Correction : Chaparro et al. Incidence, Clinical Characteristics and Management of Inflammatory Bowel Disease in Spain: Large-Scale Epidemiological Study. J. Clin. Med. 2021, 10, 2885

The authors wish to make the following corrections to this paper [...]

Incidence, Clinical Characteristics and Management of Inflammatory Bowel Disease in Spain : Large-Scale Epidemiological Study

(1) Aims: To assess the incidence of inflammatory bowel disease (IBD) in Spain, to describe the main epidemiological and clinical characteristics at diagnosis and the evolution of the disease, and to explore the use of drug treatments. (2) Methods: Prospective, population-based nationwide registry. Adult patients diagnosed with IBD-Crohn's disease (CD), ulcerative colitis (UC) or IBD unclassified (IBD-U)-during 2017 in Spain were included and were followed-up for 1 year. (3) Results: We identified 3611 incident cases of IBD diagnosed during 2017 in 108 hospitals covering over 22 million inhabitants. The overall incidence (cases/100,000 person-years) was 16 for IBD, 7.5 for CD, 8 for UC, and 0.5 for IBD-U; 53% of patients were male and median age was 43 years (interquartile range = 31-56 years). During a median 12-month follow-up, 34% of patients were treated with systemic steroids, 25% with immunomodulators, 15% with biologics and 5.6% underwent surgery. The percentage of patients under these treatments was significantly higher in CD than UC and IBD-U. Use of systemic steroids and biologics was significantly higher in hospitals with high resources. In total, 28% of patients were hospitalized (35% CD and 22% UC patients, p < 0.01). (4) Conclusion: The incidence of IBD in Spain is rather high and similar to that reported in Northern Europe. IBD patients require substantial therapeutic resources, which are greater in CD and in hospitals with high resources, and much higher than previously reported. One third of patients are hospitalized in the first year after diagnosis and a relevant proportion undergo surgery

Manejo de la tercera etapa del parto: variabilidad en la práctica clínica y evidencia del empleo del Milking

Las Guías de Práctica Clínica recomiendan el manejo activo de la tercera etapa del parto para la prevención de la hemorragia postparto. En este manejo, se incluye el uso de un fármaco uterotónico, el pinzamiento del cordón (recomendándose realizar un pinzamiento tardío, debido a los beneficios para el neonato) y la tracción controlada del mismo. En la actualidad se desconoce las prácticas que realizan realmente los profesionales y cuáles son las alternativas por las que optan en el caso de no poderlas llevarlas a cabo. Dentro de estas alternativas, se ha descrito el ordeño del cordón umbilical (OCU) como posible opción en los casos en los que no se pueda realizar pinzamiento tardío del cordón umbilical (PTC). A pesar de haber demostrado algunos beneficios, esta técnica aún no está estandarizada en la práctica clínica. Objetivo: Evaluar la variabilidad de práctica clínica en cuanto al manejo del alumbramiento, y especialmente discernir las ventajas e inconvenientes que puede tener el OCU o milking en el recién nacido. Metodología: Para los estudios transversales a fin de determinar la variabilidad de la tercera etapa del parto y del pinzamiento del cordón, se elaboró un cuestionario administrado online, sobre 1,054 y 1,045 profesionales de la obstetricia, distribuido a través de sociedades científicas durante el año 2018. Las Odds ratios crudos (OR) y odds ratios ajustados (ORa) se estimaron mediante regresión logística binaria. Por otra parte, para la revisión sistemática y metaánalis del ordeño del cordón umbilical se realizaron búsquedas en MEDLINE, EMBASE, CINAHL, Pubmed, the Cochrane Database of Clinical Trials, the clinicaltrails.gov de ensayos clínicos aleatorizados sin restricciones de tiempo ni de idioma, que compararon el OCU con otras estrategias. Los datos fueron recopilados por dos revisores y la calidad de los estudios se evaluó mediante la metodología del Manual Cochrane. Resultados: La mayoría de los profesionales emplearon oxitocina y realizaron PTC en el alumbramiento. La mayoría conocían la técnica del OCU y el 55.9% (584) nunca lo habían realizado. El número de partos anual del hospital donde trabaja influyó en el manejo, de tal forma que; trabajar en un hospital que asistió > 4000 partos anuales (ORa: 7.95; 95% IC: 4.02-15.72) aumentaba la probabilidad de empleo de uterotónicos, mientras que, los centros donde se asistieron entre 1001-2000 partos anuales con una ORa de 2.72 (95% IC: 1.35-5.47) tiene mayor probabilidad de realizar pinzamiento tardío con respecto a los asisten menos de 1000 partos al año. La asistencia de partos a domicilio mostró una menor probabilidad de uso de uterotónicos (ORa: 0.23; 95% IC: 0.12-0.47), al igual que haber finalizado la formación tras el año 2007 (ORa: 1.57; 95% IC: 1.13-2.18). En el mismo sentido los profesionales encuestados mayores de 50 años presentaban menor probabilidad de realizar pinzamiento tardío con una ORa de 0.24 (95% IC: 0.11-0.52). También se observaron diferencias estadísticamente significativas en el manejo clínico de la tercera etapa del parto entre matronas y ginecólogos. Al evaluar los efectos del OCU en 2,083 recién nacidos prematuros y 1,845 prematuros tardíos y a término, mediante la revisión sistemática y metaánalisis se observó que el OCU en los recién nacidos prematuros reduce el riesgo de transfusión (Riesgo Relativo (RR) = 0.78 [Intervalo de Confianza (IC) del 95%: 0.67-0.90]) y aumentaba la hemoglobina (Diferencia de Medias Ponderada agrupada (DMP) = 0.89 g / L [95%: IC; 0.55, 1.22]) y la presión arterial media (DMP = 1.92 mmHg [95% IC; 0.55, 3.25]). En los recién nacidos con <33 semanas de gestación (SG), el OCU se asoció con un riesgo reducido de transfusión (RR = 0.81 [95% IC: 0.66- 0.99]), así como mayores cantidades de hemoglobina (DMP = 0.91 g / L [95% IC: 0.50, 1.32]). También se contempló que en recién nacidos prematuros el OCU aumentó el riesgo de síndrome de dificultad respiratoria (RR = 1.54 [95% IC: 1.03-2.29]), en comparación con el control grupos. Por otra parte cuando se evaluó el OCU en recién nacidos prematuros tardíos y a término se observó que el OCU en los recién nacidos ? 34 SG no se relacionó con los niveles de hemoglobina iniciales (DMP = [95% IC: 0.40 g/L (-0.16, 0.95)]), ni a las 6 semanas (DMP= [95% IC: 0.07 g/L (-0.29 - 0.43)]). También se observó una reducción de lo niveles de hemoglobina a las 6 semanas cuando el grupo control fue PTC (DMP= [95% IC: -0.16 g/L [-0.26, -0.06]). Conclusiones: Factores profesionales y del entorno del trabajo son en parte responsables de la variabilidad que presentan en la clínica los profesionales de la obstetricia españoles en cuanto al manejo del alumbramiento en los partos normales. Por otra parte se ha demostrado que la realización de OCU en los recién nacidos prematuros, aumenta la hemoglobina, el hematocrito y la presión arterial iniciales, además de disminuir el riesgo de transfusión con respecto a los controles. La realización del OCU en los recién nacidos prematuros tardíos no se observan diferencias en cuanto a variables hematológicas, viendo una pequeña disminución de la hemoglobina a las 6 semanas cuando el grupo de control era PTC. La técnica recomendada debe ser el pinzamiento tardío, pero el OCU se podría contemplar como alternativa al PTC en recién nacidos >28 semanas de gestación en situaciones que no pueda realizarse PTC

Variability and associated factors in the management of cord clamping and the milking practice among Spanish obstetric professionals

Clinical practice guides recommend delayed clamping of the umbilical cord. If this is not possible, some authors suggest milking as an alternative. The objective of this study was to determine the variability in professional practice in the management of umbilical cord clamping and milking and to identify factors or circumstances associated with the different methods. An observational cross-sectional study done on 1,045 obstetrics professionals in Spain in 2018. A self-designed questionnaire was administered online. The main variables studied were type of clamping and use of milking. Crude odds ratios (OR) and adjusted odds ratios (ORa) were estimated using binary logistic regression. 92.2% (964) performed delayed clamping. 69.3% (724) clamped the cord when it stopped beating. 83.8% (876) had heard of milking, and 55.9% (584) had never performed it. Professionals over 50 were less likely to perform delayed clamping, with an ORa of 0.24 (95% CI: 0.11–0.52), while midwives were more likely to perform delayed clamping than obstetricians, with an ORa of 14.05 (95% CI: 8.41–23.49). There is clinical variability in the management of umbilical cord clamping and the use of milking in normal births. Part of this variability can be attributed to professional and work environment factors

Effects of cord milking in late preterm infants and full-term infants: A systematic review and meta-analysis

Background: Umbilical cord milking (UCM) consists of performing several milkings of the cord from the placenta to the newborn. The objective was to evaluate the effects of UCM on newborns ≥34 weeks’ gestation. Methods: Searches were conducted in MEDLINE, EMBASE, CINAHL, the Cochrane Database of Clinical Trials, and the clinicaltrails.gov database for randomized clinical trials (RCT), with no time or language restrictions, and for articles that compared UCM with other strategies. The main results were initial hemoglobin and hemoglobin after 6 weeks. The data were collected by two reviewers and the quality of the studies was assessed using the Cochrane Manual methodology. Results: The sample included 1845 newborns in 10 RCTs. The use of UCM in ≥34 weeks’ gestation newborns was not related to initial hemoglobin levels (pooled weighted mean difference: (PWMD = 0.40 g/L [−0.16 to 0.95]) or after 6 weeks (PWMD = 0.07 g/L [−0.29 to 0.27]). A reduction in hemoglobin levels was also observed at 6 weeks when the control group had undergone late clamping (PWDM = 0.16g/L [−0.26 to −0.06]). Conclusions: UCM produced no differences in hematologic variables for newborns with ≥34 weeks of gestation relative to controls. However, a slight decrease in hemoglobin levels is observed at 6 weeks when the control group is made up of newborns with late clamping

Factors that influence mothers’ prenatal decision to breastfeed in Spain

Background: Parents’ decisions about how to feed their newborns are influenced by multiple factors. Our objective was to identify the factors that can influence the decision to breastfeed. Methods: Cross-sectional observational online study was conducted in Spain on women who gave birth between 2013 and 2018. The total number of participants was 5671. Data collection was after approval by the ethics committee in 2019. The data were collected retrospectively because the information was obtained from women who were mothers during the years 2013–2018. An online survey was distributed to breastfeeding associations and postpartum groups. Multivariate analysis with binary logistic regression was done to calculate the Adjusted Odds Ratios (aOR). The main result variable was “intention to breastfeed”. Results: Ninety-seven percent (n = 5531) of women made the decision to breastfeed prior to giving birth. The internet played a role in deciding to breastfeed in 33.7% (n = 2047) of women, while 20.1% (n = 1110) said the same thing about their midwife. We identified five significant factors associated with the mother’s prenatal decision to breastfeed: attending maternal education (aOR 2.10; 95% CI 1.32, 3.34), having two (aOR 0.52; 95% CI 0.28, 0.99) and three children (aOR 0.24; 95% CI 0.10, 0.59), previous breastfeeding experience (aOR 6.99; 95% CI 3.46, 14.10), support from partner (aOR 1.58; 95% CI 1.09,2.28) and having a condition during pregnancy (aOR 0.62; 95% CI 0.43, 0.91). Conclusions: Factors related with previous breastfeeding experience and education for mothers are decisive when it comes to making the decision to breastfeed. Given the proven influence that partners have in decision-making, it is important for them to be fully involved in the process

Relationship between maternal body mass index with the onset of breastfeeding and its associated problems: an online survey

Background: Obesity is a worldwide public health problem that demands significant attention. Several studies have found that maternal obesity has a negative effect on the duration of breastfeeding and delayed lactogenesis. The World Health Organization has classified Body Max Index (BMI) as normal weight (normoweight) (BMI:18.5–24.9), overweight (BMI:25–29.9), obesity grade I (30.0–34.9), obesity grade II (BMI: 35.0–39.9) and obesity grade III (BMI 40.0). The objective of this study is to describe the relationship between maternal BMI and breastfeeding rates, as well as breastfeeding-associated problems and discomfort in women assisted by the Spanish Health System. Methods: To this end, a cross-sectional observational study aimed at women who have been mothers between 2013 and 2018 in Spain was developed. The data was collected through an online survey of 54 items that was distributed through lactation associations and postpartum support groups between March and June 2019. Five thousand eight hundred seventy one women answered the survey. In the data analysis, Crude Odds Ratios (OR) and Adjusted Odds Ratios (AOR) were calculated through a multivariate analysis through binary and multinomial regression. Results: A linear relationship was observed between the highest BMI figures and the reduction of the probability of starting skin-to-skin contact (AOR for obesity type III of 0.51 [95% CI 0.32, 0.83]), breastfeeding in the first hour (AOR for obesity type III of 0.58 [95% CI 0.36, 0.94]), and exclusive breastfeeding to hospital discharge (AOR for obesity type III of 0.57 [95% CI 0.35, 0.94]), as compared to women with normoweight. Conclusions: Women with higher BMI are less likely to develop successful breastfeeding than women with normoweight

Relationship between Maternal Body Mass Index and Obstetric and Perinatal Complications

Over the past few decades, overweight and obesity have become a growing health problem of particular concern for women of reproductive age as obesity in pregnancy has been associated with increased risk of obstetric and neonatal complications. The objective of this study is to describe the incidence of obstetric and perinatal complications in relation to maternal body mass index (BMI) at the time prior to delivery within the Spanish Health System. For this purpose, a cross-sectional observational study was conducted aimed at women who have been mothers between 2013 and 2018 in Spain. Data were collected through an online survey of 42 items that was distributed through lactation associations and postpartum support groups. A total of 5871 women answered the survey, with a mean age of 33.9 years (SD = 4.26 years). In the data analysis, crude odds ratios (OR) and adjusted odds ratios (AOR) were calculated through a multivariate analysis. A linear relationship was observed between the highest BMI figures and the highest risk of cephalopelvic disproportion (AOR of 1.79 for obesity type III (95% CI: 1.06–3.02)), preeclampsia (AOR of 6.86 for obesity type III (3.01–15.40)), labor induction (AOR of 1.78 for obesity type III (95% CI: 1.16–2.74)), emergency C-section (AOR of 2.92 for obesity type III (95% CI: 1.68–5.08)), morbidity composite in childbirth (AOR of 3.64 for obesity type III (95% CI: 2.13–6.24)), and macrosomia (AOR of 6.06 for obesity type III (95% CI: 3.17–11.60)), as compared with women with normoweight. Women with a higher BMI are more likely to develop complications during childbirth and macrosomia

Umbilical Cord Milking in Infants Born at <37Weeks of Gestation: A Systematic Review and Meta-Analysis

Umbilical cord milking (UCM) could be an alternative in cases where delayed umbilical cord clamping cannot be performed, therefore our objective was to evaluate the effects ofUCMin newborns <37 weeks’ gestation. In this systematic review and meta-analysis, we searched MEDLINE, EMBASE, CINAHL, the Cochrane Database of Clinical Trials, the clinicaltrails.gov database for randomizedUCM clinical trials with no language restrictions, which we then compared with other strategies. The sample included 2083 preterm infants. The results of our meta-analysis suggest thatUCMin premature infants can reduce the risk of transfusion (relative risk (RR)= 0.78 [95% confidence interval (CI),0.67–0.90]) and increase hemoglobin(pooled weighted mean difference (PWMD)= 0.89 g/L[95%CI 0.55–1.22]) and mean blood pressure (PWMD=1.92 mmHg [95% CI 0.55–3.25]). Conversely, UCM seems to increase the risk of respiratory distress syndrome (RR = 1.54 [95% CI 1.03–2.29]), compared to the control groups. In infants born at <33 weeks,UCMwas associated with a reduced risk of transfusion (RR= 0.81 [95%CI 0.66–0.99]), as well as higher quantities of hemoglobin (PWMD= 0.91 g/L[95%CI 0.50–1.32]). UCM reduces the risk of transfusion in preterm infants, and increases initial hemoglobin, hematocrit, and mean blood pressure levels with respect to controls

Variability of Clinical Practice in the Third Stage of Labour in Spain

Clinical practice guidelines recommend the active management of the third stage of labour, but it is currently unknown what practices professionals actually perform. Therefore, the aim of this study was to determine the variability of professional practices in the management of the third stage of labour and to identify any associated professional and work environment factors. A nationwide cross-sectional study was performed with 1054 obstetrics professionals between September and November 2018 in Spain. A self-designed questionnaire was administered online. The crude odds ratios (OR) and adjusted odds ratios (ORa) were estimated using binary logistic regression. The main outcome measures were included in the clinical management of the third stage of labour and they were: type of management, drugs, doses, routes of administration, and waiting times used. The results showed that 75.3% (783) of the professionals used uterotonic agents for delivery. Oxytocin was the most commonly administered drug. Professionals who attend home births were less likely to use uterotonics (ORa: 0.23; 95% confidence interval (CI): 0.12&#8722;0.47), while those who completed their training after 2007 (ORa: 1.57 (95% CI: 1.13&#8722;2.18) and worked in a hospital that attended &gt;4000 births per year (ORa: 7.95 CI: 4.02&#8722;15.72) were more likely to use them. Statistically significant differences were also observed between midwives and gynaecologists as for the clinical management of this stage of labour (p &lt; 0.005). These findings could suggest that there is clinical variability among obstetrics professionals regarding the management of delivery. Part of this variability can be attributed to professional and work environment factors