Perineal care and outcomes in a birth center

Objective: to analyse the perineal outcomes in childbirth and post-partum perineal care in a freestanding birth centre. Method: a cross-sectional study, with data collection performed in the women’s birth records forms from Casa Angela, a freestanding birth centre, São Paulo, Brazil, in 2016-2017 (n=415). The following data was analysed: occurrence and perineal tear degree; maternal, neonatal and birth care-related variables; perineal suture prevalence; complications in wound healing and natural methods on perineal care. Data were subjected to descriptive, inferential and multiple analyses. Results: in 11.8% of women, the perineum was kept intact, 61.9% had spontaneous first-degree tear and 26.3% had second-degree tear. The variables related to the occurrence and higher spontaneous degree tears were maternal age and second period of childbirth >2 hours. The protective factors against the occurrence and higher degree tears were number of previous vaginal childbirths and maternal position different from vertical during childbirth. Perineal suture was performed in 16.0% and 70.6% of women with spontaneous first- and second-degree tears, respectively. The main perineal complications after birth were edema (53.6%) and pain (29.4%); and the perineal suture increased the chance for these complications (OR=2.5; 95%CI 1.5-4.3). Perineum icepack compress was used in 53.8% of women during post-partum period. Conclusion: maternal and health-care related factors were associated to the prevalence and degree of spontaneous perineal tear. First-degree spontaneous perineal tears were prevalent and sutured in a low number of women. There were more complications in the wound healing process when the perineal suture was performed, regardless the tear degree. The number of natural methods in post-partum perineal care was higher than the use of medicines

Adhesión de las mujeres embarazadas a los ejercicios para fortalecer el suelo pélvico

Objective: To analyse the adherence of pregnant women to pelvic floor muscle exercises (PFME) during pregnancy. Methods: Prospective study, with 315 pregnant women; data collection was performed by phone and face-to-face; data analysis was descriptive and inferential with 5% significance level. Results: In the first half of pregnancy, the total adherence was 36.5%; when gathered total adherence and partial adherence, the percentage reached was 54%; during pregnancy, there was a gradual decrease (from 46% to 39.7%) of women who reported no adherence; there was no significant association between adherence and the sociodemographic, obstetric and clinics characteristics. Conclusion: The majority of pregnant women in all trimesters of pregnancy reported total or partial adherence to PFME; it was highly positive the proportion of women who reported performing PFME

Complementary and Integrative Health Practices in a Brazilian Freestanding Birth Center: A Cross-Sectional Study

The study aimed to analyze the use of complementary and integrative health practices (CIHPs) during labor and birth in a freestanding birth center. A total of 28 different CIHPs were applied with or used by laboring women. The most adopted CIHPs were mind-body practices (99.9%) and natural products (35.5%), mostly used by primiparous women (P <.05). Adopting CIHPs can increase care quality, increase positive experiences during childbirth, and promote evidence-based choices

Planet-star interactions with precise transit timing. III. Entering the regime of dynamical tides

Hot Jupiters on extremely short-period orbits are expected to be unstable to tidal dissipation and spiral toward their host stars. That is because they transfer the angular momentum of the orbital motion through tidal dissipation into the stellar interior. Although the magnitude of this phenomenon is related to the physical properties of a specific star-planet system, statistical studies show that tidal dissipation might shape the architecture of hot Jupiter systems during the stellar lifetime on the main sequence. The efficiency of tidal dissipation remains poorly constrained in star-planet systems. Stellar interior models show that the dissipation of dynamical tides in radiation zones could be the dominant mechanism driving planetary orbital decay. These theoretical predictions can be verified with the transit timing method. We acquired new precise transit mid-times for five planets. They were previously identified as the best candidates for which orbital decay might be detected. Analysis of the timing data allowed us to place tighter constraints on the orbital decay rate. No statistically significant changes in their orbital periods were detected for all five hot Jupiters in systems HAT-P-23, KELT-1, KELT-16, WASP-18, and WASP-103. For planets HAT-P-23 b, WASP-18 b, and WASP-103 b, observations show that the mechanism of the dynamical tides dissipation probably does not operate in their host stars, preventing them from rapid orbital decay. This finding aligns with the models of stellar interiors of F-type stars, in which dynamical tides are not fully damped due to convective cores. For KELT-16 b, the span of transit timing data was not long enough to verify the theoretical predictions. KELT-1 b was identified as a potential laboratory for studying the dissipative tidal interactions of inertial waves in a convective layer.Comment: Accepted for publication in A&

The correlation between immune subtypes and consensus molecular subtypes in colorectal cancer identifies novel tumour microenvironment profiles, with prognostic and therapeutic implications

Background Solid tumour growth is the consequence of a complex interplay between cancer cells and their microenvironment. Recently, a new global transcriptomic immune classification of solid tumours has identified six immune subtypes (ISs) (C1–C6). Our aim was to specifically characterise ISs in colorectal cancer (CRC) and assess their interplay with the consensus molecular subtypes (CMSs). Methods Clinical and molecular information, including CMSs and ISs, were obtained from The Cancer Genome Atlas (TCGA) (N = 625). Immune cell populations, differential gene expression and gene set enrichment analysis were performed to characterise ISs in the global CRC population by using CMSs. Results Only 5 ISs were identified in CRC, predominantly C1 wound healing (77%) and C2 IFN-γ dominant (17%). CMS1 showed the highest proportion of C2 (53%), whereas C1 was particularly dominant in CMS2 (91%). CMS3 had the highest representation of C3 inflammatory (7%) and C4 lymphocyte depleted ISs (4%), whereas all C6 TGF-β dominant cases belonged to CMS4 (2.3%). Prognostic relevance of ISs in CRC substantially differed from that reported for the global TCGA, and ISs had a greater ability to stratify the prognosis of CRC patients than CMS classification. C2 had higher densities of CD8, CD4 activated, follicular helper T cells, regulatory T cells and neutrophils and the highest M1/M2 polarisation. C2 had a heightened activation of pathways related to the immune system, apoptosis and DNA repair, mTOR signalling and oxidative phosphorylation, whereas C1 was more dependent of metabolic pathways. Conclusions The correlation of IS and CMS allows a more precise categorisation of patients with relevant clinical and biological implications, which may be valuable tools to improve tailored therapeutic interventions in CRC patients.This work was funded by projects DTS15/00157 , PI16/01827 and CIBER-ONC CB16/12/00442 from the Instituto de Salud Carlos III ( Ministry of Economy, Industry and Competitiveness, Spain ) and cofunded by the European Regional Development Fund (ERDF, European Union), and approved by the Ethics Committee or our Institution. BS is funded by AECC (Spain). MCR is funded by Instituto de Salud Carlos III and SEOM (Spain) CCP and BRC are funded by CAM (Programa de Empleo Juvenil (YEI)

Perineal pain effect on the activities of women who had an episiotomy

Objective: This manuscript discusses the influence of the perineal pain after normal birth on daily activities of women who had an episiotomy. Methods: Descriptive study with data collected through interviews performed from 20 to 48 hours after delivery, with 52 women, applying the pain numeric scale (0-10). Results: Perineal pain was present in 86.5% and 82.7% of women, at 20 and 48 hours after delivery, respectively. There was a predominance of mild pain (64.4% to 72.1%), followed by moderate pain (28.9% to 18.6%). The restriction of the activities varied between 92.3% and 86.5% women, from 20 to 48 hours after delivery, respectively. Conclusions: Although most women had reported mild pain, it was noted that this morbidity limits the essential activities

Modelo de atenção dos centros de parto normal peri-hospitalares: protocolo de revisão de escopo

Os centros de parto normal peri-hospitalares (CPNp) são instituições de saúde que oferecem atendimento pré, intra e pós-parto a mulheres e bebês saudáveis, destacando-se por sua filosofia e prática amparadas no modelo humanizado e biopsicossocial de cuidado. Apesar de apresentarem excelentes resultados e indicadores, estas instituições encontram dificuldades para sua manutenção e expansão no Brasil. Este artigo tem como objetivo descrever o protocolo da revisão de escopo que mapeará as características do modelo de atenção dos CPNp brasileiros. O protocolo foi registrado na plataforma Open Science Framework (OSF) e elaborado segundo recomendações do JBI Manual for Evidence Synthesis e PRISMA-ScR. As etapas da revisão são: a definição dos descritores e dos critérios de elegibilidade, a busca dos estudos nas bases de dados e repositórios, a seleção e a extração dos dados dos estudos e, finalmente, como os resultados serão apresentados. Com esta revisão, espera-se mapear o conhecimento científico existente sobre como os CPNp estão estruturados e organizados, como são acessados pela população, quais são os desfechos da assistência oferecida a mulheres e bebês e como usuários e profissionais vivenciam esse modelo de atenção. Além disso, este estudo tem o potencial de contribuir para o debate que se faz urgente frente à construção de estratégias voltadas a melhorias dos indicadores de saúde materno-infantil do país

A pragmatic effectiveness study of 10-session cognitive behavioural therapy (CBT-T) for eating disorders: Targeting barriers to treatment provision

Objective Ten‐session cognitive behavioural therapy (CBT‐T) for transdiagnostic eating disorders targets several barriers to treatment, including cost, therapist expertise, and lengthy wait lists. Method We used a case series design to investigate the effectiveness of CBT‐T delivered by trainee psychologists in a postgraduate training clinic. Participants were randomly allocated to commence treatment either immediately or after a 4‐week waitlist period. CBT‐T was delivered to 52 patients, by six different trainees under supervision. Measures of eating disorder cognitions and behaviours, quality of life, and general psychopathology were examined in completer and intention‐to‐treat analyses using multilevel modelling. Last observation carried forward was applied for abstinence, remission, and good outcome analyses to aid comparison with prior studies. Results Significant improvements, associated with medium to large effect sizes, were found for eating disorder cognitions, behaviours quality of life, and negative affect from baseline to posttreatment, and at 1‐ and 3‐month follow‐up. Attrition (38.5%) was comparable with other treatment studies. Conclusion Results provide evidence for the effectiveness of CBT‐T delivered by trainee psychologists for transdiagnostic eating disorder patients, thus tackling some important barriers for treatment. Longer follow‐up, randomised controlled trial designs, and moderator analyses will provide more robust evidence about which patients do best with a shorter therapy

BRAF V600E status may facilitate decision-making on active surveillance of low-risk papillary thyroid microcarcinoma.

Introduction: Conservative active surveillance has been proposed for low-risk papillary thyroid microcarcinoma (PTMC), defined as 641.0 cm and lacking clinical aggressive features, but controversy exists with accepting it as not all such PTMCs are uniformly destined for benign prognosis. This study investigated whether BRAF V600E status could further risk stratify PTMC, particularly low-risk PTMC, and can thus help with more accurate case selection for conservative management. Methods: This international multicenter study included 743 patients treated with total thyroidectomy for PTMC (584 women and 159 men), with a median age of 49 years (interquartile range [IQR], 39-59 years) and a median follow-up time of 53 months (IQR, 25-93 months). Results: On overall analyses of all PTMCs, tumour recurrences were 6.4% (32/502) versus 10.8% (26/241) in BRAF mutation-negative versus BRAF mutation-positive patients (P = 0.041), with a hazard ratio (HR) of 2.44 (95% CI (confidence interval), 1.15-5.20) after multivariate adjustment for confounding clinical factors. On the analyses of low-risk PTMC, recurrences were 1.3% (5/383) versus 4.3% (6/139) in BRAF mutation-negative versus BRAF mutation-positive patients, with an HR of 6.65 (95% CI, 1.80-24.65) after adjustment for confounding clinical factors. BRAF mutation was associated with a significant decline in the Kaplan-Meier recurrence-free survival curve in low-risk PTMC. Conclusions: BRAF V600E differentiates the recurrence risk of PTMC, particularly low-risk PTMC. Given the robust negative predictive value, conservative active surveillance of BRAF mutation-negative low-risk PTMC is reasonable whereas the increased recurrence risk and other well-known adverse effects of BRAF V600E make the feasibility of long-term conservative surveillance uncertain for BRAF mutation-positive PTMC