Calidad asistencial de la atención primaria en el medio rural

Atención primaria (AP), como nivel básico de salud, aborda diferentes actividades dirigidas a la población, de modo que se garantice la calidad y accesibilidad a todas ellas de forma integral. En el medio rural, concretamente en la comunidad de Castilla y León, los pacientes de atención primaria tienden a ser usuarios de edad avanzada. A esta circunstancia se le añade la problemática de la dispersión geográfica y la existencia de multitud de pueblos con una baja densidad de población, por lo cual el personal sanitario, en particular la enfermera, debe desplazarse entre municipios para realizar su trabajo asistencial haciendo que el tiempo dedicado a cada usuario se vea limitado. Frente a esto, los profesionales deben ofrecer una atención de calidad con los recursos disponibles, en ocasiones escasos, debido en gran medida a la reducción de presupuestos orientados a la AP. A través de este trabajo se pretende conocer la situación actual de atención primaria en nuestra región y plantear, en base a la evaluación de un proyecto propuesto, posibles mejoras en la asistencia en una zona básica específica de la provincia de Segovia, como por ejemplo disminuir la carga de trabajo de los sanitarios contratando a una mayor número de profesionales y cuidando también su salud física y mental.Grado en Enfermerí

Effects of a concurrent exercise training program on low back and sciatic pain and pain disability in late pregnancy

Objective: The aim of the present study was to explore the influence of a concurrent exercise (aerobic + resistance) training program, from the 17th gestational week (g.w.) until birth on low back and sciatic pain, and pain disability. A total of 93 pregnant women divided into exercise (n = 49) and control (n = 44) groups followed a 60-min, 3 days/week, concurrent exercise training. Methods: Low back and sciatic pain were measured with a Visual Analogic Scale (VAS). The disability resulting from pain was assessed with the Oswestry Disability Index (ODI). Measures were performed at the 16th and 34th g.w. Results: The exercise group increased 21.9 mm less the VAS low back (between-group differences (B): 95% CI: −33.6 to −10.2; p < 0.001) and 12.9 mm less the VAS sciatica score (between-group differences: 95% CI (B): −21.8 to −4.0; p = 0.005) than the control group. Regarding the ODI questionnaire, the exercise group increased 0.7, 0.5, and 0.7 less than the control group in pain while sleeping (between-group differences (B): 95% CI: −1.4 to −0.01; p = 0.025), pain while lifting weight (between-group differences (B): 95% CI: −0.9 to −0.01; p = 0.016), and limitations of the social life due to pain (between-group differences(B): 95% CI: −1.3 to −0.06; p = 0.032). Furthermore, the exercise group suffered 6.9% less pain than the control group in the ODI total score (between-group differences (B): 95% CI: −13.9 to 0.053; p = 0.052). Conclusion: This concurrent exercise training program adapted to pregnant women improved pain compared to controlsThe Regional Ministry of Health of the Junta de Andalucía (PI-0395- 2016)University of Granada, Excellence actions: Units of Excellence; Unit of Excellence on Exercise and HealthJunta de Andalucía, Consejería de Conocimiento, Investigación y UniversidadesEuropean Regional Development Fund (ERDF), REF. SOMM17/6107/UGRMFA was additionally funded by the Spanish Ministry of Education, Culture, and Sports (Grant number FPU17/03715

Premenstrual and menstrual changes reported after COVID-19 vaccination: The EVA project

Background: Menstrual disorders were not reported as a possible secondary effect in any of the clinical trials for the SARS-CoV-2 vaccines. Aim: To describe the prevalence of perceived premenstrual and menstrual changes after COVID-19 vaccine administration. Design: Cross-sectional study. Methods: A total of 14,153 women (mean age 31.5 ± 9.3 years old) who had received the full course of vaccination at least three months earlier were included in this cross-sectional study. Data including the type of vaccine administered, perceived changes in the amount and duration of menstrual bleeding, presence of clots, cycle length, and premenstrual symptoms were collected through a retrospective online survey from June to September 2021. Results: Of the women who participated in this study, 3136 reported no menstrual changes and 11,017 (78% of the study sample) reported experiencing menstrual cycle changes after vaccination. In summary, women who reported menstrual changes after vaccination were older (overall p < 0.001) and slightly more smokers (p = 0.05) than women who did not report any changes. The most prevalent changes in relation to premenstrual symptoms were increased fatigue (43%), abdominal bloating (37%), irritability (29%), sadness (28%), and headaches (28%). The most predominant menstrual changes were more menstrual bleeding (43%), more menstrual pain (41%), delayed menstruation (38%), fewer days of menstrual bleeding (34.5%), and shorter cycle length (32%). Conclusion: Women vaccinated against COVID-19 usually perceive mild menstrual and premenstrual changes. Future studies are warranted to clarify the physiological mechanisms behind these widely reported changes.Antonio Chamorro-Alejandro Otero Research Chair, University of Granad

Understanding the Meaning of Conformity to Feminine Norms in Lifestyle Habits and Health: A Cluster Analysis

Background: Gender roles impact different spheres of life and lead women to behavioral patterns and lifestyle habits associated with femininity, generating important differences between men and women in health. The present study analyzed relationships between conformity to the feminine norms and different lifestyle indicators: Educational level, marital status, alcohol consumption, tobacco consumption, sleeping hours, social support, and physical activity. Additionally, cluster analysis was developed in order to identify different patterns of gender role conformity. Methods: The sample was made up of 347 women age 18–70 from Spain. Data collection was conducted during 2014. Results: Multiple logistic regression analyses produced odds ratios showing that women with lower feminine role conformity were more likely to use tobacco and alcohol, but less likely to share their lives with someone. Cluster analysis found four different profiles of gender role conformity related to different patterns of alcohol consumption and marital status. Conclusions: Conformity to feminine norms was associated with basic affective conditions such as sharing life with others and with alcohol and tobacco consumption, but not with physical activity, social support, and sleep duration. Whereas tobacco and alcohol use have important health implications, public health systems should pay attention to gender-related variables in order to design and implement specific prevention programs

A 16-week multicomponent exercise training program improves menopause-related symptoms in middle-aged women. The FLAMENCO project randomized control trial

Abstract Objective: To investigate the influence of a supervised multicomponent exercise training program on menopause-related symptoms, particularly vasomotor symptoms (VMS), in middle-aged women. Methods: A total of 112 middle-aged women (mean age 52 4 y old, age range 45-60 y) from the FLAMENCO project (exercise [n ¼ 59] and counseling [n ¼ 53] groups) participated in this randomized controlled trial (perprotocol basis). The exercise group followed a multicomponent exercise program composed of 60-minute sessions 3 days per week for 16 weeks. The 15-item Cervantes Menopause and Health Subscale was used to assess the frequency of menopause-related symptoms. Results: After adjusting for body mass index and Mediterranean diet adherence, the subscales measuring menopause-related symptoms and VMSs decreased 4.6 more in the exercise group compared to the counseling group (between-group differences [B]: 95% CI: -8.8 to -0.2; P ¼ 0.040). The exercise group also showed significant improvements in the subscales of couple relationships (between-group differences [B]: -1.87: 95% CI: -3.29 to - 0.45; P ¼ 0.010), psychological state (between-group differences [B]: -2.3: 95% CI: -5 to -0.2; P ¼ 0.035), and VMSs (between-group differences [B]: -4.5: 95% CI: -8.8 to -0.2; p ¼ 0.040) in the Cervantes Menopause and Health Subscale compared with the counseling group. Conclusions: A 16-week multicomponent physical exercise program showed a positive effect on menopauserelated symptoms especially in couple relationships, psychological state, and VMS, among 45 to 60 year old women

Exercise, Mediterranean Diet Adherence or Both during Pregnancy to Prevent Postpartum Depression—GESTAFIT Trial Secondary Analyses

Targeting lifestyle behaviors during pregnancy is crucial to prevent the highly prevalent postpartum depression and its consequences. In these secondary analyses of an intervention trial to investigate the effects of concurrent exercise training on postpartum depression, we aimed to investigate the potential role of Mediterranean diet (MD) adherence on the exercise effects. A total of 85 pregnant women met the per-protocol criteria (exercise n = 46, control n = 39). The exercise program was delivered in 60 min sessions, 3 days/week, from the 17th gestational week until birth. Women's dietary habits were assessed with a food frequency questionnaire. The Mediterranean Food Pattern (an MD index) was derived from it to assess MD adherence. We used the Edinburgh Postnatal Depression Scale to assess postpartum depression. The postpartum depression score was not statistically different between control and exercise groups (p > 0.05). A higher consumption of fruits (beta = -0.242, p = 0.022), lower intake of red meat and subproducts (beta = 0.244, p = 0.020), and a greater MD adherence (beta = -0.236, p = 0.027) were associated with lower levels of postpartum depression. Greater adherence to the MD during pregnancy was associated with fewer depressive symptoms and a lower risk of postpartum depression. Postnatal depression was not reduced by prenatal exercise. Promoting fruit consumption while controlling the intake of red meat during pregnancy might prevent postnatal depression.Regional Ministry of Health of the Junta de Andalucia PI-0395-2016Research and Knowledge Transfer Fund (PPIT) 2016, Excellence Actions Programme: Scientific Units of Excellence (UCEES)Regional Ministry of Economy, Knowledge, Enterprises, and UniversityEuropean Regional Development Funds of the University of Granada SOMM17/6107/UGRSpanish Government FPU17/0371

Flora de interés en bosques-isla de Andalucía Occidental

Floristic reports in fragmented forests (island-forests) in western AndalusiaPalabras clave. Paisaje fragmentado, corología, flora, campiña, Andalucía Occidental, España.Key words. Fragmented landscape, chorology, flora, country side, Western Andalusia, Spai

Associations of Mediterranean diet with psychological ill‑being and well‑being throughout the pregnancy course: The GESTAFIT project

Purpose The relation between diet and maternal mental health during pregnancy might be relevant to prevent adverse materno-foetal outcomes. This study examined the association of Mediterranean diet (MD) adherence and MD components with mental health during pregnancy. Methods This secondary analysis of the GESTAFIT trial included longitudinal data from 152 pregnant women. Dietary habits were assessed with a food frequency questionnaire, and MD adherence was derived from it using the Mediterranean Food pattern. Psychological ill-being (i.e., negative affect, anxiety, and depression) and well-being (i.e., emotional intelligence, resilience, positive affect) were assessed with the Spanish version of well-established self-reported questionnaires. Cross-sectional (16th gestational week [g.w.]) and longitudinal associations (34th g.w.) between MD and mental health were studied using linear regression models. Results A greater MD adherence was inversely associated with negative affect and anxiety; and positively associated with emotional regulation, resilience and positive affect at the 16th and 34th g.w. (|β| ranging from 0.179 to 0.325, all p < 0.05). Additionally, a higher intake of whole grain cereals, fruits, vegetables, fish, olive oil and nuts, and a lower intake of red meat and subproducts and sweets were associated with lower negative affect, anxiety, depression and higher emotional regulation, resilience and positive affect throughout gestation (|β| ranging from 0.168 to 0.415, all p < 0.05). Conclusion A higher intake of whole grain cereals, fruits, vegetables, fish, olive oil and nuts, together with a lower intake of red meat and sweets, resulted in a higher MD adherence, which was associated with a better mental health during pregnancy.Universidad de Granada /CBUA The Regional Ministry of Health of the Junta de Andalucía (PI-0395–2016) The Research and Knowledge Transfer Fund (PPIT) 2016, Excellence Actions Programme: Scientific Units of Excellence (UCEES), and the Regional Ministry of Economy, Knowledge, Enterprises and University, European Regional Development Funds (SOMM17/6107/UGR) of the University of Granada. Spanish Ministry of Education, Culture and Sports (Grant number FPU17/03715). The Swedish Council for Health, Working Life and Welfare (2021-00036)

Effects of a concurrent exercise training program on low back and sciatic pain and pain disability in late pregnancy

Objective: The aim of the present study was to explore the influence of a concurrent exercise (aerobic + resistance) training program, from the 17th gestational week (g.w.) until birth on low back and sciatic pain, and pain disability. A total of 93 pregnant women divided into exercise (n = 49) and control (n = 44) groups followed a 60-min, 3 days/week, concurrent exercise training. Methods: Low back and sciatic pain were measured with a Visual Analogic Scale (VAS). The disability resulting from pain was assessed with the Oswestry Disability Index (ODI). Measures were performed at the 16th and 34th g.w. Results: The exercise group increased 21.9 mm less the VAS low back (between-group differences (B): 95% CI: −33.6 to −10.2; p < 0.001) and 12.9 mm less the VAS sciatica score (between-group differences: 95% CI (B): −21.8 to −4.0; p = 0.005) than the control group. Regarding the ODI questionnaire, the exercise group increased 0.7, 0.5, and 0.7 less than the control group in pain while sleeping (between-group differences (B): 95% CI: −1.4 to −0.01; p = 0.025), pain while lifting weight (between-group differences (B): 95% CI: −0.9 to −0.01; p = 0.016), and limitations of the social life due to pain (between-group differences(B): 95% CI: −1.3 to −0.06; p = 0.032). Furthermore, the exercise group suffered 6.9% less pain than the control group in the ODI total score (between-group differences (B): 95% CI: −13.9 to 0.053; p = 0.052). Conclusion: This concurrent exercise training program adapted to pregnant women improved pain compared to controls.Funding information Regional Ministry of Health of the Junta de Andalucía, Grant/Award Number: PI-0395-2016; Spanish Ministry of Education, Culture, and Sports, Grant/Award Number: FPU17/03715; University of Granada, Excellence actions: Units of Excellence; Unit of Excellence on Exercise and Health (UCEES), and by the Junta de Andalucía, Consejería de Conocimiento, Investigación y Universidades and European Regional Development Fund (ERDF), Grant/ Award Number: REF. SOMM17/6107/UGR10 página