Mantenimiento de la lactancia materna exclusiva a los 3 meses posparto: experiencia en un departamento de salud de la Comunidad Valenciana / Maintenance of exclusive breastfeeding after three months postpartum: An experience in a health department of a Valencian Community

Objetivos: Determinar la prevalencia de la lactancia materna exclusiva (LME) a los 3 meses posparto, y conocer las causas que contribuyen al abandono precoz. Diseño: Estudio observacional y restrospectivo. Emplazamiento: Departamento de Salud de la Ribera, Valencia, España. Participantes: Niños nacidos entre diciembre de 2012 y enero de 2017. Mediciones principales: prevalencia de lactancia materna al alta y de LME a los 3 meses. Motivos de abandono de LME. Determinación de Chi-cuadrado entre variables categóricas. Metodología: Las mujeres fueron entrevistadas en el posparto y a los 3 meses posparto, teniendo en cuenta las variables asociadas al inicio de la lactancia y su continuación. También se recogió información sobre las características socio-demográficas y obstétrico-neonatales. Resultados: Un total de 1.338 mujeres fueron seleccionadas. La prevalencia de lactancia materna al alta se situó en el 68,2% (913) y a los 3 meses descendió al 46,7% (625). La duración de la LME fue de 68,7±32,7 días (IC 95%: 66,9-71,2). Encontramos diferencias estadísticamente significativas entre el tipo de lactancia al alta y las variables, año del estudio, país de origen y paridad (p < 0,001; p = 0,005 y p = 0,05, respectivamente). La hipogalactia (21,8%) y el aumento de peso del recién nacido inferior al recomendado (14,9%) fueron los factores más frecuentes que motivaron el abandono precoz. Conclusiones: La prevalencia de la LME a los 3 meses es baja comparada con otros estudios similares, aunque observamos una tendencia al alza. La creencia en la hipogalactia influyó en el mantenimiento de la LME

Aims: To investigate the prevalence of EBF at 3-months postpartum, and the early factors for discontinuation. Design: Observational, retrospective study. Location: Health department of La Ribera, Valencia, Spain. Participants: Newborns between December 2012 to January 2017. Methods: Pregnant women were interviewed at postpartum and at 3 months regarding variables associated with breastfeeding initiation and continuation, matched with socio-demographic and obstetric-neonatal information. Main measurements: Prevalence of breastfeeding at discharge and exclusive breastfeeding at 3 months. Reasons for interrupt exclusive breastfeeding. Chi-square determination between qualitative variables. Findings: One thousand three hundred and thirty-eighth women were recruited. EBF at discharge was 68.2% (913) and at 3 months 46.7% (625). EBF duration was 68.7±32.7 days (95% CI: 66.9-71.2). We found statistically significant differences between the type of breastfeeding and the variables, year of study, country of origin and parity (P<0.001, P=0.005 and P=0.05 respectively). Hypogalactia (21.8%) and lower than recommended increase in newborn weight gain (14.9%) were most frequent factors for discontinuation. Conclusion: The prevalence of EBF at 3 months is low compared to other similar studies, although we see an upward trend. Belief in hypogalactia influenced the maintenance of exclusive breastfeeding

[Maintenance of exclusive breastfeeding after three months postpartum: An experience in a health department of a Valencian Community]. / Mantenimiento de la lactancia materna exclusiva a los 3 meses posparto: experiencia en un departamento de salud de la Comunidad Valenciana.

AIMS: To investigate the prevalence of EBF at 3-months postpartum, and the early factors for discontinuation. DESIGN: Observational, retrospective study. LOCATION: Health department of La Ribera, Valencia, Spain. PARTICIPANTS: Newborns between December 2012 to January 2017. METHODS: Pregnant women were interviewed at postpartum and at 3 months regarding variables associated with breastfeeding initiation and continuation, matched with socio-demographic and obstetric-neonatal information. MAIN MEASUREMENTS: Prevalence of breastfeeding at discharge and exclusive breastfeeding at 3 months. Reasons for interrupt exclusive breastfeeding. Chi-square determination between qualitative variables. FINDINGS: One thousand three hundred and thirty-eighth women were recruited. EBF at discharge was 68.2% (913) and at 3 months 46.7% (625). EBF duration was 68.7±32.7 days (95% CI: 66.9-71.2). We found statistically significant differences between the type of breastfeeding and the variables, year of study, country of origin and parity (P<0.001, P=0.005 and P=0.05 respectively). Hypogalactia (21.8%) and lower than recommended increase in newborn weight gain (14.9%) were most frequent factors for discontinuation. CONCLUSION: The prevalence of EBF at 3 months is low compared to other similar studies, although we see an upward trend. Belief in hypogalactia influenced the maintenance of exclusive breastfeeding.

Corneal Thickness Response after Anesthetic Eye Drops: Our Own Results and Meta-Analysis.

We aimed to test if there are different patterns in the central corneal thickness (CCT) response after instilling oxybuprocaine anesthetic eye drops and also to determine whether there is a significant change in the CCT. CCT was measured in 60 eyes of 60 healthy subjects before and during the hour after oxybuprocaine 0.4% eye drops were instilled. In addition, a systematic review and meta-analysis were carried out in order to answer the following PICO (patient, intervention, comparison, and outcome) question: What effect do anesthetic eye drops have on CCT values? We found no significant changes in the mean CCT values during the hour's observation (ANOVA, p = 0.209), and the meta-analysis revealed no statistically significant changes in the CCT after anesthesia (Q-Value = 1.111; p value = 1.000; I2 = 0.000; Tau2 = 0.000; Stderr = 0.020). However, we found three CCT response patterns 5 minutes after anesthesia: Pattern 1, subjects with no significant changes in their CCT values (n = 14, 46.7%); Pattern 2, subjects with significant CCT increases (n = 11, 36.7%); and Pattern 3, subjects with significant CCT decreases (n = 5, 16.7%). In sum, there are no significant changes in the CCT after anesthesia, but there are three different CCT response patterns 5 minutes after anesthesia.

The Decreasing Prevalence of the Arcuate Foramen.

BACKGROUND: The arcuate foramen (AF), or ponticulus posticus, is an anatomic variant of the first cervical vertebra that consists of a complete or partial osseous bridge over the groove for the vertebral artery and extends from the posterior aspect of the superior articular facet to the superior lateral border of the posterior arch. The AF has been associated with clinical symptoms, such as headache, migraine, neck pain, shoulder pain, arm pain, and vertebral artery dissection. We aimed to test whether the prevalence of the AF has decreased in the modern human population over the past centuries as a result of reduction in inbreeding and endogamy. METHODS: Possible reduction in the prevalence of the AF was assessed by comparing a 17th century rural sample (n = 108) with a 20th century modern urban sample (n = 192). RESULTS: When comparing the 17th and the 20th century samples, we found a statistically significant (P = 0.003) reduction of 14.5% (95% confidence interval 4.5-24.5) in the prevalence of the AF. CONCLUSIONS: Prevalence of the AF has been decreasing over the past centuries.

Intra-individual variability in TSH levels of healthy women during the first half of pregnancy / Variabilidad intra-individual de los niveles TSH en mujeres sanas en primer trimestre de gestación

Objective: TSH is the parameter most widely accepted to assess thyroid function, especially in pregnant women. The aim of this current study was to analyze intra-individual changes in TSH during the first half of pregnancy in women with TSH levels higher than 2.5mIU/L in early pregnancy. Methods: An observational, prospective study was conducted on 243 healthy pregnant women in the first trimester of pregnancy. Thyroid function was assessed by testing TSH and free T4 levels. A subgroup of women with TSH levels >2.5mIU/L underwent additional tests (TSH, free T4, peroxidase antibodies). Information on dietary iodine intake and/or iodine supplements was also recorded. Results: Mean TSH level was 1.89mIU/L (range 0.024-6.48mIU/L), and mean FT4 level was 1.19ng/dL (range 0.80-1.90ng/dL). Fifty-eight women (23.8%) had TSH levels>2.5mIU/L in the first trimester of pregnancy, and additional thyroid function tests were performed in 27 women. TSH levels significantly decreased from the first to the second test (3.59±0.92mIU/L vs 2.81±1.06mIU/L respectively; p<0.01), and the decrease was significantly greater in pregnant women who used iodized salt as compared to those who did not (1.16±0.65mIU/L vs 0.19±0.93mIUI/L respectively; p<0.01). A positive correlation was found between the time elapsed to the second measurement (24.3±17.2 days; range 8-58) and the decrease in TSH levels (r=0.40; p=0.038). Conclusion: TSH levels showed a continuous, uniform decrease during the first half of pregnancy in women with values slightly above the normal range. Pregnant women who used iodized salt were more likely to have decreased TSH levels in a second test (AU)

Objetivo: La TSH es el parámetro más aceptado para evaluar la función tiroidea, especialmente en mujeres embarazadas. El objetivo del presente estudio fue analizar los cambios intraindividuales de TSH durante la primera mitad de la gestación, en aquellos casos en los que la TSH en las primeras etapas de la gestación fue superior a 2,5 mUI/L. Métodos: Estudio observacional prospectivo que incluyó a 243 mujeres embarazadas sanas en el primer trimestre de gestación. Se estudió función tiroidea mediante TSH y T4 libre. Un subgrupo de mujeres con TSH> 2,5 mUI/L fueron sometidas a un segundo análisis (TSH, T4 libre, anticuerpos antiperoxidasa). También se registró información sobre la ingesta de yodo con la dieta y/o suplementos. Resultados: La TSH media fue de 1,89 mUI/L (rango 0,024-6,48 mUI/L), y la T4 libre media fue de 1,19 ng/dL (rango 0,80-1,90ng/dL). El 23,8% (58 mujeres) presentaron TSH> 2,5 mUI/L en el primer trimestre de gestación, realizándose una segunda valoración en 27 pacientes. La TSH disminuyó significativamente del primer al segundo análisis (3,59±0,92 mUI/L vs. 2,81±1,06 mUI/L respectivamente, p <0,01). La TSH disminuyó significativamente más en aquellas mujeres embarazadas que consumieron sal yodada que en aquellas que no lo hicieron (1,16±0,65 mUI/L vs. 0,19±0,93 mUI/L respectivamente, p<0,01). Hubo una correlación positiva entre el tiempo transcurrido para una segunda determinación (24,3±17,2 días, rango 8-58 días), y la reducción en los niveles de TSH (r= 0,40; p=0,038). Conclusión: La disminución de los niveles de TSH con la edad gestacional es uniformemente continua a lo largo de la primera mitad de la gestación en aquellos casos con TSH ligeramente por encima del rango sugerido de normalidad. Las mujeres embarazadas que consumían sal yodada tenían más probabilidades de reducir los niveles de TSH en un segundo análisis (AU)

Intra-individual variability in TSH levels of healthy women during the first half of pregnancy.

OBJECTIVE: TSH is the parameter most widely accepted to assess thyroid function, especially in pregnant women. The aim of this current study was to analyze intra-individual changes in TSH during the first half of pregnancy in women with TSH levels higher than 2.5mIU/L in early pregnancy. METHODS: An observational, prospective study was conducted on 243 healthy pregnant women in the first trimester of pregnancy. Thyroid function was assessed by testing TSH and free T4 levels. A subgroup of women with TSH levels >2.5mIU/L underwent additional tests (TSH, free T4, peroxidase antibodies). Information on dietary iodine intake and/or iodine supplements was also recorded. RESULTS: Mean TSH level was 1.89mIU/L (range 0.024-6.48mIU/L), and mean FT4 level was 1.19ng/dL (range 0.80-1.90ng/dL). Fifty-eight women (23.8%) had TSH levels>2.5mIU/L in the first trimester of pregnancy, and additional thyroid function tests were performed in 27 women. TSH levels significantly decreased from the first to the second test (3.59±0.92mIU/L vs 2.81±1.06mIU/L respectively; p<0.01), and the decrease was significantly greater in pregnant women who used iodized salt as compared to those who did not (1.16±0.65mIU/L vs 0.19±0.93mIUI/L respectively; p<0.01). A positive correlation was found between the time elapsed to the second measurement (24.3±17.2 days; range 8-58) and the decrease in TSH levels (r=0.40; p=0.038). CONCLUSION: TSH levels showed a continuous, uniform decrease during the first half of pregnancy in women with values slightly above the normal range. Pregnant women who used iodized salt were more likely to have decreased TSH levels in a second test.

Las úlceras por presión en gerontología: prevalencia y variables definitorias de las lesiones y pacientes / Pressure ulcers in gerontology: Prevalence and defining variables of injuries and patients

La prevalencia de las úlceras por presión en ancianos institucionalizados es un tema preocupante en la elaboración de los planes de cuidados de enfermería. Las úlceras por presión son el resultado de un conjunto de factores: encamamiento prolongado, movilidad reducida, malnutrición, alteraciones fisiológicas, incontinencia, etc. Deseamos conocer y especificar las características de los pacientes con úlceras por presión, así como los aspectos relacionados con las estrategias y prácticas actuales de prevención de las mismas en los pacientes de un centro sociosanitario. Hemos realizado un estudio observacional, descriptivo de prevalencia retrospectivo. La recogida de datos se realizó en el periodo de un año (septiembre de 2012-septiembre de 2013). Para el cálculo de la epidemiología de las úlceras por presión se utilizaron directrices de clasificación e indicadores epidemiológicos recomendados por el GNEAUPP. Según el diseño del estudio, se utilizaron diversos estadísticos descriptivos: valores de frecuencia, medidas de tendencia central y de dispersión, así como tablas de contingencia. Se estudió una muestra de 191 pacientes, de los cuales 56 eran hombres y 135 mujeres, con una media de edad de 83 años y una desviación típica de 14,23. Se estudió la prevalencia de padecer úlceras por presión, se contrastó con diferentes factores predisponentes y se estudió el comportamiento de estos con las medidas de prevención. Es importante realizar estudios de prevalencia sistemática y periódicamente para conocer su importancia real a todos los niveles y poder abordar políticas eficaces y eficientes de tratamiento y prevención

The prevalence of pressure sores in institutionalized elderly is a worrisome topic developing Nursing Care Plans. Bedsores are the result of a set of factors: prolonged bed rest, reduced mobility, malnutrition, physiological disorders, incontinence and so on. The purpose of this study is to determine and specify patients characteristics with pressure ulcers, as well as some aspects related to strategies and current practices in order to prevent this disease in nursing home. I have developed an observational, descriptive retrospective prevalence. The data was collected during one-year period (September 2012- September 2013). To calculate the epidemiology of pressure ulcers, it will be used classification guidelines and epidemiological indicators recommended by GNEAUPP. According to the study design, various descriptive statistics will be used: Frequency values, measures of central tendency and dispersion, as well as contingency tables. A sample of 191 patients was studied, of whom 56 were men and 135 women, with a mean age of 83 years and a standard deviation of 14.23. The prevalence of having pressure ulcers was studied, it was checked with different predisposing factors and its behaviour was studied with preventive measures. Is important to perform periodically systematic studies of prevalence in order to know its real importance at all levels and to address effective and efficient treatment policies and prevention