The first alongside midwifery unit in Spain: A retrospective cohort study of maternal and neonatal outcomes.

BACKGROUND: Midwife-led units have been shown to be safer and reduce interventions for women at low risk of complications at birth. In 2017, the first alongside birth center was opened in Spain. The aim of this study was to compare outcomes for women with uncomplicated pregnancies giving birth in the Midwife-led unit (MLU) and in the Obstetric unit (OU) of the same hospital. METHODS: Retrospective cohort study comparing birth outcomes between low-risk women, depending on their planned place of birth. Data were analyzed with an intention-to-treat approach for women that gave birth between January 2018 and December 2020. RESULTS: A total of 878 women were included in the study, 255 women chose to give birth in the MLU and 623 in the OU. Findings showed that women in the MLU were more likely to have a vaginal birth (91.4%) than in the OU (83.8%) (aOR 2.98 [95%CI 1.62-5.47]), less likely to have an instrumental delivery, 3.9% versus 11.2% (0.25 [0.11-0.55]), to use epidural analgesia, 19.6% versus 77.9% (0.15 [0.04-0.17]) and to have an episiotomy, 7.4% versus 15.4% (0.27 [0.14-0.53]). There were no differences in rates of postpartum hemorrhage, retained placenta, or adverse neonatal outcomes. Intrapartum and postpartum transfer rates from the MLU to the OU were 21.1% and 2.4%, respectively. CONCLUSIONS: The high rate of obstetric interventions in Spain could be reduced by implementing midwife-led units across the whole system, without an increase in maternal or neonatal complications.

The Effects of Accompaniment on Maternal Anxiety During Elective Cesarean Delivery: A Quasi-experimental Study.

BACKGROUND: In Spain, allowing women to be accompanied by their partners during cesarean deliveries is a poorly consolidated practice. Going through this experience alone, not only deprives women from the opportunity of sharing the birth with their partners, but also, forces them to face, on their own, one of the most stressful experiences during pregnancy. OBJECTIVE: To analyze whether significant differences exist in levels of anxiety of women who receive an elective cesarean delivery, according to whether they are allowed to be accompanied by their partners. DESIGN: Quasi-experimental, longitudinal, prospective study, comparing a group of 31 women receiving elective cesarean deliveries, without the presence of their partners, with a group of 33 women with elective cesarean deliveries who were accompanied by their partners. Anxiety levels were assessed using the STAI-State/Trait scale. Participants were given a questionnaire to assess their level of satisfaction with the care received. RESULTS: Anxiety measured via total scores on the STAI-S scale was significantly lower (p < 0.004) among the women who were accompanied by their partners during the elective cesarean delivery (median = 25), compared to the group who were not (median = 50). The differences were also significant (p < 0.003) considering the impact of accompaniment upon the group with high scores in the STAI-S (> 31) and continue to be significant when using the cut-off point of very high scores on the STAI-S (> 45). CONCLUSIONS: Presence of partners during elective cesareans is a key factor for decreasing the anxiety caused by the surgery and for improving the overall experience of cesarean deliveries.

What is already known on this subject? Cesarean deliveries are one of the most stressful life experiences. Allowing women to be accompanied by their partners during cesarean deliveries is a poorly consolidated practice in some countries. Otherwise relevant international institutions recommend allowing an accompanying adult, present with the mother in the operating room during the entire process.What this study adds? Presence of partners during elective cesareans is a key factor for decreasing deliveries' anxiety, improving the overall experience, but it needs a mentality change in the obstetric and surgical team. These results could change the services organization in a more humane delivery, with overall positive impact in the patients' care.

ATP Induces Interleukin-8, Intracellular Calcium Release, and ERK1/2 Phosphorylation in Bovine Endometrial Cells, Partially through P2Y Receptors.

The bovine endometrium has an important defensive role in the postpartum period that acts when an inflammatory process associated with tissue damage or infection by bacteria is produced. Endometrial cells release cytokines and chemokines that recruit inflammatory cells, which release danger-associated molecular patterns (DAMPs), such as adenosine triphosphate (ATP), and initiate and regulate the inflammatory response. However, the role of ATP in bovine endometrial cells is unclear. The aim of this study was to determine the effect of ATP on interleukin-8 (IL-8) release, intracellular calcium mobilization, ERK1/2 phosphorylation, and the role of P2Y receptors, in bovine endometrial cells. Bovine endometrial (BEND) cells were incubated with ATP and the IL-8 release was determined by the ELISA assay. ATP of 50 and 100 µM significantly increased IL-8 released in BEND cells (50 µM: 23.16 ± 3.82 pg/mL, p = 0.0018; 100 µM: 30.14 ± 7.43 pg/mL, p = 0.0004). ATP (50 µM) also induced rapid intracellular calcium mobilization in Fura-2AM-loaded BEND cells, as well as ERK1/2 phosphorylation (ratio 1.1 ± 0.04, p = 0.0049). Suramin (50 µM), a pan-antagonist of P2Y receptors, partially reduced the intracellular calcium mobilization, ERK1/2 phosphorylation (ratio 0.83 ± 0.08, p = 0.045), and IL-8 release (9.67 ± 0.02 pg/mL, p = 0.014) induced by ATP. Finally, BEND cells expressed higher mRNA levels of P2Y1 and P2Y2 purinergic subtype receptors, and lower levels of P2Y11 and P2Y12 receptors, as determined by RT-qPCR. In conclusion, these results showed that ATP activates pro-inflammatory responses in BEND cells, which are partially mediated via P2Y receptors, and BEND cells express the mRNA of subtypes of P2Y receptors, which could have a key role in bovine endometrial inflammation.

"Care left undone" and quality of care during the COVID-19 pandemic: Influential factors and modulating strategies.

OBJECTIVE: To analyze the quality of care provided during the COVID-19 pandemic, identifying what care has been prioritized and factors that have influenced such care. BACKGROUND: Given the need to adapt care due to the pandemic, nurses may have been subjected to factors that have negatively affected them, however it has also been possible to find actions that have enabled nurses to maintain the quality of care provided. METHOD: Exploratory study with a sample of 225 nurses. Data collection was performed using a self-assessment of the care provided, the 'Care Left Undone' Scale, and ad hoc questionnaire for demographic variables. RESULTS: The mean rate of missed care was 5.76. Significant differences were identified according to age, professional experience, field of specialty and personal and professional strategies. CONCLUSION: Both personal and professional feelings, characteristics, and strategies have an effect in the perception of quality of care provided and missed care during the pandemic.

«Cuidados perdidos» y calidad de los cuidados durante la pandemia por COVID-19: factores y estrategias influyentes / “Missed care” and quality of care during the COVID-19 pandemic: Influential factors and modulating strategies

Objetivo:Analizar la calidad de los cuidados brindados durante la pandemia por COVID-19, identificando los cuidados que se han priorizado y los factores que han influido. Ante la situación de adaptación de los cuidados exigidos por la pandemia, las enfermeras han podido estar sometidas a factores que las hayan afectado de manera negativa, pero también se han podido encontrar estrategias que han permitido mantener la calidad de los cuidados.Método:Estudio descriptivo con muestra de conveniencia de 225 enfermeras que atendieron a pacientes con COVID-19. Para la recogida de datos se emplea un cuestionario ad hoc de variables personales y laborales, una autovaloración de los cuidados y la escala Care Left Undone.Resultados:La tasa media de cuidados perdidos ha sido de 5,76 (DS 3,1). Se identifican diferencias significativas en función de la edad, experiencia profesional y del cambio de estructura y de especialidad. Las estrategias que se asocian de manera significativa con mayor valoración de la calidad de los cuidados estuvieron relacionadas con la cohesión del equipo, evitar la despersonalización, búsqueda activa de información, estrategias de control de estrés y de pensamiento positivo. Se han identificados sentimientos, características y estrategias personales y profesionales, que influyen tanto en la percepción de la calidad como en la pérdida de cuidados durante la atención a la pandemia.

Objective:To analyze the quality of care provided during the COVID-19 pandemic, identifying what care has been prioritized and factors that have influenced such care.Background:Given the need to adapt care due to the pandemic, nurses may have been subjected to factors that have negatively affected them, however it has also been possible to find actions that have enabled nurses to maintain the quality of care provided.Method:Exploratory study with a sample of 225 nurses. Data collection was performed using a self-assessment of the care provided, the ‘Care Left Undone’ Scale, and ad hoc questionnaire for demographic variables.ResultsThe mean rate of missed care was 5.76. Significant differences were identified according to age, professional experience, field of specialty and personal and professional strategies.Conclusion:Both personal and professional feelings, characteristics, and strategies have an effect in the perception of quality of care provided and missed care during the pandemic.

["Missed care" and quality of care during the COVID-19 pandemic: Influential factors and modulating strategies]. / «Cuidados perdidos¼ y calidad de los cuidados durante la pandemia por COVID-19: factores y estrategias influyentes.

Objective: To analyze the quality of care provided during the COVID-19 pandemic, identifying what care has been prioritized and factors that have influenced such care. Background: Given the need to adapt care due to the pandemic, nurses may have been subjected to factors that have negatively affected them, however it has also been possible to find actions that have enabled nurses to maintain the quality of care provided. Method: Exploratory study with a sample of 225 nurses. Data collection was performed using a self-assessment of the care provided, the 'Care Left Undone' Scale, and ad hoc questionnaire for demographic variables. Results: The mean rate of missed care was 5.76. Significant differences were identified according to age, professional experience, field of specialty and personal and professional strategies. Conclusion: Both personal and professional feelings, characteristics, and strategies have an effect in the perception of quality of care provided and missed care during the pandemic.

La inducción de la lactancia en madres que no han dado a luz: un desafío para las matronas ante nuevas demandas / The induction of lactation in mothers who have not given birth: a challenge for midwives in the face of new demands

Objetivo: Conocer las demandas que dirigen a las matronas las mujeres que han pasado por un proceso de inducción de la lactancia o relactación en España, así como profundizar en los sentimientos que pueden presentar estas mujeres. Métodos: Estudio cualitativo fenomenológico. Se realizó un muestreo de máxima variabilidad con el fin de entrevistar a 9 mujeres españolas: 3 de cada perfil (adopción, subrogación, pareja de dos mujeres) que habían pasado por un proceso de inducción de la lactancia materna o relactación entre los años 2000 y 2015. Como técnica se usó la entrevista en profundidad. Después de transcribir las entrevistas, los datos fueron interpretados mediante análisis de contenido con la ayuda del programa Atlas.ti versión 7.5.7.Resultados: Participaron 9 mujeres. De los principales hallazgos se desprenden demandas de información, seguimiento y apoyo durante el proceso. La mayoría de las mujeres no recibió seguimiento por parte de los profesionales sanitarios, quienes mostraron desconocimiento o poca confianza en el proceso y en su éxito. El apoyo recibido vino fundamentalmente por parte de sus parejas. Esta falta de apoyo profesional se tradujo en sentimientos de soledad y vulnerabilidad entre las participantes. Los foros sobre lactancia en internet, las experiencias en la red de otras madres que habían pasado por el mismo proceso y los grupos de lactancia fueron la fuente principal de información para poder realizar los procesos.Conclusiones: Para dar respuesta a la demanda de información, seguimiento y apoyo durante el proceso de inducción de la lactancia y relactación es necesario incluir dichos contenidos en la formación de matronas y otros profesionales sanitarios. Dando respuesta a estas demandas, se podrán evitar situaciones de soledad y vulnerabilidad entre las mujeres que deciden pasar por estos procesos, así como mejorar los índices de lactancia materna. (AU)

Objective: To know what are the demands that women who have undergone a process of induction of lactation or relactation direct to midwives, as well as to delve into the feels that these women may present. Methods: Qualitative phenomenological study. A maximum variability sampling was carried out in order to interview 9 Spanish women: 3 of each profile (adoption, surrogacy, female couple) who had undergone a process of induction of breastfeeding or relactation between the years 2000 and 2015. The in-depth interview was used as a technique. After transcribing the interviews, the data were analyzed by content analysis with the help of Atlas.ti version 7.5.7 program.Results: 9 women participated. The women interviewed expressed demands for information, follow-up and support during the process. Most of the women were not followed up by health professionals, since they showed ignorance or little confidence in the process and its success. The women state that the support, received which was mainly from their partners. This lack of professional support translated into feelings of loneliness and vulnerability among the participants. The forums on breastfeeding on the Internet, experiences in the network of other mothers who had gone through the process and the breastfeeding groups were the main source of information to be able to carry out the processes of induction of lactation and relactation.Conclusions: It is necessary to include both processes, induction of lactation and relactation, in the training of midwives and other health professionals to avoid situations of loneliness and vulnerability of women who decide to go through these processes. (AU)

Obstetric Violence as an Infringement on Basic Bioethical Principles. Reflections Inspired by Focus Groups with Midwives.

BACKGROUND: obstetric violence is still far too invisible; the word "violence" generates rejection and obstetric violence is complex to define and typify, as it is a subjective experience. It has been widely analyzed from legal, sociological, and clinical perspectives, but not equally so from the bioethical point of view. This article sets out to take a more in-depth look at the experiences of midwives in order to describe the ethical perspectives of obstetric violence. We intend to describe the effects that malpractice and violence within obstetric care have on American and European bioethical principles. METHODOLOGY: A qualitative methodology of the phenomenological tradition was used: 24 midwives participated in three focus groups. RESULTS AND DISCUSSION: four categories were arrived at; they are "the maleficence of forgetting my vulnerability", "beneficence requires respect for my integrity and dignity", "my autonomy is being removed from me" and "a problem of social justice towards us, women". CONCLUSION: obstetric violence infringes on the main bioethical principles (non-maleficence, beneficence, autonomy, justice, vulnerability, dignity, and integrity). Beyond whether it is called violence or not, what matters from an ethical perspective is that, as long as women have such negative experiences during pregnancy and childbirth, obstetric care needs better humanizing.

Level of Job Burnout among Midwives Working in Labour Rooms in Barcelona Region: A Cross-Sectional Study.

BACKGROUND: Nowadays, burnout syndrome (BS) symptoms appear to have increased in healthcare workers, specifically midwives, but there are no studies on burnout among midwives in Catalonia. The present study aimed to assess and describe the prevalence of BS in midwives working in labour rooms. METHODS: A cross-sectional descriptive study was conducted on 122 midwives working in 24 maternity hospitals in the Barcelona (region) which were selected using purposive sampling from January to March 2017. Data were collected using two questionnaires (demographic information, job burnout using Spanish Burnout Inventory with 20 items and four subscales). Data analysis was performed using SPSS software version 21 and Chi-Square, U Mann-Whitney, and Kruskall-Wallis. P<0.05 was considered statistically significant. RESULTS: None of the participants obtained a critical level of BS. 37 (30.33%) participants scored medium burnout and 47 (38.52%) recorded low burnout. Statistically, work stress (P=0.01), marital status (P=0.006), attendance of more than three women per shift (P=0.001), the number of children (P=0.01), parity (P=0.005), health status (P=0.04), and being on sick leave over last year (P=0.04) were significantly correlated with medium-high levels of burnout. Burnout scores were higher in midwives having a life partner and those without children. CONCLUSION: Following the results, no participant obtained a critical level of BS; about one-third of them scored medium-high burnout. However, specific interventions are suggested to be conducted to maintain the midwives' motivation and prevent burnout development.

Understanding the Challenges of Induction of Lactation and Relactation for Non-Gestating Spanish Mothers.

BACKGROUND: Induced lactation and relactation are the processes that enable breastfeeding in non-gestating mothers. RESEARCH AIM: The aim of this study was to describe and interpret the challenges faced by mothers who undergo induced breastfeeding and relactation for adopted infants, infants born via surrogacy, and infants born to same-sex female partners. METHODS: A qualitative study was performed using in-depth interviews conducted with Spanish women (N = 9) who had decided to undergo induced lactation or relactation. The data were collected between October 2014 and May 2017. The length of the study was due to the difficulty in locating and recruiting the sample. Interviews were transcribed and coded with the ATLAS.ti v.7.5.7 software. We performed a deductive thematic analysis, creating categories based on the interview questions, which we developed on the basis of previous literature about induced lactation and relactation. RESULTS: Participants described the following challenges: the physical hardships of the process; breastfeeding problems; difficulty with accessing information about induced lactation or relactation; and lack of support from health professionals. Breastfeeding periods lasted from 1.5 months to 4 years. Participants reported that breastfeeding increased the closeness between the mother and child and that this feeling of closeness tended to decrease after breastfeeding cessation. CONCLUSION: We offer data and analysis that can improve our understanding of the lived experiences of women undergoing the process of relactation or induced lactation and may help guide intervention strategies to support women in this situation.

Multi-strain probiotics enhance immune responsiveness and alters metabolic profiles in the New Zealand black-footed abalone (Haliotis iris).

We assessed whether dietary administration of a multi-strain probiotic (Exiguobacterium JHEb1, Vibrio JH1 and Enterococcus JHLDc) lead to enhanced immune responsiveness in juvenile New Zealand black-footed abalone (Haliotis iris). Two groups of abalone were fed (1% body weight per day) over a four-month period with different diets. The control diet consisted of a standard commercial pellet feed (AbMax 16), whereas the treatment diet was additionally enriched with the probiotic mix. At the end of the experiment, probiotic-fed animals showed improved growth compared with control-fed abalone in length (32.3% vs 22.3%), width (31.9% vs 20.7%) and wet weight (109.6% vs 72.8%), respectively. Haemolymph sampling was conducted at the beginning of the experiment and after 2 and 4 months. Haemolymph samples were analysed for total haemocyte count (THC) and viability, presence of apoptotic cells and production of Reactive Oxygen Species (ROS). Compared with control abalone, probiotic-fed abalone had significantly higher THC (1.9 × 106 vs 5.6 × 105 cells), higher viability (90.8% vs 75.6%), higher percentage of ROS-positive cells (19.4% vs 0.5%) and higher numbers of non-apoptotic cells (88.0% vs 78.0%), respectively. These results indicate that the probiotic-enriched diet enhanced the immunostimulatory mechanisms, with a simultaneous low-level up-regulation of ROS production as a priming mechanism of the antibacterial defence system. Metabolomics-based profiling of foot muscle tissue additionally revealed that probiotic-fed abalone differentially expressed 17 unique metabolites, including amino acids, fatty acids and TCA cycle related compounds. These data suggest that the probiotic-supplemented diet can also alter central carbon metabolic processes, which may improve the survival, as well as the growth of abalone.

Virtual Reality as a New Approach for Risk Taking Assessment.

Understanding how people behave when facing hazardous situations, how intrinsic and extrinsic factors influence the risk taking (RT) decision making process and to what extent it is possible to modify their reactions externally, are questions that have long interested academics and society in general. In the spheres, among others, of Occupational Safety and Health (OSH), the military, finance and sociology, this topic has multidisciplinary implications because we all constantly face RT situations. Researchers have hitherto assessed RT profiles by conducting questionnaires prior to and after the presentation of stimuli; however, this can lead to the production of biased, non-realistic, RT profiles. This is due to the reflexive nature of choosing an answer in a questionnaire, which is remote from the reactive, emotional and impulsive decision making processes inherent to real, risky situations. One way to address this question is to exploit VR capabilities to generate immersive environments that recreate realistic seeming but simulated hazardous situations. We propose VR as the next-generation tool to study RT processes, taking advantage of the big four families of metrics which can provide objective assessment methods with high ecological validity: the real-world risks approach (high presence VR environments triggering real-world reactions), embodied interactions (more natural interactions eliciting more natural behaviors), stealth assessment (unnoticed real-time assessments offering efficient behavioral metrics) and physiological real-time measurement (physiological signals avoiding subjective bias). Additionally, VR can provide an invaluable tool, after the assessment phase, to train in skills related to RT due to its transferability to real-world situations.

Ansiedad y depresión en las madres de recién nacidos prematuros. Estrategias de intervención y revisión de la bibliografía / Anxiety and depression in mothers of preterm infants. Intervention strategies and literature review

INTRODUCCIÓN: El parto prematuro es una situación muy estresante para las mujeres que lo sufren, ya que supone enfrentarse a una realidad no esperada, en la que se pierden sus expectativas sobre la vivencia del embarazo y el parto normal. Además, deberán afrontar no sólo la separación inicial de su hijo, sino también la pérdida de su rol maternal, ya que los cuidados se asumirán en la unidad neonatal (UNN). Por todo ello, durante el puerperio estas mujeres serán especialmente vulnerables a los problemas de salud mental, y tendrán más riesgo de sufrir niveles altos de ansiedad, depresión e incluso síntomas de estrés postraumático. OBJETIVOS: Conocer y valorar las estrategias de intervención que han demostrado ser eficaces para prevenir, mejorar y/o tratar los riesgos para la salud mental de las madres que pasan por el proceso de tener un hijo prematuro. METODOLOGÍA: Se ha realizado una búsqueda de la bibliografía publicada en los últimos 5 años en las bases de datos CINHAL, PubMed, Web of Science y PsycINFO. RESULTADOS: Las estrategias que han demostrado ser eficaces para mejorar la salud mental son las que incluyen a las madres como cuidadoras, ya sea a través de la promoción de la lactancia materna, el método canguro o los masajes en la UNN, y también las intervenciones que aumentan los conocimientos, tanto en referencia al ambiente de la UNN como a los cuidados y progresos de sus hijos. CONCLUSIONES: La matrona, como profesional de referencia del cuidado del puerperio, ha de conocer el riesgo para la salud mental de estas puérperas, con el fin de detectarlo precozmente y promover actividades preventivas que faciliten su rol maternal, y así contribuir a mejorar la experiencia de tener un hijo prematuro

INTRODUCTION: Preterm birth represents a stressful situation for women who suffer it. They have to face an unexpected reality. A new reality far from their initial expectations about pregnancy and birth, as well as the separation from their baby after giving birth. Premature babies need special cares assumed by the neonatal intensive care unit so mothers have to delegate her maternal role to health professionals. Therefore, all women who have to face a preterm birth are especially vulnerable during the postpartum period to develop mental health problems and to present more anxiety, depression and even post-traumatic stress. OBJECTIVE: Identify and evaluate intervention strategies that proved to be effective in order to prevent, improve and/or treat the risks in mental health of all mothers who have to face a preterm baby. METHODOLOGY: Bibliographic research in the scientific literature published during the last five years in the databases CINHAL, PubMed, Web of Science and PsycINFO. RESULTS: The strategies which demonstrated to be more effective to improve the mental health are interventions that included mothers as the responsible of giving care to the baby. There are different strategies such the promotion in breastfeeding, the kangaroo method or the introduction in massage techniques in the neonatal unit. The activities that help them to increases the knowledge about the function of the neonatal intensive care unit and giving them all the information about the care and progress of their baby are effective options as well. CONCLUSIONS: The midwife is the responsible to take care of mothers during the postpartum. This professional has to know the risk of this women to develop mental health problems during this process. In that case, they have to detect it early and work to promote preventive activities that help mothers to develop her maternal role in this way they will contribute to improve the experience of having a premature baby

Severe changes in colon epithelium in the Mecp2-null mouse model of Rett syndrome.

BACKGROUND: Rett syndrome is best known due to its severe and devastating symptoms in the central nervous system. It is produced by mutations affecting the Mecp2 gene that codes for a transcription factor. Nevertheless, evidence for MECP2 activity has been reported for tissues other than those of the central nervous system. Patients affected by Rett presented with intestinal affections whose origin is still not known. We have observed that the Mecp2-null mice presented with episodes of diarrhea, and decided to study the intestinal phenotype in these mice. METHODS: Mecp2-null mice or bearing the conditional intestinal deletion of MECP2 were used. Morphometirc and histologic analysis of intestine, and RT-PCR, western blot and immunodetection were perfomed on intestinal samples of the animals. Electrical parameters of the intestine were determined by Ussing chamber experiments in freshly isolated colon samples. RESULTS: First we determined that MECP2 protein is mainly expressed in cells of the lower part of the colonic crypts and not in the small intestine. The colon of the Mecp2-null mice was shorter than that of the wild-type. Histological analysis showed that epithelial cells of the surface have abnormal localization of key membrane proteins like ClC-2 and NHE-3 that participate in the electroneutral NaCl absorption; nevertheless, electrogenic secretion and absorption remain unaltered. We also detected an increase in a proliferation marker in the crypts of the colon samples of the Mecp2-null mice, but the specific silencing of Mecp2 from intestinal epithelium was not able to recapitulate the intestinal phenotype of the Mecp2-null mice. CONCLUSIONS: In summary, we showed that the colon is severely affected by Mecp2 silencing in mice. Changes in colon length and epithelial histology are similar to those observed in colitis. Changes in the localization of proteins that participate in fluid absorption can explain watery stools, but the exclusive deletion of Mecp2 from the intestine did not reproduce colon changes observed in the Mecp2-null mice, indicating the participation of other cells in this phenotype and the complex interaction between different cell types in this disease.

Desigualdades en el acceso a los programas preventivos en salud sexual y reproductiva / Inequalities in access to preventive programs in sexual and reproductive health

La presente revisión tiene como objetivos analizar si dentro de los programas preventivos europeos de salud sexual y reproductiva existen barreras de acceso, identificar qué grupos son más vulnerables respecto a la prevención y conocer estrategias que permitan un mejor acceso a dichos programas. El método es una revisión de la bibliografía publicada en los últimos 10 años sobre iniciativas de prevención en salud sexual y reproductiva en Europa. Los resultados muestran la existencia de desigualdades en el acceso, y se identifican propuestas para contribuir a su disminución. La conclusión principal es que las mujeres con condiciones socioeconómicas desfavorables tendrán un mayor riesgo de exclusión sino se aplican medidas correctoras en el diseño de los programas (AU)

This present review aims to analyze, within the European preventive programs of sexual and reproductive health: the existence of barriers to access, identify vulnerable groups, and recognize the proposed strategies to ensure a better access to such programs. The method is a literature review of references published in the last 10 years, about prevention efforts in reproductive health. The results identified inequalities in access, in the activities of prevention, and some proposes strategies to reduce inequalities of access, ranging from changes to the design and evaluation of programs and greater community participation. The principal conclusion is that the women with unfavorable socioeconomic conditions will have a higher risk of exclusion, if corrective measures are not applied in their design (AU)

Chemometric tools to evaluate the spatial distribution of trace metals in surface sediments of two Spanish rías.

A suite of relevant trace metals (Hg, Pb, Cd, Cu, Zn and Ni) was measured in surface sediment samples to assess the environmental situation of the largest two Atlantic Spanish 'rías' (a form of estuaries, ría of Pontevedra, ROP, and ría of Vigo, ROV). The level of contamination originated by these metals was assessed against international guidelines, the threshold effect, ERL, and the midrange effect, ERM. Six unsupervised and supervised multivariate chemometric techniques were applied to model each ría, compare them and select those metals that characterize the samples. This is first time that such a study is performed for these two important seafood-producing areas. Maximum concentrations at ROP occurred in the vicinities of an inner island, where Cu, Zn, Ni and Pb presented concentrations over the ERL and Hg over the ERM. Highest concentrations of metals in ROV were observed in the proximities of Vigo shipyards and port, except for Pb, with peak values in San Simon Bay. ERL limits were exceeded in the inner part of this ría for Cu, Zn and Hg and in a wider area for Pb and Ni. Levels for Pb went beyond the ERM boundary in the axial part of San Simon Bay. In general, the distribution of the metals was more homogeneous in ría of Pontevedra than in ría of Vigo (where three morphological zones were characterized). Both rías could be differentiated using only two metals: Ni and Hg, as deduced from the multivariate techniques.

El triaje obstétrico: nuevo reto para las matronas. Experiencia del Hospital Parc Taulí en la implementación de un sistema de triaje obstétrico / The obstetric triage: a new challenge for midwives. Experience at the Hospital Parc Taulí in the implementation of an obstetric triage system

El triaje es una práctica ampliamente implantada en los servicios de urgencias generales de nuestro país, que ha demostrado su eficacia en la identificación de situaciones de riesgo al asegurar la priorización de la visita médica en función de la urgencia. En las urgencias obstétricas el triaje es una actividad relativamente nueva. Basándonos en la revisión bibliográfica y competencial realizada, se defiende que el profesional más adecuado para realizar esta actividades la matrona, ya que la valoración de la gestante y la atención de enfermería que de ella se deriva requieren la actuación de una enfermeraespecializada. Mediante el ejemplo de la instauración del triaje obstétrico en el Hospital de Sabadell se describe cómo se intenta mejorar la respuesta a las necesidades de las usuarias que acuden a urgencias (AU)

Triage practice is widely implemented in general emergency departments of our country, which has proved effective in identifying risk situations,ensuring prioritization of medical visits according to urgency. In midwifery is the midwife who performs the triage, as it is the nursespecialist in obstetrics and gynecology. The resulting nursing care of the grounds of urgency as well as conducting advanced triage requires actionby a nurse practitioner.The introduction of obstetric triage in CSPT, while improving responsivenessto the needs of users, establishes uniform criteria and consistent scientific adequate attention to the needs of the user has about their demand for care (AU)