Cox regression with doubly truncated responses and time-dependent covariates: the impact of innovation on firm survival.

The creation of new firms is an important incentive for the economic growth of a country, since it generates employment, it encourages the competition, and promotes innovation. In this work, we investigate the survival of Spanish firms which were created since 2001 and closed down between 2004 and 2012. The information was gathered from Technological Innovation Panel (PITEC), a survey with a focus the technological innovation in Spanish firms. In particular, a Cox regression model with time-dependent covariates was used in order to identify and quantify the determinants of the risk of exit for the firm. The selection bias due to the interval sampling for the firms was corrected by using methods for doubly truncated lifetimes. Interestingly, it is seen how the correction for the selection bias changes both the size and the statistical significance of the effects provided by standard Cox regression.

Efficacy and safety of delafloxacin compared with vancomycin plus aztreonam for acute bacterial skin and skin structure infections: a Phase 3, double-blind, randomized study.

BACKGROUND: Delafloxacin is an investigational anionic fluoroquinolone in development for oral or intravenous administration for the treatment of infections caused by Gram-positive (including MRSA), Gram-negative, atypical and anaerobic organisms. OBJECTIVES: To establish the non-inferiority of delafloxacin compared with vancomycin plus aztreonam for the treatment of acute bacterial skin and skin structure infections and to compare the safety of the two antimicrobials. PATIENTS AND METHODS: A Phase 3, multicentre, randomized, double-blind, active-controlled study with 660 patients compared delafloxacin 300 mg or vancomycin 15 mg/kg plus aztreonam 2 g each administered twice daily intravenously for 5-14 days. Non-inferiority was evaluated by objective response (≥20% erythema reduction) at 48-72 h after initiation of study drug, investigator subjective assessment of outcome and microbiological responses. Clinical Trials Registration: NCT01811732. EudraCT number: 2012-001767-71. RESULTS: In the ITT analysis set, the objective response was 78.2% in the delafloxacin arm and 80.9% in the vancomycin/aztreonam arm (mean treatment difference, -2.6%; 95% CI, -8.78% to 3.57%). Investigator-assessed cure was similar between the two groups at follow-up (52.0% versus 50.5%) and late follow-up (70.4% versus 66.6%). Bacterial eradication of MRSA was 100% and 98.5% in the delafloxacin group and the vancomycin/aztreonam group, respectively. Frequency of treatment-emergent adverse events in the delafloxacin and vancomycin/aztreonam groups was similar. Treatment-emergent adverse events leading to study drug discontinuation were higher in the vancomycin/aztreonam group compared with the delafloxacin group (4.3% versus 0.9%). CONCLUSIONS: Delafloxacin, an anionic fluoroquinolone, was statistically non-inferior to vancomycin/aztreonam at 48-72 h following the start of therapy and was well tolerated as monotherapy in the treatment of acute bacterial skin and skin structure infections.

In Vitro Activity of Delafloxacin and Microbiological Response against Fluoroquinolone-Susceptible and Nonsusceptible Staphylococcus aureus Isolates from Two Phase 3 Studies of Acute Bacterial Skin and Skin Structure Infections.

Delafloxacin is an investigational anionic fluoroquinolone antibiotic with broad-spectrum in vitro activity, including activity against Gram-positive organisms, Gram-negative organisms, atypical organisms, and anaerobes. The in vitro activity of delafloxacin and the percent microbiological response in subjects infected with fluoroquinolone-susceptible and nonsusceptible Staphylococcus aureus isolates were determined from two global phase 3 studies of delafloxacin versus vancomycin plus aztreonam in patients with acute bacterial skin and skin structure infections (ABSSSI). Patients from 23 countries, predominately the United States but also Europe, South America, and Asia, were enrolled. The microbiological intent-to-treat (MITT) population included 1,042 patients from which 685 S. aureus isolates were submitted for identification and susceptibility testing per CLSI guidelines at the central laboratory (JMI Laboratories, North Liberty, IA). The comparator fluoroquinolone antibiotics included levofloxacin and ciprofloxacin. Nonsusceptibility to these antibiotics was determined using CLSI breakpoints. S. aureus isolates were 33.7% levofloxacin nonsusceptible (LVX-NS). The delafloxacin MIC90 values against levofloxacin-nonsusceptible S. aureus, methicillin-resistant S. aureus (MRSA), and methicillin-susceptible S. aureus isolates were all 0.25 µg/ml. Delafloxacin demonstrated high rates of microbiological response against LVX-NS isolates as well as isolates with documented mutations in the quinolone resistance-determining region (QRDR). S. aureus was eradicated or presumed eradicated in 98.4% (245/249) of delafloxacin-treated patients. Similar eradication rates were observed for delafloxacin-treated subjects with levofloxacin-nonsusceptible S. aureus isolates (80/81; 98.8%) and MRSA isolates (70/71; 98.6%). Microbiological response rates of 98.6% were observed with delafloxacin-treated subjects with S. aureus isolates with the S84L mutation in gyrA and the S80Y mutation in parC, the most commonly observed mutations in global phase 3 studies. The data suggest that delafloxacin could be a good option for the treatment of infections caused by S. aureus isolates causing ABSSSI, including MRSA isolates, where high rates of ciprofloxacin and levofloxacin nonsusceptibility are observed. (The phase 3 studies described in this paper have been registered at ClinicalTrials.gov under identifiers NCT01984684 and NCT01811732.).

Huntington disease and Huntington disease-like in a case series from Brazil.

The aim of this study was to identify the relative frequency of Huntington's disease (HD) and HD-like (HDL) disorders HDL1, HDL2, spinocerebellar ataxia type 2 (SCA2), SCA17, dentatorubral-pallidoluysian degeneration (DRPLA), benign hereditary chorea, neuroferritinopathy and chorea-acanthocytosis (CHAC), in a series of Brazilian families. Patients were recruited in seven centers if they or their relatives presented at least chorea, besides other findings. Molecular studies of HTT, ATXN2, TBP, ATN1, JPH3, FTL, NKX2-1/TITF1 and VPS13A genes were performed. A total of 104 families were ascertained from 2001 to 2012: 71 families from South, 25 from Southeast and 8 from Northeast Brazil. There were 93 HD, 4 HDL2 and 1 SCA2 families. Eleven of 104 index cases did not have a family history: 10 with HD. Clinical characteristics were similar between HD and non-HD cases. In HD, the median expanded (CAG)n (range) was 44 (40-81) units; R(2) between expanded HTT and age-at-onset (AO) was 0.55 (p=0.0001, Pearson). HDL2 was found in Rio de Janeiro (2 of 9 families) and Rio Grande do Sul states (2 of 68 families). We detected HD in 89.4%, HDL2 in 3.8% and SCA2 in 1% of 104 Brazilian families. There were no cases of HDL1, SCA17, DRPLA, neuroferritinopathy, benign hereditary chorea or CHAC. Only six families (5.8%) remained without diagnosis.

A study of neurotoxic biomarkers, c-fos and GFAP after acute exposure to GSM radiation at 900 MHz in the picrotoxin model of rat brains.

The acute effects of microwave exposure from the Global System for Mobile Communication (GSM) were studied in rats, using 900MHz radiation at an intensity similar to mobile phone emissions. Acute subconvulsive doses of picrotoxin were then administered to the rats and an experimental model of seizure-proneness was created from the data. Seventy-two adult male Sprague-Dawley rats underwent immunochemical testing of relevant anatomical areas to measure induction of the c-fos neuronal marker after 90min and 24h, and of the glial fibrillary acidic protein (GFAP) 72h after acute exposure to a 900MHz electromagnetic field (EMF). The experimental set-up facilitated measurement of absorbed power, from which the average specific absorption rate was calculated using the finite-difference time-domain (FDTD) 2h after exposure to EMF radiation at 1.45W/kg in picrotoxin-treated rats and 1.38W/kg in untreated rats. Ninety minutes after radiation high levels of c-fos expression were recorded in the neocortex and paleocortex along with low hippocampus activation in picrotoxin treated animals. Most brain areas, except the limbic cortical region, showed important increases in neuronal activation 24h after picrotoxin and radiation. Three days after picrotoxin treatment, radiation effects were still apparent in the neocortex, dentate gyrus and CA3, but a significant decrease in activity was noted in the piriform and entorhinal cortex. During this time, glial reactivity increased with every seizure in irradiated, picrotoxin-treated brain regions. Our results reveal that c-fos and glial markers were triggered by the combined stress of non-thermal irradiation and the toxic effect of picrotoxin on cerebral tissues.

Relationship between habitual breakfast and intellectual performance (logical reasoning) in well-nourished schoolchildren of Madrid (Spain).

OBJECTIVE: To determine the relationships between habitual breakfast habits and performance in verbal aptitude, logical reasoning and mathematical tests in a group of well-nourished scholars from Madrid. DESIGN: The study subjects were 180 children between 9 and 13 y of age. A dietetic study was undertaken using a 7-day food record. Scholastic aptitude was examined using the scholastic aptitude test (SAT-1) test. RESULTS: Breakfast made up 19.1% of total daily intake. No differences were found between subjects in terms of personal data or total diet with respect to whether they habitually took adequate breakfasts (AB) (ie, more than 20% of daily energy being provided by this meal) or inadequate breakfasts (IB) (less than 20%). However, AB subjects achieved better reasoning scores in the SAT-1 test. CONCLUSIONS: The normal breakfast habits of schoolchildren should be taken into account when studying diet-mental function relationships, even when studying well-nourished populations.

Influence of dietetic and anthropometric factors and of the type of sport practised on bone density in different groups of women.

OBJECTIVE: The aim of this work was to analyse the influence of dietetic and anthropometric data, as well as the sport practised, on the bone density of different groups of sportswomen. SUBJECTS AND METHODS: Dietetic, anthropometric and bone density data were collected from 74 women who practised different sports (15 skiers, 26 basketball players and 33 ballet dancers), and compared to those of 90 women who led sedentary lifestyles. RESULTS: The sportswomen had higher bone mineral contents and bone densities than controls. However, the dancers showed similar spinal and hip values as those of controls, and lower forearm values. Low body weight and body mass index, and insufficient energy intake-characteristic of the dancers-were associated with poorer bone mineralisation status. Increased energy, protein, vitamin D, calcium, zinc and magnesium intakes were associated with greater bone density and mineral content at different sites. CONCLUSIONS: The worst bone density status was that of the dancers, who, as a group, displayed characteristics that have negative impacts in this respect (low energy intakes and low body weight). Dancers should therefore take steps to avoid suffering fractures and skeleto-muscular lesions which could negatively influence their health and physical performance. The greater consumption of milk products and calcium and better Ca/P ratio seen in the dancers could help this group to avoid bone deterioration.

The influence of vitamin B2 intake on the activation coefficient of erythrocyte glutation reductase in the elderly.

OBJECTIVE: To evaluate the influence of dietetic vitamin B2 on the activation coefficient of erythrocyte glutation reductase (alpha-EGR) of a group of elderly people. DESIGN: The study subjects were 133, independently-living elderly people, between 65 and 90 years of age. A dietetic study was performed using a 7-day food record. Riboflavin status was measured by determining the alpha-EGR. RESULTS: Some 23.9% of subjects had riboflavin intakes lower than those recommended. At the biochemical level, 9.8% of subjects (7.7% of men and of 10.6% women) showed alpha-EGR>1.2. Those subjects with riboflavin intakes below 90% of those recommended showed significantly higher alpha-EGR levels (1.15+/-0.16), an indication of a poorer riboflavin status at the biochemical level. Those with greater intakes showed lower alpha-EGR values (1.05+/-0.10). Furthermore, the mean consumption of dairy products (an important source of this vitamin) by subjects is insuficiente (341.1+/-159.8 g/day, 2.1+/-1 servings/day). The data show that those with riboflavin intakes below those recommended took 204.7+/-89.4 g/day of milk products (1.3+/-0.5 servings/day) compared to the 384+/-153.1 g/day (2.4+/-1 servings/day) (p<0.001) consumed by those with higher riboflavin intakes. CONCLUSION: Although the mean riboflavin intake is acceptable, there remain some insufficiencies that require attention. It would seem advisable to recommend the elderly increase their intake of milk products. This would be especially important for subjects who take less than two rations per day.

Appropriateness of emergency department visits in a Portuguese university hospital.

STUDY OBJECTIVE: There are no studies in Portugal supporting a common claim that most emergency department visits are inappropriate. The aim of this study was to determine the prevalence of and to evaluate factors associated with an appropriate ED visit in a major public hospital. METHODS: A cross-sectional prospective study was performed at a public university hospital ED. Data for demographic variables, duration of complaint, transfer from other medical sources, and previous medical care for the same complaints were collected by interviewing all patients who arrived at the ED within a consecutive period of at least 24 hours. Data for diagnostic tests, treatment performed, and final patient destination were collected by triage records review. An appropriate ED visit was defined by explicit criteria: interhospital transfer, patient death at the ED, hospitalization, and diagnostic tests or treatments performed. RESULTS: The study included 5,818 adult patients. The prevalence of an appropriate ED visit, by use of our criteria, was 68.7%. Sex was an effect modifier. According to this study, determinants of an appropriate visit for men and women were age 60 years or older and complaints of 24 hours or less and in women but not in men, retired from work and with arrival between midnight and 8 AM. CONCLUSIONS: In a university hospital in Oporto, the majority of ED visits were appropriate according to explicit criteria. Some variables may be associated with appropriateness of ED visits. A duration of the complaint 24 hours or less along with an arrival between midnight and 8 AM in women and age 60 years or older in men were the most important determinants.

Perception of teratogenic risk of common medicines.

OBJECTIVE: To assess the perception of the teratogenic risk of common medication by professionals and lay people. STUDY DESIGN: A visual-analogue scale was used to measure the perceived percentage of mothers who will deliver a child with a malformation, including those exposed to a list of drugs. Fifteen general practitioners, 10 gynaecologists, 106 pre-clinical students, 150 students in their clinical training, 81 pregnant women and 63 non-pregnant women were interviewed. RESULTS: The perception of the teratogenic risk related to medication used in pregnancy was higher than the recognised risk in all groups, and for all drugs. The risk associated with safe medications was perceived to be higher by non-pregnant women as compared with the pregnant women. Pregnant women perceived the medication associated risk to be higher than physicians did for all drugs included in the questionnaire. CONCLUSIONS: The high and unrealistic perception of teratogenic risk amongst women and health professionals may lead to abortions of otherwise wanted and healthy children.

Neumomediastino infantil en el Área de Salud del Bierzo, 1989-2000 / Pneunomediastinum in children in the Health Care Area of Bierzo (Spain), 1989-2000

El neumomediastino infantil es una afección aparentemente infrecuente, excepto en el periodo neonatal. Puede aparecer en niños sanos o asociarse a múltiples procesos patológicos. Con el fin de conocer la incidencia acumulada y las características del neumomediastino en nuestra Área de Salud, se realizó un estudio retrospectivo de los casos acaecidos entre 1988 y 2000 en niños. Los síndromes de aire extraalveolar neonatal fueron excluidos. Se diagnosticaron 7 casos de neumomediastino, lo que supone una incidencia acumulada en dicho periodo de 31,69 por 100.000 habitantes, frente a la de 9,05 por 100.000 para los neumotórax .Existió un leve predominio en varones (57 por ciento). Con respecto a la etiología en 4 casos existió asociación con enfermedad respiratoria (bronquiolitis, crisis asmática, aspiración de cuerpo extraño) y en uno de los casos existió antecedente traumático claro. La clínica fue muy variable predominando la disnea y el dolor torácico o cervical. Sólo en dos de los casos se detectó el signo de Hamman. El tratamiento fue siempre conservador y la evolución favorable (AU)

Age related changes in the elastic fiber system of the interfoveolar ligament.

In order to evaluate age related changes of the elastic fiber system in the interfoveolar ligament, we studied the deep inguinal ring from 33 male cadavers aged from stillborn to 76 years. Selective and alternated staining methods for elastic fibers were performed to differentiate oxytalan, elaunin, and mature elastic fibers. We confirmed quantitative changes of the elastic fiber system with aging. There was a significant and progressive reduction of the oxytalan fibers (responsible for tissue resistance) and a significant increment in the mature elastic and elaunin fibers (responsible for tissue elasticity). Furthermore, there were structural changes in the thickness, shortness and curling of these mature elastic fibers. These changes induced loss of the elastic fiber function and loss of the interfoveolar ligament compliance. These factors predispose individuals to the development of indirect inguinal hernias that frequently emerge in adults and aged individuals, especially above the fifth decade.

Influence of calcium intake on gestational hypertension.

Calcium intake during the third trimester of pregnancy was determined in 82 pregnant women by recording the consumption of foods over a 5-day period and by calculation of the quantity of this element provided by dietary supplements. For each subject, blood pressures were measured once per week using an aneroid sphygmomanometer, to detect and analyze differences in calcium intake between those with normal blood pressure and those suffering from gestational hypertension (7.3%). Calcium intake was significantly lower amongst subjects with high blood pressure (757.7 +/- 154.5 compared to 986.4 +/- 502.3 mg/day in normotensive subjects). The relationship between calcium intake and blood pressure was independent of other variables such as body mass index, number of previous pregnancies, weight gain, subject age or hematocrit levels. Though further investigation is needed, the results obtained seem to support the idea that pregnant women should try to maintain an optimal calcium intake.

Riboflavin levels in maternal milk: the influence of vitamin B2 status during the third trimester of pregnancy.

OBJECTIVE: The aim of the present investigation was to study the relationship between riboflavin status during the third trimester of pregnancy and levels of this vitamin in transition milk (days 13 to 14 of lactation) and mature milk (day 40 of lactation). METHODS: The pregnancies and lactation periods of 57 healthy women between 18 and 35 years of age (27+/-3.7 years) were monitored, vitamin intake during the third trimester was determined by recording the consumption of foods over five days and by registering the quantities provided by dietary supplements. Riboflavin status during this stage of pregnancy was determined via the measurement of the activation of erythrocyte glutathione reductase (EGR) by flavine adenine dinucleotide (FAD). Milk riboflavin levels were determined by fluorometry. RESULTS: Those subjects with riboflavin intakes below recommended (1.6 mg/day) (Group L) showed lower consumption of milk products (305.2+/-88.5 g/day) than did those with greater intakes (Group H) (507.9+/-137.2 g/day). The consumption of riboflavin containing supplements was very low and was seen only in two H subjects. Transition and mature milk riboflavin levels were significantly higher in H subjects (948.1+/-700.1 nmol/L for transition milk and 993.8+/-436.6 nmol/L for mature milk) than L subjects (574.9+/-258.7 nmol/L for transition milk and 725.4+/-254.3 nmol/L for mature milk). Subjects with alpha-EGR coefficients over 1.2 in the third trimester showed significantly lower mature milk riboflavin levels (704.1+/-241.8 nmol/L) than did subjects with more satisfactory alpha-EGR coefficients (996.4+/-302.9 nmol/L). CONCLUSION: The influence of maternal vitamin B2 status during pregnancy on breast milk riboflavin levels was confirmed.

[Dietary cholesterol as a conditioner of ingestion of other nutrients and various blood parameters in young women]. / El colesterol dietético como condicionante de la ingesta de otros nutrientes y de diversos parámetros sanguíneos en mujeres jóvenes.

The aim of the study was to determine the effects of cholesterol intakes of greater (HC) or less than 300 mg/day (LC) (the upper advisable limit for the control of cholesterolaemia and the risk of cardiovascular disease) on a range of blood parameters, and to determine any influence such intakes might have on the consumption of food, energy and nutrients. The study subjects we one hundred and thirty young women. Food intake was determined using a 7-day dietary record (including a Sunday). A range of serum lipid parameters, and haematological and biochemical indicators of iron status were also determined. The percentage discrepancy between observed energy intake and theoretical energy expenditure was greater amongst LC subjects (9.7 +/- 18.8% compared to 5.5 +/- 24.4% in HC subjects) (P < 0.05). Analysis of covariance was therefore performed with respect to the degree of underestimation/overestimation of intake. The comparison of the adjusted means showed that HC subjects consumed greater quantities of eggs and meat and less alcohol, than did LC subjects. HC subjects also showed greater intakes of protein, carbohydrates, total fats, monounsaturated fatty acids, polyunsaturated fatty acids, saturated fatty acids, cholesterol, riboflavin, niacin, folic acid, vitamin E, zinc and iron. At blood level, HC subjects showed greater quantities of red blood cells, haemoglobin and HDL cholesterol. No significant differences were seen between LC and HC subjects for the remaining blood and biochemical parameters investigated. The development of criteria for the greatest protection against cardiovascular disease whilst maintaining good nutritive condition, is the subject of studies soon to be commenced. Women may need different advice to men, owing to their greater need of iron. Greater quantities of foods rich in haem iron, such as meat and fish, might be appropriate for the female population.

[Supplementation with iron and folates during gestation: influence on the zinc status in the mother and on the zinc content in the maternal milk]. / Suplementación con hierro y folatos durante la gestación: influencia en la situación en cinc de la madre y en el contenido en cinc de la leche materna.

BACKGROUND: The aim of the present study was to investigate whether such supplementation impairs the zinc status of pregnant women or the zinc content of maternal milk. MATERIAL AND METHODS: Fifty seven women were studied during pregnancy and lactation. Zinc, iron and folate intakes were monitored during the third trimester of pregnancy using a five day food record and by registering intake of the same in the form of dietary supplements. Zinc levels were determined, using flame-atomic-absorption spectrophotometry, in serum during the third trimester of pregnancy, in transition milk (day 13-14 of lactation), and in mature milk (day 40 of lactation). RESULTS: 1.8% of pregnant women took zinc supplements whilst 7% took folate supplements. However, 100% of subjects showed zinc intakes (the sum of dietary and supplementary intakes) lower than those recommended. 87.7% showed the same for folate intake, 29.8% of pregnant women took iron supplements. When dietary and supplementary intakes were added, 26.3% of subjects showed iron intakes of over 200% of those recommended. Pregnant women with iron intakes in the third trimester of pregnancy of over 200% those recommended, showed lower serum zinc levels during the third trimester and, at a later date, lower mature milk zinc levels than did subjects with lower iron intakes. CONCLUSIONS: The combined dietary and supplementary intake of iron in some subjects provided total intakes of over 200% those recommended. Though this might be associated with an improvement in iron status it may impair those of zinc. Subjects with an intake of iron of over 200% of that recommended showed significantly lower serum and mature milk zinc levels than did those with lower iron intakes. It is suggested that the nutritional status of pregnant women should be carefully monitored and supplementation tailored to the needs of each individual.

[Relationship between the number of daily meals and the energy and nutrient intake in the elderly. Effect on various cardiovascular risk factors]. / El número de comidas diarias como condicionante de la ingesta de alimentos energía y nutrientes en ancianos. Influencia en relación con diversos factores de riesgo cardiovascular.

The metabolic consequences of the consumption of a diet depend, in part, on the frequency and distribution of meals. The aim of the present study was to examine the number of meals taken per day by elderly persons, and to analyse the relationship between the number of meals per day on the intake of energy and nutrients, the incidence of obesity/overweight, and different cardiovascular risk factors. Food intake was monitored for five consecutive days using 'precise individual weighing' for institutionalised subjects (n = 58), and by means of a 'food intake record' for independent subjects (n = 92). The number of meals taken per day was recorded, along with anthropometric data, blood pressure and serum lipid and lipoprotein levels. No subject took only one meal per day, 7.3% took two, 56.7% took three, 33.3% took four and 2.7% took five. Only 10% of subjects took a mid-morning meal. Breakfast and merienda (a light evening snack) were the meals most frequently omitted. A positive, significant relationship was found to exist between the number of meals taken per day and the intake of fibre (r = 0.2737), thiamin (r = 0.1671), pyridoxine (r = 0.2060), magnesium (r = 0.2423) and the percentage of energy provided by carbohydrates (r = 0.2144). Women subjects who took 2-3 meals per day showed greater body mass indices and a greater proportion were overweight/obese compared to those who took 4-5 meals per day. Subjects who took 4-5 meals per day showed higher levels of HDL-cholesterol and lower levels of LDL-cholesterol/HDL-cholesterol and cholesterol/HDL-cholesterol than did those who took fewer meals per day. Inverse, significant relationships were also found between the number of meals per day and serum cholesterol (r = 0.2297) and LDL-cholesterol levels (r = 0.1984). Taking into account energy and nutrient intakes, the incidence of obesity/overweight and serum lipid and lipoprotein levels, the consumption of 4-5 meals per day would seem more advisable for the elderly than the taking of fewer meals.

Calcium levels in maternal milk: relationships with calcium intake during the third trimester of pregnancy.

The aim of the present study was to investigate the relationship of Ca intake and serum Ca levels during the third trimester of pregnancy with levels of the same mineral in transition milk (days 13-14 of lactation) and mature milk (day 40 of lactation). The study subjects were a group of fifty-seven healthy, lactating mothers aged between 18 and 35 years (mean 27 (SD 3.7) years) whose pregnancies and labour were attended by the Department of Obstetrics and Gynaecology of Cuenca INSALUD Hospital, Spain. Ca intake during the third trimester was determined by recording the consumption of foods over a 5 d period and by registering Ca provided by dietary supplements. The same method was used to investigate the intake of protein, vitamin D, fibre and Fe, nutrients that could affect the use of dietary Ca. Ca levels in maternal serum during this stage of pregnancy, during lactation and in transition and mature milk samples, were determined using 2-cresolphthalein complexone. During pregnancy 70.2% of subjects showed Ca intakes below 1100 mg/d (75th percentile). The consumption of Ca supplements was very small and hardly modified the mean quantity supplied by the diet. Subjects with an intake < 1100 mg/d showed no fall in Ca levels in serum, either during pregnancy or lactation, nor were decreased levels found in transition milk. However, these subjects showed lower Ca levels in mature milk (5.95 (SD 1.56) mmol/l) than did subjects with greater Ca intakes (6.82 (SD 1.31) mmol/l). This may suggest that breast-fed babies of mothers with lower Ca intakes during pregnancy also receive less Ca.

Influence of smoking on vitamin E status during the third trimester of pregnancy and on breast-milk tocopherol concentrations in Spanish women.

Concentrations of antioxidants in breast milk probably define the degree of protection it can offer against peroxidation. The aim of the present investigation was to determine the differences in vitamin E status of Spanish women smokers and nonsmokers in their third trimester of pregnancy and the concentrations of tocopherol in their milk. Vitamin E intake was determined during the third trimester of pregnancy by using a 5-d dietary record (including a Sunday) and by recording the quantities provided by supplements. HPLC was used to determine vitamin E concentrations in subjects' serum during the third trimester, in transitional breast milk on days 13-14 of lactation, and in mature breast milk on day 40 of lactation. Subjects also answered a questionnaire about their smoking habits during pregnancy. Subjects were grouped as nonsmokers (71.9%; n = 41) or smokers (28.1%; n = 16). Although vitamin E intake was somewhat greater in nonsmokers, the difference was not significant. Ratios of vitamin E to polyunsaturated fatty acids were practically the same in both groups. The use of vitamin E supplements was limited and did not modify the results of the study. No significant differences in these serum indexes were found between smokers and nonsmokers, and no subject had deficient serum vitamin E concentrations. However, vitamin E concentrations in mature milk were significantly lower in smokers than in nonsmokers. Although it is already known that maternal smoking favors peroxidation events in newborns, if the concentration of antioxidants (vitamin E) in smokers' breast milk is also lower, it might aggravate the peroxidation problems of their newborns.