Evolución en 12 años de los indicadores de lactancia materna y factores asociados en un Centro de Salud acreditado IHAN / 12-year evolution of breastfeeding indicators and associated factors in a recently accredited as BFHI Health Center

INTRODUCCIÓN: La Organización Mundial de la Salud (OMS) recomienda la lactancia materna exclusiva 6 meses y la mantenida hasta 2 años o más. Nuestro objetivo es estudiar la evolución de indicadores de lactancia (duración, porcentajes de inicio y mantenimiento hasta los 12 meses) en los últimos 12 años en nuestro centro, acreditado recientemente como Centro de Salud IHAN, y la asociación de estos indicadores con distintos factores: educación maternal, forma de nacimiento (parto vaginal o cesárea) y tipo de maternidad (pública o privada). MATERIAL Y MÉTODOS: Estudio descriptivo prospectivo de cohorte con 803 lactantes nacidos en dos periodos de tiempo separados 12 años: 2003-2004 y 2015-2016. Datos recogidos por entrevista personal en las revisiones del niño sano. RESULTADOS: La mediana de duración de la lactancia ha mejorado de forma significativa en el segundo periodo (10 meses) respecto al primero (5 meses; p <0,001); también los porcentajes de lactancia al nacimiento y hasta 12 meses (p <0,05). La asistencia a educación maternal ha sido el factor que se asocia de forma más significativa a estos indicadores en ambos periodos; también el parto vaginal (en el primer periodo) y la maternidad pública (en el segundo). Estos resultados se confirman en el análisis multivariante. CONCLUSIONES: En estos 12 años se ha producido una mejora significativa en los indicadores de lactancia de nuestro centro. Los factores favorables para iniciar y mantener la lactancia materna son asistir a los cursos de educación maternal (el más importante), nacer por parto vaginal y en maternidad pública

INTRODUCTION: WHO recommends exclusive breastfeeding for 6 months and continue up to the age of 2 years or beyond. Our objective is to study the evolution of lactation indicators (length, start and maintenance up to 12 months percentages) in the last 12 years in our health center, recently accredited as BFHI, and the association of these indicators with different factors: prenatal education, childbirth (vaginal delivery or cesarean section) and hospital maternity (public or private). MATERIAL AND METHODS: Prospective descriptive cohort study with 803 infants born in two periods separated from each other 12 years: 2003-2004 and 2015-2016. Data collected by personal interview in pediatric health checks. RESULTS: Lactation length (median) has improved significantly in the second period (10 months) compared to first one (5 months; p <0.001); lactation percentages at birth and up to 12 months also improved (p <0.05). Attending prenatal education courses was the most significantly associated factor with these indicators in both periods; it was also significant the association with vaginal delivery (in first period) and public hospital maternity (in second period). These results are confirmed in the multivariate analysis. CONCLUSIONS: There has been a significant improvement on our health center lactation indicators in these 12 years. Favorable factors to initiate and maintain breastfeeding are attending prenatal education courses (the most important), and childbirth by vaginal delivery and at a public hospital maternity

[Construction and initial validation of a research attitude questionnaire in primary care]. / Construcción y validación inicial de un cuestionario de actitud hacia la investigación en atención primaria.

OBJECTIVE: To construct and validate a research attitude questionnaire in primary care physicians. DESIGN: Validation study of a attitude questionnaire. SETTING: Teaching health centres of family medicine in Valencia (Spain). SUBJECTS: All the physicians (253) of 18 centres: family and general physicians, pediatricians and third-year family residents. MEASUREMENTS AND RESULTS: It was constructed a five Likert scale of 31 items and two dichotomic items. Pretest phase to 25 physicians. Validation Phase: 1. Reliability: a) Spearman-Brown correlation coefficient item-global and Cronbach coefficient; b) test-retest through comparing item punctuation and global. 2. Content validation; construction validation through exploratory factorial analysis and method of extreme groups (research or no) [corrected]. One hundred and fifty physicians (59.3%) answered the first contact, and 107 (71.3%) of them, the second contact. The questionnaire evidenced good internal consistency (alpha = 0.82) and time stability. Five factors were extracted that explained 58.7% of variability: research integration in primary care, self-capacity in study development, subjectives barriers, perception of education's need in research methodology, and structural barriers. Three factors showed significant differencies between extreme groups [corrected]. Definitive questionnaire of 20 items. CONCLUSIONS: The questionnaire is a valid and reliable instrument to know the research attitude of primary care physicians.

[The special training month for tutors and residents in family medicine in Valencia: evaluation of 3 cases]. / Mes de formación específica en tutores y residentes de medicina familiar de Valencia: evaluación de 3 años.

OBJECTIVE: To evaluate the activity in the special training month (STM) for tutors and residents in Family Medicine in Valencia between 1994 and 1996. DESIGN: Descriptive and longitudinal. SETTING: Thirteen teaching health centres. PARTICIPANTS: 48 tutors and 102 residents. MEASUREMENTS AND MAIN RESULTS: Requests from tutors for clinical recycling, research and other activities. Evaluations of hospital staff, tutors and residents. 41.6% of tutors did their STM in three years, 29.2% in 2 years and 29.2% in one. Of the 105 evaluations sent in, 92 (87.6%) were for clinical recycling, 9 (8.6%) research and 4 (3.8%) other activities. The most visited specialities were Dermatology, Cardiology, Radiology and Rheumatology. Staff evaluated as very good the interest shown and punctuality; between good and very good, their knowledge and skills, with commentaries in 36% of evaluations on improvement of coordination between levels. 64.4% of tutors considered the STM very favourably, reflected in nine commentaries that the activity was motivating and in six that it promoted relationships between the Primary and Specialist care levels; and that it had an objective repercussion on teaching through 44 clinical sessions reported during 1996. Improvements were proposed in the organisation of teaching activities. 49% of residents were assigned a set tutor. CONCLUSIONS: The STM is valued positively by tutors, residents and staff.