Proceso de adaptación cultural del “Questionnaire for Assesing the Childbirth Experience (QACE)”

Background: Negative experiences during delivery are associated with women disempowerment, postpartum depression, post-traumatic stress disorder, and low breastfeeding rates. The Questionnaire for Assessing the Childbirth Experience (QACE) is a 23-item screening tool useful for discovering women with a negative experience in their birth process and avoids future complications in following pregnancies or couple's relationships. Objective: The general objective is to adapt the Questionnaire for Assessing the Childbirth Experience (QACE) to the Spanish population and to obtain its psychometric characteristics.Methodology: The cultural adaptation process consisted of forwarding translation and back translation into Spanish, conceptual equivalence evaluation by a committee of judges, comprehensibility evaluation and cognitive interview to a postpartum group. Psychometric characteristics were obtained throughout the factorial analysis, Kaiser-Meyer-Olkin (KMO) and Bartlett’s test of sphericity and Cronbach alpha level.Results: After complete the adaptation process, the committee of judges made several adjustments to achieve a better comprehension in the Spanish population, avoid misunderstandings or offensive words in the target language. 138 participants were needed to calculate factor analysis. The KMO (0.838) and Bartlett test (p < 0.001) confirmed the adequacy of factor analysis and the Scree plot showed 6 factors with the predictive power of 73.75% supported total variance. Internal consistency was assured using a Cronbach α of 0.896.Conclusions: Data from this study demonstrate that the Spanish version of QACE is a valid and reliable measure of childbirth experience in the Spanish population.Introducción: Las experiencias negativas durante el parto se han asociado con desempoderamiento de la mujer, depresión postparto, trastorno por estrés postraumático y bajas tasas de lactancia maternal, entre otros. El Questionnaire for Assessing the Childbirth Experience (QACE) es una herramienta de 23 ítems útil para identificar mujeres que han tenido una mala experiencia en su proceso de parto y evitar así futuras complicaciones en embarazos posteriores o en la relación de pareja.Objetivo: El objetivo general consiste en adaptar el Questionnaire for Assessing the Childbirth Experience (QACE) a la población española y obtener sus características psicométricas.Metodología: El proceso de adaptación cultural ha consistido en la traducción y retro traducción al español, evaluación de la equivalencia conceptual por un comité de jueces, evaluación de la comprensibilidad y una entrevista cognitiva a un grupo de mujeres puérperas. Las características psicométricas se han obtenido mediante el análisis factorial, los test de Kaiser-Meyer-Olkin (KMO) y Bartlett y el alfa de Cronbach.Resultados: Tras el proceso de adaptación transcultural, el grupo de expertos realizó las modificaciones necesarias para conseguir una mayor compresión del cuestionario en la población española, evitar malentendidos y palabras ofensivas en la lengua de destino. Se necesitaron 138 participantes para obtener el análisis factorial. El KMO (0,838) y el test de Bartlett (p < 0,001) confirmaron la adecuación del análisis factorial y el grafico de sedimentación mostró 6 factores con un poder predictivo del 73,75% del total de la varianza. La consistencia interna se obtuvo mediante un alfa de Cronbach de 0,896.Conclusiones: Los datos obtenidos en este estudio demuestran que la versión española del QACE es una herramienta válida y fiable para medir la experiencia en el nacimiento en la población española

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

Clustering COVID-19 ARDS patients through the first days of ICU admission. An analysis of the CIBERESUCICOVID Cohort

Background Acute respiratory distress syndrome (ARDS) can be classified into sub-phenotypes according to different inflammatory/clinical status. Prognostic enrichment was achieved by grouping patients into hypoinflammatory or hyperinflammatory sub-phenotypes, even though the time of analysis may change the classification according to treatment response or disease evolution. We aimed to evaluate when patients can be clustered in more than 1 group, and how they may change the clustering of patients using data of baseline or day 3, and the prognosis of patients according to their evolution by changing or not the cluster.Methods Multicenter, observational prospective, and retrospective study of patients admitted due to ARDS related to COVID-19 infection in Spain. Patients were grouped according to a clustering mixed-type data algorithm (k-prototypes) using continuous and categorical readily available variables at baseline and day 3.Results Of 6205 patients, 3743 (60%) were included in the study. According to silhouette analysis, patients were grouped in two clusters. At baseline, 1402 (37%) patients were included in cluster 1 and 2341(63%) in cluster 2. On day 3, 1557(42%) patients were included in cluster 1 and 2086 (57%) in cluster 2. The patients included in cluster 2 were older and more frequently hypertensive and had a higher prevalence of shock, organ dysfunction, inflammatory biomarkers, and worst respiratory indexes at both time points. The 90-day mortality was higher in cluster 2 at both clustering processes (43.8% [n = 1025] versus 27.3% [n = 383] at baseline, and 49% [n = 1023] versus 20.6% [n = 321] on day 3). Four hundred and fifty-eight (33%) patients clustered in the first group were clustered in the second group on day 3. In contrast, 638 (27%) patients clustered in the second group were clustered in the first group on day 3.Conclusions During the first days, patients can be clustered into two groups and the process of clustering patients may change as they continue to evolve. This means that despite a vast majority of patients remaining in the same cluster, a minority reaching 33% of patients analyzed may be re-categorized into different clusters based on their progress. Such changes can significantly impact their prognosis

Mineralogy of a Mudstone at Yellowknife Bay, Gale Crater, Mars

Sedimentary rocks at Yellowknife Bay (Gale Crater) on Mars include mudstone sampled by the Curiosity rover. The samples, John Klein and Cumberland, contain detrital basaltic minerals, Ca-sulfates, Fe oxide/hydroxides, Fe-sulfides, amorphous material, and trioctahedral smectites. The John Klein smectite has basal spacing of ~10 Å indicating little interlayer hydration. The Cumberland smectite has basal spacing at ~13.2 Å as well as ~10 Å. The ~13.2 Å spacing suggests a partially chloritized interlayer or interlayer Mg or Ca facilitating H_2O retention. Basaltic minerals in the mudstone are similar to those in nearby eolian deposits. However, the mudstone has far less Fe-forsterite, possibly lost with formation of smectite plus magnetite. Late Noachian/Early Hesperian or younger age indicates that clay mineral formation on Mars extended beyond Noachian time

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Putting plant resistance traits on the map : a test of the idea that plants are better defended at lower latitudes

It has long been believed that plant species from the tropics have higher levels of traits associated with resistance to herbivores than do species from higher latitudes. A meta-analysis recently showed that the published literature does not support this theory. However, the idea has never been tested using data gathered with consistent methods from a wide range of latitudes. We quantified the relationship between latitude and a broad range of chemical and physical traits across 301 species from 75 sites world-wide. Six putative resistance traits, including tannins, the concentration of lipids (an indicator of oils, waxes and resins), and leaf toughness were greater in high-latitude species. Six traits, including cyanide production and the presence of spines, were unrelated to latitude. Only ash content (an indicator of inorganic substances such as calcium oxalates and phytoliths) and the properties of species with delayed greening were higher in the tropics. Our results do not support the hypothesis that tropical plants have higher levels of resistance traits than do plants from higher latitudes. If anything, plants have higher resistance toward the poles. The greater resistance traits of high-latitude species might be explained by the greater cost of losing a given amount of leaf tissue in low-productivity environments.12 page(s