El Papel de la matrona en la higiene del sueño del futuro bebé. Introducción al sueño y claves principales en la prevención de riesgos durante el sueño del bebé.

Dormir de forma correcta y segura permite al bebé regular el ritmo circadiano que mantendrá durante toda su vida, un factor clave para que el niño pueda crecer física y cognitivamente. Se ha demostrado que, cuando existe un déficit crónico de sueño, los niños aumentan notablemente el nivel de ansiedad, agresividad, falta de rendimiento y memoria. El incremento del tiempo en vigila favorece la degeneración neuronal en determinadas áreas cerebrales (locus coeruleus).También se ha demostrado que los trastornos del sueño afectan gravemente al sistema endocrino, lo que puede provocar trastornos en la alimentación y derivar también en obesidad infantil, apnea del sueño e hiperactividad. Asimismo, cuando los trastornos o problemas de sueño se prolongan hasta la preadolescencia y adolescencia, favorecen la aparición del trastorno bipolar, abuso de sustancias, depresión y trastornos alimentarios. Más allá de los trastornos que afectan a la calidad del sueño, también destacan (por su gravedad) diferentes situaciones de riesgo que ocurren durante el sueño y que pueden derivar en lesión traumática (golpes, cortes y caídas), atrapamiento, asfixia, obstrucción de vías respiratorias, deformación craneal postural y otros problemas. En un estudio encargado por la US Consumer Product Safety Commission y publicado en 2009, se señalaba que, entre las muertes accidentales debidas a productos de puericultura, el colchón y la cuna triplicaban el número de muertes del segundo producto con más riesgo (las bañeritas). Asimismo, por su pasado desconocimiento y por los avances en materia de prevención, también destaca el riesgo de sufrir la temida muerte súbita del lactante. La sensibilización temprana en la familia es crucial antes del nacimiento del futuro bebé, ya que coincide con la preparación de su habitación y la compra de todos los elementos que configurarán el espacio donde va a dormir y descansar el bebé (colchón, cuna, carro, silla de coche, minicuna, pijamas, etc.). Por lo tanto, los problemas que pueden aparecer durante el sueño del bebé y las medidas de prevención para evitarlos son de necesario conocimiento por parte de los padres y de los profesionales relacionados con el cuidado de los recién nacidos, y más concretamente en la profesión de matrona. Sleeping correctly and safely allows babies to regulate the circadian rhythm they will follow throughout their life, a key factor in children"s physical and cognitive development. It has been proven that children"s levels of anxiety, aggression and poor performance memory increase significantly when there is a chronic lack of sleep. The increase in time awake encourages neurodegeneration in certain parts of the brain (locus coeruleus). It has also been proven that sleep disorders seriously affect the endocrine system, which can cause eating disorders and also lead to child obesity, sleep apnoea and hyperactivity. Moreover, where sleep disorders or issues extend into preadolescence or adolescence, they encourage the appearance of bipolar disorder, substance abuse, depression and food disorders. Above and beyond disorders affecting sleep quality, also important (because of their seriousness) are different risk situations which arise during sleep and can lead to traumatic injury (impacts, cuts and falls), trapping, asphyxia, obstruction of respiratory channels, postural cranial deformity and other problems. In a study commissioned by the US Consumer Product Safety Commission and published in 2009, it was pointed out that, among accidental deaths due to childcare products, the mattress and the cot caused three times as many deaths as the product with the second-highest risk (baby baths). Also, due to ignorance of it in the past and progress in the area of prevention, there is the important risk of the dreaded sudden infant death syndrome, or cot death. Early education of the family is crucial before the birth of the child, as this coincides with preparation of the baby room and the all the items that equip the place where he or she is to sleep and rest (mattress,cot, pram, car seat, mini-cot, pyjamas, etc.). Therefore, the problems that can arise while the baby is asleep and preventive measures to avoid them must be known to parents and the professionals who help to care for newly borns, more specifically to midwives

Estudio del umbral de disconfort a la presión en el pie de las personas mayores

INTRODUCCIÓN El dolor en el pie en los mayores es uno de los principales problemas de la salud pública¹. El 41,9% de los mayores de 50 años tiene al menos una dolencia del pie². Los problemas más frecuentes de los pies se asocian con la existencia de sobrepresiones³. Los profesionales tratan de disminuirlas mediante adaptaciones⁴. Pero al no tener valores de referencia, dichas adaptaciones suelen realizarse de forma intuitiva⁵. La cuantificación de los umbrales de tolerancia a la presión en la planta del pie permitiría establecer tanto patrones de distribución como criterios de tratamiento y/o prevención del dolor. Conociendo el umbral de disconfort podremos evitar el siguiente estadío, es decir, el dolor y sus problemas asociados. Pero pese a la importancia que tendría cuantificar el umbral de disconfort a la presión en el pie, solamente cuatro estudios lo han medido⁶⁻⁹. Ninguno de ellos ha estudiado a los mayores. OBJETIVOS 1. Desarrollar una metodología para estudiar el umbral de disconfort a la presión en la planta del pie. 2. Identificar cómo se modifica el umbral de tolerancia a presiones plantares en función de la zona del pie, de la edad, del sexo y de la obesidad. 3. Conocer la relación entre el umbral de tolerancia y las presiones plantares producidas al caminar. MATERIAL Y MÉTODOS Un total de 36 sujetos, divididos en 3 grupos según la edad (20-35, 50-65 y mayores de 65 años), realizaron los ensayos de tolerancia a la presión en la planta del pie y de presiones plantares durante la marcha. El equipo para el registro de la sensibilidad a la presión consistió en un dinamómetro adaptado con una galga cilíndrica de 0,8 cm2. La presión se aplicaba de forma creciente en 12 puntos de la planta del pie hasta que el sujeto notaba disconfort. Para el análisis de las presiones actuantes en la planta del pie durante la marcha se utilizó el equipo de plantillas instrumentadas Biofoot/IBV. RESULTADOS Existe un patrón de tolerancia a presiones plantares en función de cada zona del pie, siendo el talón la zona que alcanza mayores niveles de tolerancia. La edad influye sobre los umbrales de tolerancia al disconfort en la planta del pie, exististiendo un punto de inflexión en torno a los 65 años. Los mayores de 65 años presentan mayores umbrales en todas las zonas del mediopié y del talón. El sexo también influye sobre los umbrales de tolerancia, siendo las mujeres quienes presentan mayores umbrales. Las personas obesas toleran presiones más altas que las no obesas en todas las zonas del pie estudiadas. Al comparar los resultados de las presiones plantares de la marcha con el umbral de disconfort a la presión observamos que no existe una correlación significativa entre ambos. CONCLUSIONES La zona del pie, edad, sexo y obesidad influyen en el umbral de tolerancia a las presiones plantares. Los mayores de 65 años, las mujeres y los obesos podrían considerarse poblaciones de riesgo dada la disminución de la sensibilidad a la presión en la planta del pie

Assessing the existence of a semantic space to express action tendencies

[EN] There is an abundance of literature showing that action tendencies measure can help in improving prediction of people final behaviour in different fields. Applying action tendencies in combination with differential semantics could be useful in understanding the relationship between product design and people final decision making. In this regard, a questionnaire including a reduced set of action tendencies would be desirable. The present research applies differential semantics to assess the existence of a semantic space of action tendencies people use to express their intention to react. One hundred volunteers reported to which extent 19 images prompted them to react in 37 different ways. They also selected the emotion and meaning they most associated to each image. Results show that there exists a semantic space with 11 axis people use to express their intention to react. The semantic space is little sensitive to the sample of people in the experiment. The observed relationship of semantic axes with emotions and meanings, and the comparison of the resulted axis with previous literature, evidence that they correspond to action tendencies.Alcantara, E.; Ruescas-Nicolau, M.; Artacho Ramírez, MÁ.; Sánchez-Sánchez, ML.; Dueñas, L. (2022). Assessing the existence of a semantic space to express action tendencies. International Journal of Industrial Ergonomics. 90:1-15. https://doi.org/10.1016/j.ergon.2022.1033171159

An Instrument-Assisted coracoid pain test : an exploratory diagnostic accuracy study

The coracoid pain test (CPT) could contribute to the diagnosis of frozen shoulder (FS) with palpation. However, due to assessor performance these values might be unreliable. Therefore, the aim was to explore the diagnostic accuracy of an instrument-assisted CPT and two alternative approaches (pain severity and side comparison) for assistance in the diagnosis of FS. Patients with FS and healthy age-matched controls were recruited. All participants underwent the instrument-assisted CPT on both shoulders with a pressure algometer. Sensitivity, specificity, and likelihood ratios were determined for the three approaches. In total, 35 patients with FS and 35 healthy participants were included. The original approach was positive in eight participants (11.4%), with only sufficient specificity to draw a conclusion. The pain severity approach was positive in 31 participants (44.3%) with sufficient sensitivity, specificity and likelihood ratios. The side comparison approach was positive in 10 participants (14.3%) with excellent specificity and positive likelihood ratio. The specificity of the instrument-assisted CPT can be used to increase the probability of FS with both the original and alternative approaches. Only the pain severity approach can draw a conclusion with a negative test result. This study should be repeated with a cross-sectional design to strengthen and confirm the conclusions

Differences in Inter-Rectus Distance and Abdominopelvic Function between Nulliparous, Primiparous and Multiparous Women

Widening of the inter-rectus distance (IRD) is highly prevalent among postpartum women and can lead to dysfunction of abdominopelvic muscles. The aim of this study was to evaluate the differences in IRD and abdominopelvic function between nulliparous, primiparous and multiparous women. A cross-sectional study was conducted on 75 women (25 nulliparous, 25 primiparous and 25 multiparous at 6 months postpartum). The participants underwent ultrasound assessment under three conditions (at rest, abdominal draw-in maneuver (ADIM) and curl-up) at two locations (2 cm above and 2 cm below the umbilicus). Furthermore, abdominopelvic muscle function was determined by prone, supine and side bridge tests. In all conditions and locations, the IRD were significantly higher (p 0.05) IRD at rest and during ADIM compared to the primiparous women. Regarding abdominopelvic muscle function, differences were only significant (p < 0.05) between the nulliparous with primiparous women in prone and supine conditions. These findings suggest that parity influences IRD: women at 6 months postpartum present greater IRD compared to nulliparous women; multiparous women present greater IRD at rest and during the activation of deep abdominal muscles than primiparous women; and primiparous women exhibit worse abdominopelvic muscle function than nulliparous women

The Spatial Extent of Pain Is Associated with Pain Intensity, Catastrophizing and Some Measures of Central Sensitization in People with Frozen Shoulder

The aim of this cross-sectional study was to explore the spatial extent of pain and its association with clinical symptoms, psychological features, and pain sensitization in people with frozen shoulder (FS). Forty-eight individuals with FS completed pain drawings (PDs) and reported their clinical symptoms including pain intensity (Visual Analogue Scale) and shoulder disability (Shoulder Pain and Disability Index). Moreover, pain sensitization measurements (pressure pain thresholds, temporal summation, conditioned pain modulation, and Central Sensitization Inventory (CSI)) were assessed. Psychological features were assessed by Pain Catastrophizing Scale (PCS) and Pain Vigilance and Awareness Questionnaire. Pain frequency maps were generated, Margolis rating scale was used for pain location, and Spearman correlation coefficients were computed. The mean (SD) pain extent was 12.5% (6.7%) and the most common painful area was the anterolateral shoulder region (100%). Women presented a more widespread pain distribution compared with men. Significant positive associations were obtained between pain extent and current pain intensity (rs = 0.421, p < 0.01), PCS (rs = 0.307, p < 0.05) and CSI (rs = 0.358, p < 0.05). The anterolateral region of the shoulder was the most common painful area in people with FS. Women with FS presented more extended areas of pain; and a more widespread distribution of pain was correlated with higher levels of pain, pain catastrophizing and pain sensitization

A Central Nervous System Focused Treatment Program for People with Frozen Shoulder: A Feasibility Study

Background: Frozen shoulder (FS) is a highly disabling pathology of poorly understood etiology, which is characterized by the presence of intense pain and progressive loss of range of motion (ROM). The aim of this study is to evaluate the feasibility and clinical impact of a CNS-focused treatment program for people with FS. Methods: 10 subjects with primary FS received a 10-week CNS-focused intervention including sensory discrimination training and graded motor imagery techniques delivered as clinic sessions (60 min) and home therapy (30 min five times per week). Measurements were taken at baseline, after a 2-week 'washout' period, after treatment, and at three months followup. The Shoulder Pain and Disability Index (SPADI) was the primary outcome. Secondary measures were feasibility-related outcomes, self-reported shoulder pain, active and passive range of motion, two-point discrimination threshold (TPDT), left/right judgement task (LRJT), fear-avoidance (Tampa Scale for Kinesiophobia), pain catastrophization (Pain Catastrophizing Scale), and pain sensitization (Central Sensitization Inventory). A Student's t-test was used to assess the 'washout' period. A repeated measure analysis of variance (ANOVA) was used to evaluate within-subjects' differences for all outcome measures in the different assessment periods and a pairwise analysis was used to compare between the different assessment points. Statistical significance was set at p < 0.05. Results: 70% of participants completed the treatment. No significant changes were found after 'washout' period except for TPDT (p = 0.02) and SPADI (p = 0.025). Improvements in self-reported shoulder pain (p = 0.028) and active shoulder flexion (p = 0.016) were shown after treatment (p = 0.028) and follow-up (p = 0.001) and in SPADI at follow-up (p = 0.008). No significant changes were observed in TPDT, LRJT, fear-avoidance, pain catastrophization, and pain sensitization. Conclusions: a CNS-focused treatment program might be a suitable approach to improve pain and disability in FS, but further research is needed to draw firm conclusions

El portafolios como herramienta facilitadora del aprendizaje en la asignatura "Procedimientos generales de intervención en fisioterapia II"

[SPA]INTRODUCCIÓN: El portafolios es un método de enseñanza, aprendizaje y evaluación de gran utilidad educativa desde el enfoque constructivista. Su objetivo principal es que los estudiantes aprendan a buscar, relacionar y analizar información que consolide y complemente las sesiones de clase. MÉTODOS: Con el objetivo de valorar su utilidad, ventajas e inconvenientes en la asignatura “Procedimientos Generales de Intervención en Fisioterapia II” (PGIF II) pasamos una encuesta de valoración a los estudiantes. La elaboración del portafolios supone un volumen de 0,5 créditos ECTS y su calificación supone el 20% de la nota final. RESULTADOS: La encuesta fue contestada por 74 de los 100 alumnos matriculados. Las actividades realizadas que obtuvieron una mayor puntuación fueron la complementación de apuntes (8,92 ± 1,55) y la elaboración de casos clínicos (7,81 ± 1,60). El 83,8% opinó que el portafolios le había ayudado a complementar los contenidos teóricos; el 67,5% que había potenciado su pensamiento crítico y reflexivo; el 93,2% lo consideró una herramienta facilitadora del 2122 aprendizaje; el 33,1% confesó sentirse inseguro durante su realización. Sólo el 29,8% lo consideró un excesivo gasto de tiempo. CONCLUSIÓN: El portafolios es considerado por los alumnos como un método de enseñanza-aprendizaje de gran utilidad para propiciar el trabajo autónomo, completar la información de las clases teóricas y facilitar el aprendizaje de la asignatura “PGIF II”. [ENG]INTRODUCTION: The portfolio is a method of teaching, learning and evaluation. It is useful in an educational program from the constructivist approach. Its main objective is that students learn to find, correlate and analyze information to strengthen and complement the classroom sessions. METHODS: In order to assess its usefulness, advantages and disadvantages in the course "General Procedures in Physiotherapy II” (PGIF II) we carried out a closed survey with students. The development of the portfolio represents a volume of 0.5 ECTS credits and the mark is 20% of the total course marks. RESULTS: The survey was answered by 74 of the 100 students enrolled. The activities that scored highest marking (10 points, mean ± standard deviation) were notes supplementation (8.92 ± 1.55) and the development of case studies (7.81 ± 1.60). 83.8% of the students felt that the portfolio had helped to supplement the theoretical concepts, 67.5% replied that it had enhanced their critical and reflective thinking, 93.2% saw it´s a learning facilitator tool, 33,1% stated they felt unsacure during the performance. Only 29.8% of students considered it an excessive waste of time. CONCLUSION: The portfolio is considered by students as a teaching-learning method useful for promoting self-study, completing the information obtained in the classroom and facilitating learning of the course "PGIF II”.Campus Mare Nostrum, Universidad Politécnica de Cartagena, Universidad de Murcia, Región de Murci

Las prácticas de simulación como herramienta facilitadora de enseñanza-aprendizaje en fisioterapia

[SPA]INTRODUCCIÓN: Gran parte del contenido de las materias del Grado de Fisioterapia se desarrolla mediante sesiones prácticas. En ellas cobran especial importancia las prácticas de simulación: el profesor toma como modelo a un estudiante y realiza la demostración de diferentes técnicas fisioterápicas. A continuación, los estudiantes, practican hasta consolidar, mediante la repetición y la corrección de errores, lo aprendido. MÉTODOS: Para el diseño de la asignatura “Procedimientos Generales de Intervención en Fisioterapia II” (PGIF-II), se ha elegido como metodología didáctica las prácticas de simulación. Con el objetivo de valorar la utilidad, ventajas e inconvenientes de las prácticas de simulación en la asignatura al finalizar la docencia los estudiantes rellenaron una encuesta de valoración. RESULTADOS: Las prácticas de simulación constituyeron un 43,3% de las horas totales de práctica. La encuesta fue contestada por 74 de los 100 estudiantes matriculados. La pregunta sobre la utilidad de las prácticas de simulación para completar la información de las sesiones teóricas obtuvo un 7,5 ± 2,27 sobre 10 (media ± desviación estándar). Las prácticas de masaje fueron las mejor valoradas, con un puntuación media de 9,11 ± 1,14. El 98,6% opinó que les había ayudado a complementar los contenidos teóricos; el 98,6% lo consideró una herramienta facilitadora del aprendizaje y 2090 el 79,5% opinó que este tipo de prácticas había mejorado su relación con los profesores. No obstante, el 84,9% las consideraron insuficientes en cuanto a horas dedicadas. CONCLUSIÓN: Las prácticas de simulación constituyen una herramienta fundamental para la adquisición de las habilidades y destrezas específicas de la materia “PGIF II” necesarias para la adquisición de competencias. [ENG]INTRODUCTION: Much of the content of the Degree in Physiotherapy is developed through practice sessions. The simulation practices are particularly important: the professor explains physical therapy techniques and students practice to consolidate learning by repetition and error correction. METHODS: For the design of the subject "General Procedures in Physical Therapy Intervention II" (PGIF-II) a methodology based in simulation practices has been chosen. In order to evaluate the usefulness, advantages and disadvantages of this methodology studients completed a survey. RESULTS: Simulation practices constitute 43.3% of the total hours of practice. The survey was answered by 74 of the 100 students. The question of the usefulness of simulation exercises to supplement the information from the theoretical sessions obtained 7,5 ± 2,27 out of 10 (mean ± standard deviation). Practices about massage received a mean score of 9,11 ± 1,14. 98.6% of students felt that they had helped them to supplement the theoretical contents, 98,6% considered it a learning facilitator tool and 79,5% thought that such practices had improved their relationship with professors. 84,9% considered them inadequate in terms of hours spent. CONCLUSION: Simulation practices are a fundamental tool for the acquisition of specific skills and abilities of the subject "PGIF-II", necessary for the acquisition of competences.Campus Mare Nostrum, Universidad Politécnica de Cartagena, Universidad de Murcia, Región de Murci

Determining cut-off points in functional assessment scales in stroke

[EN] BACKGROUND: A wide variety of well-validated assessment scales of functioning and disability have been developed for stroke population. However, these instruments have limitations in their interpretation. Therefore, determining cut-off points for their categorization becomes necessary. OBJECTIVES: To determine cut-off points for the BI, FIM and FAM scales to differentiate clinical disability categories and to establish the relationship between mRS and DOS scales. METHODS: One hundred and six adults with ischemic or haemorrhagic stroke were mainly recruited from a rehabilitation facility (Hospitales Nisa, Valencia, Spain). RESULTS: A high correlation was observed between the DOS and mRS scales (Kendall's tau-b = 0.475; p = 0.000) although a certain amount of disagreement between the two scales was detected. The cut-off points were 62.90 (95% CI, 57.26-69.29) and 21.30 (95% CI, 16.34-26.03) for the BI; 70.62 (95% CI, 66.65-75.22) and 38.29 (95% CI, 34.07-42.25) for the FIM; and 116.07 (95% CI, 110.30-122.68) and 66.02 (95% CI, 59.20-72.35) for the FAM. CONCLUSION(S): DOS was observed to be more demanding than the mRS, in terms of patient independence. Additionally, the lower cut-off points separating the levels of severe and moderate disability in the BI, FIM and FAM were determined. These findings would facilitate practitioners clinical interpretation of disability levels in post-stroke patients.Balasch I Bernat, M.; Balasch Parisi, S.; Noe Sebastian, E.; Dueñas Moscardo, L.; Ferri Campos, J.; Lopez Bueno, L. (2015). Determining cut-off points in functional assessment scales in stroke. NeuroRehabilitation. 37(2):165-172. doi:10.3233/NRE-151249S16517237