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This report analyzes the evolution of cancer nursing research in Italy, focusing on 207 publications from nursing journals indexed in MEDLINE. Using Latent Dirichlet Allocation, we identified four primary research topics from the included abstracts: Patient-Centered Care, Clinical Nursing Practice, Healthcare Institutions and Systems, and Research and Data Analysis. The temporal trends reveal a shift from foundational studies on healthcare systems in the late 1990s to more recent emphases on patient-centered care and clinical practice. This progression underscores the growing importance of personalized healthcare approaches. Our findings highlight the need for continued investment in innovative nursing interventions and advanced technologies, such as telehealth, to enhance patient outcomes. Research priorities need to investigate how to tailor nursing interventions to individual patient characteristics, such as their cultural background, lifestyle, and personal values, in the area of clinical nursing practice, which is less represented in the literature thus far. The limited publications regarding clinical nursing practice in the Italian context might reflect the need to strengthen cancer nursing as a specialization in Italy to trigger research and practice that address unmet patient needs. The current analysis provides a foundation for future comprehensive studies and strategic development of a research agenda for cancer nursing research in Italy, led by the Italian Association of Cancer Nursing.
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This study critically examines the public's perception of Florence Nightingale's legacy through a critical discourse analysis (CDA) of digital media, specifically podcasts and YouTube. Nightingale, who is often remembered as "The Lady with the Lamp", holds a complex identity within modern narratives that is celebrated for her pioneering contributions to nursing and public health, even if there are some disagreements about her, given the colonialist setting that may have shaped some of her opinions and decisions. This research employed CDA to analyze 25 podcasts and 18 YouTube videos, which were systematically included according to a priori inclusion criteria. The study synthesized how these media products portray Nightingale and, by extension, shape public discourse about the nursing profession. The findings reveal five thematic representations of Nightingale: as a legendary figure, a modern feminist, a dedicated statistician, a pioneer in public health, and a pivotal STEM contributor. These portrayals challenge traditional nursing stereotypes by emphasizing Nightingale's role as a rigorous scientist and reformer, suggesting broader perceptions of nurses that encompass leadership, analytical skills, and strategic thinking. The study supports the hypothesis that digital narratives significantly influence the public's understanding and appreciation of nursing, advocating for a more nuanced professional identity that integrates traditional caregiving roles with critical and analytical capabilities.
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INTRODUCTION: Given the significance of healthcare decisions in women with BRCA1 and BRCA2 mutations and their impact on patients' lives, this study aims to map the existing literature on decision regret in women with BRCA1 and BRCA2 mutations. METHODS: A scoping review was conducted in the following databases: PubMed, Embase, Scopus, CINAHL, Cochrane, and Google Scholar. Inclusion criteria focused on decision regret in the female population with BRCA1 and/or BRCA2 mutations, with no restrictions on the methodologies of the included studies, but only in the English language. The selection process led to the inclusion of 13 studies. RESULTS: The analysis revealed a significant trend toward decision regret among patients facing complex medical choices. The quality of healthcare communication, decision support, and genetic counselling emerged as key factors influencing patients' perceptions and experiences, with direct implications for their quality of life and psychological well-being. The results suggest that these decisions considerably impact patients, both in terms of clinical outcomes and emotional experiences. DISCUSSION: The investigation highlights the vital importance of a personalized care approach, emphasizing the critical role of managing patients' emotional and psychological complexity. Managing decision regret requires acute attention to individual needs and effective communication to mitigate emotional impact and improve patient outcomes. CONCLUSIONS: Insights from a nursing perspective in the analysis of results indicate the need for informed, empathetic, and integrated care that considers the emotional complexity of women with BRCA1 and/or BRCA2 mutations in their lives and health choices.
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Proteína BRCA1 , Proteína BRCA2 , Neoplasias de la Mama , Toma de Decisiones , Emociones , Mutación , Calidad de Vida , Humanos , Femenino , Proteína BRCA1/genética , Proteína BRCA2/genética , Neoplasias de la Mama/genética , Neoplasias de la Mama/psicología , Asesoramiento Genético/psicología , Asesoramiento Genético/métodos , Genes BRCA1 , Comunicación , Técnicas de Apoyo para la Decisión , Genes BRCA2RESUMEN
Symptom management remains challenging in cancer care. Emerging from nutritional science, nutritional metabolomics has seen exponential growth over recent years, aiming to discern the relationship between dietary habits and health consequences. This protocol aims to present the rationale and methodology for conducting a scoping review to summarize the extent of evidence on synbiotics utilization in cancer symptom management among adults. The scoping review will be undertaken in accordance with the Joanna Briggs Institute (JBI) principles and the research process guided by the PRISMA 2020 scoping reviews extension. The following electronic databases will be searched from the inception: PubMed, Cinahl, Web of Science and Scopus. The authors expect to map the literature regarding the clinical outcomes, including patient-report measures and patient-experience measures, on which the effects of probiotics were tested, and identify potential gaps. This protocol presents a rigorous methodological approach to map the literature on the clinical outcomes that the utilization of synbiotics might improve. This analysis will shape future researchers to examine the efficacy of probiotics on specific clinical outcomes in oncology care. Nurses are uniquely positioned to influence cancer symptom management through the selection and use of appropriate interventions in the field of nutritional supplements, along with nutritional counseling.
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PURPOSE: Main question The aim of this study is to describe and analyze the frequency of acute perioperative (intraoperatively and 30 days after) complications of open/MISS thoracolumbar spine surgery. Secondary questions A) Describe the treatment of choice for every kind of complication mentioned. B) Perform a bibliographic search and compare the complications described and their frequency with those studied in the manuscript. METHODS: A retrospective cohort of 816 patients undergoing spinal surgery over a two year period was analyzed. Acute complications of 59 patients are described whether those with a greater number of levels required longer periods of hospitalization. RESULTS: The frequency of acute complications was 7.2%. The most common was infection (2.7%), followed by dural tear (1.7%), and screw malpositioning (1%), which is consistent with the current literature. No statistically significant results were observed when comparing the mean length of hospital stay among patients operated on a greater number of levels compared to the rest (P: 0.344; 95% CI: -3.88-10.93). CONCLUSIONS: The subsidiary patient of spinal surgery is getting older and has more comorbidities, and therefore, has a higher risk of complications. Although there are models predicting the risk of complications, they are not used in routine clinical practice. It would be necessary to unify the main criteria and establish guidelines for risk detection and therapeutic algorithms based on new high-quality studies.
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Fusión Vertebral , Humanos , Estudios Retrospectivos , Fusión Vertebral/efectos adversos , Fusión Vertebral/métodos , Procedimientos Neuroquirúrgicos/métodos , Descompresión Quirúrgica/métodos , Tiempo de Internación , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Vértebras Lumbares/cirugíaRESUMEN
OBJECTIVES: Psychosocial care is essential in oncology to address specific cancer-related fatigue dimensions. Psychosocial interventions have been defined as nonpharmacologic interventions that address psychological or social factors rather than biological mechanisms and might positively influence symptoms, quality of life, and social functioning. This systematic review of systematic reviews pooled the effects from the recent systematic reviews describing the relationships between psychosocial interventions and fatigue in adult patients with cancer, providing an overall estimate of their effect on cancer-related fatigue. DATA SOURCES: PubMed, CINAHL, Cochrane Database of Systematic Reviews, PEDro, and PsycINFO were searched from 2010 through 2022. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The risk of bias in eligible systematic reviews was assessed using the Cochrane Collaboration's risk of bias tool (ROBIS). PROTOCOL REGISTRATION: Prospero (CRD42020194254). CONCLUSION: Psychosocial interventions are a promising option to reduce cancer-related fatigue, albeit with short-term effects. However, further research is needed to evaluate the efficacy of specific interventions within population clusters and to examine their long-term effectiveness. IMPLICATIONS FOR NURSING PRACTICE: Nurses play a crucial role in promoting psychosocial dimensions in cancer care. This study provides clinicians and researchers with up-to-date information on the efficacy of psychosocial interventions for reducing cancer-related fatigue overcoming the limits of several separate systematic reviews. The results might guide future research and facilitate the translation of the evidence into clinical practice, acknowledging that a gap between the unmet needs of patients with cancer and appropriate health care services still needs addressing.
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Neoplasias , Intervención Psicosocial , Adulto , Humanos , Calidad de Vida , Neoplasias/complicaciones , Neoplasias/psicología , Fatiga/etiología , Fatiga/terapiaRESUMEN
BACKGROUND: Evidence regarding the pharmacological interventions to manage cancer-related fatigue (CRF) is currently synthesized in several systematic reviews, portraying a fragmented literature synthesis. Thus, we aimed to critically appraise the available systematic reviews on pharmacological intervention for improving CRF in adult cancer patients. METHODS: Three databases were systematically searched from January 2010 to July 2020. The pooled meta-analyses' effect sizes (standardized mean difference, SMD) were quantitatively pooled using a random-effects model. Chi-squared (Q) and I-square statistics (I²) tested the heterogeneity. RESULTS: The SMD of the effect of psychostimulants on CRF was -0.20 (95 % CI: -0.32, 0.08; p < 0.0001), along with significant higher improvement of fatigue (SMD=-0.69; 95 % CI=-1.29, -0,09, p < 0.0001) after methylphenidate administration. No statistical differences were found in the occurrences of adverse events between methylphenidate and placebo. CONCLUSIONS: This study corroborated that psychostimulant therapy may be moderately effective in reducing CRF. Scarce evidence on the short- and long-term adverse events. PROSPERO: CRD42020181879 (registration date: 26/07/2020).
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Fatiga , Metilfenidato , Neoplasias , Adulto , Fatiga/tratamiento farmacológico , Fatiga/etiología , Humanos , Metilfenidato/uso terapéutico , Neoplasias/complicaciones , Revisiones Sistemáticas como AsuntoRESUMEN
Introducción: Los valores de la frecuencia cardiaca normales y anormales registrados en los equipos electrocardiográficos ambulatorios o continuos han sido caracterizados mediante nuevas metodologías diagnósticas, las cuales se han desarrollado en el contexto de la teoría de los sistemas dinámicos y la entropía. Objetivo: Evaluar la dinámica cardiaca de adultos, teniendo en cuenta su comportamiento en el contexto de la teoría de sistemas dinámicos y las proporciones de la entropía mediante un estudio ciego. Métodos: Se realizó una prueba diagnóstica mediante un estudio ciego de 500 Holter, aplicando una nueva metodología basada en las proporciones de la entropía del atractor numérico construido con los valores registrados en el Holter. Para esto, los valores máximos y mínimos de la frecuencia cardiaca para cada hora, así como el número de latidos, fueron tomados de cada Holter durante, mínimo, 18 horas. Con estos valores se generó un atractor numérico que cuantificó la probabilidad de parejas de frecuencias cardiacas consecutivas. Se evaluó cada dinámica a partir de los valores de entropía y de sus proporciones. Posteriormente, estos resultados fueron comparados con la evaluación clínica convencional estimando la sensibilidad y especificidad, así como el coeficiente Kappa. Resultados: Se encontraron diferencias entre la dinámica de casos normales y anormales, en las dinámicas cardiacas evaluadas en 18 horas, hallando valores de sensibilidad y especificidad del 100 por ciento y coeficiente Kappa de uno, respecto al diagnóstico clínico convencional. Conclusiones: Los valores de entropía y de sus proporciones permiten diferenciar cuantitativamente la normalidad de la enfermedad en la dinámica cardiaca, durante un mínimo de 18 horas(AU)
Introduction: The normal and abnormal heart rate values recorded on ambulatory or continuous electrocardiographic devices have been characterized with novel diagnostic methodologies developed in the context of dynamic systems and entropy theory. Objective: Through a blind study, evaluate the heart dynamics of adults taking into account their behavior in the context of dynamic systems theory and entropy proportions. Methods: A diagnostic test was conducted through a 500 Holter blind study, applying a novel methodology based on the entropy proportions of the numerical attractor constructed with the values registered on the Holter device. To achieve this end, maximum and minimum heart rate values for each hour, as well as the number of beats, were obtained from each Holter device for at least 18 hours. Based on these values, a numerical attractor was generated which quantified the probability of consecutive heart rate pairs. Each dynamic was evaluated in terms of entropy values and their proportions. These results were then compared with the conventional clinical evaluation, estimating the sensitivity and specificity as well as the kappa coefficient. Results: Differences were found between the dynamics of normal and abnormal cases, in the heart dynamics evaluated in 18 hours, finding sensitivity and specificity values of 100 percent and a kappa coefficient of 1, with respect to conventional clinical diagnosis. Conclusions: Entropy values and their proportions make it possible to quantitatively differentiate the normality of the disease in heart dynamics for a minimum of 18 hours(AU)
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Humanos , Conducta , Diagnóstico Clínico , Equipos y Suministros , Identidad de Género , Corazón , Frecuencia Cardíaca/fisiología , Pruebas Diagnósticas de RutinaRESUMEN
INTRODUCTION: The Lights4Violence project was created to promote healthy relationships among adolescents using a school intervention in which participants developed video-capsules where they highlighted skills to resolve situations of dating violence. This study aims to assess the results of the Lights4Violence training program by identifying different types of violence and positive development assets that Spanish adolescents use in their video-capsule scripts. METHODS: A thematic analysis of the Lights4Violence video capsules was carried out. Open coding was used to identify violence patterns. A deductive analysis was used to identify student assets using the "Positive Youth Development Model". FINDINGS: Adolescents describe different patterns of violence, such as psychological violence, sexist violence or verbal violence that is present on the scripts. However, they showed themselves capable of resolving these situations using language and personal empowerment skills as resources. Family, friends and community were identified in adolescents' scenarios as the most frequent assets to address situations of conflict. CONCLUSION: Adolescents can promote healthy relationships using protective factors against violence. Interventions that use this approach can potentially be useful in preventing violence.
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Conducta del Adolescente , Violencia de Pareja , Violencia , Adolescente , Humanos , Factores Protectores , EspañaRESUMEN
Metastatic pheochromocytoma and paraganglioma (mPHEO/PGL) are frequently associated with succinate dehydrogenase B (SDHB) mutations. Cyclophosphamide-dacarbazine-vincristine (CVD) regimen is recommended as standard chemotherapy for advanced mPHEO/PGL. There is limited evidence to support the role of metronomic schemes (MS) of chemotherapy in mPHEO/PGL treatment. We report 2 patients with SDHB-related mPGL who received a regimen consisting of MS temozolomide (TMZ) and high-dose lanreotide after progression on both CVD chemotherapy and high-dose lanreotide. Molecular profiling of the tumor tissue from both patients revealed hypermethylation of the O6-methylguanine-DNA-methyltransferase (MGMT) promoter. In one patient, progression-free survival was 13 months and the second patient remained under treatment after 27 months of stabilization of metabolic response of his disease. Treatment was well tolerated, and adverse effects were virtually absent. A modification in the scheme of TMZ from standard schemes to MS is safe and feasible and can be considered in patients with progressive mPHEO/PGL refractory to dacarbazine in standard doses.
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Introducción El presente artículo hace una revisión sobre los hallazgos radiológicos mediante radiografía simple, así como también los hallazgos clínicos en el diagnóstico de la osteopetrosis una enfermedad poco común que afecta el desarrollo normal óseo, se trata de un caso clínico reportado en el Hospital Pediátrico Baca Ortiz de la Ciudad de Quito. Reporte de Caso: Nos apoyamos en la presentación de un caso clínico de una paciente que acude por consulta externa con cuadro de fatiga y decaimiento de 2 años de evolución, se realizan exámenes complementarios demostrando presencia de anemia así como los hallazgos característicos de osteopetrosis por imagen posteriormente detallados. Conclusiones: La osteopetrosis es una enfermedad poco común, compleja y por lo menos con cuatro subtipos que difieren en la forma de herencia o de las manifestaciones adicionales asociadas, sin embargo todas se caracterizan por presentarse clínicamente con fatiga debido a anemia crónica, puede presentar o no hepatoesplenomegalia, conjuntamente asociadas siempre a osteoesclerosis difusa con ensanchamiento óseo, fracturas patológicas.
Introduction This article reviews the radiological findings by simple radiography as well as the clinical findings in the diagnosis of osteopetrosis, a rare disease that affects normal bone development. This is a case report reported in the Hospital Pediátrico Baca Ortiz at Quito City. Case Report: We rely on the presentation of a clinical case of a patient who goes by external consultation with fatigue and decay of 2 years of evolution, complementary tests are performed demonstrating the presence of anemia as well as the characteristic findings of osteopetrosis by image later detailed. Conclusions: Osteopetrosis is an uncommon, complex disease and with at least four subtypes that differ in the form of inheritance or associated additional manifestations, however all are characterized by presenting clinically with fatigue due to chronic anemia, may present or not hepatosplenomegaly, Always associated with diffuse osteosclerosis with bone spreading, pathological fractures.
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Humanos , Femenino , Preescolar , Osteopetrosis , Radiología , Anemia , Ecuador , FatigaRESUMEN
Cervical spine injury is rare in children. It is seen primarily in those who sustain significant, severe blunt trauma, occurring in 1 to 2 percent of such cases. The interpretation of cervical spine radiographs and the clinical examination in children may be difficult.The objective of this case clinic is to report on a physiological radiographic finding of the cervical spine in childhood that trends to be misjudged as pathologic: C2-C3 pseudosubluxation. We presented a boy, aged 5 years, who came to our Traumatic pediatric emergency center for cervical pain after falling from a height. In lateral radiographs we observed a disruption of the alignment of the anterior and posterior vertebral body line in C2-C3 space. A detailed anamnesis as well as a meticulous radiological and clinical exploration, allow to establish the right diagnosis in most cases, without any other complementary probe. Pseudosubluxation of C2 anterior to C3 is seen in approximately 40 percent of children under the age of 8 years. Pseudosubluxation can be differentiated from true subluxation by evaluating the spinolaminal line (Swischuk), line between the anterior aspects of the C1 and C3 spinous processes. The suitable radiographic interpretation of the cervical spine in children requires the knowledge of the peculiarities of this segment in the pediatric age.
Las lesiones traumáticas de la columna cervical son infrecuentes en los niños, representando el 1% de las fracturas pediátricas y el 2% de todas las lesiones raquídeas.Es importante conocer que la columna cervical en la infancia presenta variaciones anatómicas que en ocasiones pueden interpretarse como patológicas ya que en los niños una adecuada exploración física muchas veces puede ser complicada.El objetivo de este caso clínico es mostrar un hallazgo radiológico fisiológico de la columna cervical infantil que tiende a ser malinterpretado como patológico: la pseudosubluxación C2-C3.Se presenta un caso de un niño de 5 años de edad que acude a urgencias de traumatología pediátrica de nuestro centro por dolor cervical tras caída desde un tobogán. Se realizan radiografías cervicales de urgencias observando una disrupción de la línea cervical anterior y posterior entre C2 y C3. Una adecuada anamnesis junto con un meticuloso examen clínico y radiológico permite su correcto diagnostico sin necesidad de otras pruebas complementarias. La pseudoluxación anterior de C2 sobre C3 se puede estar presente en el 40% de los niños menores de 8 años. Este hallazgo puede diferenciarse de la luxación traumatic valorando la línea espinolaminar o línea de Swischuk, línea entre el borde anterior de las apófisis espinosas de C1 a C3. La interpretación adecuada de las radiografías de la columna cervical en la infancia requiere del conocimiento de estas variantes radiológicas y de las peculiares características de este segmento vertebral en la edad pediátrica.
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Vértebras Cervicales/diagnóstico por imagen , Luxaciones Articulares/diagnóstico por imagen , Traumatismos de la Médula Espinal/diagnóstico por imagen , Vértebra Cervical Axis/diagnóstico por imagen , Vértebra Cervical Axis/lesiones , Vértebras Cervicales/lesiones , Preescolar , Humanos , Masculino , RadiografíaRESUMEN
PURPOSE: The purpose of this study was to analyze the prognostic factors that influence postrelapse survival (PRS) in children and adolescents with initial localized high-grade osteosarcoma. METHODS/PATIENTS: This is a retrospective evaluation of patients aged 21 years and below with nonmetastatic high-grade osteosarcoma treated at our institution from 1985 to 2011 who developed recurrent disease after achievement of an initial complete response (CR). PRS and postrelapse event-free survival (PREFS) analyses were performed using the Kaplan-Meier method and log-rank test. Multivariate Cox regression analysis was used to determine which variables were independently prognostic. RESULTS: Thirty-one patients were included. Median age at primary diagnosis was 13.7 years (range, 1.9 to 21.0 y). Median time to first relapse was 16 months (range, 3 to 36 mo). Fourteen patients achieved a second CR (CR2) after surgery±chemotherapy treatment. The 5-year PRS and PREFS were both 26% (95% confidence interval, 14%-49%), with a median follow-up of 99 months (range, 27 to 271 mo). Multivariate analysis showed that achievement of CR2 (P<0.001) and histologic response to first-line treatment (P=0.02) were significantly associated with PRS, whereas time to first relapse did not retain univariate significance. CONCLUSIONS: Achievement of CR2 and histologic response to preoperative first-line treatment are independent survival prognostic factors in osteosarcoma recurrence.
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Neoplasias Óseas/patología , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/patología , Osteosarcoma/patología , Adolescente , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Óseas/mortalidad , Neoplasias Óseas/terapia , Quimioterapia Adyuvante/métodos , Niño , Preescolar , Supervivencia sin Enfermedad , Femenino , Humanos , Lactante , Estimación de Kaplan-Meier , Masculino , Osteosarcoma/mortalidad , Osteosarcoma/terapia , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Adulto JovenRESUMEN
This study aimed to describe the residential use of insecticides in a birth cohort in Spain. Study subjects were 2,456 women enrolled into the INMA (Environment and Childhood) birth cohort followed prospectively during pregnancy and in the early postnatal period. The women were recruited at the beginning of their pregnancy between 2003 and 2008 in four regions of Spain. Socio-demographic, environmental and lifestyle information was obtained at two interviews during pregnancy, one at the first (mean:13.8±2.6 weeks of gestation) and the other at the third trimester (mean: 33.3±2.3 weeks of gestation). Information about prenatal use of indoor and outdoor insecticides (type, timing, place of application, place of storage) was obtained from the second interview. In a 3rd interview (mean: 16.2±6.9 months of age of children), information about postnatal indoor and outdoor insecticide use was obtained. Regression models examined the association between demographic and lifestyle factors and pesticide use to determine which characteristics predicted use prenatally and postnatally. Fifty-four percent of women reported using indoor insecticides during pregnancy, 45% in their bedroom and 47% elsewhere in the house. Plug-in devices were the most frequent application methods used in the pregnant woman's bedroom and insecticide sprays elsewhere in the house. The maternal factors related to prenatal use of indoor insecticides were parity, country of birth, educational level, region of residence, having a garden or yard with plants, and living near an agricultural area. These products continued to be used postnatally, although 20% of the women stopped using them. Foetuses and children are especially vulnerable to pesticide exposure; thus knowing how pesticides are used during pregnancy and infancy may be a starting point for the study of their potential effects on health as well as useful for designing preventive actions.
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Insecticidas/toxicidad , Adulto , Exposición a Riesgos Ambientales/análisis , Femenino , Humanos , Estilo de Vida , Estudios Longitudinales , Exposición Materna , Embarazo , Análisis de Regresión , Factores Socioeconómicos , EspañaRESUMEN
We examined the relationship between dietary folate intake and periconceptional use of folic acid (FA) supplements, and small-for-gestational age for weight (SGA-W) and height (SGA-H). The study is based on 786 Spanish women aged 16 years or above, who attended the first-term prenatal population-based screening programme (10-13 weeks) at the reference hospital 'La Fe', Valencia, with singleton pregnancy. Periconceptional use of FA supplements was categorised as non-users, moderate users ( ≤ 1 mg/d) and high users (>1 mg/d). Babies born to mothers who used high doses of FA supplements had a significant reduction in mean birth height compared with babies of non-users (ß = - 0·53, 95 % CI - 0·96, - 0·09). As regards weight, mothers using moderate and high doses of FA supplements had lower-birth-weight babies for gestational age than non-users (ß = - 22·96, 95 % CI - 101·14, 55·23; ß = - 89·72, 95 % CI - 188·64, 9·21, respectively), although these decreases were not significant. Results from the multivariate logistic regression models showed that high FA supplement users had a higher significant risk for SGA-H (OR 5·33, 95 % CI 2·08, 13·7), and that users of moderate doses were not associated with a higher risk of either a SGA-W or a SGA-H baby. In contrast, increased quintiles of the dietary intake of folate were associated with a decreased risk of SGA-W (P for trend = 0·002), although no association was observed for SGA-H. Our findings suggest that periconceptional use of FA supplements greater than 1 mg/d is associated with decreased birth height and may entail a risk of decreased birth weight.
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Ácido Fólico/administración & dosificación , Ácido Fólico/farmacología , Antropometría , Peso al Nacer , Estudios de Cohortes , Suplementos Dietéticos , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Recién Nacido , Fenómenos Fisiologicos Nutricionales Maternos , Embarazo , EspañaRESUMEN
Persistent organic pollutants (POPs) comprise a large variety of toxic substances with ample distribution. While exposure to these toxins occurs mainly through diet, maternal POP levels may be influenced by certain sociodemographic, environmental, or lifestyle factors. This is important given that these substances may have adverse effects on fetal development. The aim of this study is to examine the sociodemographic, environmental, lifestyle, and dietary determinants of the levels of hexachlorobenzene (HCB), b-hexachlorocyclohexane (b-HCH), 1,1,1-trichloro-2,2-bis(4-chlorophenyl)ethane (4,4'-DDT), 1,1-dichloro-2,2-bis(4-chlorophenyl)ethylene (4,4'-DDE), and polychlorinated biphenyls (PCB congeners 118, 138, 153, 180) measured in the blood of pregnant women participating in a mother-child cohort study conducted in Valencia (Spain). The study population consisted of 541 pregnant women who formed part of the INMA (Childhood and the Environment) cohort (2004-2006). POP levels were determined in blood taken during the 12th week of pregnancy with the aid of gas chromatography with electron capture detection. Sociodemographic, environmental, and dietary information was obtained from a questionnaire. Multivariate Tobit regression models were constructed in order to assess the association between POP levels and selected covariates. The results showed that all the women had detectable levels of at least one of these compounds while in 43% of the subjects, all eight compounds were detected. The compounds found in the greatest number of women were 4,4'-DDE (100%) and PCBs 153 and 180 (95%). The most important determinants of high POP levels were the mother's age, country of origin, increased body mass index, and number of weeks of breastfeeding after previous pregnancies. With regard to diet, 4,4'-DDT and 4,4'-DDE levels increased with the intake of meat, fruit, and cereal. PCB 153 levels increased with the intake of seafood. The levels of HCB, b-HCH, 4,4'-DDT, and 4,4'-DDE observed in this study were slightly higher than in other studies, whereas the PCB levels were similar.
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Contaminantes Ambientales/sangre , Hidrocarburos Clorados/sangre , Exposición Materna/estadística & datos numéricos , Embarazo/sangre , Adulto , DDT/sangre , Diclorodifenil Dicloroetileno/sangre , Femenino , Hexaclorobenceno/sangre , Hexaclorociclohexano/sangre , Humanos , EspañaRESUMEN
BACKGROUND: Maternal diet has been associated with fetal growth outcomes; however, evidence is scarce on the role of dietary quality. OBJECTIVE: The objective was to assess the effect of diet quality during the first trimester of pregnancy, as measured by the Alternate Healthy Eating Index (AHEI) adapted for pregnancy, on fetal growth. DESIGN: We studied 787 women and their newborns from a Spanish cohort study. Diet quality was assessed by using a modification of the AHEI. Adjusted birth weight, birth length, and head circumference were used as continuous outcomes. We used a customized model to define fetal growth restriction in weight, length, and head circumference. RESULTS: After adjustment of multivariate models, a positive association was observed between diet quality and adjusted birth weight and adjusted birth length. The greatest differences were found between the fourth and first quintiles of the AHEI. Newborns of women in the fourth quintile were on average 126.3 g (95% CI: 38.5, 213.9 g) heavier and 0.47 cm (95% CI: 0.08, 0.86 cm) longer than those in the lowest quintile (P for trend = 0.009 and 0.013, respectively). Women with the highest AHEI scores had a significantly lower risk of delivering a fetal growth-restricted infant for weight (odds ratio: 0.24; 95% CI: 0.10, 0.55; P for trend = 0.001) than did women in the lowest quintile, but this was not the case for fetal growth restriction in length (P for trend = 0.538) or head circumference (P for trend = 0.070). CONCLUSION: A high-quality diet in the first trimester of pregnancy is associated with birth size and the risk of fetal growth restriction.
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Peso al Nacer/fisiología , Dieta/normas , Desarrollo Fetal/fisiología , Primer Trimestre del Embarazo/fisiología , Fenómenos Fisiologicos de la Nutrición Prenatal/fisiología , Adulto , Estudios de Cohortes , Femenino , Cabeza/fisiología , Humanos , Recién Nacido , Masculino , Embarazo , Análisis de Regresión , Factores Socioeconómicos , España , Encuestas y Cuestionarios , Adulto JovenRESUMEN
STUDY DESIGN: : Case report. OBJECTIVE: : To describe a case of septic arthritis of the facet joint in an infant. SUMMARY OF BACKGROUND DATA: : To our knowledge, no more than 50 cases of septic arthritis of a facet joint are reported in literature, including only 4 cases in children and none in infants. METHODS: : A girl of age 18 months presented with a fever pattern of 4 days evolution, right lumbar paravertebral tumefaction with local inflammatory signs and limping related to pain with weight-bearing on the right lower extremity. The mother reported a pharyngeal infection 2 weeks earlier.Conventional radiology showed no alterations. MR and scintigraphy with radioactivity-marked leukocytes showed affectation only of the posterior facet joint of right L4-L5, without associated collections. Blood and urine cultures were negative. The diagnosis was established as right L4-L5 septic arthritis of a lumbar facet joint, probably of hematogenous origin. RESULTS: : The fever pattern and the limp disappeared in 24 hours with wide-spectrum empirical intravenous antibiotherapy. Although no microorganism was isolated, the good response to the empirical treatment and the background of pharyngeal infection point to a hematogenous dissemination by Staphylococcus aureus or Streptococcus spp. CONCLUSION: : Septic arthritis of a facet joint does not differ clinically from other spinal infections and its incidence is possibly underestimated in favor of other more common entities. Only imaging techniques can differentiate the affected structures and establish the exact diagnosis.MR allows the detection in initial stages, delimits the affectation and extension through the soft tissues, and rules out other more common entities such as discitis. Scintigraphy and SPECT can detect other active foci and be useful in the follow-up.The result achieved with antibiotic treatment in early stages is usually satisfactory. Surgical debridement is only necessary when associated purulent collections appear. From the pediatric point of view, spinal infections should also be taken into consideration within the differential diagnostic of limp in children.
Asunto(s)
Artritis Infecciosa/diagnóstico , Vértebras Lumbares , Articulación Cigapofisaria/patología , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Artritis Infecciosa/tratamiento farmacológico , Artritis Infecciosa/microbiología , Femenino , Humanos , Lactante , Infecciones Estafilocócicas/diagnóstico , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/tratamiento farmacológico , Resultado del TratamientoRESUMEN
INTRODUCTION: Several epidemiological studies have reported that some organochlorine compounds (OCs), such as polychlorobiphenyls (PCBs) and 1,1-dichloro-2,2-bis(4-chlorophenyl)ethylene (4,4'-DDE), may alter thyroid function. OBJECTIVE: The aim of the present study was to investigate the association of maternal serum OC concentrations of 4,4'-DDE and the sum of seven PCB congeners (PCB 28, 52, 101, 118, 138, 153, and 180) with thyroid hormone (TH) status. METHODS: We measured OC concentrations in 157 maternal serum samples at 12 weeks of pregnancy in a cohort from Valencia (Spain). Thyroid-stimulating hormone (TSH), total triiodothyronine (TT3), and free thyroxine (FT4) were measured as biomarkers of thyroid function in the same samples. Linear and logistic regression analyses were performed between OCs and TH levels, and variables were log transformed. RESULTS: Mothers with higher levels of 4,4'-DDE had higher odds of having TSH levels >2.5 mIU/L (OR=2.53; 95% CI=1.36; 4.73; p=0.004), and we found a significant negative association between serum 4,4'-DDE concentrations and FT4 levels (beta=-0.03; 95% CI=-0.05; 0.00; p=0.050) after adjustment for covariates and total lipids. No association was found between sum of PCBs and TH levels. CONCLUSION: Serum concentrations of 4,4'-DDE were associated with increased TSH and reduced FT4 but not TT3 levels. Our results suggest that some environmental chemicals may interfere with the thyroid system of pregnant women. The major role that maternal THs may play in fetal neurodevelopment makes these findings especially relevant.
Asunto(s)
Diclorodifenil Dicloroetileno/sangre , Desarrollo Fetal/efectos de los fármacos , Bifenilos Policlorados/sangre , Efectos Tardíos de la Exposición Prenatal/sangre , Glándula Tiroides/efectos de los fármacos , Hormonas Tiroideas/sangre , Adolescente , Adulto , Biomarcadores/sangre , Estudios de Cohortes , Diclorodifenil Dicloroetileno/efectos adversos , Femenino , Desarrollo Fetal/fisiología , Humanos , Insecticidas/efectos adversos , Insecticidas/sangre , Modelos Lineales , Modelos Logísticos , Exposición Materna/efectos adversos , Oportunidad Relativa , Bifenilos Policlorados/efectos adversos , Embarazo , Primer Trimestre del Embarazo/sangre , Efectos Tardíos de la Exposición Prenatal/epidemiología , España/epidemiología , Glándula Tiroides/fisiopatología , Hormonas Tiroideas/fisiología , Tirotropina/sangre , Tiroxina/sangre , Triyodotironina/sangre , Adulto JovenRESUMEN
We examined the relationship between consumption of fruit and vegetables during pregnancy and anthropometric measures at birth in a general population mother-infant cohort in Valencia, Spain. A total of 787 infants born between May 2004 and February 2006 were included. Fruit and vegetable consumption during pregnancy was assessed by a FFQ administered using an in-person interview. We used multiple linear regression to assess associations between fruit and vegetable intake (in quintiles) and birth weight and length adjusted for sex and gestational age, and logistic regression to assess being small for gestational age (SGA) in weight and SGA in length, defined as adjusted birth weight or length below the 10th percentile. A linear relationship was found between vegetable consumption and having a SGA (weight) and SGA (length) baby. Women in the lowest quintile of vegetable intake during the first trimester had a higher odds of having a SGA (weight) baby than women in the highest quintile [odds ratio (OR), 3.7; 95% CI: 1.5-8.9; P-trend < 0.001] and had a higher odds of having an SGA (length) baby in the third trimester (OR, 5.5; 95% CI: 1.7-17.7; P-trend = 0.04) in multivariate analysis. We found a nonmonotonic relationship between adjusted birth weight and length and vegetable consumption during the first trimester; newborns in the 2 lowest quintiles of intake had a significantly lower weight and length than those in the 4th quintile. There was no association between fruit consumption and birth outcomes. Our findings indicate that vegetable consumption throughout pregnancy may have a beneficial effect on fetal growth.