Conocimiento y prácticas sobre la lactancia materna exclusiva en madres primíparas que acuden a consultar a dos hospitales amigo del niño de Paraguay / Knowledge and practices on exclusive breastfeeding in primiparous mothers who consult in two child friendly hospitals in Paraguay

La lactancia materna brinda un medio incomparable para otorgar un alimento ideal para el crecimiento y desarrollo del recién nacido. El objetivo fue evaluar los conocimientos y las prácticas relacionadas a la lactancia materna exclusiva en madres primíparas que acuden a los hospitales Materno Infantil Reina Sofía de la Cruz Roja Paraguaya y Hospital Materno Infantil de Trinidad que tienen la denominación "amigo del niño y de la madre" y la asociación entre estas variables. Se realizó un estudio descriptivo analítico de corte transversal, realizado en los meses de enero y febrero del 2020 a 90 primíparas. Las variables estudiadas fueron sociodemográficas, de conocimientos y prácticas sobre lactancia materna exclusiva. La edad promedio fue de 27. La mayoría eran solteras (46 %). El secundario fue el nivel de escolaridad en general con un 49 %. La ocupación de las madres fue el de ama de casa en su mayoría (57 %). En cuanto al conocimiento sobre lactancia materna exclusiva se encontraron las siguientes proporciones: regular fue el mayor con 53%, seguido de bueno en un 29% y por último deficiente con 18 %. En cuanto al nivel de prácticas, se halló un 54 % inadecuada y adecuada en 45%. Al analizar si existe asociación entre los conocimientos y prácticas sobre lactancia materna exclusiva, no hemos encontrado asociación entre estas variables (P=0,233). El conocimiento sobre lactancia materna en primíparas fue regular en su mayoría, y en cuanto a las prácticas se observó un nivel inadecuado en mayor cantidad. No se encontró asociación entre el conocimiento y las prácticas sobre lactancia materna exclusiva.

House Calls.

The demand for house calls is increasing because of the aging U.S. population, an increase in patients who are homebound, and the acknowledgment of the value of house calls by the public and health care industry. Literature from current U.S. home-based primary care programs describes health care cost savings and improved patient outcomes for older adults and other vulnerable populations. Common indications for house calls are management of acute or chronic illnesses, coordination of a post-hospitalization transition of care, health assessments, and end-of-life care. House calls may also include observation of activities of daily living, medication reconciliation, nutrition assessment, evaluation of primary caregiver stress, and the evaluation of patient safety in the home. Physicians can use the INHOMESSS mnemonic (impairments/immobility, nutrition, home environment, other people, medications, examination, safety, spiritual health, services) as a checklist for providing a comprehensive health assessment. This article reviews key considerations for family physicians when preparing for and conducting house calls or leading teams that provide home-based primary care services. House calls, with careful planning and scheduling, can be successfully and efficiently integrated into family medicine practices, including residency programs, direct primary care practices, and concierge medicine.

Bilateral kinematic and kinetic analysis of the squat exercise after anterior cruciate ligament reconstruction.

OBJECTIVES: To characterize the bilateral lower-extremity kinematics and kinetics associated with squatting exercise after anterior cruciate ligament (ACL) reconstruction. DESIGN: We evaluated bilaterally sagittal plane kinematics and kinetics of the ankle, knee, and hip joints during submaximal squatting exercise in rehabilitating patients after ACL reconstruction. Comparisons were performed between involved and noninvolved limbs, and regression models were created to examine the relations between the bilateral kinetic differences and time postsurgery. SETTING: A motion analysis laboratory. PARTICIPANTS: Eight adults (27.9+/-6.8y) with unilateral ACL reconstruction (postsurgical time, 30+/-12wk). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Sagittal plane ankle, knee, and hip peak net moments of force, maximum joint excursion angles, and peak vertical ground reaction forces. RESULTS: Peak vertical ground reaction forces did not differ between limbs. The peak knee extensor moment generated during the submaximal squatting exercise was 25.5% greater in the noninvolved limb than in the involved limb (P=.003). The peak ankle plantarflexor moment did not differ between limbs (P=.85); however, there was a trend toward a greater hip extensor moment in the involved limb (P=.06). The ratio of the peak hip extensor moment to the peak knee extensor moment was 46.5% greater in the involved limb (P=.02). Only the peak dorsiflexion angle differed between limbs (P=.02). None of the linear models examining the relations between differences in the involved limb and noninvolved limb kinetics, and postsurgical time, were statistically significant. CONCLUSIONS: Patients performing the squat exercise, within 1 year of ACL reconstructive surgery, used 2 strategies for generating the joint torques required to perform the movement: (1) in the noninvolved limb, patients used a strategy that equally distributed the muscular effort between the hip and knee extensors, and (2) in the involved limb, patients used a strategy that increased the muscular effort at the hip and reduced the effort at the knee. These intra- and interlimb motor-programming alterations (ie, substitution strategies) could potentially slow or limit rehabilitation, and induce strength and performance deficits.

Patellofemoral joint kinetics while squatting with and without an external load.

STUDY DESIGN: Single-group repeated measures design. OBJECTIVE: To quantify patellofemoral joint reaction forces and stress while squatting with and without an external load. BACKGROUND: Although squatting exercises in the rehabilitation setting are often executed to a relatively shallow depth in order to avoid the higher joint forces associated with increased knee flexion, objective criteria for ranges of motion have not been established. METHODS AND MEASURES: Fifteen healthy adults performed single-repetition squats to 90 degrees of knee flexion without an external load and with an external load (35% of the subject's body weight [BW]). Anthropometric data, three-dimensional kinematics, and ground reaction forces were used to calculate knee extensor moments (inverse dynamics approach), while a biomechanical model of the patellofemoral joint was used to quantify the patellofemoral joint reaction forces and patellofemoral joint stress. Data were analyzed during the eccentric (0-90 degrees) and concentric (90-0 degrees phases of the squat maneuver. RESULTS: In both conditions, knee extensor moments, patellofemoral joint reaction forces, and patellofemoral joint stress increased significantly with greater knee flexion angles (P < 0.05). Peak patellofemoral joint force and stress was observed at 90 degrees of knee flexion. Patellofemoral joint stress at 45 degrees, 60 degrees, 75 degrees, and 90 degrees of knee flexion during the eccentric phase, and at 75 degrees and 90 degrees during the concentric phase, was significantly greater in the loaded trials versus the unloaded trials. CONCLUSION: The data indicate that during squatting, patellofemoral joint stress increases as the knee flexion angle increases, and that the addition of external resistance further increases patellofemoral joint stress. These findings suggest that in order to limit patellofemoral joint stress during squatting activities, clinicians should consider limiting terminal joint flexion angles and resistance loads.