Patterns of childhood adversity and health outcomes in early adolescence: Results from the Generation XXI cohort.

This longitudinal population-based birth cohort study aims to identify childhood adversity patterns over the first 13 years of life and to examine its association with health-related behaviours and outcomes in early adolescence. Using data from the Portuguese birth cohort Generation XXI, we performed latent class analysis to explore the underlying patterns of adversity from birth to early adolescence, using 13 adversity items assessed in five time points. Health-related behaviours and outcomes were evaluated at 13 years. Adjusting for parental unemployment, logistic regression models were performed to determine the association between adversity patterns and outcomes. Among 8647 participants, three adversity patterns were identified: "low adversity" (56.1%), "household dysfunction" (17.2%) and "multiple adversities" (26.7%). For the "household dysfunction" pattern, girls and boys showed associations with increased odds of alcohol/tobacco use (adjusted odds ratio [AOR]: 1.78; 95% confidence interval [CI]: 1.32-2.40; AOR:1.84; CI:1.38-2.46, respectively) and depressive symptoms (AOR:2.34; CI:1.58-3.48; AOR:5.45; CI:2.86-10.38, respectively). Boys also presented low consumption of fruits/vegetables (AOR:1.51; CI:1.04-2.19). For the "multiple adversities" pattern, both girls and boys showed an increased probability of alcohol/tobacco use (AOR:1.82; CI:1.42-2.33; AOR:1.63; CI:1.30-2.05, respectively) and depressive symptoms (AOR:3.41; CI:2.46-4.72; AOR:5.21; CI:2.91-9.32, respectively). Boys also revealed increased odds of low consumption of fruits/vegetables (AOR:1.67; CI:1.24-2.23). Childhood adversity patterns are associated with unhealthy behaviours and depressive symptoms in early adolescence. Public policies and early interventions targeting vulnerable children, families and communities can potentially reduce the detrimental effects of adversities on health and promote individual and community resilience.

"Excess" Doubling Up During COVID: Changes in Children's Shared Living Arrangements.

The proportion of U.S. children living in doubled-up households, in which a child lives with a parent plus adult kin or nonkin, has increased in the last 40 years. Although shared living arrangements are often understood as a strategy to cope with crises, no research to date has examined changes in children's living arrangements during the first year of the COVID-19 pandemic. We use the American Community Survey and the Current Population Survey to examine children's doubled-up living arrangements during 2020 and the extent to which children may have experienced "excess" doubling up relative to earlier years. We consider trends by household type (multigenerational, extended with other relatives, and nonrelative households) and differences by demographic characteristics (marital status, race and ethnicity, work status, education, age, and number of coresident children). We find evidence that more than half a million (509,600) children experienced "excess" doubling up in 2020. Greater than expected increases in doubled-up arrangements were driven by increases in multigenerational households, in particular among Black and Hispanic children, young children (under age six), those whose mothers never married, and those whose mothers were not working. Correlates of coresidence remained largely unchanged over time, although having a mother who had never married became a stronger correlate in 2020. Our findings suggest that both economic and instrumental needs likely explained the rise in multigenerational coresidence in 2020.

Quality of Life of Mothers and Fathers 4 to 6 Months After Birth: The Effect of a Very Preterm Delivery.

OBJECTIVES: The sparse literature on the effect of a preterm delivery on parents' quality of life (QoL) yields inconsistent results, restricting their analysis to mothers. The present study aimed to assess the effect of a very preterm delivery on parents' gender-specific perception of QoL, 4 to 6 months after birth. METHODS: A total of 117 parents of very preterm infants hospitalized at birth in a level III Neonatal Intensive Care Unit, and 214 parents of never hospitalized full-term infants born in a public maternity, both located in the North of Portugal, participated in the study, 4 to 6 months after delivery (November 2013-June 2015). The Portuguese version of the World Health Organization Quality of Life - BREF Inventory was applied and scores were transformed to reflect a 0 to 100 scale. RESULTS: The mean [standard deviation (SD)] of overall QoL ranged between 72.1 (13.3) among mothers of full-term infants and 74.6 (12.5) among mothers of very preterm infants. The perception of QoL was not significantly different among parents of very preterm and full-term infants, according to gender. The highest scores were observed in the psychological and physical dimensions, for both mothers and fathers. CONCLUSIONS FOR PRACTICE: The lack of differences on the perception of QoL among mothers and fathers of very preterm and full-term infants, highlights the need to deeply understand and explore the influence of accommodation mechanisms, the extended family/community and health policies on parental QoL trajectories.

Antileishmanial Screening, Cytotoxicity, and Chemical Composition of Essential Oils: A Special Focus on Piper callosum Essential Oil.

Leishmania amazonensis is the etiological agent of tegumentary leishmaniasis, a disease characterized by the emergence of cutaneous and mucocutaneous ulcerated lesions that can evolve into severe destruction of skin tissue. Treatment of the disease is often accompanied by high toxicity and variable efficacy. Essential oils stand out for having diverse pharmacological properties. Here, we screened a panel of fourteen essential oils for their anti-L. amazonensis activity, cytotoxicity, and chemical profile. Lippia sidoides (LSEO) and Piper callosum (PCEO) oils displayed the best anti-promastigote and anti-amastigote activities with IC50 of 31 and 21 µg/ml, respectively. PCEO was the safest oil with a desirable selectivity index >10. In addition, PCEO showed no cytotoxicity against the VERO line and erythrocytes. PCEO-treated amastigotes displayed mitochondrial membrane depolarization and high levels of intracellular ROS. Safrole (54.72 %) was the main component of PCEO. The results described here highlight the use of essential oils to combat tegumentary leishmaniasis.

A scoping review on studies about the quality of life of informal caregivers of stroke survivors.

PURPOSE: To assess the available evidence regarding the quality of life (QoL) of informal caregivers of stroke survivors, by identifying the instruments used to assess QoL, and its associated characteristics. METHODS: A scoping review was performed, following PRISMA-ScR guidelines. The electronic databases PubMed, ISI Web of Science, PsycINFO, and SciELO were searched for empirical, peer-reviewed, original, and full-length studies on the characteristics influencing the QoL of informal caregivers of stroke survivors. Eligibility and data extraction were conducted by two independent researchers. The main quantitative findings were synthesized, and qualitative data were explored by thematic content analysis. RESULTS: The included studies, 56 quantitative, 1 qualitative, and 1 mixed methods, were published between 1999 and 2020. A high heterogeneity was found regarding the assessment of QoL, and the characteristics influencing it. Only one study used an instrument specifically designed to assess the stroke caregivers' QoL. The QoL of informal caregivers was inversely associated with physical and mental health of stroke survivors and caregivers, while stroke characteristics with a better prognosis, caregivers' positive relationships, and a more supportive and participative social context were positively associated to QoL. CONCLUSION: There is a need for standardizing the assessment of the QoL of informal caregivers of stroke survivors, as well as for investing in cross-country/cultural studies with robust mixed methods designs to allow a deeper understanding of the experiences of caregivers. Further research, policies, and practices should consider the diversity and complexity of the characteristics influencing QoL, to empower informal caregivers and improve their QoL.

Analysis of the uterine flush fluid proteome of healthy mares and mares with endometritis or fibrotic endometrial degeneration.

The objective of this study was to evaluate the differences in the uterine flush fluid proteome between healthy mares and mares with endometritis or fibrotic endometrial degeneration (FED). Uterine flush fluid samples were collected from healthy mares (n=8; oestrus n=5 and dioestrus n=3) and mares with endometritis (n=23; oestrus n=14 and dioestrus n=9) or FED (n=7; oestrus n=6 and dioestrus n=1). Proteomic analysis was performed using label-free liquid chromatography-tandem mass spectrometry. Of 216 proteins identified during oestrus, 127 were common to all three groups, one protein was exclusively detected in healthy mares, 47 proteins were exclusively detected in mares with endometritis and four proteins were exclusively detected in mares with FED. Of 188 proteins identified during dioestrus, 113 proteins were common between healthy mares and mares with endometritis, eight proteins were exclusively detected in healthy mares and 67 proteins were exclusively detected in mares with endometritis. Quantitative analysis revealed a subset of proteins differing in abundance between the three groups during oestrus and between healthy mares and mares with endometritis during dioestrus. These results provide a springboard for evaluation of specific proteins as biomarkers of uterine health and disease and for investigation of their roles in the establishment and maintenance of pregnancy.

Historical Trends in Children Living in Multigenerational Households in the United States: 1870-2018.

Over the last two decades, the share of U.S. children under age 18 who live in a multigenerational household (with a grandparent and parent) has increased dramatically. Yet we do not know whether this increase is a recent phenomenon or a return to earlier levels of coresidence. Using data from the decennial census from 1870 to 2010 and the 2018 American Community Survey, we examine historical trends in children's multigenerational living arrangements, differences by race/ethnicity and education, and factors that explain the observed trends. We find that in 2018, 10% of U.S. children lived in a multigenerational household, a return to levels last observed in 1950. The current increase in multigenerational households began in 1980, when only 5% of children lived in such a household. Few differences in the prevalence of multigenerational coresidence by race/ethnicity or education existed in the early part of the twentieth century; racial/ethnic and education differences in coresidence are a more recent phenomena. Decomposition analyses do little to explain the decline in coresidence between 1940 and 1980, suggesting that unmeasured factors explain the decrease. Declines in marriage and in the share of White children most strongly explained the increase in multigenerational coresidence between 1980 and 2018. For White children with highly educated parents, factors explaining the increase in coresidence differ from other groups. Our findings suggest that the links between race/ethnicity and socioeconomic status and multigenerational coresidence have changed over time, and today the link between parental education and coresidence varies within racial/ethnic groups.

Lizards on newly created islands independently and rapidly adapt in morphology and diet.

Rapid adaptive changes can result from the drastic alterations humans impose on ecosystems. For example, flooding large areas for hydroelectric dams converts mountaintops into islands and leaves surviving populations in a new environment. We report differences in morphology and diet of the termite-eating gecko Gymnodactylus amarali between five such newly created islands and five nearby mainland sites located in the Brazilian Cerrado, a biodiversity hotspot. Mean prey size and dietary prey-size breadth were larger on islands than mainlands, expected because four larger lizard species that also consume termites, but presumably prefer larger prey, went extinct on the islands. In addition, island populations had larger heads relative to their body length than mainland populations; larger heads are more suited to the larger prey taken, and disproportionately larger heads allow that functional advantage without an increase in energetic requirements resulting from larger body size. Parallel morphological evolution is strongly suggested, because there are indications that, before flooding, relative head size did not differ between future island and future mainland sites. Females and males showed the same trend of relatively larger heads on islands, so the difference between island and mainland sites is unlikely to be due to greater male-male competition for mates on islands. We thus discovered a very fast (at most 15 y) case of independent parallel adaptive change in response to catastrophic human disturbance.

Qualitative analysis and functional classification of the uterine proteome of mares in oestrus and dioestrus.

Quantitative analysis of the uterine flush fluid proteome of mares in oestrus and dioestrus has been previously reported. The objectives of this study were to: a) evaluate qualitative differences in the uterine flush fluid proteome between mares in oestrus and mares in dioestrus and b) perform a functional classification of proteins either unique to each stage or common between the two stages. Uterine flush fluid samples were collected from 8 light breed mares in either oestrus (n = 5) or dioestrus (n = 3). Proteomic analysis of the samples was conducted using liquid chromatography-tandem mass spectrometry. Proteins exclusively detected in oestrus or dioestrus and those common to both stages were identified using the Scaffold software (version 4.4.8, Proteome Software Inc., Portland, OR). The identified proteins were classified into gene ontology (GO) categories (cellular component [CC], molecular function [MF] and biological process [BP]) using the PANTHER (www.pantherdb.org) classification system version 14.0. Of 172 proteins identified, 51 and 28 were exclusively detected in mares in oestrus and dioestrus, respectively, and 93 proteins were common to both stages. The most represented terms in various GO categories were similar among the three subsets of proteins. The most represented CC terms were extracellular region and cell, the most represented MF terms were catalytic activity and binding, and the most represented BP terms were metabolic process and cellular process. In conclusion, proteomic analysis of the uterine flush fluid enabled the identification of subsets of proteins unique to oestrus or dioestrus, or common to both stages. The results of this study can serve as a baseline for future research focused on finding stage-specific protein markers or evaluating differences in the uterine flush fluid proteome between normal mares and those with uterine disease.

Prematurity-related knowledge among mothers and fathers of very preterm infants.

OBJECTIVE: Empowering parents as health promoters may contribute to decrease the costs associated with prematurity. In Portugal, 8% and 1% of the births occurring in 2018 were preterm and very preterm, respectively. This study aimed to assess prematurity-related knowledge with regard to its prevalence, causes and consequences, according to sociodemographic, obstetric and offspring's characteristics, among mothers and fathers of very preterm infants. METHODS: Between May and July 2017, mothers and fathers of very preterm infants were invited to participate through the Portuguese association of parents for support to the premature baby, with 196 parents being included. Knowledge on prematurity (prevalence, causes and consequences) was collected through a structured online questionnaire. Reporting of this research follows STROBE guidelines for cross-sectional studies. RESULTS: Parents estimated a median prevalence of preterm and of very preterm delivery in Portugal of 15% and 8%, respectively. However, approximately 20% did not provide an estimate. More than 90% of the participants acknowledged placental complications, hypertensive disorders of pregnancy, multiple pregnancy and intrauterine growth restriction as causes of preterm delivery, whereas only 24.2% identified low socioeconomic status. Cardiac complications and respiratory morbidity were recognised as the main consequences of prematurity by more than 80% of the parents. Overall, parents with a higher socioeconomic status tended to provide correct responses more frequently than those with a low socioeconomic status. CONCLUSIONS: The results revealed the existence of knowledge gaps regarding the prevalence, causes and consequences of premature delivery. Understanding the main facilitators and barriers to the achievement of prematurity-related knowledge may contribute for the global improvement of preventing this condition. RELEVANCE TO CLINICAL PRACTICE: It is crucial to include the improvement of parents' knowledge about prematurity as a complementary dimension during the provision of medical care, with nurses playing a key role as main sources of information.

Uterine perforation secondary to metritis and placenta percreta in a postpartum bitch.

A 3-year-old intact female Labradoodle bitch was referred due to fever and lethargy 4 days postpartum. The dog was reported to have had prolonged labor that required assistance and fetal membranes were retained. Physical examination and diagnostics led to a suspicion of metritis and uterine perforation. Ovariohysterectomy was performed. Gross and histopathology findings revealed multifocal uterine perforation, necrosuppurative metritis, and placenta percreta. Post-operative antibiotic therapy and supportive care resulted in an uneventful clinical recovery. This is the first reported case of placenta percreta in a bitch. It is presumed that this pathology was paramount in the patient's development of metritis and subsequent uterine rupture. Key clinical message: Placenta percreta may lead to more severe clinical consequences of metritis, including uterine rupture.

Perforation utérine secondaire à une métrite et un placenta percreta chez une chienne en période post-partum. Une femelle Labradoodle intacte âgée de 3 ans fut référée pour cause de fièvre et léthargie 4 jours post-partum. Il fut rapporté que la chienne avait eu un travail long qui demanda de l'assistance et qu'il y avait eu rétention des membranes foetales. L'examen physique et le diagnostic mena à un doute de métrite et de perforation utérine. Une ovario-hystérectomie fut réalisée. Les trouvailles de pathologie macroscopique et d'histopathologie révélèrent des perforations utérines multifocales, une métrite nécro-suppurative et un placenta percreta. Une antibiothérapie post-opératoire et des soins de support ont résulté en une guérison clinique sans conséquence. Ceci représente le premier cas rapporté de placenta percreta chez une chienne. Il est présumé que chez cette chienne cette pathologie était vitale dans le développement de la métrite et de la rupture utérine subséquente.Message clinique clé :Un placenta percreta peut mener à des conséquences cliniques plus sévères de métrite, incluant la rupture utérine.(Traduit par Dr Serge Messier).

Multiple-Partner Fertility and Cohort Change in the Prevalence of Half-Siblings.

The transformation of the American family under the second demographic transition has created more opportunities for parents to have children with multiple partners, but data limitations have hampered prevalence estimates of multiple-partner fertility from the perspective of children. This study uses nationally representative data from the 1979 and 1997 cohorts of the National Longitudinal Surveys of Youth to examine cohort change in children's exposure to multiple-partner fertility. We find that one in five children in the 1979 cohort had at least one half-sibling by their 18th birthday, and the prevalence grew to more than one in four children by the 1997 cohort. A strong educational gradient in exposure to half-siblings persists across both cohorts, but large racial/ethnic disparities have narrowed over time. Using demographic decomposition techniques, we find that change in the racial/ethnic and socioeconomic composition of the U.S. population cannot explain the growth in exposure to half-siblings. We conclude by discussing the shifting patterns of fertility and family formation associated with sibling complexity and considering the implications for child development and social stratification.

A comparison of the uterine proteome of mares in oestrus and dioestrus.

Proteomic analysis of mare uterine flush fluid provides a minimally invasive technique for studying protein changes associated with the oestrous cycle. The aim of this study was to identify differentially abundant proteins in the uterine flush fluid of mares in oestrus and dioestrus. In this study, uterine flush fluid samples were collected from eight reproductively healthy mares in either oestrus (n = 5) or dioestrus (n = 3). Proteomic analysis was performed using liquid chromatography-tandem mass spectrometry. Of 172 proteins identified, six proteins (immunoglobulin lambda-like polypeptide 1, haemoglobin subunit alpha, alpha-1B-glycoprotein, serotransferrin, apolipoprotein A-1, and haemoglobin subunit beta) were significantly more abundant in oestrus. These proteins may contribute to the endometrial defence system through roles in inflammation, immunity or antimicrobial activity. In other species, some of these proteins have been described as immunoglobulins, negative acute phase proteins or defence agents against micro-organisms. During dioestrus, immunoglobulin alpha-1 chain C region-related, complement factor I, CD 109 antigen and uterocalin, were significantly more abundant. Research in other species suggests that these four proteins contribute to the immune response through proposed immunoregulatory characteristics, complement system involvement or roles in B cell-T cell interactions. In conclusion, ten differentially abundant proteins were identified in the uterine flush fluid of mares in oestrus and dioestrus. Targeted studies on these proteins could elucidate their role in uterine defence mechanisms during the oestrous cycle in the mare.

Bilateral granulosa cell tumor in a cycling mare.

A 16-year-old Oldenburg mare was evaluated for stallion-like behavior. The mare had given birth to 2 foals previously. Transrectal palpation revealed bilaterally enlarged ovaries with no palpable ovulation fossa. Ultrasound examination showed both ovaries to have small follicles giving a honeycomb appearance, concurrent with a single large cystic structure in the left ovary (10.2 cm diameter). Serum Anti-Müllerian hormone (AMH) was elevated (95.7 pmol/L), consistent with granulosa cell tumor (GCT). Both ovaries were removed via flank laparoscopy and were evaluated by histopathology, which confirmed bilateral GCT and concurrent presence of fresh luteal tissue, demonstrating the unusual presentation of bilateral granulosa cell tumor in a cycling mare.

Tumeur bilatérale de la granulosa chez une jument en cycle. Une jument Oldenburg âgée de 16 ans a été évaluée pour un comportement s'apparentant à celui d'un étalon. La jument avait précédemment donné naissance à deux poulains. La palpation transrectale a révélé des ovaires élargis bilatéralement sans fosse d'ovulation palpable. L'échographie a indiqué que les deux ovaires avaient de petits follicules à l'apparence de nid d'abeilles ainsi qu'une seule grande structure cystique dans l'ovaire gauche (diamètre de 10,2 cm). L'hormone antimllérienne (HAM) était élevée (95,7 pmol/L), conformément à une tumeur de la granulosa (TG). Les deux ovaires ont été enlevés par laparascopie du flanc et ils ont été évalués par histopathologie qui a confirmé les TG bilatérales et la présente concomitante de tissu lutéal frais, ce qui démontre la présentation inusitée des tumeurs granulosa bilatérales chez une jument en cycle.(Traduit par Isabelle Vallières).

Successful management of hydrallantois in a Standardbred mare at term resulting in the birth of a live foal.

A 6-year-old Standardbred mare was presented at 339 days of gestation for investigation of abnormal abdominal distension and ventral edema. Transrectal palpation and ultrasound examination revealed the uterus to be enlarged with an excessive volume of fetal fluid, characteristic of hydrops. Gradual transcervical drainage of 55 L of allantoic fluid over 45 minutes, with concurrent intravenous fluid therapy followed by assisted vaginal delivery, resulted in the birth of a live foal with long-term survival. The birth and long-term survival of a foal from a mare with hydrallantois at term has not been previously reported in horses. However, this report demonstrates that successful outcome for both mare and foal may be achieved in a mare at term with hydrallantois.

Gestion réussie de l'hydrallantois chez une jument Standardbred à terme donnant lieu à la naissance d'un poulain vivant. Une jument Standardbred âgée de 6 ans a été présentée à 339 jours de gestation pour investiguer une distension abdominale anormale et un oedème ventral. La palpation transrectale et l'échographie ont révélé que l'utérus était enflé en raison d'un volume excessif de liquide foetal, ce qui est caractéristique de l'hydrops fetalis. Un drainage transcervical graduel de 55 L de liquide allantoïdien pendant plus de 45 minutes et une fluidothérapie par intraveineuse suivis d'une mise bas vaginale assistée ont donné lieu à la naissance d'un poulain vivant avec survie à long terme. La naissance et la survie à long terme d'un poulain provenant d'une jument atteinte de l'hydrallantois à terme n'avaient pas été précédemment signalées chez les chevaux. Cependant, des résultats fructueux pour la jument et le poulain peuvent être obtenus chez une jument atteinte d'hydrallantois à terme.(Traduit par Isabelle Vallières).

Are grandparents a blessing or a burden? Multigenerational coresidence and child-related spending.

Economic investments in children may represent a powerful mechanism to explain differences in child outcomes across family types. Unfortunately, evidence on child-related spending across family structures remains poorly understood. Using the Consumer Expenditure Survey (1996-2015), this study is the first to investigate patterns of child-related spending in an increasingly common type of extended family household: multigenerational households, in which children reside with at least one parent and grandparent. This study also contributes to a growing literature giving primacy to parents' socioeconomic disadvantage as moderating the association between multigenerational relationships and child well-being. Results indicate that, when compared to similar two-generation households, multigenerational households are associated with increased spending on education and with decreased spending on child care. Differences in child-related spending between multigenerational and two-generation households differ according to parents' income and relationship status. Overall, living with grandparents represents an adaptive strategy that helps low-income or single parents invest more money in their children's education, hobbies and activities, and to save on the costs of child care.

Quality of life of parents of very preterm infants 4 months after birth: a mixed methods study.

BACKGROUND: Knowledge about parental quality of life (QoL) is paramount to family-centred and integrated healthcare on prematurity, but evidence is limited. We aimed to explore mothers' and fathers' perspectives about their QoL 4 months after a very preterm childbirth. METHODS: This is a cross-sectional mixed methods study using a convergent design. Parents of very preterm infants were systematically recruited at all level III neonatal intensive care units in the Northern health region of Portugal for one year. Four months after childbirth, 61 mothers and 56 fathers filled-in the World Health Organization Quality of Life - BREF Inventory, and 26 couples were interviewed. Linear regression models were computed to assess the association between participants' characteristics and the QoL. Qualitative data were thematically analysed. RESULTS: A quantitative analysis revealed that the perception of QoL was not significantly different by gender. QoL scores increased slightly from the environment (Mean (SD): 72.1 (14.2)) to the psychological domains (Mean (SD): 78.7 (14.4)). All scores were influenced by psychological characteristics. Socioeconomic position influenced both parents' perceptions concerning the environment domain, and maternal physical and psychological QoL. Infant-related factors were associated with overall QoL among women and with the physical, psychological, social and environment domains among men. Qualitative findings indicated accommodation mechanisms that intertwine the focus on constraining factors (surveillance, sleep disturbances, non-supportive healthcare policies, hygienization) with facilitating factors (social support, accessibility/quality of healthcare, opportunities for developing parental skills). These processes were anchored in child-centredness and a framework that construct hierarchies of hope and expectations about infant's health and development. CONCLUSIONS: To capture parental QoL using mixed methods raises awareness for developing intersectoral family-centred policies, integrated health services and focused-interventions to decrease the disempowering effects of surveillance and hygienization.

Quality of life among parents of preterm infants: a scoping review.

PURPOSE: To synthesize the body of knowledge on the factors influencing the QoL of mothers and fathers of preterm infants. METHODS: A scoping review was performed. Publications indexed in PubMed®, Web of Science™, CINAHL® and PsycINFO® were searched, targeting studies presenting original empirical data that examined parental perception on QoL after a preterm delivery. Eligibility and data extraction were conducted by two independent researchers. The main quantitative findings were synthesized and qualitative data were explored by content analysis. RESULTS: The studies, 11 quantitative and 1 mixed methods, were derived mainly from the USA (n = 6). Heterogeneity across the studies was observed regarding the operationalization of QoL and the use of units of analysis (mothers, parents, families and caregivers). In a context where 40 out of 45 covariates were analysed by only one or two studies, results suggested that parental QoL after a preterm delivery is influenced by factors related with mother's characteristics, family issues and health care environment rather than infants' variables. Factors regarding fathers' characteristics and structural levels were not addressed. CONCLUSIONS: Standardizing the operationalization of the QoL when analysing mothers and fathers of preterm infants calls for a structured questionnaire adapted to their specific needs. Further research should include both mothers and fathers, invest in mixed methods approaches and be performed in different countries and settings for allowing integration and comparison of findings.

Singleton pregnancy with concurrent pyometra in the contralateral horn in a bitch with a live puppy outcome.

A 20-month-old, 48-day pregnant female American Bulldog was presented for intermittent bloody vaginal discharge of 4-day duration. The bitch was clinically healthy with a mild neutrophilia. Transabdominal ultrasound revealed a viable foetus in the left uterine horn and fluid in the right uterine horn. She was treated with amoxicillin/clavulanic acid and re-examined at regular intervals to monitor for deterioration of the bitch or foetus. The uterine fluid progressively decreased in volume, and the puppy remained viable. A Caesarean section was performed on the bitch's expected due date, resulting in a healthy puppy. This is only the second published report of a pregnancy and concurrent pyometra with a live puppy outcome. This case is unique in that the bitch's pyometra resolved grossly during pregnancy.

Patients' views on the embryo storage time limits.

The establishment of the length of embryo storage has been based on socio-political criteria. There are different regulations, guidelines and health care policies worldwide. This mixed-methods study aimed to assess the opinion of patients about the embryo storage time limit, and the perception of the criteria underlying the establishment of the storage period offered to them. Between August 2011 and December 2012, 534 IVF patients from Portugal participated in a quantitative questionnaire and 34 couples were interviewed. Overall, 38% of participants preferred the duration of 4-5 years, 38% extended it beyond 5 years and 23% indicated 3 years. Having experienced at least one previous cycle was directly associated with agreeing with a duration of storage longer than 5 years, for both women and men. Having children was inversely associated with longer duration of storage, among women. One-third of the 34 interviewed couples stated that their knowledge concerning embryo storage was insufficient. Nevertheless, all the interviewees reported at least one possible reason for the legal establishment of the storage period offered to them, highlighting financial costs and decreased embryo quality. There are misconceptions and gaps in awareness of cryopreservation, which may shape patients' opinions. Accurate information regarding policy on storage of embryos is needed.