Comodidad materna y reducción del dolor en mujeres con posición fetal occipitoposterior durante el parto con el uso de las posturas de decúbito lateral y manos-rodillas: Ensayo clínico aleatorizado

Objective: To assess the maternal comfort and reduction of pain associated with contractions during labor with “hands-knees” (HK) maternal posture compared with “lateral maternal postures toward the fetal back” in pregnant women with occipitoposterior (OP) fetal position. Methods: In the multicenter trial by randomization, 70 women with OP fetal position during labor took the lateral posture and 65 women the HK posture for at least 30 minutes. We analyzed maternal comfort, perceived pain, influence of epidural analgesia and use of fit-ball on posture HK. Results: Back pain and abdominal pain reduction was higher with HK posture. With lateral posture 78.6% of women expressed comfort versus 73.8% of women with HK posture. Regarding the lateral posture, the comfort with HK posture reduces in multiparous women, with an odds ratio (OR) of 0.29, for a confidence interval (CI) 95% 0.12 to 0.76, and epidural analgesia (OR= 0.39; CI 95%: 0.15-1.03), comfort with K posture is higher with reduction of pain (OR= 4.13, 95% CI: 1.34- 12.72) and abdominal pain compared with back pain (OR= 4.05, 95% CI: 1.36-11.85). Conclusions: Women consider comfortable lateral and HK maternal postures during labor. The lateral posture is most comfortable for multiparous and epidural analgesia. The reduction of pain during labor is higher with HK posture, recommending this posture in primiparous women without epidural analgesia.

Estrategia de reducción de costes en la artroplastia total de rodilla

Aim: Assess the clinical utility of plain radiography in the first postoperative outpatient visit after total knee arthroplasty. Patients and Methods: 200 patients which underwent a total knee arthroplasty from January to May 2012 were analyzed retrospectively, they had two previous control radiographs at hospital discharge and two more at 4-6 weeks after surgery, which were compared, seeking for radiographics signs that would induce a therapeutic changes in the patient’s clinical course. Results: No radiographics signs were observed in the cases studied in the first postoperative visit one month after the surgery, consequently the patient’s treatment plan had no change. Discussion: Our results support those of other authors who have recognized the benefits of reducing the number of postoperative radiographs, improve the cost effectiveness of outpatients care and avoid an extra damage to the patient’s health. We believe that repeated use of serial radiographs in outpatient is simply a custom that has become law, to calm down the patient, and his surgeon, with no scientific evidence to support it use. Conclusions: Our results suggest that the plain AP and L radiographic projection at the first visit, one month later after a TKA, does not provide any clinic information, adds substantial cost to the heath-care system and unnecessary harms the patient.

Ceruloplasmina y su importancia clínica como factor indicador del riesgo cardiovascular en una población de escolares de Granada.

Also known as ferroxidase ceruloplasmin, belongs to the family of inflammation-sensitive proteins, and its main function to transport copper in the blood. Although, in addition to this transport function, at present, there are numerous studies that have attempted to use the determination of serum concentrations as a predictive indicator of cardiovascular risk in patients who are overweight or obese. The results of this study confirm the existence of a significant correlation between serum ceruloplasmin and nutritional status of the subjects, which means that for the population of students assessed, serum levels of this protein are an important predictor the risk of cardiovascular disease.

Conferencia de expertos "Hacia la equidad en salud": Monitorización de los determinantes sociales de la salud y reducción de las desigualdades en salud

Boletín semanal para profesionales sanitarios de la Secretaría General de Salud Pública y Participación Social de la Consejería de Salud

La vigilancia de los determinantes sociales, fundamente en la reducción de las desigualdades en salud

Boletín semanal para profesionales sanitarios de la Secretaría General de Salud Pública y Participación Social de la Consejería de Salud

La apuesta estratégica por la salud en todas las políticas y la reducción de desigualdades, retos de la nueva salud pública

Boletín semanal para profesionales sanitarios de la Secretaría General de Salud Pública y Participación Social de la Consejería de Salud

Efectividad de una estrategia de intervención preventiva, basada en entrevistas telefónicas estructuradas, en una población laboral con riesgo cardiovascular moderado/alto.

OBJECTIVE This study assesses the effectiveness of a structured telephone survey on cardiovascular prevention, in modifying lifestyle, on cardiovascular risk parameters, percentage of smoking cessation and overall cardiovascular risk (CVR). DESIGN Quasi-experimental study of preventive intervention. SETTING Ibermutuamur (Spanish Accident and Health Insurance Company). Centres established throughout Spain. PARTICIPANTS A total of 4,792 workers with moderate/high cardiovascular risk who had agreed to be contacted by phone. Subjects with a previous diagnosis of cardiovascular disease and those receiving treatment for hypertension, hypercholesterolemia or diabetes were excluded. INTERVENTION A final total of 3,085 workers were contacted and were followed up by telephone surveys on the first, fourth and eighth month after the initial check up (CU) in order to emphasise cardiovascular health advice (Group A); we failed to contact 1,707 workers, who only attended the baseline and one year CUs (Group B). PRINCIPAL OUTCOMES: CUs included medical records and physical examination, with two blood pressure measurements, Body Mass Index (BMI), and biochemical parameters. Cardiovascular risk was stratified following the European cardiovascular SCORE. Individuals with a relative risk higher than 4 were also considered as high-risk. All workers were informed about their cardiovascular risk profile (CVRF) and healthy cardiovascular lifestyle measures. They were also given a letter for their General Practitioner (GP) to inform them on the worker's cardiovascular risk level. RESULTS A total of 71.5% of the workers were over 45 years, 95.0% males, 76.6% manual workers ("Blue Collar") and 69.7% smokers. Both groups showed improvement in lipid parameters, blood pressure, smoking cessation and overall cardiovascular risk in the second CU. There were significant differences in favour of Group A as regards blood pressure, lipids (except HDL cholesterol), BMI, glycaemia, smoking cessation (A: 23.5%/B: 19.44%, P=0.001) and CVR stratum improvement (A: 46.6%/B: 37.7%, P=0.0001). The large majority (85%) of workers read preventive recommendations; 33% knew their risk level and 73% knew their CVRF. 52.9% gave the letter to the GP, which led them to start therapies on diet (47%), hypertension (19.5%), dyslipidaemia (16.7%), diabetes (4.4%) and smoking (2.9%) and no changes were made in 36.5% of cases. CONCLUSIONS The results of this study suggests that cardiovascular prevention strategy based on structured telephone surveys on high/moderate CVR subjects to promote lifestyle changes could be effective at reducing CVR. A clinical trial is required for confirmation. Sending information on CVRF following routine medial CUs and Primary Care involvement, could contribute to the positive changes observed.

Al lado: Un método para la reducción del sufrimiento mediante decisiones compartidas, en Andalucía

The strategy "Next To", developed in Andalusia, about cooperation between public health services and associations of affected people, to improve the quality of care, has been applied, among other diseases, to the problems of adversity on child health. In order to explore the needs of affected population, it has been made a qualitative study with parents of deceased children, through which it has been identified the key points of improvement in relation to the suffering that occurs in the affected person and their next caregiver environment. The purpose of the study, in addition to identifying areas for improvement, includes providing proposals as recommendations. "Next To" as a participatory and transversal strategy, currently under development, is implicit in the objectives of the Fourth Andalusian Health Plan, since its application encourages the participation and empowerment of people affected by health adversity

Riesgo de infección en pacientes de diálisis peritoneal: factores potencialmente relacionados

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