Menstrual blood concentrations of parabens and benzophenones and related factors in a sample of Spanish women: An exploratory study.

AIM: To evaluate concentrations of parabens (PBs) and benzophenones (BzPs) in menstrual blood and explore related sociodemographic/lifestyle factors, and to compare between menstrual and peripheral blood concentrations in a subset of samples. MATERIAL AND METHODS: Concentrations of 4 PBs [methyl- (MeP), ethyl- (EtP), propyl- (PrP) and butyl-paraben (BuP)] and 6 BzPs [BzP-1, BzP-2, BzP-3, BzP-6, BzP-8 and 4-OH-BzP] were determined in menstrual blood from 57 women and in both menstrual and peripheral blood samples from 12 women, all healthy Spanish women of reproductive age. Socio-demographic characteristics and lifestyle habits [diet and use of cosmetics and personal care products (PCPs)] were gathered using an online questionnaire. Spearman correlation analysis was performed to examine the relationship between menstrual and peripheral blood concentrations, while multivariable linear regression was used to identify potential explanatory variables for menstrual PB and BzP concentrations. RESULTS: Globally, all menstrual blood samples had detectable levels of ≥3 compounds, and 52.6% of the samples contained ≥6 compounds. MeP, PrP, and BzP-3 were the most frequently detected compounds (detection frequencies >90.0%), with median concentrations of 1.41, 0.63, and 1.70 ng/mL of menstrual blood, respectively. Age, the use of PCPs, and consumption of some food items (meat, pasta, cheese, or dairy products) were related to the menstrual blood concentrations of some PBs/BzPs. Serum:menstrual blood ratios of PBs/BzPs ranged from 1.7 to 3.6, with no inter-matrix correlations. CONCLUSIONS: This study reveals, to our knowledge for the first time, the widespread presence of several PBs and BzPs in intimate contact with gynecological tissues, although their concentrations in menstrual blood were not correlated with those in peripheral blood from the same women. These results shed light on the information provided by the menstrual blood as a potential matrix for characterizing exposure to PBs and BzPs, whose consequences for women's reproductive health need to be addressed.

Determination of personal care products -benzophenones and parabens- in human menstrual blood.

Benzophenones and parabens are synthetic chemicals used in many personal care products, foods and pharmaceuticals. Benzophenones are used to protect the skin and materials from the adverse effects of UV-radiation, and parabens are used as preservatives. Despite their widespread occurrence and proven endocrine disrupting activity, relatively little is known about human exposure to these compounds. In the present work, an analytical method based on sample treatment using dispersive liquid-liquid microextraction (DLLME) for the extraction of six benzophenones (benzophenone-1, -2, -3, -6, -8 and 4-hydroxybenzophenone) and four parabens (methyl-, ethyl-, propyl- and butyl- paraben) from human menstrual blood samples, followed by ultrahigh performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) analysis, is proposed and validated. The method was validated using matrix-matched standard calibration followed by a recovery assay with spiked samples. The limits of detection ranged from 0.1 to 0.3ngmL-1, with recoveries of 93.8% to 108.9%, and precision (evaluated as relative standard deviation) lower than 14% for all selected compounds. This method was successfully applied for the determination of the target compounds in 25 samples of human menstrual blood. Methylparaben and benzophenone-3 were the most frequently detected compounds (96%).

Relación entre función y volumen renal en la poliquistosis renal autosómica dominante: estudio transversal / Relationship between renal function and renal volume in autosomal dominant polycystic kidney disease: cross-sectional study

Objetivo. Determinar en pacientes con poliquistosis renal autosómica dominante la relación entre el volumen renal total (suma de ambos riñones, VRT) medido con resonancia magnética y la función renal; y su comportamiento según el sexo y la presencia de hipertensión arterial, hipercolesterolemia e hiperuricemia. Método. Estudio transversal en el que se incluyen pacientes con poliquistosis renal autosómica dominante que realizan revisiones periódicas en las consultas externas de Nefrología del Hospital Virgen de las Nieves de Granada, a quienes entre enero de 2008 y marzo de 2011 se les realizó una resonancia magnética para estimar el volumen renal. Resultados. Se evaluaron 67 pacientes (59,7% mujeres, edad media 48±14,4 años). Encontramos asociación positiva significativa entre VRT y creatinina sérica o urea, que resultó inversa frente al filtrado glomerular estimado por MDRD-4 y Cockcroft-Gault. Las mujeres mostraron un nivel medio de creatinina sérica y VRT inferior respecto al varón de forma significativa. Los subgrupos afectos de hipertensión arterial e hiperuricemia mostraron valores medios de creatinina sérica, urea y VRT más altos y filtrados glomerulares estimados inferiores. El subgrupo con hipercolesterolemia mostró valores medios de urea más altos y filtrados glomerulares estimados inferiores sin detectarse diferencias significativas respecto al VRT. Conclusión. El volumen de los riñones poliquísticos medido por resonancia magnética se asocia con la función renal, y puede ser útil como estudio complementario para monitorizar la progresión de la enfermedad. La presencia de hipertensión arterial, hiperuricemia o hipercolesterolemia están asociados a una peor función renal (AU)

Objective. To determine in patients with autosomal dominant polycystic kidney disease the relationship between total renal volume (the sum of both kidneys, TRV) as measured by magnetic resonance and renal function; and its behaviour according to sex and the presence of arterial hypertension, hypercholesterolaemia and hyperglycemia. Method. Cross-sectional study including patients with autosomal dominant polycystic kidney disease who underwent periodic reviews at Nephrology external consultations at Hospital de las Nieves de Granada, and who underwent an magnetic resonance to estimate renal volume between January 2008 and March 2011. Results. We evaluated 67 patients (59.7% women, average age of 48±14.4 years) and found a significant positive association between TRV and serum creatinine or urea, which was reversed compared with estimated glomerular filtration by MDRD-4 and Cockcroft-Gault. Women showed an average serum creatinine level and a significantly lower TRV level compared with males. Subgroups affected by arterial hypertension and hyperuricemia presented average values for serum creatinine and urea, higher for TRV and lower for estimated glomerular filtration. The hypercholesterolaemia subgroup showed higher average values for urea and lower for estimated glomerular filtration, without detecting significant differences compared with TRV. Conclusion. The volume of polycystic kidneys measured by magnetic resonance is associated with renal function, and can be useful as a complementary study to monitor disease progression. The presence of arterial hypertension, hyperuricemia or hypercholesterolaemia is associated with a poorer renal function (AU)

Relationship between renal function and renal volume in autosomal dominant polycystic kidney disease: cross-sectional study.

OBJECTIVE: To determine in patients with autosomal dominant polycystic kidney disease the relationship between total renal volume (the sum of both kidneys, TRV) as measured by magnetic resonance and renal function; and its behaviour according to sex and the presence of arterial hypertension, hypercholesterolaemia and hyperglycemia. METHOD: Cross-sectional study including patients with autosomal dominant polycystic kidney disease who underwent periodic reviews at Nephrology external consultations at Hospital de las Nieves de Granada, and who underwent an magnetic resonance to estimate renal volume between January 2008 and March 2011. RESULTS: We evaluated 67 patients (59.7% women, average age of 48±14.4 years) and found a significant positive association between TRV and serum creatinine or urea, which was reversed compared with estimated glomerular filtration by MDRD-4 and Cockcroft-Gault. Women showed an average serum creatinine level and a significantly lower TRV level compared with males. Subgroups affected by arterial hypertension and hyperuricemia presented average values for serum creatinine and urea, higher for TRV and lower for estimated glomerular filtration. The hypercholesterolaemia subgroup showed higher average values for urea and lower for estimated glomerular filtration, without detecting significant differences compared with TRV. CONCLUSION: The volume of polycystic kidneys measured by magnetic resonance is associated with renal function, and can be useful as a complementary study to monitor disease progression. The presence of arterial hypertension, hyperuricemia or hypercholesterolaemia is associated with a poorer renal function.

Factores de Riesgo para la Diabetes Mellitus en el Profesional de Enfermería / Risk Factors for Diabetes Mellitus in Nursing Professional

Introducción: Los factores de riesgo para la Diabetes Mellitus, son aquellos que aumentan la posibilidad de padecer la enfermedad. Su conocimiento permite ser la base para el desarrollo de actividades preventivas y promotoras de salud. Objetivo: identificar los factores de riesgo para la Diabetes Mellitus en un grupo de enfermeras, mediante los conceptos de la Norma Oficial Mexicana 015 y lo propuesto por la OMS. Metodología: el estudio fue de tipo descriptivo, transversal, se realizó en un grupo de profesionales de Enfermería inscritas en un programa de nivelación académica. A través de un muestreo no probabilístico por conveniencia. La información se obtuvo mediante una cédula de datos personales y el Cuestionario de Factores de Riesgo de la Secretaría de Salud. Resultados: La media para el Cuestionario de Factores de Riesgo para la Diabetes Mellitus de 11.85 (DE=9.06), lo que significa la posibilidad de padecer la enfermedad en el profesional de Enfermería. Discusión y Conclusiones: los hallazgos en este estudio ubican a la población en un riesgo alto para desarrollar Diabetes Mellitus, resultados que coinciden con los obtenidos en otros estudios.

Introduction: risk factors for diabetes mellitus are those that increase the chance of developing the disease. His knowledge, allows it to be the basis for the development of preventive and health promotion. Objective: To identify risk factors for diabetes mellitus in group of nurses, using the concepts of the Norma Official Mexicana 015 and proposed by the WHO. Methodology: The study was descriptive, transversal, was conducted in a group of nursing professionals enrolled in an academic program placement. Through a non-probability convenience sampling. The information was obtained through a certificate of personal data and the Risk Factor Questionnaire of the Ministry of Health. Results: We found an average for the Survey of Risk Factors for Diabetes Mellitus of 11.85 (SD = 9.06), which means the chance of developing the disease in the nursing professional. Discussion and Conclusions: The findings in this study placed the population at high risk for developing diabetes mellitus. Results that agree with those obtained in other studies.

Comorbidity and clinical features in elderly patients with dementia: differences according to dementia severity.

OBJECTIVES: To evaluate comorbidity and clinical features in elderly patients with dementia to determine differences according to dementia severity. DESIGN: Observational study with medical record review. SETTING: Eight hospitals in the Barcelona area. PARTICIPANTS: 515 consecutive admissions aged > 64 years with dementia, 89.1% of whom lived in the community. MEASUREMENTS: We collected data on sociodemographic variables, type of dementia, Barthel Index (BI), Lawton and Brody Index (LI), Mini-Mental State Examination (MMSE), Charlson Index and the total number of drugs chronically prescribed. We stratified the population into two groups according to disease severity with the Global Deterioration Scale (GDS): mild-moderate (GDS 3-5) and severe (GDS 6-7). RESULTS: There were a total of 515 participants of which 364 females (70%) and 151 males with a mean age of 81 +/- 6 years old. The total number of chronic prescription drugs was 5.6 +/- 2.4. The mean Charlson Index score was 2 +/- 1.2. The 270 (52.5%) patients with a GDS score of 3-5 were compared with the 245 patients with a GDS score of 6-7. In the multivariate analysis, a GDS score of 6-7 was associated with poorer LI, BI, and MMSE scores and greater neuroleptic therapy. CONCLUSIONS: Important comorbidity conditions are common in elderly individuals with dementia. The patients with more severe dementia had poor functional status and higher frequency of neuroleptic use. Medical comorbidities should be taken into account in the management of patients with dementia.

La Atención Primaria en los programas de cuidados paliativos. Análisis de una serie de 34 pacientes / Primary Care in Palliative Care Programs. Analysis of a series of 34 patients

Objetivos: Destacar el papel de la Atención Primaria en los equipos de cuidados paliativos con análisis de una serie personal y ventajas de su implicación en el equipo. Material y métodos: Treinta y cuatro pacientes tratados en 20 meses por el equipo básico del Centro de Salud Gonzalo Bilbao de Sevilla junto con el equipo de soporte de Hospitalización Domiciliaria del Hospital Virgen Macarena de Sevilla. Se establece un organigrama de actuación con un análisis de criterios de inclusión y exclusión, diagnósticos, síntomas, cuidadores, motivos de ingreso en hospital y lugar de fallecimiento según pacto previo o no. Se hace una amplia revisión bibliográfica que avala nuestras conclusiones finales. Resultados: La serie analizada presenta un predominio del sexo masculino del 55,9% y una edad media de 75,1 años. La patología predominante fue en cáncer de pulmón y próstata, y el síntoma más frecuente en el 88,2% de los casos fue el dolor, lo que obligó a tratamiento con mórficos al 65%. Los cuidadores principales fueron cónyuges o hijos/as, con un riesgo de claudicación de alrededor del 30% por separado, pero cuando compartían esa función el riesgo de claudicación disminuía ostensiblemente. Se tomó la decisión junto a la familia respecto al lugar de la muerte en el 64,7% de los casos. Esta tuvo lugar en el domicilio en el 77,8%. Conclusiones: La atención integrada con participación de todos los niveles asistenciales es el mejor sistema para garantizar la continuidad asistencial en cuidados paliativos. La Atención Primaria es el pilar básico de la asistencia domiciliaria. Los programas de cuidados paliativos han demostrado su eficiencia, consiguiendo una asistencia domiciliaria de más calidad, que incluye cada día mayor porcentaje de pacientes, con gran satisfacción de los pacientes y familiares y reducción de gastos (AU)

Objectives: To emphasize the role of Primary Care within Palliative Care Teams, analyzing a personal series and the advantages of its implication in the team. Material and Methods: Thirty four patients treated during 20 months by the basic team of the Health Care Center Gonzalo Bilbao of Seville, together with the support team of Home Hospitalization of the local hospital Virgen Macarena were studied. An action organizational chart with an analysis of inclusion and exclusion criteria, diagnoses, symptoms, caretakers, reasons for hospitalization, and site of death according to previous agreement or not was established. An extensive review of the literature was made to support our final conclusions. Results: The analyzed data revealed a predominance of male gender (55.9%) and average age of 75.1 years. The most common disease was lung and prostate cancer and the most frequent syndrome was pain (88.2%), these requiring treatment with morphine in 65% of the cases. The main caretakers were partners, sons or daughters, with risk of claudication of approximately 30% when this was performed separately, this decreasing noticeably when this function was shared. Site of death was jointly decided jointly by the family in 64.7% of the cases, the home being the site in 77.8% of the cases. Conclusion. Integrated care with involvement on all the different care levels is the best system to guarantee continuity of Palliative Cares. Primary Care is the basis of Home Medical Care. Palliative care programs have demonstrated their efficiency, providing Home Medical Care of greater quality that includes an increasing number of patients every day, with high satisfaction of the patients and family and lower costs (AU)

[Medical comorbidity in elderly patients with dementia. Differences according age and gender]. / Aspectos de comorbilidad en pacientes ancianos con demencia. Diferencias por edad y género.

BACKGROUND: Prevalence of dementia in elderly patients is high. The goal of the study was to assess some aspects of comorbidity in the patients with dementia. We also analyzed comorbidity differences according to age and gender. PATIENTS AND METHODS: A total of 311 patients older than 64 years old with dementia were prospectively evaluated. Data were collected on sociodemographic endpoints, type of dementia, Barthel Index (BI), Lawton Index (LO), Mini-Mental State Examination (MMSE), Charlson Index, total number of drugs, history of high blood pressure (HT), diabetes (DM), dyslipidemia (DL), heart failure (HF), chronic obstructive pulmonary disease (COPD) and cancer. RESULTS: The sample consisted of 222 women (71.4%) and 89 men. Mean age (standard deviation [SD]) was 80.6 (6) years. Patients were taking an average of 5.8 (2.6) drugs. The mean of Charlson Index was of 2.1 (1.3). Fifty-one percent had HT, 24% DM, 24% DL, 13% HF, 11% COPD and 8% cancer. We found better scores in the MMSE, higher comorbidity and percentage of married people and prevalence of vascular dementia in men with respect to women, who had higher percentage of Alzheimer disease, and widowers. When differences were analyzed according to age, we found a higher percentage of widowers and HF diagnosis, a lower LI values and DL percentage in the patients older than 84 years with respect to younger subjects. CONCLUSIONS: Our results showed the presence of high comorbidity and chronic drugs prescription in elderly people with dementia. There are some differences in comorbidity according to age and gender that must be taken into account.

Aspectos de comorbilidad en pacientes ancianos con demencia. Diferencias por edad y género / Medical comorbidity in elderly patients with dementia. Differences according age and gender

Fundamento y objetivo. La prevalencia de demencia en pacientes ancianos es alta. El objetivo del estudio es evaluar algunos aspectos de comorbilidad en los pacientes con demencia. Además se explora si existen diferencias según la edad (mayores o no de 84 años) y el género de los pacientes. Pacientes y métodos. Se evaluaron prospectivamente 311 pacientes mayores de 64 años con demencia. Se recogieron variables sociodemográficas, el tipo de demencia, el índice de Barthel (IB), el índice de Lawton (IL), el Mini Mental State Examination (MMSE), el índice de Charlson, el número total de medicamentos, los antecedentes de hipertensión (HTA), diabetes (DM), dislipidemia (DL), insuficiencia cardíaca (IC), enfermedad pulmonar obstructiva crónica (EPOC) y neoplasia. Resultados. Se trataba de 222 mujeres (71,4%) y 89 varones, con una edad media (desviación estándar [DE]) de 80,6 (6) años. La media del número total de medicamentos fue de 5,8 (2,6). La media del índice de Charlson fue de 2,1 (1,3). Existía en el 51% de los casos HTA, en 24% DM, en 24% DL, en 13% IC, en 11% EPOC y en el 8% neoplasia. Respecto al género, destacaba mejor puntuación en el MMSE, mayor comorbilidad, mayor porcentaje de casados y mayor prevalencia de demencia vascular en hombres en comparación con las mujeres, donde había mayor presencia de enfermedad de Alzheimer y mayor porcentaje de viudas. En relación a la edad había mayor número de viudos, peor IL, más IC y menos DL en los mayores de 84 años. Conclusiones. Los pacientes ancianos con demencia tienen una alta comorbilidad y un importante consumo de fármacos de prescripción crónica. Existen variaciones en la comorbilidad según la edad y el género, que deben tenerse en cuenta (AU)

Background. Prevalence of dementia in elderly patients is high. The goal of the study was to assess some aspects of comorbidity in the patients with dementia. We also analyzed comorbidity differences according to age and gender. Patients and methods. A total of 311 patients older than 64 years old with dementia were prospectively evaluated. Data were collected on sociodemographic endpoints, type of dementia, Barthel Index (BI), Lawton Index (LO), Mini-Mental State Examination (MMSE), Charlson Index, total number of drugs, history of high blood pressure (HT), diabetes (DM), dyslipidemia (DL), heart failure (HF), chronic obstructive pulmonary disease (COPD) and cancer. Results. The sample consisted of 222 women (71.4%) and 89 men. Mean age (standard deviation [SD]) was 80.6 (6) years. Patients were taking an average of 5.8 (2.6) drugs. The mean of Charlson Index was of 2.1 (1.3). Fifty-one percent had HT, 24% DM, 24% DL, 13% HF, 11% COPD and 8% cancer. We found better scores in the MMSE, higher comorbidity and percentage of married people and prevalence of vascular dementia in men with respect to women, who had higher percentage of Alzheimer disease, and widowers. When differences were analyzed according to age, we found a higher percentage of widowers and HF diagnosis, a lower LI values and DL percentage in the patients older than 84 years with respect to younger subjects. Conclusions. Our results showed the presence of high comorbidity and chronic drugs prescription in elderly people with dementia. There are some differences in comorbidity according to age and gender that must be taken into account (AU)

Gold and silver complexes with the ferrocenyl phosphine FcCH2PPh2.

Linear gold(I) and silver(I) complexes with the ferrocenyl phosphine FcCH2PPh2 [Fc = (eta5-C5H5)Fe(eta5-C5H4)] of the types [AuR(PPh2CH2Fc)], [M(PPh3)(PPh2CH2Fc)]OTf, and [M(PPh2CH2Fc)2]OTf (M = Au, Ag) have been obtained. Three-coordinate gold(I) and silver(I) derivatives of the types [AuCl(PPh2CH2Fc)2] and [M(PPh2CH2Fc)3]X (M = Au, X = ClO4; M = Ag, X = OTf) have been obtained from the corresponding gold and silver precursors in the appropriate molar ratio, although some of them are involved in equilibria in solution. The crystal structures of [AuR(PPh2CH2Fc)] (R = Cl, C6F5), [AuL(PPh2CH2Fc)]OTf (L = PPh3, FcCH2PPh2), [Au(C6F5)3(PPh2CH2Fc)], and [Ag(PPh2CH2Fc)3]OTf have been determined by X-ray diffraction studies.

[Breast feeding: knowledge, attitudes and sociocultural ambiguity]. / Lactancia materna: conocimientos, actitudes y ambigüedad sociocultural.

OBJECTIVES: Found sociocultural attitude with regard to breast-feeding (BF) between the sanitary (SP) and no sanitary personnel (NSP) of health centers. DESIGN: Descriptive, cross-sectional study. SETTING: 4 health centres and 3 hospitals of Valencia. PARTICIPANTS: 442 workers of these centres. INTERVENTION: Structured questionnaire. MAIN RESULTS: 88% of SP and 76% of NSP (p < 0.05) believed that BF has many advantages comparing with artificial-feeding in a developed country. SP said more advantages of BF than NSP (p < 0.0001). Most renowned advantages were immunological, affective relationship and comfort. Main inconveniences were dependence, work reasons, aesthetic nature and insecurity in the ingested amount. 56% of SP and 86% of NSP (p < 0.0001) believed milk's analysis necessary. 56% women and 38% men (p < 0.001) didn't see correct give BF in public. Men were more concerned than women (p < 0.05) for local problems of chest, aesthetic results, milk's quality and transmission of illnesses. CONCLUSIONS: It's necessary to support knowledge and re-evaluating the trust in the nutritious capacity of maternal milk between the personnel of health centers and hospitals. Generic ambiguity toward functions of feminine breast exists and public'BF isn't acceptable. It's necessary recover socioculturally the image of BF and keep in mind the existent ambiguity upon designing campaigns of promotion.

Reclassification after delivery of diabetes in pregnancy.

Gestational diabetes mellitus (GDM) constitutes a risk factor for the development of non insulin-dependent diabetes mellitus (NIDDM). The search for parameters to provide discrimination between a high risk and a low risk for future development of NIDDM is today the aim of many investigations. The absence or presence of several factors such as glycemia during pregnancy and post partum, the need for insulin treatment, disorders of the pancreatic insulin secretion, the number of pregnancies, maternal obesity, the early diagnosis of GDM, the family history of diabetes mellitus, the race and immune disorders give rise to a very high relative risk (RR) of developing NIDDM. To know the degree of risk will allow a future appropriate clinical intervention to reduce the incidence of NIDDM and its economic cost.

Current status of natural family planning in Granada (Spain).

In Spain the use of natural family planning (NFP) is limited. In Barcelona, CODIPLAN, an NFP planning center, has offered natural methods to potential users for a number of years. In Granada and Jaén, information provided by health professionals on fertility awareness is now gaining importance. In 1989, a seminar introduced NFP in Granada; the program has been very active since. Two courses were run for teachers and for health personnel, and we took part in the practical training of providers of alternative medical care through two programs organized by the University of Granada. We also gave talks on local radio and television programs, presented updating sessions at daycare centers, and gave health education classes at primary and secondary schools. The international seminar on NFP in March, 1992 was organized jointly by the University and the City Council. The proceedings will be published by the University of Granada. In 1990, under the scientific auspices of the Natural Family Planning Department at the Zaidin Medical Center, we started a program of training and follow-up for NFP users via an on-going seminar on NFP. In Granada and Jaén, NFP methods are now available to the general population and to health personnel.

Fertility control by natural methods. Analysis of 218 cycles.

We have started to teach natural family planning (NFP) in our health centers. We have studied 218 cycles in 14 women using NFP to space or avoid pregnancies for an average of 15 months per woman. All women were taught the symptothermal method, and used temperature, mucus, calculations and cervix modifications; temperature, calculations and mucus; or mucus alone, as signs of fertility. Usually they kept track of signs of fertility in each cycle; temperature taking was frequently limited to the periovulatory period, when they noted changes in their mucus. User couples belonged to a middle-lower economic group, for whom motivation was not religious or ethical. Good information is essential in deciding to use NFP. Women who are satisfied users often inform other women. User couples easily become autonomous and acquire the required level of knowledge, abandoning methods they relied on previously. Autonomy is welcomed by these women.

Recruitment of pregnant women for self-examination of the postpartum return of fertility.

In our health center we use breastfeeding in teaching natural family planning (NFP) to mothers. Our objective is for the women to detect the signs of returning fertility before ovulation. Breastfeeding is a factor in amenorrhea. All pregnant women attending our health center are invited to follow our course on maternal education from the 7th month of pregnancy. We inform them of the factors that influence the return of fertility and the signs of returning fertility, and urge the women to attend a course from the 20th day after childbirth. Since the beginning of June we have had a 30% participation rate by new mothers in the postpartum course. We have observed a new or strengthened desire to breastfeed and to observe the signs of fertility.

Selection for vancomycin resistance in clinical isolates of Staphylococcus haemolyticus.

Killing curves were used to characterize Staphylococcus haemolyticus isolates previously reported to contain subpopulations showing increased resistance to vancomycin. Results suggested that vancomycin and teicoplanin were ineffective at a concentration of 8 micrograms/ml and growth was seen between 24 and 48 h. Conversely, the lipopeptide antibiotic daptomycin at the same concentration rapidly killed tested strains by 6 h. Various staphylococcal strains were examined to determine if vancomycin resistance could be selected in all strains of staphylococci, was specie(s) restricted, or was unique to this patient's clinical isolates. About 1 x 10(8) colony-forming units were added to melted brain-heart infusion agar plates containing 12 micrograms/ml of vancomycin. Plates were examined after 48 h for presence of resistant clones. Results indicated that selection for vancomycin resistance was restricted to S. haemolyticus strains. Further, all S. haemolyticus isolates that displayed a double zone of growth around imipenem agar diffusion discs (Impdz) contained stably resistant subpopulations. Vancomycin resistance could not be selected in imipenem-sensitive derivative clones. Impdz isolates that were recovered from geographically distinct locations displayed nearly identical SDS-PAGE protein profiles. It appears that a characteristic susceptibility pattern displayed by clinical isolates of S. haemolyticus may provide a marker for those strains that contain subpopulations having increased resistance to vancomycin.