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El dolor/grietas del pezón causan abandono del amamantamiento. Objetivo: demostrar que el AOVEe aporta beneficios en dolor/grietas del pezón y duración de la LM, frente a la leche materna. Ensayo clínico aleatorizado con 124 mujeres, parto a término, ≥18 años, excluyendo lesiones previas, usar productos, rechazar tratamiento. Asignación aleatoria estratificada por edad. Dolor medido con escala numérica, grietas mediante exploración y duración de LM con cuestionario. Análisis mediante tablas de contingencia, t de Student, correlaciones de Pearson/Spearman. Estimación del impacto clínico con estadístico d de Cohen y Wald. Significativo α=.05. AOVEe menos grietas pezón izquierdo en primíparas primera semana (p

Background: Childhood sexual abuse (CSA) is a significant trauma that may have lifelong impact. Due to the long-term negative personal and societal consequences of CSA, it is crucial to find treatments with enduring outcomes. Objective: The aim of this study was to determine the relative long-term efficacy of psychodynamic and systemic group therapy for adult women exposed to CSA. Method: A prospective randomized controlled trial was conducted with outcomes assessed at pre- and post-treatment, and 1 and 5 years post-treatment. All analyses were intention-to-treat. One hundred and six women with sequelae from childhood sexual abuse were treated with psychodynamic or systemic group therapy. Primary outcome was Global Severity Index (GSI) of SCL-90-R. Secondary outcomes included symptoms of PTSD and depression and psycho-social functioning. Results: Treatment was completed by 81% of participants; 64% completed the 1-year follow-up and 60% completed the 5-year follow-up. Completion rates did not differ between treatments. Significant reduction in symptoms measured on GSI and improvement of psychosocial functioning was found for both interventions at all measurement points after treatment (ES range = 0.68–1.19). However, different trajectories were observed: while outcome at end of treatment was significantly better in the systemic group, no differences in gains were observed at the 1- and 5-year follow-ups when controlling for baseline differences. Conclusions: The findings add to the evidence base for psychodynamic and systemic group therapy, but the result also underscores the importance of taking post-treatment trajectories into account in evidence-based research, in the continued efforts to improve treatment for this population., Summary HIGHLIGHTS • We compared psychodynamic and systemic group therapy for adult survivors of childhood sexual abuse.• At the end of treatment, systemic therapy had better outcomes than dynamic therapy, but there were no differences after 1 and 5 years. Both groups improved at all time points.

Introducción: El ensayo clínico aleatorizado (ECA) es una de las mejores formas de adquisición de pruebas científicas en ciencias de la salud. Es catalogado como la piedra angular de la medicina basada en la evidencia y como eje de la formación de conocimiento de alta calidad. Diversos tipos de sesgos pueden comprometer sus resultados y afectar su validez interna. Objetivos:Evaluar el «riesgo de sesgo» de los ensayos clínicos publicados en la Revista Colombiana de Anestesiología (RCA) mediante la aplicación de la herramienta para detección de «riesgo de sesgo» de la Colaboración Cochrane. Métodos:Mediante una búsqueda sistemática se identificaron todos los ensayos clínicos publicados en la RCA. Estos se distribuyeron de forma aleatoria entre 6 evaluadores entrenados en la utilización de la herramienta para detección de «riesgo de sesgo» de la Colaboración Cochrane. Los resultados se presentaron de forma descriptiva, gráfica y temporal para cada uno de los 6 dominios que constituyen la herramienta. Resultados: La RCA ha publicado 40 volúmenes desde 1973. El proceso de búsqueda identificó hasta el 2009 un total de 75 ECA. La frecuencia de publicación de ECA ha aumentado con el paso del tiempo, las ciudades con mayor publicación fueron Bogotá DC y Medellín, y en su mayoría están relacionados al manejo del dolor agudo y crónico. El mayor riesgo de sesgo (29% de los ECA) se identificó en el encubrimiento de la secuencia de aleatorización (dominio 2). El 30% de los estudios presentaron 4 dominios o más clasificados como bajo riesgo de sesgo. Se apreció una tendencia a la reducción de la proporción de dominios clasificados como alto riesgo de sesgo con el paso del tiempo. Conclusiones:Existe una tendencia sostenida al mejoramiento y a la reducción del riesgo de sesgo de los ECA publicados en la RCA, con algunos puntos a fortalecer en el proceso de diseño, conducción, análisis y reporte. Introduction: Randomized clinical trials (RCT) are one of the most reliable methods of scientific investigation in health sciences. It is a corner stone of evidence based medicine and the backbone of high standard knowledge. Several types of errors can compromise the results and affect its validity. Objectives: To assess the risk of bias of the clinical trials published in the Revista Colombiana de Anestesiología (RCA) medical journal by applying the «risk of bias detection» tool of the Cochrane Collaboration. Methods: All the clinical trials in the RCA journal were found by carrying out a systematic research. These trials were randomly distributed among 6 evaluators trained in the use of the «risk of bias detection» tool of the Cochrane Collaboration. Results were presented descriptively, graphically and chronologically to each of the 6 parameters that conform the «risk of bias detection» tool. Results:The RCA journal has published 40 volumes as of 1973. The searching process identified a total 75 RCT up until 2009. The frequency of RCT publication has risen with time. The cities with most publications were Bogotá DC and Medellín, and most trials were related to the management of acute and chronic pain. The greatest risk of bias (29% of all RCT) was found in the concealing of randomization sequences (parameter 2). 30% of the studies showed four or more parameter values of low risk of bias. A trend of decreasing proportion of high risk values was observed as time passed. Conclusions:There is a sustained trend of improvement and risk reduction in RCTs' in the RCA journal.

CONTEXT: Misoprostol, a synthetic E1 methyl analog prostaglandin, is at present receiving attention as a cervical modifier and labor induction agent. However, there is still a need for better determination of its safety and effectiveness. OBJECTIVE: To compare intravaginal misoprostol versus intravenous oxytocin for cervical ripening and labor induction in pregnant women with unripe cervices. DESIGN: Randomized controlled trial. SETTING: The study was performed at the Leonor Mendes de Barros Maternity Hospital between November 1998 and December 2000. PARTICIPANTS: 210 pregnant women with intact membranes and indication for labor induction were selected. PROCEDURES: The women randomly received 25 µg of vaginal misoprostol every 4 hours, not exceeding 8 doses (105 women), or oxytocin in a continuous infusion (105 women). MAIN MEASUREMENTS: The main parameters measured were: latent period, time from induction to vaginal delivery, delivery route, occurrence of vaginal delivery with time, occurrence of uterine tonus alterations, hypoxia and neonatal morbidity. To verify the statistical significance of the differences between the groups, the chi-squared, Student t and log-rank tests were used. RESULTS: There were no significant differences between the groups concerning conditions for labor induction, age, parity, race, marital status, family income, initial Bishop Index and number of prenatal visits. The cesarean section rate, latent period and period from induction to vaginal delivery were significantly lower for the misoprostol group. With regard to uterine tonus alterations, tachysystole was significantly more common in the misoprostol group. However, there was no difference in hypoxia and neonatal morbidity between the groups. CONCLUSION: 25 µg of misoprostol used vaginally every 4 hours is safer and more efficient for cervical ripening and labor induction than oxytocin. CONTEXTO: Na atualidade, misoprostol, um metilanálogo sintético da prostaglandina E1, vem recebendo atenção como um agente maturador do colo e indutor do trabalho de parto. No entanto, ainda é necessário determinar melhor sua segurança e eficácia. OBJETIVO: Comparar misoprostol intravaginal versus ocitocina intravenosa para amadurecimento cervical e indução de parto em mulheres com colo uterino desfavorável. TIPO DE ESTUDO: Ensaio clínico controlado aleatorizado. LOCAL: Hospital e Maternidade Leonor Mendes de Barros, em São Paulo, SP, no período de novembro de 1998 a dezembro de 2000. PARTICIPANTES: 210 gestantes com membranas íntegras e indicação para indução do parto. PROCEDIMENTOS: As mulheres, após a aleatorização, receberam misoprostol vaginal na dose de 25 µg a cada quatro horas, não excedendo oito doses (105 mulheres) ou ocitocina em uma infusão contínua (105 mulheres). VARIÁVEIS ESTUDADAS: Período de latência, tempo da indução ao parto vaginal, tipo de parto, ocorrência de parto vaginal em função do tempo, ocorrência de alterações do tônus uterino, hipóxia e morbidade neonatal. Para verificar a significância estatística das diferenças entre os grupos, utilizaram-se os testes de qui -quadrado, log-rank e t de Student. RESULTADOS: Não houve diferença significativa entre os grupos referentes às indicações de indução, idade, paridade, raça, renda familiar, índice inicial de Bishop e número de consultas de pré-natal. A incidência de cesárea, o período de latência e o período da indução ao parto vaginal foram significativamente menores para o grupo de misoprostol. Das alterações do tônus uterino, a taquissistolia foi significativamente mais comum no grupo do misoprostol, entretanto hipóxia e morbidade neonatal não foram diferentes entre os grupos. CONCLUSÃO: 25 µg de misoprostol vaginal usados a cada quatro horas é seguro e mais eficiente para o amadurecimento cervical e indução do trabalho de parto do que a ocitocina.