Development and Validation of a Rating Scale of Pain Expression during Childbirth (ESVADOPA).

One of the most representative symptoms during childbirth is pain, which is one of the most prominent concerns of pregnant women. There are different instruments to assess pain, all of which require interrupting the woman, thus interfering with the intimacy of childbirth. This study seeks to develop and validate a rating scale of the expression of childbirth pain that does not require the mother's attention and respects her privacy during labor. The study was conducted at a regional hospital in a border town in southern Spain between November 2018 and September 2019. Scale items were developed following a review of the scientific literature, and experts judged the content validity. After a pilot test, the scale was psychometrically evaluated. The psychometric tests consisted of internal consistency analysis, exploratory factor analysis, and determination of the content, construct, and convergent validity. The scale was evaluated by 36 experts in the field and was then applied to 55 women during the active phase of childbirth. The final version of the Rating Scale of Pain Expression during Childbirth (in Spanish, Escala de Valoración de la Expresión del Dolor durante el Trabajo de Parto-ESVADOPA) consists of six items in two dimensions. The scale had a Cronbach's alpha coefficient of 0.78, and the content validity measured by Aiken's V co-efficient was also 0.78. The exploratory factor analysis yielded two dimensions that explained 68.08% of the total variance. For convergent validity, a comparison was made with the visual analogue scale, yielding a medium-high value of 0.641. As indicated by the internal consistency and by the content and construct validity outcomes, the ESVADOPA successfully measures pain expression during childbirth and represents a suitable tool for pain expression during birth without the need for intervention or the need for the mother to speak the same language as the midwife.

The population genomics of archaeological transition in west Iberia: Investigation of ancient substructure using imputation and haplotype-based methods.

We analyse new genomic data (0.05-2.95x) from 14 ancient individuals from Portugal distributed from the Middle Neolithic (4200-3500 BC) to the Middle Bronze Age (1740-1430 BC) and impute genomewide diploid genotypes in these together with published ancient Eurasians. While discontinuity is evident in the transition to agriculture across the region, sensitive haplotype-based analyses suggest a significant degree of local hunter-gatherer contribution to later Iberian Neolithic populations. A more subtle genetic influx is also apparent in the Bronze Age, detectable from analyses including haplotype sharing with both ancient and modern genomes, D-statistics and Y-chromosome lineages. However, the limited nature of this introgression contrasts with the major Steppe migration turnovers within third Millennium northern Europe and echoes the survival of non-Indo-European language in Iberia. Changes in genomic estimates of individual height across Europe are also associated with these major cultural transitions, and ancestral components continue to correlate with modern differences in stature.

The effectiveness of a mobile application for the development of palpation and ultrasound imaging skills to supplement the traditional learning of physiotherapy students.

BACKGROUND: Mobile learning (m-learning) has becoming very popular in education due to the rapidly advancing technology in our society. The potentials of the mobile applications should be used to enhance the education process. Few mobile applications have been designed to complement the study of physical therapy skills for physiotherapy students. The aim of this study was to investigate whether a mobile application, as a supplement to traditional learning, is useful for physiotherapy students in the acquisition of palpation and ultrasound skills in the shoulder area. METHODS: Forty-nine students participated in this single-blinded, randomized controlled study. They were randomly distributed into two groups: experimental, with free access to the mobile application; and control, with access to traditional learning materials on the topic. Objective structured clinical evaluation (OSCE) and multiple-choice questionnaire (MCQ) were used to assess the educational intervention. Then, we also assessed the time taken to get a reliable ultrasound image and to localize a specific shoulder structure by palpation. RESULTS: There was no significant intergroup difference in the acquisition of theoretical knowledge (p = .089). Scores were significantly higher in the experimental group than in the control group for the majority items in the ultrasound assessment; positioning of patient (p < .001), positioning of ultrasound probe (p = 0.007), handling of ultrasound probe (p = .013) and global OSCE (p < .001) and skills in palpation of the shoulder; position of patient (p = .009), direction of palpation contact (p = .021) and global OSCE (p = .034). There were no significant differences in the time required to perform the examination between groups in ultrasound (p = .944) and palpation (p = .393). The results from the post-program survey assessing the global satisfaction with the mobile application were high (8.200 ± .767), on an 11 numeric point rating scale. CONCLUSION: These results suggest the effectiveness of an m-learning program as a complement to traditional education for developing skills in ultrasound and palpation of the shoulder region in undergraduate physiotherapy students.

Pressure Pain Sensitivity Maps of the Neck-Shoulder Region in Breast Cancer Survivors.

OBJECTIVE: The aim of the present study was to report pressure pain sensitivity topographical maps of the frontal and dorsal parts of the shoulder region, and locate the pressure pain sensitive areas in breast cancer survivors compared with matched healthy control subjects. METHODS: Twenty-two breast cancer survivors (BCS) and 22 matched control subjects participated. A numeric pain rating scale of the neck-shoulder area and pressure pain thresholds (PPTs) was assessed bilaterally over 28 points in the frontal and dorsal neck-shoulder area. Topographical pain sensitivity maps of the upper trapezius, pectoral, and anterior deltoid areas were computed. RESULTS: A three-way analysis of variance was carried out to evaluate the differences in PPTs. The BCS reported spontaneous neck pain (mean ± SD 3.6 ± 2.8), pain in the affected shoulder (4.3 ± 2.7), and pain in the non-affected shoulder (0.9 ± 1.8). Additionally, the BCS exhibited bilaterally lower PPTs in all the measurement points as compared with the control subjects (P < 0.05). The PPTs were lower at the superior part of the trapezius muscle (P < 0.001), the musculotendinous insertion, the anterior part of the deltoid muscle (P < 0.001), and the tendon of the pectoral muscle (P < 0.001) as compared with the control subjects. CONCLUSIONS: The results suggest the sensitization processes in the BCS and give preliminary evidence to most sensitive areas in the superior part of the upper trapezius and musculotendinous insertion of the pectoral muscle.

Heart Rate Variability in Breast Cancer Survivors After the First Year of Treatments: A Case-Controlled Study.

The same aggressive treatments that have led to a reduction in the breast cancer may also have adverse effects on cardiac autonomic balance. The objective of this study was to compare heart rate variability (HRV) between breast cancer survivors in the first year posttreatment and healthy women, controlling for known confounders. This descriptive case-controlled study included 22 breast cancer survivors and 22 healthy age- and sex-matched controls. Short-term HRV was measured using an accepted methodology to assess the cardiac autonomic balance. One-way analysis of covariance results revealed that heart rate was significantly higher (F = 15.86, p < .001) and the standard deviation of normal-to-normal (NN) interval (F = 19.93, p = .001), square root of mean squared differences of successive NN intervals (F = 18.72, p = .001), HRV index (F = 5.44, p = .025), and high-frequency (F = 5.77, p = .03) values were significantly lower in the breast cancer survivors than in the matched controls. The principal finding of the presence of a cardiovascular imbalance in breast cancer survivors in comparison to healthy age-matched controls suggests that HRV study could be a clinically useful tool to detect cardiovascular disease in early-stage breast cancer survivors.

Nerve pressure pain hypersensitivity and upper limb mechanosensitivity in breast cancer survivors: a case-control study.

OBJECTIVE: This study aims to investigate the presence of bilateral pressure pain hypersensitivity in arm trunk nerves and upper limb mechanosensitivity in breast cancer patients with neck-shoulder pain after medical treatments. METHODS: Twenty-two breast cancer survivors (mean age 49.05 ± 7.8 years) and matched healthy controls (mean age 50.76 ± 7.6 years) participated in the study. Neck and shoulder pain was evaluated using an 11-point numerical point rating scale. Pressure pain thresholds (PPTs) were bilaterally assessed over the median, radial, and ulnar nerve trunks and tibialis muscle, and the neurodynamics of the upper limb by neural tolerance to movement was evaluated in the median, radial, and ulnar nerves. RESULTS: Thirteen (59.1%) patients reported spontaneous neck pain, and 16 (72.7%) patients showed spontaneous shoulder/axillary pain. Analysis of variance revealed that breast cancer survivors showed significant between-group but not between-side differences over the median nerve trunk (group: P = < 0.001; side: P = 0.146), radial nerve trunk (group: P = < 0.001; side: P = 0.300), ulnar nerve trunk (group: P = < 0.001; side: P = 0.744), and tibialis anterior muscle (group: P = < 0.001; side: P = 0.118). The patients also showed statistically significant differences in range of motion (ROM) between groups and between sides in ULNT1(MEDIAN)(group: P = < 0.001; side: P = < 0.001) and ULNT(ULNAR) (group: P = 0.009; side: P = 0.002). The analysis did not show statistically significant differences in ROM between groups, but there was a statistical significance between sides for ULNT(RADIAL) (group: P = 0.081; side: P = 0.046). CONCLUSIONS: Breast cancer survivors present bilateral and widespread neural hypersensitivity, as they did in muscular tissue in previous studies. Breast cancer survivors demonstrate a reduction in ROM during ULNTs in the affected side.