The Maternal Education Programme in the Public Health System in Galicia

[Resumen] Objetivos. Los objetivos del presente estudio han sido conocer la presión asistencial de los cursos de Educación Maternal en los centros de salud gallegos, así como su temporalización y las actividades teóricas y prácticas realizadas. Material y métodos. Estudio observacional de prevalencia mediante cuestionario autoadministrado y autofranqueado de todos los Centros de Salud de la Comunidad Autónoma de Galicia que disponen de matrona. El análisis estadístico ha consistido en un estudio descriptivo de todas las variables incluidas en el estudio. En el 81,5 % de las encuestas recibidas se refiere la existencia del Programa de Educación Maternal. En el 93,4 % de los casos las mujeres que inician el programa lo finalizan. Los contenidos teóricos del programa más frecuentemente desarrollados han sido cuidados en el recién nacido, lactancia y cuidados en el puerperio que están presentes en el 100 % de los casos; y el menos frecuentemente abordado ha sido medicación y embarazo. Los contenidos prácticos del programa más frecuentemente desarrollados han sido las técnicas de respiración (100 %), seguida de la preparación física preparto (98,1 %); y el menos desarrollado ha sido la recuperación física posparto. El mes de gestación en el que se inició el programa tuvo como mediana 6,5. La duración del programa tuvo como mediana 10 semanas. En el 100 % de las encuestas recibidas se indica que el responsable del programa es la matrona. Según las respuestas recibidas, existe una buena implementación del Programa de Educación Maternal. En cuanto a los contenidos teóricos y prácticos abordados en el período preparto, se observa una gran homogeneidad entre las distintas Unidades, abarcando gran variedad de aspectos. Parece que se enfatiza el programa preparto respecto al posparto, que cuenta con un menor número de horas semanales y de semanas de duración.[Abstract] Aims of the study. The goals of this study have been to know the number of patients who participate in the Maternal Education Program in the Health Centers in Galicia. Timetable, theoretical and practical activities of the program have been analised. Subject and methods. transversal descriptive study. We have sent by post a survey to all the health centers of Galicia which have midwifes. The statistic analyses has been about a descriptive study of all the variables included in the questionnaire. The maternal Education Program exists in the 81.5 % of the replies we have received. In the 93.4 % of the cases, the women both started and finished the program. The theoretical contents more frequently developed have been the medical care for newborn, breast-feeding and medical care in the postpartum period, which are present in the 100 % of the cases. The less frequently developed has been the medication and pregnancy. The practical contents of the program more frequently developed have been the breathe technics (100 %) followed by physical training during pregnancy (98.1 %). The less developed topic has been the physical training after delivery. The month of pregnancy when the programme begun had as median 6.5. The lenght of the program had as median 10 weeks. The 100 % of the replies showed that the person in charge of the programme was the midwife. According to the replies we have received, there is a high development of the Maternal Education Program. Related to the theoretical and practical contents taught during the pregnancy, there is so much homogeneity about several aspects among the different centers. It seems to be more emphasis in the prepartum compared to the postpartum program, which has less number of hours per week, and also less weeks of length

Validity and reliability of an offline ultrasound measurement of bladder base displacement in women

[Abstract] The effect of different exercises on the position of pelvic organs in women has not been sufficiently assessed. The objective was to analyze the validity and reliability of a new two-dimensional ultrasound algorithm to measure offline the displacement of the bladder base during abdominal exercises. This algorithm could be a useful method to future studies in determine the most appropriate exercises in sports and in rehabilitative program for the pelvic floor in women. All subjects were tested by transverse transabdominal ultrasound. The measurements were conducted offline using a customized code written in MATLAB (Ecolab) for image-processing, and manually on the ultrasound monitor using electronic calipers. The agreement was assessed with a paired t-test, Pearson’s linear correlation coefficient (r), the Lin’s concordance correlation coefficient (CCC), the intraclass correlation coefficient ICC (A,2) and a Bland–Altman plot. The reliability was confirmed by the interdays intra-rater ICC coefficient. The results were that Ecolab and ultrasound transducer measures did not differ statistically (p = 0.246). Furthermore, both methods showed a very strong relationship, and the Ecolab demonstrated to be a valid and reliable method. We concluded that Ecolab seemed to be a valid and reliable tool to assess the effect of abdominal contractions in the female pelvic floor.Ministerio de Ciencia e Innovación (España); PID2020-113578RB-I00Xunta de Galicia; ED431C-2020/14Xunta de Galicia; ED431G 2019/0

Pressure-Induced Referred Pain as a Biomarker of Pain Sensitivity in Fibromyalgia

Background: Fibromyalgia (FM) syndrome is characterized by widespread pain, fatigue, and generalized increased pain sensitivity. Appropriate and simple pain models are methods employed to assess pain mechanisms that can potentially lead to improved treatments. Pressure pain thresholds (PPTs) or mapping the referred pain area produced by pressure stimulation at suprathreshold intensities are used to assess pain mechanisms. The optimal suprathreshold stimulation intensity to elicit referred pain with minimal discomfort for patients with FM has yet to be determined. Objectives: The aim of this study was to compare the area and intensity of pressure-induced referred pain in patients with FM as elicited by systematic increases in PPTs, compared with controls. Study Design: Observational, crossed-section study. Setting: Research laboratory. Methods: Twenty-six patients with FM and 26 healthy controls, age- and gender-matched, were included. Suprathreshold stimulation was applied to the infraspinatus muscle of the dominant side at 4 different intensities (PPT +20%, +30%, +40%, and +50%), after which referred pain was evaluated by measuring the area of pain in pixels using a digital body chart and its intensity on a Visual Analog Scale. Factors related to anxiety condition, pain catastrophizing, depression, and quality of life were recorded. Results: The referred pain areas were larger in the FM group compared with healthy individuals at 120% (P = 0.024), 130% (P = 0.001), 140% (P = 0.001), and 150% (P = 0.001) PPT, however, within the FM group no differences were found between the intensity of suprathreshold stimulation and the size of the referred pain areas (P = 0.135) or pain intensity (P > 0.05). There was a positive correlation between the size of referred pain areas and pain catastrophizing in the FM group (r = 0.457, P = 0.032). Limitations: This study presents some limitations, among which is the variability found in the referred pain areas. Conclusions: These findings show that referred pain induced by applying a suprathreshold pressure of 120% PPT can be a useful biomarker to assess sensitized pain mechanisms in patients suffering from FM

Pengembangan Media Pembelajaran Fisika Berbasis Multimedia Interaktif Terintegrasi Dengan Lks Pokok Bahasan Hukum Newton Tentang Gerak Kelas X Sma/ma

Penelitian ini bertujuan untuk: (1) mengembangkan media pembelajaran fisika berbasis multimedia interaktif dengan menggunakan software adobe flash dan XML pada pokok bahasan Hukum Newton tentang gerak; (2) mengetahui kelayakan media pembelajaran fisika berbasis multimedia interaktif menggunakan software adobe flash dan XML pada pokok bahasan Hukum Newton tentang gerak yang dikembangkan; (3) mengetahui pencapaian hasil belajar siswa setelah mengikuti proses pembelajaran menggunakan media pembelajaran fisika berbasis multimedia interaktif terintegrasi dengan lembar kerja siswa hasil pengembangan. Penelitian ini merupakan penelitian dan pengembangan (R&D) yang mengacu pada model yang dikemukakan oleh Sugiyono. Kelayakan media divalidasi oleh ahli materi, ahli media dan praktisi. Subjek Ujicoba penelitian ini adalah siswa kelas X SMA N 3 Sukoharjo tahun akademik 2013/2014 sebanyak 43 siswa dengan rincian 10 siswa sebagai subjek ujicoba produk dan 33 siswa sebagai subjek ujicoba pemakaian. Berdasarkan hasil analisis data disimpulkan: (1) media pembelajaran fisika berbasis multimedia interaktif terintegrasi dengan lembar kerja siswa berhasil dikembangkan dengan menggunakan Software Adobe Flash dan XML dengan hasil produk dikemas dalam keping CD yang didalamnya berisi software utama media dan beberapa file pendukung dari media tersebut. Media disajikan dengan dua pembagian materi yaitu materi pembelajaran dan materi penjelasan yang diproteksi serta berisi bank soal yang dapat diupdate. Media pembelajaran dikembangkan dengan mengacu pada langkah yang diberikan oleh Sugiyono dan telah tervalidasi; (2) media pembelajaran fisika berbasis multimedia interaktif terintegrasi dengan lembar kerja siswa yang dikembangkan layak digunakan dengan kategori baik; (3) pencapaian hasil belajar peserta didik setelah mengikuti proses pembelajaran menggunakan media pembelajaran fisika berbasis multimedia interaktif terintegrasi dengan lembar kerja siswa mengalami peningkatan pada aspek pengetahuan

Multiancestry analysis of the HLA locus in Alzheimer’s and Parkinson’s diseases uncovers a shared adaptive immune response mediated by HLA-DRB1*04 subtypes

Across multiancestry groups, we analyzed Human Leukocyte Antigen (HLA) associations in over 176,000 individuals with Parkinson’s disease (PD) and Alzheimer’s disease (AD) versus controls. We demonstrate that the two diseases share the same protective association at the HLA locus. HLA-specific fine-mapping showed that hierarchical protective effects of HLA-DRB1*04 subtypes best accounted for the association, strongest with HLA-DRB1*04:04 and HLA-DRB1*04:07, and intermediary with HLA-DRB1*04:01 and HLA-DRB1*04:03. The same signal was associated with decreased neurofibrillary tangles in postmortem brains and was associated with reduced tau levels in cerebrospinal fluid and to a lower extent with increased Aβ42. Protective HLA-DRB1*04 subtypes strongly bound the aggregation-prone tau PHF6 sequence, however only when acetylated at a lysine (K311), a common posttranslational modification central to tau aggregation. An HLA-DRB1*04-mediated adaptive immune response decreases PD and AD risks, potentially by acting against tau, offering the possibility of therapeutic avenues

Clinical interview and functional assessment of pelvic floor

[Resumen] Los programas de reeducación fisioterápica de la región perineal deben basarse en una completa entrevista clínica y valoración funcional de la esfera abdomino-pelvi-perineal. A partir de los datos obtenidos, estableceremos los objetivos de tratamiento y la selección de las técnicas manuales e instrumentales para alcanzar los objetivos planteados. Además de la anamnesis, realizaremos una exploración física exhaustiva del suelo pélvico, que comprenderá la exploración visual y palpatoria, la valoración muscular, la valoración de la estática de los órganos pélvicos y la exploración neurológica; completaremos la valoración específica del suelo pélvico con la valoración abdominal, del diafragma y de la región lumbopélvica.[Abstract] All the physical therapist reeducation programs of the pelvic floor must be based on a thorough clinical interview and functional assessment of the abdominal region, the pelvis and the pelvic floor. From all these data, we will establish the goals o/ the treatment and we will select the manual and instrumental technics to reach the aims we have set out. Besides the clinical interview, we must carry out a comprehensive physical examination of the pelvic floor, which covers the visual and palpable examination, the muscle assessment, the assessment of the biomechanical position of the pelvic organs, and the neurological examination; we must complete the specific assessment of the pelvic floor with the examination of the abdominal region, the diaphragm and the low back

Unimanual Intensive Therapy with or without Unaffected Hand Containment in Children with Hemiplegia. A Randomized Controlled Pilot Study

Children with hemiplegia have lower spontaneous use and quality of movement in the affected upper limb. The modified constraint-induced movement therapy (mCIMT) is applied to improve the affected upper limb function. The objective of this study was to study the efficacy of unaffected hand containment to obtain changes in the function of the affected upper limb after applying two unimanual therapies. A randomized controlled pilot study was performed with 16 children diagnosed with congenital infantile hemiplegia, with eight children randomized in each group (average age: 5.54 years; SD: 1.55). mCIMT and unimanual therapy without containment (UTWC) were applied, with a total of 50 h distributed in five weeks (two h/per day). Two assessments were performed (pre- and post-treatment) to evaluate the affected upper limb spontaneous use, measured with the Shiners Hospital Upper Extremity Evaluation (SHUEE), and the quality of movement, measured with the Quality of Upper Extremity Skills Test (QUEST scale). The progression of the variables was different in both groups. The results are expressed in the median of the improvement percent and interquartile range (IQR). The spontaneous use analysis showed an improvement percent of 31.65 (IQR: 2.33, 110.42) in the mCIMT group with respect to 0.00 (IQR: 0.00, 0.00) in the UTWC group. The quality of movement increased in the mCIMT and UTWC groups, 24.21 (IQR: 13.44, 50.39), 1.34 (IQR: 0.00, 4.75), respectively and the greatest increase was obtained in the grasp variable for both groups. The use of unaffected hand containment in mCIMT would produce improvements in the affected upper limb functionality in children with hemiplegia (4–8 years old) compared to the same protocol without containment (UTWC)

Unimanual Intensive Therapy with or without Unaffected Hand Containment in Children with Hemiplegia. A Randomized Controlled Pilot Study

Children with hemiplegia have lower spontaneous use and quality of movement in the affected upper limb. The modified constraint-induced movement therapy (mCIMT) is applied to improve the affected upper limb function. The objective of this study was to study the efficacy of unaffected hand containment to obtain changes in the function of the affected upper limb after applying two unimanual therapies. A randomized controlled pilot study was performed with 16 children diagnosed with congenital infantile hemiplegia, with eight children randomized in each group (average age: 5.54 years; SD: 1.55). mCIMT and unimanual therapy without containment (UTWC) were applied, with a total of 50 h distributed in five weeks (two h/per day). Two assessments were performed (pre- and post-treatment) to evaluate the affected upper limb spontaneous use, measured with the Shiners Hospital Upper Extremity Evaluation (SHUEE), and the quality of movement, measured with the Quality of Upper Extremity Skills Test (QUEST scale). The progression of the variables was different in both groups. The results are expressed in the median of the improvement percent and interquartile range (IQR). The spontaneous use analysis showed an improvement percent of 31.65 (IQR: 2.33, 110.42) in the mCIMT group with respect to 0.00 (IQR: 0.00, 0.00) in the UTWC group. The quality of movement increased in the mCIMT and UTWC groups, 24.21 (IQR: 13.44, 50.39), 1.34 (IQR: 0.00, 4.75), respectively and the greatest increase was obtained in the grasp variable for both groups. The use of unaffected hand containment in mCIMT would produce improvements in the affected upper limb functionality in children with hemiplegia (4–8 years old) compared to the same protocol without containment (UTWC)

Age Differences in Motor Recruitment Patterns of the Shoulder in Dynamic and Isometric Contractions. A Cross-Sectional Study

Aging processes in the musculoskeletal system lead to functional impairments that restrict participation. Purpose: To assess differences in the force and motor recruitment patterns of shoulder muscles between age groups to understand functional disorders. A cross-sectional study comparing 30 adults (20–64) and 30 older adults (>65). Surface electromyography (sEMG) of the middle deltoid, upper and lower trapezius, infraspinatus, and serratus anterior muscles was recorded. Maximum isometric voluntary contraction (MIVC) was determined at 45° glenohumeral abduction. For the sEMG signal registration, concentric and eccentric contraction with and without 1 kg and isometric contraction were requested. Participants abducted the arm from 0° up to an abduction angle of 135° for concentric and eccentric contraction, and from 0° to 45°, and remained there at 80% of the MIVC level while isometrically pushing against a handheld dynamometer. Differences in sEMG amplitudes (root mean square, RMS) of all contractions, but also onset latencies during concentric contraction of each muscle between age groups, were analyzed. Statistical differences in strength (Adults > Older adults; 0.05) existed between groups. No significant differences in RMS values of dynamic contractions were detected, except for the serratus anterior, but there were for isometric contractions of all muscles analyzed (Adults > Older adults; 0.05). The recruitment order varied between age groups, showing a general tendency towards delayed onset times in older adults, except for the upper trapezius muscle. Age differences in muscle recruitment patterns were found, which underscores the importance of developing musculoskeletal data to prevent and guide geriatric shoulder pathologies

Combined intensive therapies at home in spastic unilateral cerebral palsy with high bimanual functional performance. What do they offer? A comparative randomised clinical trial

Background: Children with unilateral spastic cerebral palsy (USCP) receive different treatments, including the application of modified constraint induced movement therapy (mCIMT) or bimanual intensive therapy (BIT) to increase affected upper limb functionality. The aim of this study was to compare the effectiveness of two protocols with different proportions and orders of mCIMT/BIT within combined intensive home-therapy in children with USCP (6–8 years old) with high bimanual functional performance, applied by the family. Methods: The protocols were performed on 20 children with an average age of 7.12 years [standard deviation (SD): 0.70], allocated to two different combined therapies. The protocols were designed by 100 h of dose for 10 weeks: 80 h of mCIMT followed by 20 h of BIT (mCIMT-B group) and 80 h of BIT followed by 20 h of mCIMT (BIT-mCI group). Bimanual functional performance was measured with Assisting Hand Assessment Scale (AHA) and the affected upper limb-use experience with Children’s Hand-use Experience Questionnaire (CHEQ). Parent satisfaction and expectations with therapy were measured using a specific questionnaire. There were five assessment timepoints (week 0, week 4, week 8, week 10 and week 34). Results: There were no statistically significant (p > 0.05) inter- and intra-group changes in the bimanual functional performance of both groups. The affected upper limb-use experience obtained significant changes in BIT-mCI group, with statistically significant differences in the pairwise comparisons between week 0–10 and week 4–10 (p = 0.028) for use of the affected hand and the use of the affected hand to grasp between week 4 and week 8 (p = 0.028). Grasp efficacy and discomfort acquired statistically significant differences only in the BIT-mCI group for pairwise comparisons week 0–week 10/week 4–week 10 (p = 0.035). Although task execution time compared with a typically developing child of the same age obtained statistically significant differences only in the group mCIMT-B for pairwise comparisons week 0–week 8 (p = 0.03), week 0–week 10 (p = 0.03), week 4–week 8 (p = 0.04) and week 4–week 10 (p = 0.03). Family satisfaction and expectations acquired an increase between week 0 and week 10 (p ⩽ 0.02). Conclusion: Applying 80 h of BIT for 8 weeks in children with high bimanual functional performance USCP (6–8 years old), executed at home with family involvement would be sufficient to obtain improvements in affected upper limb-use experience, without the need to use combined protocols of 100 h. However, no statistically significant increase in bimanual functional performance would be obtained, with the basal situation of the child being a factor to consider for the execution of mCIMT and BIT