivariate analyses were performed, and multivariate linear models were applied to identify factors influencing the importance assigned to breastfeeding. Most participants were married or in a relationship, were native Spaniards, had secondary or higher education, and had an average age of 32.6 years. Seventy percent met the physical activity recommendations, and 91% felt comfortable with their body image during pregnancy. The importance assigned to breastfeeding was high across various aspects, except for postpartum weight loss and body image. Group prenatal care was only significantly associated with the importance assigned to the breastfeeding technique (how to breastfeed). The obesogenic environment and the importance assigned to nutritional aspects and physical activity also turned out to be predictors, although not for all models. In our region, the educational strategy of antenatal care groups could contain gaps regarding the mother's health, which should be addressed in the future to improve results regarding the initiation and continuation of breastfeeding.

Effects of Acupressure on Maternal and Neonatal Obstetric Outcomes during Labor: Study Protocol.

BACKGROUND: A Cochrane review found that there is insufficient evidence to determine the effectiveness of acupressure for pain relief. One of the problems detected is the methodological variability reported. OBJECTIVE: To assess the impact of the application of acupressure on obstetric and neonatal outcomes of labor, pain experience, and mother's satisfaction with the experience. METHOD: Design of a protocol to carry out a two-arm multicenter single-blinded randomized controlled trial. Intervention (pressure on LI4 of the left hand, B6 of the left leg, GB21 of the left shoulder, and then the same sequence on the right side) and placebo (application of the technique on points not identified by acupuncture as key points) will be performed by a single researcher. RESULTS: The recruitment began in April 2021 and, to date, there has been the participation of 40 women, divided into 17 included in the experimental group and 23 in the control. Communication of future results will be made in accordance with the CONSORT checklist. CONCLUSIONS: The designed protocol could methodologically improve some aspects of previous studies while maintaining adequate statistical power. The effectiveness of acupressure for one or more outcomes proposed (time and pain in labor) could support the inclusion of a new therapeutic tool in the clinical practice of midwives that would allow them to assist pregnant women, improving their experience both physically and psycho-emotionally.

MLuq Protocol: A Proposal for the Immobilization of the White Weapon, Preservation of DNA Traces, and Its Chain of Custody.

Unprecedentedly, this article presents a useful management protocol for the workers in emergency situations assisting victims of white weapon aggressions with a dual innovation. It could presage a possible advance in the healthcare management of these patients and support important repercussions in the legal field when this type of wound is inflicted due to an aggression. The MLuq protocol has been agreed by consensus in a multidisciplinary manner including experts belonging to the state security forces (judicial and scientific Police), to the healthcare area (surgical nursing, emergency medicine, general cardiothoracic and digestive surgery, and the legal and forensic medicine area), to the legal system (a jurist specialized in the area), and to the academic sphere. It is the first paper to propose purse string sutures as a weapon immobilization technique, as well as a set of actions designed to obtain biological traces of legal interest and to preserve the chain of custody. Therefore, it is a useful tool for the health and legal personnel, and especially for the victims.

Nutritional Analysis of the Spanish Population: A New Approach Using Public Data on Consumption.

Official population consumption data are frequently used to characterize the diet of countries; however, this information may not always be representative of reality. This study analyses the food consumption of the Spanish population by reconstructing the whole food chain. The results have been compared with the data provided by the National Consumption Panel to which the food losses/waste reported in the literature along the distribution chain have been added. The difference between them allowed a new calculation of the estimated food consumption that was subjected to a dietary-nutritional analysis. Most of the foods were consumed more than those officially reported (range of 5-50%). The unhealthy ratios of consumed foods and recommended servings were: meat products (Rcr = 3.6), fruits and legumes (Rcr = 0.5), and nuts (Rcr = 0.14). Caloric intake surpasses needs. The results were consistent with the data on the prevalence of overweight and obesity in Spain, as well as with the prevalence of associated diseases. To make a judgment about the quality of a country's diet, it is necessary to have reliable data on food consumption, as well as energy and nutrient intake. This study encourages other authors to implement this method to verify and quantify the possible difference between official and real consumption data.

Clinical research focused in European adult women with minority diseases: Do we try hard enough?

We analyzed the European countries participation in clinical trials addressing to new drug development focused on rare diseases in women comparing to more prevalent diseases as breast cancer. Participation was not associated with type of healthcare system neither socio-economic features, but it was associated with population size. Protocol ratios focused on breast cancer vs. orphan drugs and rare diseases was 15:1 and 9:1, respectively, mainly focused on ovarian cancer. Protocol number was insufficient to evaluate the success of Regulation (EC) 141/2000, it is necessary to increase the scientific quality and the number of really new molecules.

Reducing health inequalities among most disadvantaged type 2 diabetes patients: A cross-sectional exploratory pilot study.

BACKGROUND: Demographic changes and the increased chronical diseases burden are global challenges that cannot go unnoticed by healthcare systems, which must be organized without losing sight of the increasing influence of social determinants. AIM: To evaluate the results of a primary care program implemented to reduce health inequalities associated with social determinants in patients with type 2 diabetes. METHOD: An exploratory pilot retrospective cross-sectional study that includes secondary data of 404 nonrandomized patients belonging to socially depressed areas and conventional areas. Descriptive, bivariate, and multivariate analyses were performed. RESULTS: The age of the subjects included in the study was 66.80 ± 9.7 years with a proportion of 56.7% men. Proportions of patients from socially depressed areas and adherence to the Nursing Follow-up Program were around 33% and 60%, respectively. The obesity rate was 51%, percentage of patients with HbA1c<7% was 59%. No significant differences were found between patients belonging to socially depressed areas and those who do not, except for greater adherence to nursing follow-up programs. Multivariate models assessed chronical complications as health outcomes (cardiovascular diseases, retinopathy, and nephropathy) as health outcomes showing the influence of previously described risk factors. However, in none of the models did belonging to a socially depressed area or adherence to the Nursing Follow-up Program were predictors. CONCLUSIONS: The program has proven to be efficient in equating the health outcomes related with cardiovascular risk of patients from both types of areas. Well-directed health policies could bring primary care systems closer to sustainable development goals through the reduction of health disparities that affect socially vulnerable groups. CLINICAL RELEVANCE: To introduce a risk strategy and to adopt a family approach, contemplating the sociocultural and educational differences that diversely affect men and women in their health status has proven to be useful in reducing health disparities due to social determinants in patients with type 2 diabetes.

Sustainable Diets as Tools to Harmonize the Health of Individuals, Communities and the Planet: A Systematic Review.

BACKGROUND: Climate change and global health are inextricably linked. Thus, health systems and their professionals must adapt and evolve without losing quality of care. AIM(S): To identify health and environmental co-benefits derived from a sustainable diet and promotion strategies that favor its implementation. METHODS: A systematic search for articles published on sustainable diets and human/planetary health published between 2013 and 2020 was conducted on the databases PubMed, Cinahl, Scopus and Trip from 4 to 7 May 2020 in accordance with the PRISMA guideline. RESULTS: A total of 201 articles was retrieved, but only 21 were included. A calorie-balanced diet mainly based on food of plant origin that would allow the attainment of 60% of daily caloric requirements and a low protein intake from animal foods (focusing in fish and poultry) could significantly reduce global morbi-mortality and the dietary environmental impact maintaining a framework of sustainability conditioned by the consumption of fresh, seasonal, locally produced and minimally packaged products. DISCUSSION: The implementation of sustainable diets requires working on the triangulation of concepts of food-health-environment from schools and that is permanently reinforced during all stages of the life by healthcare workers, who should establish the appropriate modifications according to the age, gender and health situation.

Bupivacaine infiltration for acute postoperative pain management after cardiac surgery.

BACKGROUND: Despite increased attention, acute and persistent post-operative pain are not treated efficiently and interventions against acute pain are therefore of clinical importance and should be welcomed. AIMS AND OBJECTIVES: To evaluate the effectiveness of wound infiltration with 0.5% bupivacaine for pain management in the immediate post-operative period in patients that underwent cardiac surgery with sternotomy. DESIGN: The study was performed employing a single-centre nonrandomized experimental design to evaluate a prospective cohort of patients recruited from June to December of 2017. METHODS: A single-centre study with a non-randomized experimental design compared the pain perceived by 137 patients undergoing to cardiac surgery within which 68 patients who received infiltration of bupivacaine and 69 patients received infiltration with saline solution. Pain measures were made with the numeric rating scale (NRS) at 2, 12, 24, and 48 hours. Socio-demographic and clinical variables were included too and descriptive, bivariate, and multivariate logistic regression analyses were performed. RESULTS: A statistically significant difference was found between the means of the NRS scores in favour of the intervention group. Cohen's d showed a significant effect size. NRS scores were grouped into NRS ≥4 or NRS <4 and similar results were found. Multivariate logistic regression analyses showed the absence of confounding factors that could call results into question. CONCLUSION: Subcutaneous infiltration of 0.5% bupivacaine in the surgical site of patients who have undergone cardiac surgery showed clinically and statistically significant pain relief compared with patients who received saline infiltration throughout the first 12 hours after surgery. This intervention provides promising preliminary results that, alone or in conjunction with other nursing interventions, could constitute an important therapeutic tool for this area of nursing clinical practice.

[Big Data in health: a new paradigm to regulate, a challenge for social justice.] / Big Data en salud: Un nuevo paradigma para regular, un desafío para la justicia social.

In addition to the opportunities posed by the use of Big Data in health, it also generates important challenges in the field of research, especially from the point of view of its management and ethical considerations. The European Union has been promoting different initiatives that allow the exploitation of this data in the context of the knowledge economy. The UNESCO Ethics Committee has identified three ethical principles to take into account regarding the application of Big Data in Health: independence, privacy and justice. The protection of privacy and patient safety is questioned in a context where cybersecurity is far to be complete. In addition, an imbalance in the exploitation of these data by the public and private sectors could generate inequalities that would represent a significant problem of social justice. This article follows a qualitative methodology based on the documentary analysis of current legislative texts, especially the recently approved General Data Protection Regulation (GDPR), as well as non-legislative documents of projects and parliamentary communications throughout the last two legislatures, with the aim of analyzing them and evaluating how they conform to the principles outlined by UNESCO, especially with respect to the principle of social justice. The most representative national projects that have started to be adopted are also reviewed.

Además de las oportunidades que supone el uso de Big Data en salud, también genera desafíos importantes en el campo de la investigación, especialmente desde el punto de vista de su gestión y de las consideraciones éticas. La Unión Europea ha estado promoviendo diferentes iniciativas que permitan la explotación de estos datos en el contexto de la economía del conocimiento. El Comité de Ética de la UNESCO ha identificado tres principios éticos a tener en cuenta sobre la aplicación de Big Data en Salud: independencia, privacidad y justicia. La protección de la privacidad y la seguridad de los pacientes se cuestiona en un contexto en el que la ciberseguridad está lejos de ser completa. Además, un desequilibrio en la explotación de estos datos por parte de los sectores público y privado podría generar inequidades que significarían un problema importante de justicia social. Este artículo sigue una metodología cualitativa basada en el análisis documental de los textos legislativos vigentes, especialmente el recientemente aprobado reglamento general de protección de datos (RGPD), así como documentos no legislativos de proyectos y comunicaciones parlamentarias a lo largo de las dos últimas legislaturas, con el objetivo es analizarlas y evaluar cómo se ajustan a los principios esbozados por la UNESCO, especialmente con respecto al principio de justicia social. También se revisan los proyectos nacionales más representativos que han empezado a adoptarse.

Cross-sectional study of the healthcare provided by a medicalized helicopter from Extremadura (Spain).

OBJECTIVE: To analyze geographic dispersion, demographic factors, clinical features of patients attended and response times of a helicopter emergency medical service in a region of Spain. METHODS: According to the principles of the Declaration of Helsinki and to the standards of Good Clinical Practice, a cross-sectional observational study from January 2014 to December 2016 was carried out. Socio-demographic, clinical and transfer related variables were analyzed from an anonymized database loaned by the service. RESULTS: 642 missions were flown (on average 0.59 flights per day). The patients were 65.6% males (they were significantly younger than women were) and 79% older than 45. Primary transfers composed 68.8% of cases. Medical pathologies were the most prevalent (74.9%), followed by traumatic pathologies (19.8%). Cardiovascular pathologies took up 68.8% of attended medical pathologies and 51.56% of the total of recorded cases. The accident rate was 20.25% and the response time in 75% of cases was under 32 min. Twenty deceased patients were registered (70% males). CONCLUSIONS: This study reports for the international community the features of several Spanish HEMS and profile of patients attended. Adult men are a common profile and cardiovascular issues have replaced traumatic issues as main healthcare demand. However, it should be confirmed because it could be due to differences in local profile of patients. Men had higher risk of road traffic and occupational accidents as well as a higher mortality than women did. Socio-demographical and organizational aspects have been provided that could be taken into consideration to implement new air emergency services.