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Acknowledgments: The company Manzanal Mamphel SA provided the necessary tourniquets for the pretest and post-test phases of the study (480 devices)., Among the main preventable causes of death in the area of operations is external exsanguinating hemorrhage in the extremities, hence the importance of the tourniquet as a therapeutic tool in this type of injury and, therefore, of the training of personnel participating in international missions. The main objective of this study is to determine the impact of training in the application of this device. This is a quasi-experimental, prospective, cross-sectional study, carried out with 97 healthy volunteers, military personnel who perform their work in the Royal Guard barracks of El Pardo. The study was conducted between June 2019 and July 2021. The correct determination of the device placement site and the times of correct device placement were evaluated by determining whether there was blood flow using Doppler ultrasound measurements. Statistically significant results were obtained for application time (76.68 s to 58.06 s; p < 0.001), correct device placement (p < 0.001), and achievement of complete ischemia in the upper extremity (23.7% pretest vs. 24.7% post-test; p < 0.001). In the lower extremity, after training, longer application duration (43.33 s to 47.30 s) and lower ischemia achievement (59.8% pretest vs. 37.8% post-test) were obtained. Standardized and regulated training improves device application. More intensive training is necessary to obtain better results.

A case report of an 11-year-old boy with a de novo variant in NOTCH2 and clinical features characteristic of Hajdu-Cheney syndrome is reported, with acroosteolysis of the distal phalanges of the feet and hands, generalized osteoporosis, musculoskeletal and craniofacial alterations, short stature, bowing of long bones, vertebral anomalies, genu recurvatum, hypertrichosis, joint and skin hyperlaxity, atopic dermatitis, megalocorneas, micrognathia and frequent respiratory infections, among others. Treatment is with bisphosphonates in the framework of bone density improvement and with focal vibration therapy for rehabilitation of the musculoskeletal system and gait improvement. The three generalities of this pathology—phenotypic variability, degenerative character and the presence of generalized osteoporosis and acroosteolysis of the distal phalanges—are seen in this case, whose diagnostic confirmation was made by genetic study.

Background: Bariatric surgery is a safe and effective method to lose weight over time. However, some patients fail to achieve healthy weight losses. We aimed to determine if a moderate-intensity physical exercise intervention in patients who underwent bariatric surgery increases their functional capacity thus improving bariatric surgery results. Methods: We conducted a parallel-group non-blinded randomized controlled trial at a surgery clinic in Talca, Chile. A total of 43 participants with obesity and scheduled bariatric surgery completed the six months follow-up. A physical exercise program was conducted in exercise group participants one month after bariatric surgery. Walked distance in the six-minute walk test, BMI, Borg scale of perceptive exertion results and cardiovascular variables were evaluated. Results: Patients’ weight significantly decreased after bariatric surgery but there was no difference between the groups of study. The exercise group progressed from a base value of 550 ± 75 m walked in the six-minute walk test to a sixth-month value of 649.6 ± 68.5 m (p < 0.05), whilst the control group yielded base values of 554.4 ± 35.1 and a sixth-month walked distance of 591.1 ± 75.34 (p > 0.05). Conclusions: Physical exercise in obese patients undergoing bariatric surgery increased functional capacity independently of weight losses resulting from bariatric surgery.

Hajdu–Cheney syndrome is a rare genetic disease. Its main features include phenotypic variability, age-dependent progression and the presence of acroosteolysis of the distal phalanges and generalized osteoporosis, which have significant disabling potential. Currently, there is no effective curative treatment, so nursing care is essential to ensure the maintenance of the quality of life of these patients. The main objective of this study was to establish a specific standardized nursing care plan using the NANDA–NIC–NOC taxonomy. The application of a care plan as such would improve the quality of life of patients affected by this rare disease, will contribute to increasing healthcare professionals’ knowledge on this matter and will support future studies on this disease.

Ehlers–Danlos syndrome type arthrochalasia (aEDS) is a rare genetic disease characterized by severe generalized joint hypermobility, bilateral congenital hip dislocation, skin hyperextensibility, muscle hypotonia, and mild dysmorphic features. It is an autosomal dominant connective tissue disease causing defects in collagen, associated with two genes, COL1A1 or COL1A2. Only about 42 cases have been published worldwide. Treatment is currently symptomatic and focuses on increasing the quality of life of these patients, as there is no curative treatment. The main objective of the review was to update information on Ehlers–Danlos syndrome type arthrochalasia from scientific publications. The review report was carried out in accordance with the criteria of the Preferred Reporting Items for Systematic reviews and MetaAnalyses (PRISMA) review protocol, by searching Orphanet, OMIM, PubMed, and Scopus, as well as free sources. A total of 20 articles were analyzed, which, after analysis, provide an updated report that aims to establish a solid starting point for future lines of research.

Introduction: Healthy lifestyle habits formed in childhood provide the foundation for a healthy adult life; therefore, it is important to encourage healthy habits and to correct poor habits from an early age. Aim: In this study, we aim to evaluate the influence of educational intervention in order to modify postural hygiene habits in school-age children. Materials and methods: We randomly selected three public primary education schools in the Galician provinces of Orense and Pontevedra based on stratified multistage sampling. A sample of 479 students was obtained, representing 2% of all 6- to 12-year-old children registered during the 2015/2016 academic year in those provinces. Results: Following the intervention, the students’ postural hygiene improved. We found statistically significant differences regarding a reduction in the number of hours spent watching television (0.531 h/day); the way school books and supplies were carried, with an increase in the use of backpacks with wheels (from 58.5% to 64.1%); and an improvement in postural hygiene when watching television, with an increase from 63.7% to 80.8% of those surveyed opting to watch television whilst seated on a chair instead of lying down. Conclusions: Educational intervention by inculcating healthy postural hygiene habits in children at an early age can improve and correct unhealthy behaviours.

Therapeutic hypothermia is a treatment used for patients who have suffered cardiorespiratory arrest and remain conscious after the recovery of spontaneous circulation. However, its effectiveness is controversial. The objective of this systematic review is to summarize the scientific evidence available about the effect of therapeutic hypothermia on neurological status and survival in this type of patients. Methodology: A primary search in CINAHL, CUIDEN, Pubmed, Web of Science, and Scopus databases was carried out. Randomized clinical trials (RCT) published from 2016 to 2020 were selected. Results: 17 studies were selected for inclusion and most relevant data were extracted. Methodological quality was assessed by the RoB tool. Conclusions: Although therapeutic hypothermia is a safe technique with few adverse and manageable effects, it has not shown to improve survival rate and neurological status of adult nor pediatric patients. It is possible that its positive effect on neuroprotection could be achieved only by preventing hyperthermia although further investigation is needed.

The recent respiratory virus known as SARS-CoV-2 has caused millions of deaths worldwide, causing great uncertainty due to the lack of a specific treatment, which has been mitigated by the use of various drugs traditionally used against other types of pathologies. Pregnancy presents special physiological conditions that expose the pregnant woman and the foetus to greater risk. Pregnant women are often excluded from trials due to possible risk of toxicity or side effects, resulting in a lack of knowledge about the use of drugs and treatments during pregnancy. The main objective of this review was to compile existing knowledge about currently available drug treatments for COVID-19 in pregnant women. The review report met the criteria of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) review protocol and was registered with the registration number CRD42021251036. The electronic databases searched were Scopus, PubMed, CINAHL and SciELO. Finally, 22 articles were included, resulting in an analysis of drugs with an acceptable safety profile in the treatment of pregnant women with COVID-19.

Among the types of blood cancers, non-Hodgkin lymphoma is the most common. The usual treatments for this type of cancer can cause heart failure. A descriptive observational study was conducted that included 16 non-Hodgkin lymphoma survivors and 16 healthy controls matched by age and sex. Vagal tone was evaluated in the short term with a three-channel Holter device, and the time and frequency domains were analyzed following a previously accepted methodology to evaluate cardiac autonomic balance. The results of the analysis revealed that the standard deviation of the NN interval (F = 6.25, p = 0.021) and the square root of the mean of the sum of the differences between NN intervals (F = 9.74, p = 0.004) were significantly higher in healthy subjects than in lymphoma survivors. In the heart rate variability (HRV) index, there were no significant differences between the groups (F = 0.03, p = 0.85), nor in the parameters of the frequency domains LF (F = 1.94, p = 0.17), HF (F = 0.35, p = 0.55), and the ratio LF/HF (F = 3.07, p = 0.09). HRV values were lower in non-Hodgkin lymphoma survivors in the first year after treatment, resulting in autonomic imbalance compared to healthy paired subjects., Education Ministry (Program FPU16/01437), Madrid, Spanish Government

Se realizó un análisis de la literatura cuyo objetivo principal fue evaluar cómo repercute la actividad física realizada por la mujer en la fatiga posparto. Se llevó a cabo una revisión sistemática de estudios de investigación cumpliendo con los criterios del protocolo de revisión Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Se realizaron búsquedas aplicando los criterios de inclusión en las siguientes bases de datos electrónicas; Web of Science, Scopus, PubMed, Cuiden; y en el motor de búsqueda Google Académico; también se han realizado búsquedas inversas realizadas a través de la bibliografía procedente de los artículos encontrados. Se identificaron 2460 artículos que cumplían los criterios de inclusión. Al realizar una criba por duplicados, lectura de título y abstract de los artículos identificados, y posteriormente una lectura en profundidad de los artículos, se incluyeron en la presente revisión sistemática 13 artículos. Una vez analizados los artículos se observa en los resultados de los mismos que se pone de manifiesto la relación positiva que existe entre realizar actividad física durante el embarazo o el posparto y la reducción de los niveles de Fatiga Posparto.

The research group behind this project wishes to thank the following associations for their collaboration in the distribution of the study questionnaire: Asogaf–Asociación Granadina de la Ataxia de Friedreich. Asociación de Enfermos Musculares de Granada. AGRADA Asociación de Ataxias de Granada. Asociación española de afectados por Epilepsia Grave. Phelan Mcdermid. 22q13. Asociación Síndrome Shy Drager–Atrofia Multisistémica. Adisen–Asociación Nacional de Addison y Otras Enfermedades Endocrinas. ASENCO, Asociación de Enfermedades Neuromusculares de Córdoba. Asociación 22 q Andalucía. Asociación Andaluza de Esclerosis Lateral Amiotrófica. Asociación Andaluza de Fibrosis Quística. Asociación Andaluza de Hemofilia. Asociación Cordobesa para la Investigación de Corea de Huntington. Asociación de Enfermedades Neuromusculares de Andalucía. Asociación de Enfermos con Neurodegeneración por Acumulación Cerebral de Hierro. Asociación de Familiares y Afectados Síndrome de Coffin-Lowry España. Asociación de Retinosis Pigmentaria de Andalucía. Asociación del Síndrome de Prader Willi de Andalucía. Asociación Española de Enfermos por Pseudoxantoma Elástico. Asociación Española de Familiares y Enfermos de Wilson. Asociación Española para la Investigación y Ayuda al Síndrome de Wolfram. Asociación Síndrome de Turner de Andalucía. Asociación Sindrome de Williams de Andalucía. Asociación Valverdeña de la Enfermedad de Andrade. DEBRA Piel de Mariposa (Asociación de Epidermólisis Bullosa de España). Federación Andaluza de Asociaciones de Ataxias. Asociación de Atrofia del Nervio Óptico de Léber. Acción y Cura para Tay Sachs. ACTAYS. Asociación 11q España. Asociación AMC–Artrogriposis Múltiple Congénita–España. Asociación de Afectados de Neurofibromatosis. Asociación de Afectados Síndrome Landau –Kleffner. Asociación de Apoyo e Investigación del Síndrome de 5p-. Asociación de Corea de Huntington Española. Asociación de Enfermedades Raras de Alcalá de Henares. Asociación de Enfermos de Patología Mitocondrial. Asociacion de Familias con Perthes. Asociación Española de Porfiria. Asociación Española del Síndrome de Beckwith– Wiedemann. Asociación Española del Síndrome de Joubert. Asociación Huesos de Cristal de España. Asociación Nacional Síndrome de Apert y otras Craneosinostosis Sindrómicas. Asociación de Enfermedades Raras D’Genes. FEGEREC–Federación Gallega de enfermedades raras. Asociación Chiari y Siringomielia del Principado de Asturias (CHySPA). Asociación Asturiana contra la Fibrosis Quística (F.Q.). Asociación Ataxias de Extremadura. Asociación de Retinosis Pigmentaria Extremeña. Asociación ELA Extremadura. Asociación Española de Cavernomas. Asociación Española de Lucha contra las Hemoglobinopatias y Talasemias. Asociación Española de Stickler. Asociación Extremeña contra la Fibrosis Quística. Asociación Extremeña de Enfermos de Huntington. Asociación La Vida con Hernia Diafragmática Congénita. Asociación PrincesaRett. Asociación Síndrome X Frágil de Extremadura. Alba, Asociación de Ayuda a Personas con Albinismo. Asociación “Síndrome de Microdeleción 5q14.3–MEF2C”. Asociación ADIBI. Asociación de Discapacitados y Enfermedades Raras de IBI. Asociación Afectados CDKL5. Asociación Conquistando Escalones. Asociación de Enfermedades Minoritarias de la Comunidad Valenciana. Asociación de Enfermedades Raras de Benidorm y Comarca. Asociación de enfermedades raras y discapacidad Sense Barreres de Petrer. Asociación de enfermos de FMF y síndromes autoinflamatorios de España. Asociación de Esclerodermia Castellón. Asociación de Fibrosis Quística de la Comunidad Valenciana. Asociación de lucha contra la Distonía Mioclónica de Valencia. Asociación de Microsomia Hemifacial. Asociación de Padres de Niños y Jóvenes con Enfermedades Reumáticas de la Comunidad Valenciana. Asociación CADASIL España. Asociación Catalana de Espina Bífida e Hidrocefalia. Asociación Duchenne Somriures Valents. Asociación Española de Enfermos del Síndrome de Camurati–Engelmann. Asociación Española del Síndrome de Cornelia de Lange. Asociación Microtia España. Asociación Síndrome STXBP1. Associació Catalana de la Síndrome de Rett. Associació Catalana de Malaltia de Huntington., Scientific knowledge on depression and anxiety in patients with rare diseases during the COVID-19 pandemic is scarce; however, it is essential to perform comprehensive management of these patients. The aim of this study was to research how the situation caused by the SARS-CoV-2 pandemic has influenced the lives of patients with rare diseases regarding depression and anxiety. This Spanish study considered a heterogeneous population sample of 86 patients with confirmed diagnosis of different rare diseases. Participants took part in a cross-sectional online study by completing specific questionnaires on the study topic. Depression was measured using the Patient Health Questionnaire (PHQ-9), and the General Anxiety Disorder Scale (GAD-7) was used for evaluating anxiety. Data collection through an online questionnaire allowed for a greater population scope and therefore the inclusion patients of other nationalities in the study sample. Finally, as a general result, this study found that, in the face of the pandemic, anxiety and depression remained at a higher level in this group than in the general population, making these patients a vulnerable population group.

Background: Caring for a loved one can be rewarding but is also associated with substantial caregiver burden, developing mental outcomes and affecting happiness. The aim of this study was to determine the effects of a four-week, 16-h presential meditation program on physiological and psychological parameters and vagal nerve activity in high-burden caregivers, as compared to a control group. Methods: A non-randomized repeated-measures controlled clinical trial was conducted. Results: According to the ANCOVA results, the global happiness score (F = 297.42, p &lt, 0.001) and the scores for all subscales were significantly higher in the experimental group than in the control group at 5 weeks. Anxiety levels were also significantly reduced in the experimental group (F = 24.92, p &lt, 0.001), systolic (F = 16.23, p &lt, 0.001) and diastolic blood (F = 34.39, p &lt, 0.001) pressures, and the resting heart rate (F = 17.90, p &lt, 0.05). HRV results revealed significant between-group differences in the HRV Index (F = 8.40, p &lt, 0.05), SDNN (F = 13.59, p &lt, 0.05), and RMSSD (F = 10.72, p &lt, 0.05) in the time domain, and HF (F = 4.82 p &lt, 0.05)) in the frequency domain, which were all improved in the experimental group after the meditation program. Conclusions: Meditation can be a useful therapy to enhance the mental health and autonomic nervous system balance of informal caregivers, improving symptoms of physical and mental overload.

Introducción. El cáncer de mama es la neoplasia más frecuente en la mujer tanto en España como a nivel mundial, considerándose un gran problema para la salud pública. El cribado se realiza mediante la mamografía. Actualmente el enfoque terapéutico incluye tratamiento quirúrgico, existiendo la posibilidad de cirugía conservadora o no conservadora o mastectomía. Esta segunda opción fue introducida por Halsted y Meyer como intervención pautada, con bases científicas, en el año 1890. Hoy día sigue realizándose, desencadenando un gran impacto en todos los ámbitos de la vida de la mujer. Objetivo. Establecer los cuidados de salud apropiados para mujeres con cáncer de mama sometidas o en previsión de ser sometidas a una mastectomía, por parte de los profesionales de enfermería. Metodología. Esta revisión bibliográfica siguió el protocolo PRISMA. Los artículos seleccionados fueron únicamente ensayos clínicos aleatorizados (ECA). La búsqueda bibliográfica se realizó en las bases de datos Medline, Cinahl y Scopus mediante los términos MeSH “mastectomíy” , “nursing care” y “clincal trial” y el operador boleano “AND”. Se encontraron 20 artículos que cumplían los criterios de inclusión, y fueron transferidos al software Mendeley Desktop. Resultados. Tras una serie de cribados, fueron 9 los artículos incluidos en la revisión bibliográfica. Se midió su calidad metodológica mediante la escala PEDro. Conclusiones. A pesar de la gran incidencia del cáncer de mama, así como de la mastectomía, existen pocos ensayos clínicos aleatorizados publicados. Por tanto, sería interesante profundizar más respecto a este tema en futuras líneas de investigación.

Hajdu–Cheney syndrome (HCS) is a rare genetic disease that causes acroosteolysis and generalized osteoporosis, accompanied by a series of developmental skeletal disorders and multiple clinical and radiological manifestations. It has an autosomal dominant inheritance, although there are several sporadic non-hereditary cases. The gene that has been associated with Hajdu-Cheney syndrome is NOTCH2. The described phenotype and clinical signs and symptoms are many, varied, and evolve over time. As few as 50 cases of this disease, for which there is currently no curative treatment, have been reported to date. The main objective of this systematic review was to evaluate the results obtained in research regarding Hajdu–Cheney Syndrome. The findings are reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and were registered on the web PROSPERO under the registration number CRD42020164377. A bibliographic search was carried out using the online databases Orphanet, PubMed, and Scielo; articles from other open access sources were also considered. Finally, 76 articles were included, and after their analysis, we have obtained a series of hypotheses as results that will support further studies on this matter.

Objective: To perform a systematic review of scientific literature on the impact of oral health on the quality of life of pregnant women. Methods: A systematic search following PRISMA guidelines was carried out and 16 specific articles/studies on the subject were selected. Results: Pregnant women's quality of life (QoL) is related to age, number of pregnancies, pain, difficulty eating and presence of dental caries. Quality of life was directly related to oral health. Conclusions: It was found that most studies associating QoL and oral health during pregnancy were cross-sectional and observational; therefore, for a better understanding of these impacts, performing longitudinal studies from the beginning of pregnancy until postpartum is necessary. The need for preventive oral health counseling and dental care assistance during pregnancy is highlighted.

Introduction: Periodontal Disease during pregnancy can influence in maternal-fetal health. Two hypotheses have been established in relation to oral health and alterations in pregnancy. The first one determines that periodontal disease causes immunological changes, which causes complications during pregnancy. The second hypothesis proposes that oral bacteria colonize the placenta, cause inflammatory responses and result in preeclampsia and prematurity. Objective: To carry out a systematic review on periodontal disease and its relationship with complications during pregnancy. Methodology: A systematic review was carried out using PRISMA methodology. An electronic search was conducted in three databases (PUDMED, CINAHL and SCOPUS) for articles published in English. The keywords or search terms used were the following: Low birth weight / Low birth weight; Periodontal disease / Periodontal disease, pregnant / Pregnant women. Results: For this review, 19 specific articles on periodontal disease and its relation to pregnancy complications have been selected. Discussion / Conclusions: The publications analyzed in this study, according to their results, revealed that the association between periodontal disease and the health of the pregnant women and their baby is still contradictory

Background: Childhood obesity is one of the most important problems in public health in 21st century. The high level of adiposity is associated with hypertension in early childhood, which could be related to a cardiovascular risk in different periods of life. Aim: To identify the relationship between obesity and hypertension in children Materials and methods: A systematic review of the PUDMED, CINAHL and SCOPUS databases have been done. The keywords or search terms used were: obesidad/obesity, presión arterial/blood pressure, hipertensión/hypertension, infancia/childhood, pediátrico/pediatric y niño/children. Results: For this bibliographic review, 23 specific articles on childhood obesity and their relationship with arterial hypertension have been selected. To describe the relationship between these two pathologies and their impact on adulthood. Conclusion: The obesogenic epidemic increases in developed and developing countries, which elevate cardiovascular factors. In the medium and long term, they can produce diseases in adult health. It is difficult the clinical management of hypertension in children. Nowadays, there are few actions, in terms of prevention, promotion and treatment of these pathologies.

An analysis of the literature was carried out whose main objective was to evaluate the influence of the Body Mass Index, pregestational and gestational, on the weight of newborns. We designed a systematic review of observational studies (retrospective, cross-sectional or prospective), fulfilling the guidelines of the review protocol Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). The protocol was registered on the PROSPERO website, and it was assigned the registration number: CRD42017080707. We searched by applying the inclusion criteria in the following electronic databases; Pubmed, Scielo, Cuiden, Google Scholar and Scopus. We identified 372 articles that met the inclusion rules. We carried out a screening in duplicates, reading the title and abstract of the identified articles, and subsequently an in-depth reading of the articles, 10 articles were included in the present systematic review. Once the articles are analyzed, it is observed in the results that the BMI is positive and significantly related to the birth weight of the children. Thus, mothers who begins gestation with low weight have a greater risk of conceiving children with low birth weight for gestational age, just as obese and overweight women have a greater risk of having macrosomic children. No data have been observed that relate the weight of newborns of women with normal weight, with the weight gain of mothers.

Introduction: The oral health of pregnant women depends on the knowledge, attitudes and behaviors learned prior to pregnancy. Research shows that the most frequent and specific problem encountered during this period, which continues during lactation, is gestational gingivitis, that is, inflammation of the gums. Therefore, the knowledge that the pregnant woman has about these alterations is essential, not only to prevent them, but for the consequences that can have during pregnancy, childbirth and postpartum. Aim: To analyze the main studies on the level of oral health knowledge of pregnant women. Method: The systematic review was performed according to the PRISMA guidelines. We have selected 18 studies that analyze the subject matter. Results: The studies reviewed did not present similar samples at the time of assessing the level of knowledge of the oral health of pregnant women. This can create problems comparing studies with each other. The issue addressed to measure the knowledge of pregnant women served to determine this discernment, and thus orient the research towards those aspects that presented difficulties. Conclusions: All of the studies reviewed show that the level of knowledge of pregnant women about their oral health is regular. This result that the surveys show, is not validated by a unified protocol, this means that there is no unanimity when verifying the knowledge of pregnant women, in relation to their oral health, as a health problem in general.

Aims: Study the influence of moderate aquatic physical exercise following the SWEP methodology (Study of Water Exercise Pregnant) on the episiotomy rate. Methods and Material: Randomized Clinical Trial, with 140 randomized subjects; 129 subjects (Group of Exercises n = 65, Control Group n = 64) completed the requirements of the study. The study began in the 20th week of gestation and ended in week 37. The perinatal results were obtained from the partogram registered in the Paritary Services of the University Hospital Complex of Granada and from the clinical history of each woman. Results: There were no statistically significant differences in the episiotomy rate, although a percentage difference of 10% lower was observed in active women (45.31% vs. 35.4%). The weight of the RN remained within the normal weight range in both groups (2,500 g - 4,000 g), for the GC of 3,460 g (Q1 = 3,207.5 - Q3 = 3,770.0) and for the GE of 3,250 g (Q1 = 2.955.0 - Q3 = 3.572.5) (p = 0.011). In relation to epidural and subdural anesthesia, there are no statistically significant differences between both groups, obtaining 85.9% for CG and 72.3% for EG (p = 0.092). Conclusions: The births of the women who have followed the SWEP methodology have presented a lower rate of episiotomy, although this has not been statistically significant, which is associated with the improvement of the abdominal muscles and better control of the musculature of the pelvic floor.

Introduction: Both pregnancy and childbirth are important risk factors for urinary stress incontinence in women. For its prevention, exercies of the pelvic floor musculature have been shown to be effective. Guidelines for urinary stress incontinence management recommend offering pelvic floor muscle training to women during their first pregnancy as a preventive measure. Objective: To update the information provided in the scientific literature on urinary stress incontinence during postpartum and possible forms of treat it. Methodology: A systematic bibliographic review was carried out in the following databases: PUBMED, COCHRANE, CINHAL, MEDLINE, SciELO and SCOPUS. The date was restricted to the last 5 years (2012-2017), in Spanish, English and Portuguese. Restrictions were made regarding the type of study, and Randomized Clinical Trials (RCTs) were considered for this review. Results: After reviewing the literature consulted, it is concluded that the training of the pelvic floor musculature is beneficial to prevent the occurrence of urinary stress incontinence during pregnancy and the postpartum period. Conclusions: The results obtained in this review are consistent with previous studies and bibliographic reviews of the same topic. It follows that training of the pelvic floor muscles is beneficial in preventing the occurrence of urinary stress incontinence during pregnancy or postpartum.

Introduction. The woman presents during pregnancy a weight gain that, in most cases, does not carry risks associated with weight gain, but that if that gain is not lost adequately in the postpartum, it can be harmful to their health. Promoting physical exercise programs during the postpartum period can be an effective tool in the recovery of women's pregestational weight, in addition, it can also be associated with an improvement in the healthy habits of both the woman and her family. Aim. To analyze the results of a program of hipopressive abdominal physical activity in a sample of women, starting four months after birth, and its influence on the recovery of pregestational weight. Material and methods. A randomized clinical trial was performed of observational and longitudinal cut. The study included a behavioral intervention, starting at 16 weeks postpartum and ended 12 weeks later. A moderate-intensity exercise program was followed, according to the Low Pressure Fitness methodology. The evolution of weight gained during pregnancy was known through the personal interview between the weeks 14-16 postpartum. Weight retention was assessed during the postpartum period, and measured again at week 28 postpartum. Results. At the beginning of the intervention, the women did not present statistically significant gestational weight gains between the two groups, being recommended by the American College of Obstetrics and Gynecology (ACOG), which ranged from 8.05 kg to 11.63 kg. The total drop out rate for the trial was 7.8%. No statistically significant differences were found between the two groups in the evolution of the woman's weight from the beginning to the end of the intervention. Neither when comparing the weights at the beginning and at the end of the intervention of each group. The value of p was 0.751 for CG and 0.691 for EG. No statistically significant differences were found in the characteristics of the sample. Conclusion. Statistically, no differences were found in weight loss gained during pregnancy among sedentary women and those who followed the LPF method during the postpartum period.

Background: Physical exercise helps to maintain a healthy lifestyle and its practice is recommended for women during pregnancy as a means of limiting the negative effects on the body that may take place and to optimise well-being, mood and sleep patterns, as well as encouraging daily physical activity, enhancing the ability to work and preventing pregnancy-related complications. Aim: To analyse the quality of life in pregnancy for women who complete a programme of moderate physical activity in water, following a designed method that the woman can perform physical exercise safely during pregnancy called the SWEP (study of water exercise during pregnancy) method. Materials and methods: A randomised clinical trial was performed. One hundred and twenty-nine pregnant women were randomly assigned either to an exercise class following the SWEP method (EG, n = 65) or to a control group (CG, n = 64). The trial began in week 20 of pregnancy (May 2016) and ended in week 37 (October 2016). Heath-related quality of life (HRQoL) was evaluated with the SF36v2 health questionnaire at weeks 12 and 35 of pregnancy. Results: The HRQoL score decreased significantly between weeks 12 and 35 of gestation, except for the mental health component, which in the CG fell by -3.28 points and in the EG increased slightly (p > 0.05). Among the CG, the score for the mental health component at week 35 was

Objective: To evaluate the technique and duration of breastfeeding in healthy children and children with Down Syndrome (DS) using the breastfeeding observation form. Materials and methods: An observational study of a prospective cohort was carried out at the Clinical Hospital of Granada during 2015. The Study Group consisted of 40 children with DS and the control group was formed by each new-born with DS and a healthy new-born with the same characteristics of weight and gestational age was selected. The new-borns evaluated shared housing with the mother where the technique was valued during the first 5 days postpartum by a health professional. A bivariable analysis was performed to compare the groups using Student’s T test for numerical variables and chi-square for categorical variables. Results: Lactogenesis onset was earlier in the DS group (92.5 % in the first 24 hours vs 20 %; p

Introduction: Many women change their lifestyles and habits when they become pregnant, to avoid potentially harmful effects to themselves and their babies. This is especially so with respect to physical exercise, which is often greatly reduced due to ignorance of the benefits it provides during pregnancy. Aim: To evaluate the prevalence of spontaneous birth among women who participated in a water-based physical exercise program. Methods: A randomized clinical trial was conducted with a sample of 129 pregnant women (Control Group, CG = 64, Exercise Group, EG = 65). A physical exercise protocol, specifically designed for pregnant women, was created and applied. Those in the EG performed 60 min exercise sessions, three times per week for 17 weeks. The participants in the CG received routine check-ups and advice throughout their pregnancy. Findings: The women in the EG presented better results for the onset of spontaneous birth (OR = 2.060 (0.980&ndash, 4.332)) and for neonate Apgar score of 10 at five minutes (OR = 8.53 (3.60&ndash, 20.17)). Those who had normal weight at the start of pregnancy achieved better results for spontaneous delivery (OR = 2.099 (1.017&ndash, 4.335)) than those with overweight/obesity. The rate of caesarean delivery was higher in the women with overweight/obesity (OR = 3.570 ((1.226&ndash, 10.397)) than in those with normal weight. Conclusions: In our study, the women who followed the water-based exercise program gained less weight during pregnancy, which facilitated a better rate of spontaneous, non-instrumental childbirth, together with a better Apgar test score at five minutes.

BACKGROUND The prevalence of childhood hypertension (HT) is growing exponentially, influenced by environmental factors such as foods with high salt content, sedentary lifestyles, and poor-quality food. The incidence of HT is about 10.4% in well-nourished children, but when associated with obesity or overweight, this can rise to 38% and 68%, respectively. To assess the influence of physical activity on the blood pressure (BP) of children who are overweight or obese. METHODS This randomized clinical trial was carried out in Granada (Spain), from October 2015 to June 2016. The sample consisted of 98 children, all of whom were overweight or obese. The intervention group (IG) (n = 49) practised physical activity and received nutritional advice, while the control group (n = 49) only received theoretical–practical sessions on nutrition. Body composition was measured, a nutritional assessment was made and BP was determined (in percentiles, to avoid the misclassification of children who are located at the extremes of normal growth). RESULTS Before the physical activity intervention, 85.7% of the children in the IG (with overweight/obesity) were in the 95th or higher percentile for BP, a situation representative of high BP (HT). However, by the end of the study period, this value had decreased significantly (P = 0.001), to 16.13%. CONCLUSIONS Childhood obesity is a risk factor for HT. Physical activity, together with nutritional advice, effectively reduces BP in children who are overweight or obese. The use of percentiles, according to age, weight, and height, is an effective means of measuring BP. CLINICAL TRIALS REGISTRATION This study is registered at https://www.clinicaltrials.gov (identifier NCT02779647).

Objective: This work sought to evaluate a physical exercise program of moderate intensity in patients operated of bariatric surgery and its influence on muscle strength. Method: Randomized clinical trial, with an intervention group and a control group. Forty three patients were operated of bariatric surgery. The intervention group was applied a program of moderate physical activity during six months. Grip strength and bioimpedance were measured at their baseline form, at one month, and six months after surgery. A bivariate study was conducted to observe variable changes. Results: Upon conducting Student´s t for independent samples in all the variables (weight, body mass index, grip strength, lean mass, fat mass, and metabolism), the result is that no significant differences exist between the intervention group and the control group with p > 0.05. Conclusion: A program of moderate physical activity lasting six months in patients intervened of bariatric surgery has no significant result in the development of muscle mass evaluated through manual dynamometry and bioimpedance. RESUMEN Objetivo: evaluar un programa de ejercicio físico de intensidad moderada en pacientes operados de cirugía bariátrica y su influencia en la fuerza muscular. Método: ensayo clínico aleatorizado, con un grupo de intervención y un grupo control. Cuarenta y tres pacientes fueron operados de cirugía bariátrica. Al grupo de intervención se le aplicó un programa de actividad física moderada durante seis meses. La fuerza de agarre y la bioimpedancia se midieron en su forma basal, al mes y a los seis meses después de la cirugía. Se realizó un estudio de bivariante para observar los cambios de las variables. Resultados: al realizar la prueba de t de student para muestras independientes en todas las variables (peso, índice de masa corporal, fuerza de agarre, masa magra, masa grasa y metabolismo), el resultado es que no hay diferencias significativas entre el grupo de intervención y el grupo control con p>0,05. Conclusión: un programa de actividad física moderado de seis meses de duración en pacientes intervenidos de cirugía bariátrica no tiene resultados significantes en el desarrollo de la masa muscular evaluada a través de la dinamometría manual y la bioimpedancia. RESUMO Objetivo: avaliar um programa de exercício físico de intensidade moderada em pacientes submetidos à cirurgia bariátrica e sua influência na força muscular. Materiais e método: ensaio clínico randomizado, com um grupo de intervenção e um grupo controle. Quarenta e três pacientes foram operados de cirurgia bariátrica. Ao grupo de intervenção, foi aplicado um programa de atividade física moderada durante seis meses. A força muscular e a bioimpedância foram medidas em sua forma basal em um mês e aos seis meses depois da cirurgia. Foi realizado um estudo de bivariante para observar as mudanças das variáveis. Resultados: ao realizar o teste t de Student para amostras independentes em todas as variáveis (peso, índice de massa corporal, força muscular, massa magra, massa gordurosa e metabolismo), não se verificam diferenças significativas entre o grupo de intervenção e o grupo controle com p > 0,05. Conclusão: um programa de atividade física moderada de seis meses de duração em pacientes submetidos à cirurgia bariátrica não apresenta resultados significantes no desenvolvimento da massa muscular avaliada por meio da dinamometria manual e da bioimpedância.

Introduction During pregnancy, women often change their lifestyle for fear of harmful effects on the child or themselves. In this respect, many women reduce the amount of physical exercise they take, despite its beneficial effects. Objective To determine the duration of labor in pregnant women who completed a program of moderate physical exercise in water and subsequently presented eutocic birth. Methods A randomized trial was performed with 140 healthy pregnant women, divided into an exercise group (EG) (n = 70) and a control group (CG) (n = 70). The women who composed the study population were recruited at 12 weeks of gestation. The intervention program, termed SWEP (Study of Water Exercise during Pregnancy) began in week 20 of gestation and ended in week 37. Perinatal outcomes were determined by examining the corresponding partographs, recorded by the Maternity Service at the Granada University Hospital Complex. Results The intervention phase of the study took place from June through October 2016, with the 120 women finally included in EG and CG (60 in each group). At term, 63% of the women in EG and 56% of those in CG had a eutocic birth. The average total duration of labor was 389.33 ± 216.18 min for the women in EG and 561.30 ± 199.94 min for those in CG, a difference of approximately three hours (p Conclusions The women who exercised in water during their pregnancy presented a shorter duration of labor than those who did not. The difference was especially marked with respect to the duration of the first and second stages of labor.

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Background Despite of advances in research, at the moment, various points related to the physiology of gestation and the etiology of severe diseases that can be developed in the course of it remain unknown. One of those aspects is the behavior of biomarkers (triglycerides, prolactin, glucose and cholesterol) during pregnancy, which experience a gradual increase in their levels until they reach the peak of hypertriglyceridemia, a few days before delivery. Several studies have reported that biomarkers experience a higher elevation in diabetic and obese pregnant women and in those women who suffer preeclampsia. The description of their behavior in different population of pregnant women (healthy women and women at risk) would identify the relation of these with some of the alterations that occurs more frequently during pregnancy. Objective The aim of this study is to develop a multi-paradigm biological model of systems to determine triglyceride, prolactin, glucose and cholesterol levels during pregnancy and its relation with lactogenesis in healthy and risk pregnant women. Methods A prospective cohort study will take place with women during pregnancy and lactation. Participating women will be divided into two groups. One group will be integrated by healthy women and the other group by pregnant women with a risk medical history. The personal, family and a detailed medical history will be collected in each group. A study of all the variables which influence the level of the mentioned biomarkers (triglycerides, cholesterol, glucose and prolactin) will be done. The universe consists in 4,300 women, who constitute the historical average deliveries during the semester in the city of Granada (Spain). The sample collection will be made in medical office’s pregnancy control in Granada’s hospitals, in their respective health centers and during the second half of 2015. The sample will be stratified and probabilistic. Peculiarities of pregnant women will be taken into account when calculating the size of the study sample. This sample will be made up of 224 women who comply with the inclusion criteria and that have signed the informed consent. To achieve the project objectives an organization comprising six theoretical and practical phases enabling the scientific development of the project. During the first phase, the technical and administrative preparation of the project is constructed. Thereafter, the work is divided into two action areas which encompass the collection and data modeling. The creation of a biological multi-paradigm computer simulation model of the levels of biomarkers in different months of pregnancy and in the various pathologies of pregnant women can be very effective to know the risks that involve high levels of lipids for the mother and for the baby.