scholarly journals Human Milk Concentrations of Minerals, Essential and Toxic Trace Elements and Association with Selective Medical, Social, Demographic and Environmental Factors

Nutrients ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1885
Author(s):  
Natalia Mandiá ◽  
Pilar Bermejo-Barrera ◽  
Paloma Herbello ◽  
Olalla López-Suárez ◽  
Jose M. Fraga ◽  
...  
Keyword(s):  
Trace Elements ◽  
Human Milk ◽  
Case Series ◽  
Full Term ◽  
Nutritional Deficiencies ◽  
Cross Sectional ◽  
Toxic Trace Elements ◽  
Case Series Study ◽  
Increased Risk ◽  
First Time

This study aims to quantify concentrations of minerals and trace elements in human milk (HM) and infant formula (IF) and evaluate associations with medical, social, environmental, and demographic variables. A prospective, case series study of 170 nursing mothers was made. HM samples were obtained from full-term (colostrum, intermediate and mature HM) and preterm (mature HM) mothers. Variables of interest were assessed by a questionnaire. For comparison, IF samples (n = 30) were analyzed in a cross-sectional study. Concentrations of 35 minerals, essential and toxic trace elements were quantified, 5 for the first time: thallium in HM and IF; strontium in preterm HM; and gallium, lithium and uranium in IF. In preterm and full-term HM, levels of selenium (p < 0.001) were significantly lower than recommended and were associated with low birth weight (p < 0.002). Cesium and strontium concentrations were significantly higher than recommended (p < 0.001). Associations were observed between arsenic and residence in an urban area (p = 0.013), and between lead and smoking (p = 0.024) and well-water consumption (p = 0.046). In IF, aluminum, vanadium, and uranium levels were higher than in HM (p < 0.001); uranium, quantified for the first time, was 100 times higher in all types of IF than in HM. Our results indicate that concentrations of most trace elements were within internationally accepted ranges for HM and IF. However, preterm infants are at increased risk of nutritional deficiencies and toxicity. IF manufacturers should reduce the content of toxic trace elements.

scholarly journals Exposure therapy for PTSD during pregnancy: a feasibility, acceptability, and case series study of Narrative Exposure Therapy (NET)

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Natalie R. Stevens ◽  
Michelle L. Miller ◽  
Christina Soibatian ◽  
Caitlin Otwell ◽  
Anne K. Rufa ◽  
...  
Keyword(s):  
Mental Health Treatment ◽  
Exposure Therapy ◽  
Case Series ◽  
Perinatal Outcomes ◽  
Post Treatment ◽  
Depression Symptoms ◽  
Narrative Exposure Therapy ◽  
Ptsd Treatment ◽  
Case Series Study ◽  
Increased Risk

Abstract Background Prenatal posttraumatic stress disorder (PTSD) is a significant complication of pregnancy linked to increased risk of adverse perinatal outcomes. Although 1 in 5 pregnant trauma-exposed individuals have PTSD, most PTSD treatment trials exclude participants who are pregnant, and none focus on treatment specifically during pregnancy. Moreover, access to mental health treatment is particularly challenging in low-resource settings with high rates of trauma. This study examined implementation of Narrative Exposure Therapy (NET), a short-term evidence-based PTSD treatment, in an urban prenatal care setting. Partial telehealth delivery was used to increase accessibility. Study aims were to examine (a) feasibility, (b) acceptability, and (c) case-based treatment outcomes associated with NET participation. Method Eight pregnant participants (median age = 27, median gestational week in pregnancy = 22.5) received up to six sessions of NET with partial telehealth delivery. PTSD and depression symptoms were assessed at pre-treatment intake (T1), at each session (T2), and 1-week post-treatment (T3). A multiple case study approach was used to examine recruitment and engagement, retention, treatment completion, treatment barriers, use of telehealth, participants’ experiences of treatment, and PTSD and depression symptoms. Results Nine of the 16 participants (56%) who were invited to participate engaged in treatment, and one dropped out after the first session. Eight participants completed the minimum “dose” of 4 NET sessions (N = 8/9, 89%). Seven participants gave the highest ratings of treatment acceptability. The most frequently reported barriers to treatment were competing priorities of work and caring for other children. Pre-post treatment symptom measures revealed clinically meaningful change in PTSD severity for nearly all participants (7/8, 88%). Conclusions Results suggest that a brief exposure therapy PTSD treatment can be successfully implemented during pregnancy, suggesting promising results for conducting a larger-scale investigation. Trial registration ClinicalTrials.gov, NCT04525469. Registered 20 August 2020–Retrospectively registered, https://register.clinicaltrials.gov/prs/app/template/EditRecord.vm?epmode=View&listmode=Edit&uid=U00058T2&ts=3&sid=S000A59A&cx=-w1vnvn

scholarly journals Who are dying and why? A case series study of maternal deaths in Nepal

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e042840
Author(s):  
Rajendra Karkee ◽  
Kirti Man Tumbahangphe ◽  
Nashna Maharjan ◽  
Bharat Budhathoki ◽  
Dharma Manandhar
Keyword(s):  
Case Series ◽  
Public Hospitals ◽  
Birth Preparedness ◽  
Framework Analysis ◽  
Cross Sectional ◽  
Maternal Deaths ◽  
Social Autopsy ◽  
Case Series Study ◽  
Referral Hospitals ◽  
Series Study

ObjectivesTo identify delays and associated factors for maternal deaths in Nepal.DesignA cross-sectional case series study of maternal deaths. An integrated verbal and social autopsy tool was used to collect quantitative and qualitative information regarding three delays. We recorded death accounts and conducted social autopsy by means of community Focus Group Discussions for each maternal death; and analysed data by framework analysis.SettingSixty-two maternal deaths in six districts in three provinces of Nepal.ResultsNearly half of the deceased women (45.2%) were primiparous and one-third had no formal education. About 40% were from Terai/Madhesi and 30.6% from lower caste. The most common place of death was private hospitals (41.9%), followed by public hospitals (29.1%). Nearly three-fourth cases were referred to higher health facilities and median time (IQR) of stay at the lower health facility was 120 (60–180) hours. Nearly half of deaths (43.5%) were attributable to more than one delay while first and third delay each contributed equally (25.8%). Lack of perceived need; perceived cost and low status; traditional beliefs and practices; physically inaccessible facilities and lack of service readiness and quality care were important factors in maternal deaths.ConclusionsThe first and third delays were the equal contributors of maternal deaths. Interventions related to birth preparedness, economic support and family planning need to be focused on poor and marginalised communities. Community management of quick transportation, early diagnosis of pregnancy risks, accommodation facilities near the referral hospitals and dedicated skilled manpower with adequate medicines, equipment and blood supplies in referral hospitals are needed for further reduction of maternal deaths in Nepal.

Trace Element Deficiency and Cot Deaths

1981 ◽  
Vol 21 (1) ◽  
pp. 41-46 ◽  
Author(s):  
R. M. Raie ◽  
H. Smith
Keyword(s):  
Trace Elements ◽  
Human Milk ◽  
Trace Element ◽  
Normal Adult ◽  
Toxic Trace Elements ◽  
Essential Trace Elements ◽  
Trace Element Deficiency

The level of 10 trace elements (As, Br, Co, Cu, Fe, Hg, Mg, Mn, Se, Zn) in infant tissues (5 cot deaths, 4 other causes) are presented. These levels are compared with the normal adult levels for the same area or with the levels presented in the literature. The concentrations of 5 trace elements (As, Cu, Hg, Mn, Se) in human milk and 4 brands of artificial milks are also given and the intake of these trace elements from human and artificial milk for infants up to the age of 6 months is calculated. It is concluded that some artificial milks contain less of some essential trace elements (e.g. Cu and Se) and are richer in toxic trace elements (e.g. Hg and As). The suggestion of deficiency of the reported trace elements as a cause of cot deaths is rejected.

scholarly journals Robust association between autistic traits and psychotic-like experiences in the adult general population: epidemiological study from the 2007 Adult Psychiatric Morbidity Survey and replication with the 2014 APMS

2020 ◽  
pp. 1-7
Author(s):  
Anton P. Martinez ◽  
Sophie Wickham ◽  
Georgina Rowse ◽  
Elizabeth Milne ◽  
Richard P. Bentall
Keyword(s):  
General Population ◽  
Psychiatric Morbidity ◽  
Autistic Traits ◽  
Cross Sectional ◽  
Increased Risk ◽  
Dependent Variables ◽  
Independent Variable ◽  
Logistic Regressions ◽  
Specific Symptoms ◽  
First Time

Abstract Background Studies have shown that there are overlapping traits and symptoms between autism and psychosis but no study to date has addressed this association from an epidemiological approach in the adult general population. Furthermore, it is not clear whether autistic traits are associated with specific symptoms of psychosis or with psychosis in general. We assess these associations for the first time by using the Adult Psychiatric Morbidity Survey (APMS) 2007 and the APMS 2014, predicting an association between autistic traits and probable psychosis, and specific associations between autistic traits and paranoia and strange experiences. Methods Participants (N = 7353 in 2007 and 7500 in 2014) completed the Psychosis Screening Questionnaire (PSQ) and a 20-item version of the Autism Quotient (AQ-20). Binomial logistic regressions were performed using AQ-20 as the independent variable and probable psychosis and specific symptoms as dependent variables. Results In the APMS 2007 dataset, significant associations were found between autism traits and probable psychosis, paranoia, thought insertion, and strange experiences. These results were replicated in APMS 2014 but with the additional significant association between autistic traits and hallucinations. Participants in the highest quartile of the AQ-20, compared with the lowest quartile, had an increased risk of probable psychosis of odds ratio (OR) = 15.5 [95% confidence interval (CI) 4.57–52.6] in APMS 2007 and OR = 22.5 (95% CI 7.64–66.3) in APMS 2014. Conclusions Autistic traits are strongly associated with probable psychosis and psychotic experiences with the exception of mania. Limitations such as the cross-sectional nature of the study are discussed.

scholarly journals An Increased Risk of Stunting among Newborns in Poorer Rural Settings: A Cross-Sectional Pilot Study among Pregnant Women at Selected Sites in Rural Cambodia

2019 ◽  
Vol 16 (21) ◽  
pp. 4170 ◽  
Author(s):  
Margit Steinholt ◽  
Sam Ha ◽  
Chandy Houy ◽  
Jon Odland ◽  
Maria Odland
Keyword(s):  
Pregnant Women ◽  
Study Groups ◽  
Toxic Substances ◽  
Cross Sectional ◽  
Toxic Trace Elements ◽  
Future Studies ◽  
Increased Risk ◽  
Rural Settings ◽  
Blood And Urine Samples ◽  
Study Sites

We conducted an observational study of 194 pregnant women from two different study sites in rural Cambodia. Socioeconomic and anthropometric data was obtained from the women and their newborns. In addition, we collected blood and urine samples from the women for further analyses in planned papers. There were significant differences between the two study groups for clinical outcomes. The mothers from the poorer area were shorter and weighed less at the time of inclusion. Their babies had significantly smaller head circumferences and a lower ponderal index. Conclusion: There are significant anthropometric differences between women and their newborns from two separate study sites in Cambodia. Possible associations between stunting and exposure to Persistent Toxic Substances (PTS) as organochlorines and toxic trace elements will be investigated in future studies.

The 90-day Readmission Rate after Single-Bundle ACL Reconstruction Plus LET: Analysis of 2,559 Consecutive Cases from a Single Institution

2020 ◽  
Author(s):  
Alberto Grassi ◽  
Giuseppe Gianluca Costa ◽  
Sergio Cialdella ◽  
Mirco Lo Presti ◽  
Maria Pia Neri ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Readmission Rate ◽  
Significant Risk ◽  
Case Series ◽  
Single Bundle ◽  
Female Patients ◽  
Case Series Study ◽  
Increased Risk ◽  
Early Readmission ◽  
Over The Top

AbstractThe aim of the present study is to examine the readmission rate within 90 days of a cohort of patients, who underwent an arthroscopic anterior cruciate ligament (ACL) reconstruction with a lateral extraarticular tenodesis, from a single highly specialized sports traumatology department. From our institutional database, we identified 2,559 patients (78.5% males and 21.5% females, with a mean age at surgery of 30.9 ± 11.5 years) who underwent primary ACL reconstruction with the same “over-the-top” technique plus lateral extraarticular tenodesis (LET) from January 2010 to December 2017. From this count, we extracted all patients who were readmitted within 90 days and focused on causes of readmission and reoperation rate. Moreover, a multivariate logistic regression was performed to identify possible variables, such as gender, age, and concomitant meniscus surgery, which could predict the risk of early readmission. From the aforementioned cohort, 58 patients (2.27%) were readmitted within 90 days from surgery after a mean time of 31 ± 23 days. The most common cause of readmission was fever and knee swelling (0.78%), followed by superficial infection (0.63%), deep infection (0.55%), and joint stiffness (0.23%). The patients' age and meniscal lesions requiring concomitant arthroscopic treatment were found to be correlated to an increased risk of early readmission. Superficial infections were more common in female patients (odds ratio [OR] = 3.01), whereas the meniscal treatment was also a significant risk factor specifically for deep infections (OR = 3.56). In conclusion, this technique of arthroscopic ACL reconstruction with LET showed a low readmission rate within 90 days from surgery. However, patients and physicians should be aware of the risk of serious complications, such as deep and superficial infections, mostly in female patients and in cases of concurrent meniscal treatments. This is a Level IV, retrospective case series study.

scholarly journals The microbiological and physical properties of catheters for intermittent catheterization: A systematic review on the impact of reuse and cleaning methods

2021 ◽  
Author(s):  
Mark Grasdal ◽  
Matthias Walter ◽  
Andrei V. Krassioukov
Keyword(s):  
Systematic Review ◽  
Physical Properties ◽  
Bacterial Colonization ◽  
Case Series ◽  
Intermittent Catheterization ◽  
Cochrane Central Register ◽  
Cross Sectional ◽  
Case Series Study ◽  
Cleaning Methods ◽  
The Impact

AbstractThis systematic review provides an up to date and comprehensive summary of the clinical evidence of the effectiveness of various cleaning methods of intermittent catheterization that have been proposed to prepare catheters for reuse. This systematic review is registered at PROSPERO (registration number: CRD42020176065). A key word search of Medline (OVID), Excerpta Medica dataBASE (EMBASE, OVID), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science and the Cochrane Central Register of Controlled Trials (CENTRAL), in addition to manual searches of retrieved articles, was undertaken to identify all English, Russian and German language literature evaluating the effectiveness of various cleaning methods of intermittent catheterization. Studies selected for review included analytical experimental, prospective cohort, cross-sectional and case series study designs. Prospective cleaning methods analyzed included heat-based sterilization, chemical cleaning solutions, mechanical abrasion, photocatalytic sterilization, and combined methods. Studies that failed to assess the bacterial colonization or physical properties of catheters following cleaning were excluded. In total, 12 studies (i.e. 9 analytical experimental, 1 cohort study, 1 cross-sectional and 1 case series) were included. Two cleaning methods were identified as likely being most promising: five-minute submersion in 70% alcohol and the “Milton method”. Each eliminated bacterial colonization without affecting the physical properties of the catheters. All other cleaning methods were either non-bactericidal or caused gross visual or microscopic damage to the catheters, rendering their reuse unsafe. Additional higher-powered studies confirming the safety and efficacy of these cleaning methods must be obtained before we would feel comfortable challenging current clinical recommendations.

scholarly journals Risk of Immune Thrombocytopenia Induced By Influenza Vaccine. a Nationwide Population-Based Study in France

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 1086-1086
Author(s):  
Margaux Lafaurie ◽  
Bérangère Baricault ◽  
Maryse Lapeyre-Mestre ◽  
Laurent Sailler ◽  
Agnès Sommet ◽  
...  
Keyword(s):  
Influenza Vaccine ◽  
Influenza Vaccination ◽  
Research Funding ◽  
Case Series ◽  
Population Based ◽  
Case Control ◽  
Population Based Study ◽  
Case Series Study ◽  
Increased Risk ◽  
Series Study

Introduction: Epidemiological studies suggest a risk of immune thrombocytopenia (ITP) following viral infections, particularly influenza. Conversely, an increased risk of ITP following vaccination has been proven for some vaccines like Measles-Mumps-Rubella vaccine. However, the risk of ITP induced by influenza vaccine is debated. Two case-controls studies has been conducted, with contradictory results: in the Berlin Case-Control Surveillance Study, an increased risk has been found (odds ratio - OR: 3.8 [95% confidence interval - CI: 1.5- 9.1]. Conversely, the French PGRx study suggested the absence of risk of ITP after influenza vaccination [OR: 0.9; 95% CI: 0.4-2.1]. These studies were limited by the number of ITP patients included (169 and 198, respectively) and other limitations. Therefore, we aimed to assess the risk of ITP induced by influenza vaccine in a nationwide cohort in France. Methods: We conducted a population-based study in France within the FAITH cohort (NCT03429660). This cohort is built within the National Health Database that links sociodemographic, hospital and out-hospital data. The FAITH cohort includes all adult patients with incident ITP in France since 2009. Patients are identified using a validated algorithm combining diagnosis codes and drug exposures (with very high positive predictive values). We included in the present study all patients with incident primary ITP aged ≥65 years at ITP diagnosis (indication of influenza vaccination in the general population in France) between July 2009 and June 2015. We assessed the link between influenza vaccine and ITP onset using two designs: a case-control and a self-controlled case series designs. In the case-control design, ITP cases were matched with four controls from the general population for age, sex and place of residency. Index dates for controls were similar to index dates of their matched cases. Cases and controls were compared for exposure to influenza vaccine in the 6 weeks before the index date using conditional logistic regression models adjusted for exposure to other drugs known as inducers of ITP. In the self-controlled case series study, only vaccinated ITP cases were included. The analysis compared the incidence of ITP within periods of risk (6 weeks following vaccination) to the incidence of ITP within other periods of time. We further excluded the 2 weeks prior to vaccine dispensing from the analysis to address selective survival bias (healthy vaccinee effect). Incidence rate ratios (IRRs) adjusted for seasonality were calculated. Results: We included 3,142 incident primary ITP patients aged ≥65 years matched with 12,528 controls in the case-control study. Overall, 147 cases (4.7%) and 579 controls (4.6%) were vaccinated with influenza vaccine during the 6 weeks prior to the index date (adjusted OR: 0.99; 95% CI: 0.80-1.23]). In the self-controlled case series study, 1,875 vaccinated ITP cases were included. Among them, 146 (7.8%) patients were diagnosed for ITP during one of the risk periods following vaccination. The adjusted IRR was 0.96 [95 CI%: 0.80-1.17]. Conclusion: This nationwide population-based study using two different designs showed no increased risk of ITP after influenza vaccination. Disclosures Moulis: Novartis pharma: Research Funding, Speakers Bureau; Amgen pharma: Research Funding, Speakers Bureau; CSL Behring: Research Funding.

scholarly journals Cardiovascular and metabolic risk of antipsychotics in children and young adults: a multinational self-controlled case series study

2021 ◽  
Vol 30 ◽  
Author(s):  
Kenneth K. C. Man ◽  
Shih-Chieh Shao ◽  
Yu-Chuan Chang ◽  
Mei-Hung Chi ◽  
Han Eol Jeong ◽  
...  
Keyword(s):  
Young Adults ◽  
Cardiovascular Events ◽  
Case Series ◽  
Real World Evidence ◽  
Case Series Study ◽  
Increased Risk ◽  
Children And Young Adults ◽  
Exposure Windows ◽  
The Uk

Abstract Aims The risk of antipsychotic-associated cardiovascular and metabolic events may differ among countries, and limited real-world evidence has been available comparing the corresponding risks among children and young adults. We, therefore, evaluated the risks of cardiovascular and metabolic events in children and young adults receiving antipsychotics. Methods We conducted a multinational self-controlled case series (SCCS) study and included patients aged 6–30 years old who had both exposure to antipsychotics and study outcomes from four nationwide databases of Taiwan (2004–2012), Korea (2010–2016), Hong Kong (2001–2014) and the UK (1997–2016) that covers a total of approximately 100 million individuals. We investigated three antipsychotics exposure windows (i.e., 90 days pre-exposure, 1–30 days, 30–90 days and 90 + days of exposure). The outcomes were cardiovascular events (stroke, ischaemic heart disease and acute myocardial infarction), or metabolic events (hypertension, type 2 diabetes mellitus and dyslipidaemia). Results We included a total of 48 515 individuals in the SCCS analysis. We found an increased risk of metabolic events only in the risk window with more than 90-day exposure, with a pooled IRR of 1.29 (95% CI 1.20–1.38). The pooled IRR was 0.98 (0.90–1.06) for 1–30 days and 0.88 (0.76–1.02) for 31–90 days. We found no association in any exposure window for cardiovascular events. The pooled IRR was 1.86 (0.74–4.64) for 1–30 days, 1.35 (0.74–2.47) for 31–90 days and 1.29 (0.98–1.70) for 90 + days. Conclusions Long-term exposure to antipsychotics was associated with an increased risk of metabolic events but did not trigger cardiovascular events in children and young adults.

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