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Background: At the time of our study, occupational health evidence specific for long-term care employees was mostly lacking. The purpose of this study was to determine the proportion of positive cases in employees after the first COVID-19 wave in May 2020. We also determined the prevalence of asymptomatic cases. Method: The study population included all health care workers (HCW) employed at one mid-size long-term hospital in Spain (May 2020). A cross-sectional study design included an interviewer-administered self-reported questionnaire (including sociodemographic questions, risk factors for COVID-19 complications such as hypertension or diabetes, and previous polymerase chain reaction [PCR] results) and antibody determination (Biozek rapid test). Data were analyzed using Student's t, Fisher, and chi-square tests. Two multivariate logistic models were created to evaluate exposure factors and symptoms separately on the outcome of having had COVID-19. Findings: Of the 97% of workers who participated (580/596), 300 (51.7%) suffered symptoms of COVID-19, 161 (27.8%) of the rapid antibody tests were positive for IgM and/or IgG, 160 (27.6%) workers had at least one risk factor, and 32 (19.0%) of the 168 SARS-CoV-2-positive cases were asymptomatic. The proportion of negative or unavailable PCRs, with positive antibody, was 11.7% (56/477). Casual contact without protection (odds ratio [OR]: 1.9, 95% confidence interval [CI]: 1.1–3.4), doctor occupation (OR 3.3, 95% CI: 1.1–10.2), and nursing assistant occupation (OR 2.5, 95% CI: 1.2–5.8) were independently associated with SARS-CoV-2 infection. Conclusion: Physicians and nursing assistants in a long-term care setting were at a higher risk of SARS-COV-2 infection over other occupations in the first wave of the pandemic, especially when in contact with patients without protection. Almost one-fifth of the workers with a positive PCR test for SARS-COV-2 were asymptomatic and seroprevalence (27.8%) was well below the approximated herd immunity cutoff (60–70%). Essential workers in long-term care must be monitored frequently by Employee Health Service and should be required to wear personal protective equipment including a fit-tested N-95 while in close contact with patients and coworkers. [ABSTRACT FROM AUTHOR]

Intimate Partner Violence (IPV) constitutes a major public health problem worldwide. The existing links between childhood family violence experiences and perpetration of IPV during adulthood suggest that violence is transmitted across generations. The aims of this study were to provide new insights into characteristics of the history of childhood family violence in a sample of Spanish convicted male batterers and to examine what typology of batterer (specialist or generalist) is more likely to have had different types of childhood experiences of violence in the family context. Participants were 740 men convicted of IPV whose ages ranged from 18 to 71 years old (M = 39.74; SD = 10.01). Of them, 305 men were classified as specialist batterers, and 391 men were classified as generalist batterers. Participants completed a questionnaire made ad hoc regarding family of origin violence and sociodemographic aspects. Results showed that, in comparison with generalist batterers, specialist batterers had higher likelihood of having experienced child abuse or maltreatment during their childhood, having experienced physical punishment and child neglect, having their father as the aggressor of such experienced situations of abuse, or maltreatment. Likewise, specialist batterers had higher likelihood of having been witnesses of family violence, having witnessed physical and psychological violence in the family, having witnessed their mother and siblings being the victims and their father being the aggressor when family violence occurred. This study emphasized the need for identifying children exposed to direct and indirect family violence because they could be a vulnerable group for future IPV perpetration. Moreover, variables related to childhood family violence must be considered when developing intervention treatment programs focused on male specialist batterers. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of adding an Upper Cervical Translatoric Mobilization (UCTM) or an Inhibitory Suboccipital Technique (IST) to a physiotherapy treatment in the symptomatology and function of mechanical chronic neck pain patients. Design: Randomized controlled trial. Setting: Primary Care Center in Cornellà, Spain. Subjects: 78 patients (64 women), with mean age (SD) of 59.96 (13.30) years with mechanical chronic neck pain were divided in three groups: control, IST and UCTM groups. Interventions: All groups received 15 physiotherapy sessions for three weeks. The UCTM and IST groups added 5 minutes of the assigned technique during six sessions. Main measures: Neck disability index (NDI) and numeric pain rating scale (NPRS) for neck pain were measured baseline, three-weeks and 15-weeks follow-up. Results: NDI (SD) at baseline, three-weeks and 15-weeks were 11.62 (7.08), 9.65 (6.25), 7.58 (5.64) for the control group, 14.38 (6.92), 8.50 (6.11), 7.12 (4.98) for the IST group and 13.19(7.23), 5.35(6.10), 4.35(2.76) for the UCTM group. NPRS (SD) at baseline, three-weeks and 15-weeks were 58.69 (19.46), 45.19 (23.43), 44.58 (24.08) for the control group; 64.08 (19.26), 42.19 (19.69), 34 (21.14) for the IST group; and 67.65 (20.65), 36.23 (20.10), 39.85 (25.44) for the UCTM group. Conclusions: Compared with no treatment, both forms of mobilization were associated with reduced disability at three weeks, and UCTM remained better than control at 15 weeks; there were no significant differences between the two mobilization groups. Trial registration: This study was registered in Clinicaltrials.gov (NCT02832232). [ABSTRACT FROM AUTHOR]

The purpose of this study was to compare the predictive ability of waist-to-height ratio (WHtR) compared with other anthropometric indicators in the incidence of metabolic syndrome (MetS) and to propose cutoff values for its early detection in nursing practice. A longitudinal cohort study was conducted on a sample of 630 workers (137 exposed and 493 nonexposed), free of MetS at baseline. WHtR was compared with body mass index (BMI), waist circumference (WC), and the percentage of body fat (BF%). In the Cox regression, the adjusted values of hazard ratio (HR) were 5.4 (confidence interval [CI] = [3.1, 9.5]) for WHtR and 7.4 (CI = [3.7, 14.9]) for components of MetS. WHtR obtained the largest area under the curve 0.82 (CI = [0.76, 0.88]), and with a cutoff value of 0.54, values were obtained for sensitivity (70%) and specificity (77%). WHtR was the best predictor of incidence of MetS, with a cutoff value of 0.54. Nursing can improve the early detection of MetS by measuring WHtR. [ABSTRACT FROM AUTHOR]

Background: In the last decades, there have been important developments in the scientific and technological areas of healthcare. On certain occasions this provokes conflict between the patients' rights and the values of healthcare professionals which brings about, within this clinical relationship, the problem of conscientious objection. Aims: To learn the opinions that the Nurses of the Madrid Autonomous Community have regarding conscientious objection. Research design: Cross-cutting descriptive study. Participants and research context: The nurses of 9 hospitals and 12 Health Centers in the Madrid Autonomous Community. The study was done by means of an auto completed anonymous questionnaire. The variables studied were social-demographical and their opinions about conscientious objections. Ethical considerations: The study was approved by the Ethical Community of Clinical Research of the University Hospital Príncipe de Asturias. Participants were assured of maximum confidentiality and anonymity. Findings: A total of 421 nurses answered the questionnaire. In total, 55.6% of the nurses confirmed they were religious believers, and 64.3% declared having poor knowledge regarding conscientious objection. The matters that caused the greatest objections were voluntary abortions, genetic embryo selection, refusal of blood transfusions, and therapy refusal. Discussion: Different authors state that the most significant cases of conscientious objections for health professionals are those regarding carrying out or assisting in abortions, euthanasia, the practice of assisted reproduction and, finally, the prescription and dispensing of the morning-after pill. In our study, the most significant cases in which the nurses would declare conscientious objections would be the refusal to accept treatment, the selection of embryos after genetic diagnosis preimplantation, the patient's refusal to receive blood transfusions due to religious reasons and pregnant women's request for voluntary abortions within the first 14 weeks. Conclusion: Nurses' religious beliefs influence their opinions regarding conscientious objection. The nurses who declare themselves as religious believers object in a higher percentage than those without religious beliefs. [ABSTRACT FROM AUTHOR]

Objective: To determine the changes produced by trigger point dry needling (TrP-DN) of sternocleidomastoid in patients with neck pain, and to observe how it might modify cervical motor control (CMC). Design: Single-centre, randomised, double-blinded clinical trial. Setting: Participants were recruited through advertising. The duration of the study was 6 months. Subjects: Thirty-four subjects with non-specific neck pain, aged over 18 years with an active myofascial trigger point in sternocleidomastoid, participated in the study. They were randomly assigned to treatment or control groups. Methods: TrP-DN inside or (1.5 cm) outside of the active myofascial trigger point of sternocleidomastoid. Main outcome measures: CMC, visual analogue scale and cervical range of motion were assessed before treatment, immediately post treatment, and 24 h, 1 week and 1 month after the intervention; the neck disability index was evaluated before treatment and 1 month later. Results: With a confidence interval of 99%, TrP-DN of sternocleidomastoid was associated with a decrease in pain after 1 week and CMC improved 1 month after the intervention (p < 0.001), when compared with baseline measurements, within the experimental group; there were no statistically significant differences between experimental and control groups. Conclusion: The effects of TrP-DN inside and outside of active myofascial trigger points did not differ in this study. Both interventions were associated with a similar temporal effect, specifically a reduction in neck pain at 1 week and an increase CMC at 1 month. However, these findings should be interpreted with caution due to the lack of a contemporaneous untreated control group. [ABSTRACT FROM AUTHOR]

Epidural analgesia (EA) is one of the methods of choice for labor pain relief, but its adverse effects on the mother and child remain controversial. The objective of this study was to determine whether there is an association between the use of EA and different aspects of labor. The author(s) analyzed the effect of EA on different aspects of labor in a retrospective cohort observational study of deliveries in a public Spanish hospital during a 3-year period. Women with EA administration were found to increase the risk of stimulated labor, reduce the percentage of spontaneous deliveries, increase the risk of instrumental labor due to stalled labor or loss of fetal well-being, and increase the percentage of episiotomies. However, women with EA were not and increased risk for perineal laceration or the condition of the membranes at the delivery or with the type of placental expulsion. Thus, the administration of EA should be assessed in each case by the health care professional. [ABSTRACT FROM AUTHOR]

Objective: To assess the end of treatment and three months after treatment effects of diacutaneous fibrolysis as adjuvant of physical therapy for chronic lateral epicondylalgia. Design: Double-blind (patient and evaluator) randomized controlled trial. Setting: Primary Care Center of the Spanish NHS. Subjects: A total of 54 people with 60 elbows affected with chronic lateral epicondylalgia, 33 women, mean (SD) age was 48.43 (8.69) years. Interventions: All three groups (Intervention, Placebo and Control) received three weeks of physical therapy treatment and in addition Intervention Group received six sessions of real diacutaneous fibrolysis and Placebo Group received six sessions of sham diacutaneous fibrolysis. Main measures: Pain intensity, pressure pain threshold, pain free grip strength, function and subjective assessment were assessed at baseline, at the end of treatment and three months after treatment. Results: Between-group results at three months after treatment showed a statistically significant improvement of the Intervention Group in pain free grip strength (mean, 7.91 km/cm2; SD, 9.23) compared to the Placebo Group (mean, 1.47 km/cm2; SD, 7.86) and to the Control Group (mean, 2.09 km/cm2; SD, 4.45) (P values <0.01 and <0.03, respectively) and also in function (mean, 20.87; SD, 14.25) compared to the Control Group (mean, 4.17; SD, 18.02) (P < 0.01). Subjective assessment was statistically better in the Intervention Group both at the end of treatment (P < 0.01) and three months after treatment (P < 0.03). Conclusion: Diacutaneous fibrolysis added to physical therapy provides better results in the treatment of chronic lateral epicondylalgia, with greater clinical satisfaction among patients. [ABSTRACT FROM AUTHOR]

Introduction: Epidural analgesia (EA) is the most widespread pharmacologic method of labor pain relief. There remains disagreement, however, regarding its adverse effects. The objective of this study was to determine the effect of EA administration on the risk of cesarean delivery and its causes (e.g., stalled labor, risk of loss of fetal well-being, among others) and the degree to which this effect may be modulated by mother-, newborn-, and labor-related variables. Method: A retrospective cohort observational study was conducted including all deliveries in a Spanish public hospital between March 2010 and March 2013 (N = 2,450; EA = 562, non-EA = 1,888). Results: Risk of a cesarean section was significantly increased by EA administration (odds ratio [OR] = 2.673; p < .0001). The percentage of cesarean deliveries due to the risk of loss of fetal well-being was significantly higher in the EA (47.8%) versus non-EA group (27.5%; OR = 1.739; p = 0.0012,). The EA-associated risk of cesarean section was not significantly modified as a function of maternal age or parity, fetal position, newborn weight, weeks of gestation, or sedation administration alone. However, these variables in combination may increase the risk. We present multivariate models for each group that account for these variables, allowing for estimation of the risk of a cesarean delivery if EA is administered. Conclusion: EA is associated with an increased risk of cesarean delivery. Other variables in combination (maternal age or parity, fetal position, newborn weight, weeks of gestation, or sedation administration) may increase this risk. [ABSTRACT FROM AUTHOR]

Objectives: To compare the effectiveness of a daily home-based facial exercise therapy with a supervised rehabilitation technique for the treatment of postoperative facial dysfunction in patients undergoing conventional superficial parotidectomy. Design: Prospective, randomized trial, controlled. Setting: Surgery and Rehabilitation Units, university hospital. Subjects: Consecutive patients (n=79, mean age 48 years) who underwent superficial parotidectomy with facial nerve dissection were randomly divided into two groups. Intervention: Control group (CG) were given a daily homework manual to perform ordinary postoperative facial mimic exercises autonomously in front of the mirror at home. Experimental group (EG) patients with moderate-severe paresis received supervised rehabilitation therapy that consisted in weekly sessions with facial exercises and massages and performed daily facial exercises at home. EG patients with slight paresis were instructed to undertake self-massage and mirror exercises. Main outcome measures: Postoperative dysfunction of facial nerve and branches was quantified measuring the prevalence, magnitude and duration of paresis by the House-Brackmann Facial Nerve Grading System up to 12th months. Results: Facial paresis incidence at 1st week was 77.2%, being the marginal-mandibular nerve the most affected (64.5%). No statistically significant differences were found at any time of the study when comparing the frequency, magnitude and duration of paresis between EG and CG and among patients who had presented moderate-severe paresis. In the absence of intraoperative nerve injury, complete recovery of facial mobility was observed within 12 months, regardless of treatment group. Conclusion: Rehabilitation therapy and mirror facial exercises performed autonomously at home were equally effective for postoperative functional recovery. [ABSTRACT FROM AUTHOR]

This article aims to determine the functional recovery of older people, who were previously independent in activities of daily living (ADLs) and without cognitive impairment, in the year following a fall-related hip fracture. A cohort study was carried out among patients admitted to University General Hospital of Albacete (Spain). Consecutive sampling was performed. Variables included demographic, habitual residence, type of hip fracture, mental status (Short Portable Mental Status Questionnaire [SPMSQ] Pfeiffer), and independence in ADLs (according to the Barthel Index [BI]) prior to the fall and after the fracture. For 205 patients, 1 year after surgery, the mean BI score was 78.09 (SD = 25.13); (vs. 90.02 before the hip fracture), 59% showed urinary continence (vs. 79%), and 65% walked without assistance (vs. 82%). Regarding predictors of recovery, results indicate that patients who are older, who suffer complications after hospital discharge, or who reside in nursing homes experience poorer recovery in ADLs. Only 47.9% of the patients regained prior levels of autonomy 1 year after surgery. [ABSTRACT FROM AUTHOR]

The aim of this study is to assess the knowledge, attitudes and experiences of Spanish nurses in relation to euthanasia and physician-assisted suicide. In an online questionnaire completed by 390 nurses from Andalusia, 59.1% adequately identified a euthanasia situation and 64.1% a situation involving physician-assisted suicide. Around 69% were aware that both practices were illegal in Spain, while 21.4% had received requests for euthanasia and a further 7.8% for assisted suicide. A total of 22.6% believed that cases of euthanasia had occurred in Spain and 11.4% believed the same for assisted suicide. There was greater support (70%) for legalisation of euthanasia than for assisted suicide (65%), combined with a greater predisposition towards carrying out euthanasia (54%), if it were to be legalised, than participating in assisted suicide (47.3%). Nurses in Andalusia should be offered more education about issues pertaining to the end of life, and extensive research into this area should be undertaken. [ABSTRACT FROM AUTHOR]

Background: Most of the published series of transplanted menisci have consistently shown some degree of allograft extrusion. The speculation is that this meniscal extrusion may be caused by the soft tissue technique used to fix the allograft. Hypothesis: The percentage of extruded meniscal graft would be higher if the allograft were only fixed with sutures rather than with associated bony fixation. Study Design: Cohort study; Level of evidence, 2. Methods: We performed a prospective series of 88 meniscal allograft transplantations. Thirty-three of the grafts were fixed with the suture-only technique (group A). The remaining 55 cases were performed with the bone plug method (group B). All patients were studied with magnetic resonance imaging (MRI) at a minimum 3 years’ follow-up to determine the degree of meniscal extrusion. The time between surgery and MRI evaluation was 40 months (range, 36-48 months) in both groups. Meniscal extrusion was measured on coronal MRI. The percentage of the meniscal body width that was extruded was calculated. The average percentage of extrusion for each group was compared. The Lysholm score was analyzed in relation to the fixation method and degree of meniscal extrusion. Tears of the allograft that required surgical intervention were also reported. Results: The average percentage of meniscal tissue extruded in group A was 36.3% ± 13.7% without differences between the medial (35.9% ± 18.1%) and lateral (38.3% ± 14.4%) compartments (P = .84). Group B had a mean 28.13% ± 12.2% of the meniscal body extruded without differences between the medial (25.8% ± 16.2%) and lateral (30.14% ± 13.5%) compartments. A higher percentage of extruded meniscal tissue was found in group A than in group B (P < .001). No association between the degree of meniscal extrusion and the functional score was observed (P = .4). Graft tears were observed in 21.4% of the cases in group A and in 7.3% of the cases in group B (P = .09). Conclusion: A meniscal allograft fixed with the suture-only technique showed a significantly higher degree of extruded meniscal body than that fixed with the bony fixation method, with no influence on the functional outcome. There was also a considerably higher rate of graft tears observed in those menisci fixed only with sutures, although this difference was not statistically significant with the numbers available. [ABSTRACT FROM AUTHOR]