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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.

BACKGROUND Humans have consumed lactic bacteria throughout history, but it was at the beginning of the 20th century when this consumption was first related to beneficial properties for health1. From that moment on, multiple studies both in vitro and in vivo have shown the beneficial effects that the consumption of this type of bacteria, called probiotics, has on health. Effects such as the improvement of intestinal function2,3, prevention of intestinal infections4 and immunomodulation have been widely demonstrated5. In addition to these beneficial effects, the consumption of probiotic has been related with a reduction in incidence and severity of respiratory infections4,6. Oral administration of lactic acid bacteria has been associated with an increase in the innate and acquired immune response7,8. The consumption of certain strains has been shown to induce an increase in IgA related to the anti-infective properties of probiotic bacteria on diarrhoea9,10. Innate immunity is increased through an increase in the proportion and activity of phagocytic cells of the immune system, such as monocytes and neutrophils. The function of natural killer (NK) cells is also enhanced by the consumption of probiotic bacteria11. Activation of the innate immune system is essential, as it produces cytokines that will lead to more specialized activation of the specific immune response. It has been suggested that it is through this mechanism that probiotic bacteria activate the immune response, thus being able to function as adjuvants in vaccination processes12. The European Food Safety Agency (EFSA) has published guidelines on how studies should be conducted to demonstrate the effect of a probiotic or natural ingredient on the immune system. Among its recommendations is the use of vaccination protocols that demonstrate how the administration of the probiotic translates into an improvement in the response to an antigen13. Recently, a study carried out at the Center Institute of Food Science and Technology and Nutrition (ICTAN) del CSIC demonstrated that the administration of L. coryniformis K8 CECT5711 increases the response of specific antibodies against hepatitis A in a vaccination protocol against this virus 14. In addition, a certain effect on memory T-helper lymphocytes was observed, which increased in the probiotic group with respect to baseline values (660 ± 223 vs 551 ± 213 cells/µl). These results highlight the potential of this probiotic strain to improve the immune response against viral antigens. To evaluate this activity that boosts the immune response, another study was carried out in an elderly population. This population is more susceptible to infections due to the characteristic immunosenescence of age. A total of 98 elderly people residing in nursing homes participated in this study. The volunteers received a daily capsule of L. coryniformis K8 CECT5711 (3x109 colony former units (cfu)/day) for 2 weeks prior to being vaccinated against the flu or a placebo. The percentage of seroconversion was higher in the group receiving the probiotic than in the control group (93.1 vs 72.7%; p value 0.036). During the months of October to April, the volunteers were monitored, and the incidence of local symptoms associated with respiratory infections (sore throat, cough and nasal congestion) was 48% lower in the group that received the probiotic strain than in the control group (p-value: 0.007). Furthermore, the consumption of analgesics was significantly reduced in this group by 86% (p value: 0.008)15. This latest study corroborates the strain's ability to improve the immune response against viral antigens even in the elderly population. We are currently experiencing a pandemic due to coronavirus COVID-19 (English acronym for coronavirus disease 2019), which started in the Chinese city of Wuhan in December 2019. Having reached more than 100 territories, the disease was declared by the World Health Organization to be a pandemic on March 11, 2020 16. The number of confirmed cases continued to grow until reaching 5,371,660 cases worldwide on May 22, 2020. In Spain, at the end of May 2020 and despite the containment measures initiated in early March, more than 235,772 cases were registered, and of these patients, more than 27,940 have died 17. COVID-19 infection produces flu-like symptoms, including fever, dry cough, dyspnoea, myalgia, and fatigue. In severe cases, it is characterized by pneumonia, acute respiratory distress syndrome and septic shock that leads to death in approximately 3% of those infected. Transmission occurs through small droplets that are emitted when speaking, sneezing, or coughing by a carrier and pass directly to another person through inhalation or by contact of contaminated objects with the recipient's nasal and ocular mucous membranes. Symptoms start after approximately 7-20 days of exposure, and prevention at the population level consists of frequent hand washing, disinfecting surfaces with alcohol and avoiding close contact with other people.15. Some drugs have been proposed as antiviral treatment, such as hydroxychloroquine, lopinavir/ritonavir and others; severe pneumonia is treated with broad-spectrum antibiotics. There is no, up to date, effective treatment for the COVID-19 infection. An article published in March 2020 shows how the immune response to the COVID-19 virus is similar to the response generated by the influenza virus 18. Some authors propose the use of probiotic as a strategy to mitigate the effects of virus.19. In this context, it is proposed that the immunomodulatory properties of Lactobacillus coryniformis K8 CECT5711 might be useful for COVID-19 management. OBJECTIVE The objective of the present study is to evaluate the effects of the consumption of Lactobacillus coryniformis K8 on the incidence and severity of symptomatic infection by SARS CoV-2 and severity of COVID-19 in health personnel who carry out their professional work among patients with infection or suspected infection by SARS CoV-2 at the San Cecilio Clinical University Hospital. METHODS Description of treatments. The administration of the experimental product and the placebo will be carried out in the form of a gelatine capsule that will have the same weight, consistency and colour. The Experimental Group will receive hard gelatine capsules that will contain 3 x 109 cfu of Lactobacillus coryniformis K8 (120 mg), 10 mg magnesium stearate and 120 mg maltodextrin. The control group will receive hard gelatine capsules that will contain magnesium stearate (10 mg) and maltodextrin (220 mg). Subjects from both groups will take 1 capsule a day (preferably with dinner). Capsules for the probiotic and placebo will be provided by Biosearch Life (Granada, Spain). Study design The study is a nutritional, randomized, double-blind, controlled, parallel group observational prospective cohort study. Volunteers will be distributed into two groups: control group and experimental group. The study will be performed as shown in figure 1. This clinical research protocol has been prepared with full understanding and in accordance with the standards of Good Clinical Practice in accordance with CPMP/ICH/135/95, the Declaration of Helsinki (64th General Assembly, Fortaleza, Brazil, October 2013), ISO 14155 and all relevant national guidelines. All investigators participating in the study are appropriately qualified. The protocol was approved by the Research Ethics Committee for the province of Granada (CEIM/CEI Provincial of Granada). Volunteers will be included in the study after informed written consent is obtained. The trial has been registered on the ClinicalTrials.gov website, with the registration code NCT04366180. Participants, intervention and outcomes Inclusion criteria Individuals over 20 years of age; active health personnel, including all professional categories such as medicine, nursing and caretaking who attend cases classified as positive or suspicious for COVID-19 in the emergency department, ICU or in the wards designated to care for such patients; and ability to complete the surveys and having signed the informed consent. Exclusion criteria Individuals with a positive test for COVID-19 confirmed by PCR or serology; individuals with concomitant pathology such as HIV, transplantation, active cancer or other active immunosuppression; and women who are pregnant or intend to become pregnant in the subsequent months. Recruitment The recruitment of subjects will take place at the San Cecilio University Clinical Hospital in Granada among health personnel with high exposure to patients with COVID-19. Randomization, allocation and blinding Patients will be randomly allocated to a Control group or Experimental group in a 1:1 ratio by block randomisation method with a block size of four. Subjects and investigators will be blinded to the treatment allocation during the course of the intervention. The blind will be broken after statistical analysis is completed. Capsules of Control and Experimental group will be provided in white containers labelled with the random number. Intervention Participants meeting the inclusion criteria will be randomly assigned to the Control or Experimental group. During the intervention participants will be asked to ingest a capsule per day with some food (preferably with dinner). Follow-up visits will be scheduled at the beginning, midpoint (1 month) and at the end of the intervention period (2 months). At the first visit baseline data (age, sex, lifestyle, medication, concomitant diseases and current symptoms) will be collected. At follow-up visits data about symptoms, medication and adverse effects will be recorded (Table 1). Outcomes measures Primary outcome The main outcome will be the incidence of symptomatic SARS CoV-2 infection confirmed by PCR or serology in health personnel caring for patients with suspected or confirmed COVID-19 at the San Cecilio Clinical University Hospital. Secondary outcomes: Incidence of hospital admissions caused by SARS-CoV-2 infection, incidence of ICU admissions caused by SARS-CoV-2 infection, incidence of pneumonia caused by SARS-CoV-2 infection, incidence of need for oxygen support, incidence of gastrointestinal symptoms, days with body temperature > 37.5°C, days of persistent cough, days of persistent feeling of fatigue, use of pharmacological treatments. Data for mild symptoms will be recorded daily in notebook´s volunteer and, in case of hospitalization, data will be collected by investigators from medical history. Withdrawal, dropout, discontinuation, and compliance. Withdrawal will be allowed at any time during the trial. Investigators may recommend discontinue the trial if in their opinion, staying in the study would be detrimental to the subject's well-being. This decision must be based on the appearance of an adverse effect that will be duly included in the case report form. Volunteers will return the unconsumed capsules. Compliance ≤80% of the total will be considered violation of the protocol and will be considered dropouts. Adverse effects Lactobacillus coryniformis species are included in the QPS list (Qualified Presumption of Safety) published by the European Food Safety Authority (EFSA), which guarantees safety for consumption20. In each visit it will be monitored for adverse effects which will be recorded in the patient's medical history and will be evaluated by the principal investigator. In case of serious adverse event considered related to the experimental product the researcher will inform the Health Authorities and the Clinical Research Ethics Committee involved in the clinical trial. Sample size Given that the current rates of infection among health professionals worldwide are very different, the sample size has been based on the comparison of two independent proportions for the use of the chi-square test. For an alpha of 5%, a power of 80%, taking a percentage of affected individuals in the control group of 15% and 10% as the minimum meaningful difference to be detected, a sample of 157 per branch would be necessary, taking into account a loss of 10% of subjects. Statistical analysis Due to the urgency of the circumstances of the pandemic, the statistical methods have not been fully planned. A Statistical Analysis Plan (SAP) will be prepared during the execution of the study and before the closure of the database. The statistical methods to be used, the strategy to be followed in the case of missing values, and the tables and figures to include in the statistical report will be in detail described. Sample size has been calculated assuming 10% of dropouts. It is not planned the replacement of withdrawal subjects. Analysis by intention to treat (ITT) will be carried out taking into account all data of the recruited volunteers into the study even if they have not completed the intervention. In general, the data will be presented as absolute frequencies and percentages in the case of qualitative variables. For the quantitative variables, central tendency statistics, such as the mean and median, and dispersion statistics, such as the standard deviation and the interquartile range, minimum and maximum values, to indicate the shape of the distribution, shape measures such as coefficients of skewness and kurtosis will be used. In the case of ordinal variables, depending on the number of categories, one form or another of description will be used. In all cases, a column that includes the number of volunteers with available data must be added to the data presentation table. The analyses will be divided by randomization group. To analyse the comparisons between groups, parametric tests (Student's t-test or ANOVA) and nonparametric tests (Mann – Whitney U or Kruskal – Wallis) will be used for continuous variables, according to the characteristics of the study variables (assumption normality), while for the categorical variables, chi square tests or Fisher's exact test will be used. In the case of between-visit comparisons of continuous variables, parametric tests (Student's t test for paired data or RM-ANOVA) and non-parametric tests (Wilcoxon or Friedman) will be used, as appropriate, according to the characteristics of the study variables (assumption of normality) and the number of visits to be compared, while the categorical variables will be compared using the McNemar test. The effect size will be estimated using confidence intervals. The significance level of the statistical tests used will be 0.05. All calculations will be performed with the SPSS statistical software package, version 26. For the analysis of adverse events, a descriptive analysis (frequencies and percentages) will be carried out throughout the study, presenting a list of the adverse events grouped according to severity. These events will be listed by volunteer and randomization group. Adverse events and concomitant medication will be coded using a standardization system. In the case of adverse events, the most current version of the MedDRA system will be used, and for concomitant medication, the ATC code will be used. Data management Collected data will be computerised in the coordinating centre in Granada, Spain. Source documents and databases will be anonymous and locked with a password known only to the scientific staff. These data will be kept for a minimum of 5 years after the end of the study. Dissemination Communications and scientific reports that emerge from this study will be carried out under the responsibility of the principal investigator in agreement with the associated investigators. Publication rules will follow international recommendations.25 The findings will also be shared with national health authorities. Authorship will follow the guidelines established by the International Committee of Medical Journal Editors (http://www.icmje.org/), which require substantive contributions to the design, conduct, interpretation and reporting of a trial. RESULTS COVID-19 is the infectious disease caused by the most recently discovered coronavirus SARS-CoV-2. This new virus and disease were first described during the outbreak began in Wuhan, China, in December 2019. COVID-19 is progressing rapidly throughout the world. The most common symptoms of COVID-19 are fever, dry cough, and tiredness. These symptoms are usually mild and begin gradually. In fact, most people (about 80%) recover from the disease without needing hospital treatment. However, according to World Health Organization, around 1 out of every 5 people who gets COVID-19 becomes seriously ill and develops difficulty breathing. While effective therapies to treat and prevent disease are identified or developed, additional preventive strategies are urgently needed. An article published in March 2020 shows how the immune response to the COVID-19 virus is similar to the response generated by the influenza virus 18. When the immune system works properly, the first barrier to the COVID-19 virus is the innate response. This innate response characterized by interferon and cytokines, which are small proteins responsible for symptoms such as fever, headaches, and muscle pain, has two functions: to slow down the replication and spread of the virus until the specific immune response (which, when it is a virus that has not been previously contacted, takes approximately 2 to 3 weeks) is activated. The specific immune response is what will stop and ultimately eliminate the infection. This specific response also controls the innate response in order to prevent excessive activity from damaging the tissues. When this response works in a correct and coordinated manner, the infection is overcome, showing symptoms more or less similar to flu. However, in an older population suffering from dysfunction of the age-related immune response, called immunosenescence, or in a population in which the response appears to be poorly coordinated, the innate response occurs later or is ineffective, giving the virus time to replicate and spread and delaying the activation of the specific response. Before massive invasion of tissues, the innate response exaggeratedly damages tissues, causing respiratory failure and failure in other organs, such as the kidney. Given this situation, some authors speak of 3 disease states that require different approaches: an asymptomatic state, a second state with non-severe symptoms and a third state with severe respiratory symptoms and a high viral load. During the first two states, the specific immune response is required to eliminate the virus and prevent the disease from progressing to state 3. In this phase, strategies to enhance the immune response are important. However, in state 3, when the immune system has failed and the virus has spread, the damage to the tissues causes the massive inflammatory response; the strategy should be aimed at controlling that inflammation21. Several clinical trials have evidenced the positive effects of certain probiotic strains on prevention of Respiratory Tract Infections. In fact, some authors propose the use of probiotic as an strategy to mitigate the effects of SARS-Co-2 19. Mechanisms which would be involved in a positive effect of probiotic treatments on respiratory virus include enhancement of the intestinal epithelial barrier, competition with pathogens for nutrients and adhesion to the intestinal epithelium, production of anti-microbial substances and modulation of the host immune system19. Lactobacillus coryniformis K8 CECT5711 has immunomodulatory properties that could be useful for COVID-19 management. On the one hand, we have previously discussed its ability to improve the immune response against viral antigens, leading to the production of specific antibodies14,15. On the other hand, the strain has been shown in animal experiments to have anti-inflammatory capacity in models with inflammation22,23. This anti-inflammatory activity would also be of interest in the case of COVID-19, as it could help prevent uncontrolled inflammatory processes from leading to respiratory and other organ failure. CONCLUSIONS The working hypothesis is that the administration of Lactobacillus K8 will stimulate the immune response of people exposed to COVID-19, acting as an adjuvant that contributes to developing an effective response against the virus, and therefore fewer infectious cases are presented due to this virus or, in case of occurrence, the disease is milder among the subjects taking the probiotic strain. The high degree of exposure in health personnel makes them a population at high risk of contracting the virus. If we add to this situation the fact that the stress and physical overexertion caused by the pandemic can affect the immune response, the risk increases even more. The study has been designed to demonstrate if the consumption of this probiotic bacteria might contribute to reducing the level of incidence, or at least the severity of infection, in this population. CLINICALTRIAL The trial has been registered on the ClinicalTrials.gov website, with the identifier number NCT04366180. The protocol was approved by the Research Ethics Committee for the province of Granada (CEIM/CEI Provincial of Granada).

Rare diseases, also known as orphan diseases, are medical conditions that affect a small percentage of the population [...]

This study aimed to examine the influence of new ICTs on the recording of nursing interventions in the Emergency Unit of the High Resolution Hospital (HRH) of Loja (Granada), Spain. A descriptive observational study was conducted to analyze the evolution of the Nursing Interventions (NIC) records in the Emergency Unit of the Loja HRH (Granada) from 2017 to 2021. Results showed that 11,076 NIC registrations were exploited, which increased by 51.2% from 2017 to 2021. The linear correlation between the NIC and the years was analyzed with Spearman’s coefficient, obtaining a low level of correlation (p = 0.166), but one that is statistically significant (p < 0.001). The introduction of tablet devices in the emergency room of the Loja HRH (Granada) led to a significant increase in the percentage of NIC recorded and collated during the study period without increasing the number of emergencies attended. However, usability barriers of ICTs were detected, highlighting the need to guide and train health professionals in their use and in the culture of patient safety.

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.

Pregnancy is a vital event in a woman’s life that involves not only important physical changes, but also psychological changes [...]

In healthcare practice, there may be critically injured patients in whom catheterisation of a peripheral venous access is not possible. In these cases, intraosseous access may be the preferred technique, using an intraosseous vascular access device (IOVA). Such devices can be used for infusion or administration of drugs in the same way as other catheterisations, which improves emergency care times, as it is a procedure that can be performed in seconds to a minute. The aim of this study was to analyse the level of knowledge of nursing staff working in emergency departments regarding the management of the intraosseous vascular access devices. To this end, a cross-sectional online study was carried out using an anonymous questionnaire administered to all professionals working in emergency and critical care units (ECCUs) in Granada district (Spain). The results show that 60% of the participants believe that with the knowledge they have, they would not be able to perform intraosseous vascular access, and 74% of the participants believe that the low use of this device is due to insufficient training. The obtained results suggest that the intraosseous access route, although it is a safe and quick way of achieving venous access in critical situations, is considered a secondary form of access because the knowledge of emergency and critical care professionals is insufficient, given the totality of the participants demanding more training in the management of intraosseous access devices. Therefore, the implementation of theoretical/practical training programmes related to intraosseous access (IO) could promote the continuous training of nurses working in ECCUs, in addition to improving the quality of care in emergency and critical care situations.

Rare diseases are a subject of great scientific and health interest that has been on the rise in recent years [...]

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.

Objective To determine the effect of an aquatic physical exercise program performed during pregnancy on rate of intact perineum after childbirth. Design Randomized clinical trial. Setting Health centers in the metropolitan health district of Granada, Spain. Participants A total of 129 pregnant women (control group [CG] = 64; aquatic exercise group [EG] = 65). Methods The intervention was an aquatic physical exercise program specifically designed for pregnant women (Study of Water Exercise During Pregnancy [SWEP] method). Participants were randomly assigned to the CG or EG by simple random sampling. Participants in the EG performed three sessions per week of physical exercises, which were led by the principal investigator. All participants received routine prenatal care. We evaluated status of the perineum after birth, including laceration and episiotomy rates. We also evaluated participants’ weight, body mass index (BMI) in the first and third trimesters, parity, the administration of anesthesia, and birth weight of the neonate as potential confounding variables. Results The women in the EG had a greater rate of intact perineum than those in the CG (odds ratio [OR] = 13.54, 95% confidence interval [CI] [2.75, 66.56]). After adjusting for infant birth weight, the effect of the intervention on intact perineum was an OR of 8.57 (95% CI [1.85, 39.68]. Maternal weight gain did not influence the odds of intact perineum (OR = 1.072, 95% CI [0.896, 1.283]). Women who previously gave birth and followed the SWEP method had an OR of 10.197 (95% CI [2.190, 47.476] for an intact perineum. The administration of anesthesia and previous pregnancy also were associated with intact perineum (OR = 6.68, 95% CI [1.21, 36.84] and OR = 5.42, 95% CI [1.64, 17.89] respectively. Conclusion The women who followed the SWEP method were significantly more likely to have intact perinea after childbirth.

We thank our medical translator Megan Berry for her services and comments that contributed to improving the manuscript for publication., Cerebral palsy is described as a group of permanent neuromotor-type disorders caused by non-progressive injuries in the developmental stages of the central nervous system, and which have serious repercussions on the quality of life of affected children due to the physical and psychological damage it entails for them. Today, it is the leading cause of physical disability in childhood. Since there is no cure for this disorder, treatment is based on the improvement of symptoms, which is not always achieved through conventional therapies. For this reason, the need arises to investigate other alternative therapies, such as hippotherapy, to determine the main effects of hippotherapy as a rehabilitation therapy in children with cerebral palsy. The review was performed in accordance with the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol and was registered under the number CRD42021233003. The databases used were PubMed, Dialnet and the web browser Google Scholar. After applying the inclusion criteria, we included 11 articles. As a conclusion, we found that hippotherapy provides benefits at physical, psychological, cognitive and social levels in children with cerebral palsy, and thus it should be considered as a complementary rehabilitation therapy to conventional treatments.

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.

BackgroundPracticing physical exercise is a way of maintaining a healthy lifestyle and it has been demonstrated that it benefits and improves quality of life after labour. Aim To determine whether a workout programme using the Low-Pressure Fitness methodology has an impact on the Health-Related Quality of Life after labour.Material and MethodWe carried out a 12-weeks randomized clinical trial. It started at week 16 after labour and ended at postpartum week 28. Women followed a moderate intensity workout programme, using the Low-Pressure Fitness methodology in the treatment group, and we had a control group of sedentary women to perform a comparison. We used the SF-36v2 questionnaire at the postpartum weeks 16 and 28 to assess the Health-Related Quality of Life in women.ResultsWe found statistically significant differences (p

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.

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.

The authors are grateful to all participants and to the TECNOVA company, especially for the assistance of Antonio J. Luna and Jose Caballero. The study was supported by the Educational Innovation Unit of the University of Granada (PI12-158, PI13-159)., Background: Healthcare has been revolutionized by the application of information and communication technologies. The implementation of electronic health record systems improves the quality and safety of patient healthcare. Nursing students who start learning the nursing process without contact with real patients experience difficulties in its correct application. Purpose: To compare the acquisition of skills and competencies in the nursing process by undergraduate nursing students between conventional learning with books and learning with an academic electronic health record system (Diraya). Methods: A controlled experimental study was conducted and included 379 students with a mean age of 20.54 +/- 5.09 years, enrolled in the "Nursing Process and Basic Care" degree course at the School of Health Sciences in Granada. All participants gave their informed consent and were allocated by convenience sampling to a control group (n = 187; 21.20 +/- 5.77 years) or an experimental group (n = 192, 19.91 +/- 4.24 years). Findings: The experimental and control groups did not differ in sex distribution (p = 0.20), mean age (p = 0.01), or previous knowledge of the nursing process (p = 0.96). The groups did not significantly differ in multi-choice test results on the acquisition of theoretical knowledge (p = 0.13). However, the experimental group scored higher on clinical case planning (9.47 +/- 0.80 vs. 8.95 +/- 1.17; p < 0.001), took less time to complete it (46.9 +/- 8.76 min vs. 82.66 +/- 13.14 min; p < 0.001), and needed fewer autonomous learning hours to prepare for the final examination (2.26 +/- 2.41 vs. 9.58 +/- 3.83; p < 0.001). Satisfaction with the program and the rating of its quality were generally higher in the experimental group, while greater difficulty with most phases of the nursing process was reported by the control group. Conclusions: The academic electronic health record system "Diraya" is a useful tool to improve the learning and implementation of the nursing process by undergraduate nursing students., Educational Innovation Unit of the University of Granada PI12-158 PI13-159

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.

Sleep is a physiological state of self-regulation. The international classification of sleep disorders now includes as a new category those occurring during pregnancy. Regular physical activity is known to improve the quality of life, one aspect of which is sleep quality. During pregnancy, physical activity is decreased but should not be eliminated, as studies have reported a high correlation between sleep disorders and the absence of physical activity. Regular physical exercise during pregnancy, whether performed in water or out of it, provides greater control of gestational weight gain. Furthermore, the reduced weight gain during pregnancy, as a result of physical exercise, is associated with greater physical resistance to the demands of childbirth, combats the fatigue caused by pregnancy and reduces back pain. All of these outcomes tend to enhance sleep quality, among other beneficial effects.To determine whether, in pregnant women, there is an association between moderate-intensity physical activity in an aquatic environment and sleep quality.A randomised clinical trial was conducted with a sample of 140 pregnant women aged 21-43 years, divided into two groups; Intervention Group and Control Group. The women were recruited in the twelfth week of gestation and took part in the [Study of] Water Exercise in Pregnancy programme from week 20 to week 37. Sleep quality was evaluated in the first and third trimesters of pregnancy, using the Pittsburgh Sleep Quality Index questionnaire.The Mann-Whitney U test showed that the results obtained were statistically significant (p0.05). In the Intervention Group, 44 of the women (65.67%) were classified as "poor sleepers" versus 62 women (92.54%) in the Control Group.The [Study of] Water Exercise in Pregnancy method improves the quality of sleep in pregnant women, both subjectively and in terms of latency, duration and efficiency.

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.