Toxic elements in hair and in vitro fertilization outcomes: A prospective cohort study.

We analysed the association between the concentration of four toxic elements (As, Cd, Hg and Pb) and diverse reproductive outcomes in a cohort of 194 women with fertility disorders undergoing IVF in a public hospital. Concentration in hair specimens was explored as biomarker of exposure during the three months prior to oocyte retrieval. The proportion of negative results, especially regarding pregnancy and birth outcomes, is remarkable. However, we found that the probability of mature oocytes was inversely associated with the concentration of Hg in hair (RR = 0.81, 95% CI: 0.70-0.95) and directly associated with that of Pb (RR = 1.18, 95% CI: 1.03-1.35). These findings provide insights for future research on the links between heavy metal concentrations and IVF outcomes.

Effects of oxytocin used during delivery on development: a retrospective cohort study.

OBJECTIVE: The objective was to evaluate the potential influence of oxytocin administered during delivery on children's development at the age of 5. METHOD: This study was designed as a retrospective cohort study where children from patients given synthetic oxytocin during delivery were considered as the exposed cohort and children from patients not given oxytocin as the nonexposed cohort. From a total of 7465 births attended at our maternity ward in 2006, an initial sample of 400 was randomly selected. A total of 148 children were evaluated using the Battelle Developmental Inventory. Potential confounding and adjustment factors were analyzed using stratified analysis and multivariate analysis (logistic regression). RESULTS: Oxytocin use did not significantly affect the overall risk of developmental delay in the study sample (relative risk, RR, 1.46; 95% confidence interval, CI [0.79-2.71]). The best fit regression model included twin delivery, type of delivery, and maternal age. In the group of vaginal noninstrumental deliveries, oxytocin administration increased the risk of poor Battelle Developmental Inventory outcome, particularly when maternal age was under 28 or over 35 years of age (odds ratio, OR, 67.14; 95% CI [5.46-824.86]). When delivery was instrumental or through cesarean section in mothers aged 28-35 years, oxytocin administration decreased the risk of developmental disorders (OR 0.16; 95% CI [0.04-0.66]). CONCLUSION: Although oxytocin administration during delivery did not affect the overall risk of low Battelle Developmental Inventory scores in the study sample, some effects were seen according to maternal age and type of birth.

Oxytocin administered during labor and breast-feeding: a retrospective cohort study.

OBJECTIVE: The relationship between labor physiology and the onset of lactation leads to assess the potential correlation between oxytocin administration during labor and duration of breast-feeding. METHODS: This study was designed as a retrospective cohort study where patients given synthetic oxytocin during labor induction were considered as the exposed cohort, and patients not given oxytocin formed the non-exposed cohort. Four hundred of the 7465 children born at our maternity during 2006 were randomly selected. Information about breast-feeding was available for 316 of these children. Eventual confounding or adjustment factors were analyzed using stratified and multivariate analysis. RESULTS: Oxytocin was used for delivery of 189 (59.8%) newborns, multiplying the risk of bottle-feeding by 1.451 (95% CI 1.28-1.63). The best-fit regression model of oxytocin use effect on bottle-feeding included sex and gestational age of the newborn. The use of oxytocin also multiplies the risk of breast-feeding withdrawal at 3 months by 2.29 (95% CI 1.41-3.74). This effect is confounded by maternal age, being higher for mothers under 27 years. CONCLUSION: Oxytocin administration during labor had some impact on both onset and duration of breast-feeding, particularly in mothers under 27 years of age and newborns delivered at term. Clinical Study registered at U.S. NIH, ID: NCT01951040.

Effectiveness and economic analysis of the whole cell/recombinant B subunit (WC/rbs) inactivated oral cholera vaccine in the prevention of traveller's diarrhoea.

BACKGROUND: Nowadays there is a debate about the indication of the oral whole-cell/recombinant B-subunit cholera vaccine (WC/rBS) in traveller's diarrhoea. However, a cost-benefit analysis based on real data has not been published. METHODS: A cost-effectiveness and cost-benefit study of the oral cholera vaccine (WC/rBS), Dukoral for the prevention of traveller's diarrhoea (TD) was performed in subjects travelling to cholera risk areas. The effectiveness of WC/rBS vaccine in the prevention of TD was analyzed in 362 travellers attending two International Vaccination Centres in Spain between May and September 2005. RESULTS: The overall vaccine efficacy against TD was 42,6%. Direct healthcare-related costs as well as indirect costs (lost vacation days) subsequent to the disease were considered. Preventive vaccination against TD resulted in a mean saving of 79.26 euro per traveller. CONCLUSION: According to the cost-benefit analysis performed, the recommendation for WC/rBS vaccination in subjects travelling to zones at risk of TD is beneficial for the traveller, regardless of trip duration and visited continent.

Social network of PESCA (Open Source Platform for eHealth).

Information and Communication Technologies (ICTs) are revolutionizing how healthcare systems deliver top-quality care to citizens. In this way, Open Source Software (OSS) has demonstrated to be an important strategy to spread ICTs use. Several human and technological barriers in adopting OSS for healthcare have been identified. Human barriers include user acceptance, limited support, technical skillfulness, awareness, resistance to change, etc., while Technological barriers embrace need for open standards, heterogeneous OSS developed without normalization and metrics, lack of initiatives to evaluate existing health OSS and need for quality control and functional validation. The goals of PESCA project are to create a platform of interoperable modules to evaluate, classify and validate good practices in health OSS. Furthermore, a normalization platform will provide interoperable solutions in the fields of healthcare services, health surveillance, health literature, and health education, knowledge and research. Within the platform, the first goal to achieve is the setup of the collaborative work infrastructure. The platform is being organized as a Social Network which works to evaluate five scopes of every existing open source tools for eHealth: Open Source Software, Quality, Pedagogical, Security and privacy and Internationalization/I18N. In the meantime, the knowledge collected from the networking will configure a Good Practice Repository on eHealth promoting the effective use of ICT on behalf of the citizen's health.

Third molar development according to chronological age in populations from Spanish and Magrebian origin.

Spain is frequently the entrance country into the European Union for undocumented immigrants, especially those from the Magreb (Northern Africa). Forensic age estimates for these persons are difficult because systematic studies of dental maturity are lacking. Three different populations were analyzed to determine the pattern of development of third molars as a tool for age estimation in people of different ethnic and geographic origin. Orthopantomograms from two different populations of Spanish origin (Galicia in northwestern continental Spain, and Ceuta, a Spanish province in Northern Africa) were compared to radiographs of molars from a Magrebian population (Northern Africa) resident in Ceuta. Orthopantomograms were obtained from a private dental clinic (n=344) in Galicia and from the Public Oral Health Services (n=228) in Ceuta. We looked for differences in third molar mineralization (determined with the Demirjian scale) that might serve as age indicators (older versus younger than 18 years). Differences in maturation patterns were found between sexes and populations of origin. Mineralization of tooth 38 was more advanced in males than females among subjects 18 years of age and older in all three populations. Moreover, mineralization of tooth 38 in subjects aged 18 years and older was significantly slower in the Spanish-Galicia population than in the Magrebian-Ceuta population. We found no significant differences between Magrebian and Spanish individuals from Ceuta. We conclude that differences in tooth 38 mineralization may be related more with socio-geographical than ethnic origin (ancestry), and thus constitute evidence of the relevance of socio-geographic rather than genetic factors in third molar development. We used ROC analysis to determine the accuracy of the examiner's ability to correctly estimate age as younger or older than 18 years. The results suggest that Demirjian stage for tooth 38 can be considered a good indicator of age in all three populations.