Revisiting the Mackey Childbirth Satisfaction Rating Scale: Spanish adaptation, factor analysis, and sources of construct validity

Background: Women's dissatisfaction with perinatal health care services is associated with poor postpartum outcomes for the mother and the baby. The Mackey Childbirth Satisfaction Rating Scale is a frequently used measure of women's childbirth satisfaction. However, its factor structure has been inconsistent across investigations. The goal of this study was to evaluate the psychometric properties of the scale (i.e., factor structure and sources of validity evidence). Methods: This study is a descriptive prospective investigation. Participants included 106 pregnant women (mean age = 31.86, SD = 4.12) recruited from a public university hospital situated in South Madrid. Sources of construct validity of the Mackey were explored with the Women's View of Birth Labor Satisfaction Questionnaire. Sources of criterion validity were investigated with measures of pain (labor, delivery, and just after birth) and post-traumatic stress symptoms. Results: Minor adaptations in item distribution resulted in an adequate fit of the original six-factor solution of the Mackey scale (i.e., oneself, the partner, the baby, the nurse, the physician, and overall satisfaction). Sources of validity evidence supported the construct and criterion validity of the scale. Conclusions: Obtaining a psychometrically and conceptually sound factor solution is fundamental when validating a scale. With the present study, researchers and clinicians (e.g., midwives) will be able to measure women's childbirth satisfaction in a more robust manner. Both antecedents and consequences of satisfaction were found to correlate with several satisfaction subscales, which might help guide prevention programs in mother care in a more efficient way.The study was funded by the Health Research Fund (Fondo de Investigaciones Sanitarias, FIS), grant number PI07/0571 from the Instituto de Salud Carlos III (Spain). Dr. Suso-Ribera also obtained a grant from Jaume I University to conduct this study (E-2019-06)

Associations of Cognitive Fusion and Pain Catastrophizing with Fibromyalgia Impact through Fatigue, Pain Severity, and Depression: An Exploratory Study Using Structural Equation Modeling

Differences in fibromyalgia impact on functioning exist and appear to be influenced by numerous factors, including symptomatology severity, as well as the cognitive profile of the individual. The contribution of these elements, however, tends to be explored in a fragmented manner. To address this issue, we tested a comprehensive structural equation model in which associations of cognitive fusion and pain catastrophizing with function limitations are investigated through fibromyalgia symptomatology (i.e., fatigue, pain severity, and depression) in 231 women with fibromyalgia. In the model, cognitive fusion and two catastrophizing components (magnification and helplessness) were associated with poorer functioning indirectly through fibromyalgia symptomatology. Only the rumination component of catastrophizing had a direct association with functional limitations. All fibromyalgia symptoms were linked to increased functional limitations. A parsimonious model with significant associations only obtained an excellent fit (S-B χ2 = 774.191, df = 543, p < 0.001; CFI = 0.943; RMSEA = 0.043; CAIC = −2724.04) and accounted for 50% of the variance of functional limitations. These results suggest that the relationship between psychological cognitive processes, fibromyalgia symptomatology, and functional limitations is complex and support the need for comprehensive models such as the present. The findings are discussed in the context of personalized psychological treatments (i.e., the need to address certain cognitive processes according to the problematic symptomatology or outcome)

Las propiedades psicométricas del Cuestionario de Expectativas sobre el Parto en una muestra de mujeres españolas gestantes

Childbirth expectations during pregnancy are important factors related to birth satisfaction. The aim of this study is to validate the Childbirth Expectation Questionnaire (CEQ) in a sample of Spanish pregnant women; 231 women responded to the CEQ during their first trimester of pregnancy and 106 of them completed a re-test at the third trimester. Exploratory analyses with 1-to-6 factor solutions were carried out to investigate the internal structure of the CEQ. The three-factor solution (spousal support and control, medical support and environment, and labor pain and distress) showed the best properties in terms of model fit, number of items per factor, and item loadings. The internal consistency of scales was also good (.79 ≥ α ≤ .93). Test-retest analyses showed significant intercorrelations between expectations from the first to the third trimester of pregnancy. There is a need to assess childbirth expectations, and our results suggest that the CEQ is a valid and useful instrument to be used among Spanish pregnant women.Las expectativas sobre el parto (evaluadas durante el embarazo) constituyen factores relevantes relacionados con la satisfacción del parto. El objetivo de este estudio es validar el Cuestionario de Expectativas sobre el Parto (CEQ según las siglas del nombre inglés) en una muestra de gestantes españolas. Un total de 231 mujeres cumplimentaron el CEQ durante el primer trimestre del embarazo y 106 de ellas cumplimentaron de nuevo el instrumento en el tercer trimestre. Se realizaron análisis exploratorios con soluciones factoriales de 1 a 6 factores para analizar la estructura interna del CEQ. La solución de tres factores (apoyo de la pareja y control, apoyo médico y ambiente y dolor durante el parto y malestar) mostró las mejores propiedades en cuanto a ajuste del modelo, número de ítems por factor y peso de los ítems. La consistencia interna de las escalas también fue buena (.79 ≥ α ≤ .93). Los análisis test-retest mostraron intercorrelaciones significativas entre las expectativas del primer y tercer trimestre del embarazo. Atendiendo a la necesidad de evaluar las expectativas sobre el parto, nuestros resultados sugieren que el CEQ es un instrumento válido y útil para ser utilizado en las gestantes españolas

Efectos de una intervención psicológica y fisioterapeútica sobre la ocurrencia de lesiones

This study aims to analyse the effects of a psychological intervention focused on motivation and anxiety, in combination with a physiotherapy program, upon the occurrence of injuries. The participants were 22 male soccer players (age = 23.31, SD = 4.24). The instruments used were injury protocol, Competitive State Anxiety Inventory 2 (CSAI-2) and Behavioral Regulation in Sport Questionnaire (BRSQ). The program lasted twelve sessions a periodicity of weeks and with duration of approximately 30-40 minutes each. A pre/post-treatment design with three modalities was used: psychological treatment and physiotherapy (combined modality), physiotherapy and control. The groups are formed randomly with the Windows Excel program. The results on the indication of in-jury show that the physiotherapeutic treatment and the combined treatment reduce the appearance of injury compared to the control group during the intervention. In the long term (six months after the intervention), only the combined treatment significantly reduced the injury compared to the control group. The combined program produced a reduction of de-motivation levels and external regulation, along with an increase in intrinsic motivation (accomplishment) in comparison to the group who received physiotherapy on its own. Both interventions (combined and physiotherapy alone) were efficient in decreasing anxiety levels, although the combined group was more efficient, as well as being the only one that significantly improved self-confidence levels and intrinsic motivation. Nevertheless, because of the lack of previous literature in this area and because of the methodological difficulties further studies are required.Este estudio tiene como objetivo analizar los efectos de una intervención psicológica centrada en la motivación y la ansiedad, en combinación con un programa de fisioterapia, sobre la aparición de lesiones. Los participantes fueron 22 jugadores de fútbol masculinos (edad = 23.31, SD = 4.24). Los instrumentos utilizados fueron el protocolo de lesiones, el Inventario de ansiedad de estado competitivo 2 (CSAI-2) y el Cuestionario de regulación del comportamiento en el deporte (BRSQ). El programa duró doce sesiones con una periodicidad semanal y con una duracion de 30-40 minutos cada una. Se utilizó un diseño pre/post tratamiento con tres modalidades: tratamiento psicológico y fisioterapia (modalidad combinada), fisioterapia y control. Los grupos se formaron aleatoriamente con el programa Excel de Windows. Los resultados sobre la indicidencia de lesión muestran que el tratamiento fisioterapéutico y el tratamiento combinado reducen la aparición de lesión respecto al grupo control durante la intervención. A largo plazo (seis meses después de la intervención) únicamente el tratamiento combinado reduce significativamente la lesión respecto el grupo control. El programa combinado produjo una reducción de los niveles de desmotivación y regulación externa, junto con un aumento de la motivación intrínseca (logro) en comparación con el grupo que recibió fisioterapia por sí solo. Ambas intervenciones (combinadas y fisioterapia sola) fueron eficientes para disminuir los niveles de ansiedad, aunque el grupo combinado fue más eficiente, además de ser el único que mejoró significativamente los niveles de autoconfianza y la motivación intrínseca. Sin embargo, debido a la falta de literatura previa en esta área y debido a las dificultades metodológicas, se requieren más estudios.Actividad Física y Deport

Development and psychometric properties of the maternal ambivalence scale in spanish women

Background maternal ambivalence, which refers to experiencing mixed emotions about motherhood, like happiness and sadness, is frequent during the perinatal period. Aim Due to the relevance of this topic and the lack of psychometrically-sound instruments to measure it, this study aims to develop and test a measure of maternal ambivalence called the Maternal Ambivalence Scale (MAS). Methods in this cross-sectional, observational study, participants were 1424 Spanish women recruited online who were either pregnant (33%) or recent mothers of children under 2 years (67%). They responded to the MAS and measures of anxiety and depressive symptoms and life satisfaction. Analyses included exploratory and confirmatory factor solutions for the MAS, internal consistency estimates (Cronbach’s α) for all scales, as well as bivariate correlations to investigate sources of validity evidence. Comparisons between pregnant and postpartum women were also examined. Results The assumptions for factor analysis about the relationship between items were met (Kaiser-Meyer-Olkin’s [KMO] test = 0.90; Barlett’s Chi-square sphericity test = 5853.89, p < .001). A three-factor solution (Doubts, Rejection, and Suppression) for the MAS showed a good model fit both in exploratory (Chi-square = 274.6, p < .001, Root Mean Square Error of Approximation [RMSEA] = 0.059, RMSEA 90% Confidence Interval [CI]=[0.052, 0.066], Comparative Fit Index [CFI] = 0.985, Tucker Lewis Index [TLI] = 0.974) and confirmatory analyses (Chi-square = 428.0, p < .001, RMSEA = 0.062, RMSEA 90% CI=[0.056, 0.068], CFI = 0.977, TLI = 0.971). Doubts (α = 0.83), Rejection (α = 0.70), and Suppression (α = 80) were associated with higher anxiety and depressive symptoms, as well as lower life satisfaction (all p < .001). Pregnant women presented greater Rejection (mean difference = 0.30, p = .037, 95% CI=[0.02, 0.58]) and less Suppression (mean difference=-0.47, p = .002, 95% CI=[-0.77,-0.17]) than mothers. Conclusion with this study, we provide clinicians and researchers with a novel tool that successfully captures the complex nature of maternal ambivalence. Given the associations of maternal ambivalence with important outcomes in perinatal women, this tool could be important for the prevention of distress associated with chronic ambivalence and to evaluate the effectiveness of interventions addressing ambivalence

Activity patterns and functioning. A contextual–functional approach to pain catastrophizing in women with fibromyalgia

The psychological flexibility model states that activity patterns are not deemed to be intrinsically functional or dysfunctional; it is considered that underlying factors, such as personal goals and contextual factors, are what will determine their effects on disability. Pain catastrophizing has frequently been associated with several important pain-related outcomes. Despite its recent conceptualization within affective–motivational approaches, its moderating role between activity patterns and dysfunction has not been analyzed. Methods: This study analyzes the moderating role of pain catastrophizing and its dimensions (Pain Catastrophizing Scale) between activity patterns (Activity Patterns Scale) and disease impact (Fibromyalgia Impact Questionnaire—Revised) in 491 women with fibromyalgia. Results: Activity avoidance (p < 0.001), excessive persistence (p < 0.001) and pacing (p < 0.01) patterns were positively associated with fibromyalgia impact. Helplessness shows a moderating role between pain avoidance (B = 0.100, t =2.30, p = 0.021, [0.01, 0.18]), excessive persistence (B = −0.09, t = −2.24, p = 0.02, [−0.18, −0.01]), pain persistence (B = −0.10, t = −2.04, p = 0.04, [−0.19, −0.004]) and functioning. Conclusion: Helplessness (within pain catastrophizing) is a relevant variable within psychological flexibility models applied to activity patterns. Specifically, pain avoidance is especially dysfunctional in patients with high helplessness. To improve excessive persistence and pain persistence, it is necessary to reduce helplessness before regulating activity patterns

Is the association between postpartum depression and early maternal–infant relationships contextually determined by avoidant coping in the mother?

This study analyzes the moderating role of avoidant coping (in early pregnancy) in the relationship between postpartum depressive (PPD) symptoms and maternal perceptions about mother–baby relations and self-confidence. Participants were 116 low-risk obstetric mothers (mean age = 31.2 years, SD = 3.95, range 23–42) who received care and gave birth at a Spanish public hospital. Measurements were made at two points in time: at first trimester of pregnancy (maternal avoidance coping) and four months after childbirth (PPD and maternal perceptions). Avoidant coping was associated with the perception of the baby as irritable and unstable (p = 0.003), including irritability during lactation (p = 0.041). Interaction effects of avoidant coping and postpartum depression were observed on the perception of the baby as irritable (p = 0.031) and with easy temperament (p = 0.002). Regarding the mother’s self-confidence, avoidant coping was related to a lack of security in caring for the baby (p < 0.001) and had a moderating effect between PPD and mother’s self-confidence (i.e., lack of security in caring for the baby, p =0.027; general security, p = 0.007). Interaction effects showed that the use of avoidant coping in the mother exacerbated the impact of PPD on the early mother–infant relationship

Asistencia médica en festejos taurinos populares

Los festejos taurinos forman parte esencial de las tradiciones en las festividades de muchas de las localidades de Castilla y León. El papel de los equipos médicos es evidente dado el riesgo de lesiones potencialmente graves que pueden sufrirse y se encuentra regulado tanto por una normativa autonómica como estatal.Diferenciamos festejos populares, aquellos en los que participan aficionados no profesionales y festejos serios, en los que participan exclusivamente profesionales.Esta diferencia afecta a la legislación a aplicar y a los recursos asistenciales que deben movilizarse. Si bien la crisis económica de los últimos años puede hacer creer que se ha producido un descenso en el número de festejos, este descenso no es homogéneo y afecta preferentemente a los festejos serios, con una reducción del 30% mientras que apenas afecta a los populares.Las pautas asistenciales son las mismas que podemos aplicar a cualquier otro politraumátizado, basado en el ALTS. Las heridas por asta de toro presentan características especiales y la experiencia en este tipo de lesiones por parte de los miembros del equipo es fundamental. Se requieren equipos multidisciplinarios, bien formados, que se desplazan al lugar del festejo y cuya remuneración y reconocimiento no siempre son acordes con el trabajo realizado.The bullfights are an essential part of the traditions in several of the towns of Castilla y León. The role of the medical equipment is evident given the risk of potentially serious injuries that may be suffered and is regulated by both autonomic and state regulations.We differentiate the festivals, those in whichamateur are involved and serious festivities, which only professional involved. This difference affects the legislation to implement and health care resources to be mobilized. While the economic crisis of recent years may give the impression that there has been a decline in the number of celebrations, this decline is not homogeneous and preferentially affects the serious celebrations, with a reduction of 30% while only affects Popular.The guidelines are the same care that we can apply to any other politrauma injuries, basedin the ALTS atention. The bull horn wounds have special characteristics and experience in this type of injury by team members is essential.Shapely, multididciplinary teams traveling to the place of celebration and whose remuneration and recognition are not always commensurate with the work required

A new tool to screen patients with severe obstructive sleep apnea in the primary care setting : a prospective multicenter study

Altres ajuts: Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Societat Catalana de Pneumologia (SOCAP).The coordination between different levels of care is essential for the management of obstructive sleep apnea (OSA). The objective of this multicenter project was to develop a screening model for OSA in the primary care setting. Anthropometric data, clinical history, and symptoms of OSA were recorded in randomly selected primary care patients, who also underwent a home sleep apnea test (HSAT). Respiratory polygraphy or polysomnography were performed at the sleep unit to establish definite indication for continuous positive airway pressure (CPAP). By means of cross-validation, a logistic regression model (CPAP yes/no) was designed, and with the clinical variables included in the model, a scoring system was established using the β coefficients (PASHOS Test). In a second stage, results of HSAT were added, and the final accuracy of the model was assessed. 194 patients completed the study. The clinical test included the body mass index, neck circumference and observed apneas during sleep (AUC 0.824, 95% CI 0.763-0.886, P < 0.001). In a second stage, the oxygen desaturation index (ODI) of 3% (ODI3% ≥ 15%) from the HSAT was added (AUC 0.911, 95% CI 0.863-0.960, P < 0.001), with a sensitivity of 85.5% (95% CI 74.7-92.1) and specificity of 67.8% (95% CI 55.1-78.3). The use of this model would prevent referral to the sleep unit for 55.1% of the patients. The two-stage PASHOS model is a useful and practical screening tool for OSA in primary care for detecting candidates for CPAP treatment. Clinical Trial Registration Registry: ClinicalTrials.gov; Name: PASHOS Project: Advanced Platform for Sleep Apnea Syndrome Assessment; URL: ; Identifier: NCT02591979. Date of registration: October 30, 2015. The online version contains supplementary material available at 10.1186/s12890-022-01827-0