Abordaje fisioterapéutico en el tratamiento del cólico del lactante. Una revisión sistemática / Physiotherapeutic approach in the treatment of the infant colic. A systematic review

Objetivo: El objetivo de esta revisión será evaluar la efectividad de los diferentes tratamientos fisioterapéuticos de los que disponemos actualmente para reducir los casos o mejorar la sintomatología del bebé que padece cólico del lactante. Material y métodos: La búsqueda se realizó en las bases de datos Pubmed, PEDro y Scopus con las palabras clave infantcolic, physiotherapy y musculoskeletal manipulations. Se seleccionaron publicaciones de los últimos 20 años en inglés o en español. En ellas se evaluaban bebés con cólicos infantiles que se sometieron a diferentes tratamientos fisioterapéuticos. Las principales variables estudiadas fueron el patrón de llanto y la duración del sueño, y se usó como principal instrumento de medida el diario de llanto de 24horas. Para evaluar la calidad metodológica de los estudios se empleó la escala PEDro. Resultados: Tras la búsqueda bibliográfica se seleccionaron 13 ensayos clínicos controlados y aleatorizados. Estos estudios fueron clasificados según el tipo de tratamiento aplicado (masoterapia, manipulación espinal, manipulación craneal, reflexología y acupuntura) y estudiados, obteniéndose favorables resultados sobre todo con la aplicación de masoterapia. Conclusiones: Se han encontrado resultados favorables para el manejo de la sintomatología del cólico del lactante, reduciéndose las horas de llanto y aumentado las horas de sueño a través de los tratamientos fisioterapéuticos estudiados: masoterapia, manipulación espinal, manipulación craneal, reflexología y acupuntura.

Objective: To assess critically the effectiveness of the different physiotherapeutic treatments that we currently have to reduce cases or improve the symptomatology of the infant colic. Material and methods: A randomized clinical trial search was conducted in Pubmed, PEDro and Scopus databases using “infant colic”, “physiotherapy” and “musculoskeletal manipulations” as keywords. Publications of the last 20 years and of English or Spanish language were selected. In these studies, babies with infant colic were treated with different physiotherapeutic treatments. The variables studies were mainly the crying pattern, the duration of sleep and de 24-hour crying diary, which was used as the main measuring instrument. “PEDro” scale was used in order to evaluate the quality of the studies. Results: Thirteen clinical randomized trials were selected. The studies were classified according to the treatment applied (masotherapy, spinal manipulation, cranial manipulation, reflexology and acupuncture) and the effects reported, obtaining positive results specially those where masotherapy was used. Conclusions: Most of the studies showed favorable results of the treatments for infant colic. Masotherapy, spinal manipulation, cranial manipulation, reflexology and acupuncture improve infant colic symptoms, reducing crying hours and increasing sleep hours.

Tratamiento fisioterapéutico para la dismenorrea primaria: una revisión sistemática / Physiotherapy treatment for primary dysmenorrhoea: A systematic review

Objetivo: Conocer y describir la eficacia del tratamiento de la dismenorrea primaria desde el campo de la fisioterapia. Material y métodos: Se realizó una revisión sistemática con búsqueda en las bases de datos Medline (Pubmed), Scopus y PEDro de artículos sobre el tratamiento de fisioterapia en la dismenorrea primaria. Se incluyeron ensayos clínicos aleatorizados, en inglés o en español, con una antigüedad menor de 5años y con una puntuación de 4 o más en la escala PEDro (Physiotherapy Evidence Database). Resultados: Un total de 178 artículos resultaron de la búsqueda realizada, de los cuales 13 reunían los criterios de inclusión. Los ensayos utilizaron la acupresión, el ejercicio físico incluyéndose el yoga, la terapia manual y la electroterapia como tratamiento fisioterapéutico de la dismenorrea primaria. Las medidas de resultado estudiadas fueron la intensidad y la duración del dolor, el distrés menstrual, la calidad de vida, los síntomas menstruales y la toma de medicamentos. Conclusión: Algunas modalidades de fisioterapia como acupresión, ejercicio físico, terapia manual y electroterapia mejoran el dolor y algunos de los síntomas de la dismenorrea primaria.(AU)

Objective: To know and describe the efficacy of the treatment of primary dysmenorrhoea from the field of physiotherapy. Material and methods: A systematic review was carried out with a search in the Medline (Pubmed), Scopus and PEDro databases for articles on physiotherapy treatment in primary dysmenorrhoea. Randomized clinical trials were included, in English or Spanish, less than 5years old and with a score of 4 or more on the PEDro scale (Physiotherapy Evidence Database). Results: A total of 178 articles resulted from the search, of which 13 met the inclusion criteria. The trials used acupressure, physical exercise including yoga, manual therapy, and electrotherapy as a physiotherapeutic treatment of primary dysmenorrhoea. The measures of results studied were intensity and duration of pain, menstrual distress, quality of life, menstrual symptoms and medication taking. Conclusion: Some physical therapy modalities such as acupressure, exercise, manual therapy, and electrotherapy improve pain and some of the symptoms of primary dysmenorrhea.(AU)

El método Pilates es eficaz en el tratamiento para el abordaje terapéutico del dolor lumbar crónico. Una revisión sistemática / The Pilates method is effective in the treatment for the therapeutic approach of the chronic low back pain. A systematic review / O método Pilates é eficaz no tratamento para a abordagem terapêutica da dor lombar crônica. Uma revisão sistemática

OBJETIVOS: Revisar la literatura más actual para comprobar la efectividad del método Pilates en el dolor lumbar crónico respecto a su efectividad, duración y dosimetría. MÉTODOS: Se realiza una búsqueda bibliográfica de ensayos clínicos publicados en los últimos cinco años en las bases de datos de Medline, Scopus y PEDro. De 257 estudios hallados, diez son seleccionados atendiendo a los criterios de inclusión y exclusión, siendo posteriormente evaluados en base a la calidad metodológica mediante la escala PEDro. RESULTADOS: El método Pilates reduce la sintomatología asociada al dolor lumbar crónico a corto plazo, no siendo superior a otros programas activos. Su aplicación en máquinas parece ser más efectiva. Actualmente, no existe consenso respecto a su dosimetría y su efectividad a largo plazo. CONCLUSIONES: El método Pilates puede ser efectivo a corto plazo para el abordaje terapéutico del dolor lumbar crónico, sin embargo, no ha demostrado ser superior a otros programas de ejercicios activos

OBJECTIVES: To review the most current literature to verify the effectiveness of the Pilates method for the approach of the chronic low back pain regarding to its effectiveness, its duration and its dosimetry. METHODS: A bibliography search of clinical trials published in the last five years was carried out using the databases of Medline, Scopus and PEDro. Of the 257 studies found, ten were selected according to the inclusion and exclusion criteria, and then assessed based on the methodological quality through the PEDro scale. RESULTS: The Pilates method reduces the symptoms associated with the chronic low back pain in the short term, it is not better than other active programs. Its application in machines seems to be more effective. Currently, there is no consensus regarding to its dosimetry and its effectiveness in the long term. CONCLUSIONS: The Pilates method can be effective in the short term for the therapeutic approach of the chronic low back pain. In contrast, the effectiveness of the Pilates method has not shown to be better than other active exercise programs

OBJETIVOS: Revisar a literatura mais atual para verificar a eficácia do método Pilates na dor lombar crônica quanto à sua eficácia, duração e dosimetria. MÉTODOS: É realizada uma pesquisa bibliográfica de ensaios clínicos publicados nos últimos cinco anos nas bases de dados Medline, Scopus e PEDro. Dos 257 estudos encontrados, dez foram selecionados com base nos critérios de inclusão e exclusão, sendo posteriormente avaliados com base na qualidade metodológica por meio da escala PEDro. RESULTADOS: O método Pilates reduz os sintomas associados à lombalgia crônica em curto prazo, não sendo superior a outros programas ativos. Sua aplicação em máquinas parece ser mais eficaz. Atualmente, não há consenso sobre sua dosimetria e sua eficácia em longo prazo. CONCLUSÕES: O método Pilates pode ser eficaz em curto prazo na abordagem terapêutica da lombalgia crônica, porém, não se mostrou superior a outros programas de exercícios ativos

Intoxicación por Chlorophyllum molybdites: Presentación de dos casos y revisión de la literatura / Intoxication by Chlorophyllum molybdites: Presentation of two cases and review of the literature

La intoxicación por hongos, especialmente con fines alimenticios, es un importante problema terapéutico. El hongo Chlorophyllum molybdites, es uno de los principales agentes causantes de intoxicación en países Latinoameri-canos, debido a su similitud con el hongo Agaricus comestible. Se presentan dos casos de intoxicación por Chlorophyllum molybdites los cuales fueron ingeridos y posteriormente desarrollaron manifes-taciones clínicas. Se presenta con su revisión bibliográfica centrada en las diferentes opciones terapéuticas...(AU)

Molecular identification of evolutionarily significant units in the Amazon River dolphin Inia sp. (Cetacea: Iniidae).

The Amazon river dolphin, genus Inia, is endemic to the major river basins of northern South America. No previous studies have focused on the genetic structure of this genus. In this work, 96 DNA samples from specimens of this genus were collected in the Orinoco basin (four rivers), the Putumayo River, a tributary of the Colombian Amazon and the Mamoré, and the Tijamuchí and Ipurupuru rivers in theBolivian Amazon. These samples were used to amplify a fragment of 400 bp of the mitochondrial DNA (mtDNA) control region. In addition, 38 of these samples were also used to sequence 600 bp of the mitochondrial cytochrome b gene. The analysis of the population structure subdivision with an analysis of molecular variance (AMOVA) revealed important aspects about the genetic structure of Inia groups fromthese three geographically separate regions. By comparing the control region DNA and cytochrome b sequences, distinct types of nonshared haplotypes were observed. The net genetic divergence of control region sequences was 6.53% between the Orinoco and Bolivian rivers, 5.32% between the Putumayo and Bolivian rivers, and 2.50% between the Orinoco and Putumayo rivers. For the cytochrome b gene, these values were 2.48%, 2.98%, and 0.06%, respectively. The nucleotide sequences were analyzed phylogenetically using several genetic distance matrices and applying neighbor-joining, maximum likelihood, and maximum parsimony procedures. The results support the proposal to subdivide the Inia genus into at least two evolutionarily significant units: one confined to the Bolivian river basin and the other widely distributed across the Amazon and Orinoco basins.

Antithyroid effects in vivo and in vitro of vitexin: a C-glucosylflavone in millet.

Millet diets rich in C-glycosylflavones (C-GF) are goitrogenic, and its three most abundant C-GF inhibit in vitro thyroid peroxidase, suggesting that these compounds are the goitrogens in millet. However, proof of a cause and effect relationship between C-GF and goitrogenesis requires a demonstration of in vivo antithyroid activity by the purified isolated compounds. Vitexin, one of the three major C-GF in millet, was used to test this hypothesis. Twenty-four female Wistar rats, divided into groups of six rats each and fed Purina iodine-rich diet (12 micrograms I-/day.rat), were administered acutely by gastrointestinal tube goitrogen-free water (controls), methimazole (0.5 mumol), and vitexin (20 and 80 mumol). 125I (1 microCi) was injected ip 1 h later, and the rats were killed 2 h after the injection. The thyroid glands were removed and analyzed for their content of total 125I and 125I-labeled compounds. Rats given vitexin, in contrast to those receiving methimazole, did not show suppressed thyroid 125I uptake. However, significant inhibition of the coupling mechanism (high 125I-labeled monoiodotyrosine plus diiodotyrosine/125T3 plus T4 ratio and low 125T3 and T4 concentrations) did occur with the highest dose of vitexin. These results provide direct evidence in vivo of C-GF antithyroid activity, strongly supporting the concept that C-GF are the goitrogens in millet.

Antithyroid effects in vivo and in vitro of babassu and mandioca: a staple food in goiter areas of Brazil.

Babassu (Orbignya phalerata), a palm-tree coconut fruit, mixed with mandioca (Manihot utilissima) is the staple food of people living in the endemic goiter area of Maranhao in Brazil, where goiter prevalence among schoolchildren was still 38% in 1986 despite an adequate iodine intake in most of the population. Therefore, the question arose as to whether or not the ingestion of babassu alone or mixed with mandioca contributed to the persistence of endemic goiter in this area of Brazil. In this investigation we examined the potential antithyroid effects of babassu and mandioca by means of in vivo studies in Sprague-Dawley rats, in vitro studies in porcine thyroid slices and using a purified porcine thyroid peroxidase (TPO) system. Samples of various edible parts of babassu and mandioca flour were homogenized and extracted in goitrogen-free water (GFW) for in vivo experiments, and in methanol (100 g/l), GFW or 0.06 mol/l phosphate buffer (pH 7.0) for in vitro experiments. The edible parts of babassu produced significant in vivo antithyroid effects (p < 0.05- < 0.001) in rats on a high iodine intake (14 micrograms I- day-1.rat-1), as well as distinct and reproducible antithyroid and anti-TPO activities in both in vitro systems, their action being similar to that of the thionamide-like antithyroid drugs propylthiouracil and methimazole.(ABSTRACT TRUNCATED AT 250 WORDS)

The relations between cervical cancer and serological markers of nutritional status.

We evaluated whether differences in serological nutrient indicators between cases and controls were likely to be due to different usual levels for cases or to altered metabolism due to disease. Blood samples obtained as part of a case-control study of invasive cervical cancer conducted in Latin America were evaluated for case-control differences and for trends with stage of disease. Serum alpha- and beta-carotene, cryptoxanthin, and alpha- and gamma-tocopherol showed no trend with extent of disease, although Stage IV cases had lower alpha- and beta-carotene values than did other cases. A slight trend of decreasing values with stage was observed for serum retinol, lycopene, and lutein. For cholesterol and triglyceride concentrations, an inverse trend was observed with stage of disease, which suggested a clinical effect of the disease on blood lipids. Adjustment for smoking, alcohol intake, or oral contraceptive use did not alter observed relations, nor was there evidence that the altered blood nutrient levels differed by histological type. These data suggest that serum values for some carotenoids from Stage I, II, and III cervical cancer are suitable for etiological studies, but spurious results may be obtained if late-stage cases are included. Evidence of trends with severity of disease for cholesterol and triglycerides, and possibly for retinol, lycopene, and lutein, suggest that special attention be given to disease effects of these nutrients in studies of cervical cancer.

Risk factors for cervical cancer by histology.

A case-control study in four Latin American countries enabled assessment of risk factors for different histologic types of invasive cervical cancers, with the main analyses focusing on 667 patients with squamous cell cancers and 43 with adenocarcinomas. The epidemiology of the squamous cell tumors resembled that found in other studies, namely a high risk associated with multiple sexual partners (RR = 1.5 for > or = 2 vs 1), early ages at first intercourse (RR = 2.3 for < 16 vs > or = 20), history of a sexually transmitted disease (RR = 1.8), multiple births (RR = 2.2 for > or = 7 vs 1-3), absence of prior Pap smear screening (RR = 3.0 vs Pap within 24 months), detection of HPV DNA (RR = 3.6), and limited years of schooling (RR = 1.9 for < 4 vs > or = 7). The adenocarcinomas appeared less affected by sexual, reproductive, or socioeconomic factors. There was no relationship with age at first intercourse, history of a sexually transmitted disease or education, and only marginal associations with number of sexual partners or parity. Absence of prior Pap smear screening as well as detection of HPV DNA, however, were associated with relationships equally strong as those for the squamous cell tumors. Oral contraceptive use distinctly affected risk of the adenocarcinomas, increasing risk by approximately two-fold. Analyses of the 18 subjects with adenosquamous cancer suggested some resemblance to the squamous cell tumors, especially with respect to the role of sexual and sociodemographic variables. These findings support the need for detailed studies of etiologic differences between the different histologic types of cervical cancers, with an emphasis on careful pathologic review and precise measurement of HPV.

Antithyroid and goitrogenic effects of coal-water extracts from iodine-sufficient goiter areas.

Goiter in iodine-sufficient areas has been linked to water-borne goitrogens in watersheds and aquifers rich in coal and shale. In the present study, the potential antithyroid and goitrogenic effects of coal-water extracts (CWE) were investigated in vivo in rats after chronic and acute oral administration of CWE, and in vitro by a thyroid peroxidase (TPO) enzyme system. CWE was prepared by continuous extraction of ground (40 mesh) Appalachian coal with goitrogen-free water (GFW). Female Buffalo rats fed on Purina iodine-rich diet (12 micrograms I-/day/rat), were given ad lib CWE (50 mg/ml; approximately 20 mL/day/rat) or GFW (controls) for 2 months. At the end of the experiment, 125I 1 microCi, was injected i.p. and 4 h later the thyroid glands were removed, weighed, and analyzed histologically and for total 125I and 125I-labeled compounds. Rats on CWE had larger thyroid glands [7.2 +/- 0.3 mg/100 g (mean +/- SE) vs 5.0 +/- 0.5 controls; p < 0.005] with distinct histological changes of smaller thyroid follicles, some with columnar epithelium, and with more dense colloid than in controls, and had significant inhibition of the coupling mechanism for production of thyroid hormones [125MIT + DIT/125T3 + T4: 5.1 +/- 0.2 vs 3.9 +/- 0.1 controls, p < 0.005; and 125T3 + T4 (%): 10.6 +/- 0.3 vs 12.6 +/- 0.4 controls, p < 0.005]. Female Sprague-Dawley rats under the same conditions as Buffalo rats were given acutely by GI tube 2 mL of CWE (5 g/mL) or GFW (controls).(ABSTRACT TRUNCATED AT 250 WORDS)

Decreased immune reactivity and neuroendocrine alterations related to chronic stress in spinal cord injury and stroke patients.

Both natural and adaptive immune responses were found to be strikingly decreased 2 weeks after injury in 54 spinal cord injury and stroke patients, i.e., 28 quadriplegics, 21 paraplegics and 5 stroke patients, compared with those of age-matched controls. All values are expressed as means. Natural-killer (NK)-cell function decreased to 21.0% 2 weeks after spinal cord injury compared with 48.6% in controls. At 2 weeks, plasma ACTH values increased to 17.0 pg/ml in patients compared with 11.2 pg/ml in controls, and urine free cortisol levels were elevated to 162.4 micrograms/24 h in patients compared with 53.6 micrograms/24 h in controls. T-cell function decreased to 40.2% of normal (lymphocyte transformation) by 3 months after injury. T-cell activation (IL-2R) was diminished, i.e., 183.4 micrograms/ml compared with 328.2 micrograms/ml in controls. With rehabilitation therapy, NK-cell function increased to 41.6% by 7 months after injury. NK-cell-mediated lysis diminished sharply between 7 and 9 months, decreasing to 22.8% at 10 months and ultimately returning to the level seen 2 weeks after injury. Rehabilitation therapy contributed to the restoration of T-cell function to 92.0% of normal by 6 months after injury where it remained for 6+ months. IL-2R values improved in parallel with lymphocyte transformation. Whereas NK-cell-induced lysis remained depressed, i.e., 11.8% at 6 months and 11.4% at 12+ months in patients not receiving therapy, the restoration of NK-cell function at 6 months to 40.6% in rehabilitated patients decreased to 23.0% with cessation of treatment. NK-cell-mediated lysis values in cervical injury patients were significantly less than those in the thoracic injury group. Functional independence measurement (FIM) scores of the two paralleled their NK-cell function. With rehabilitation therapy, NK-cell-mediated lysis in the cervical group increased from 15.2 to 28.4%, whereas it improved in the thoracic group with therapy from 26.8 to 43.7%. With rehabilitation therapy, lymphocyte transformation in the cervical group increased from 37.3 to 85.6% and improved in the thoracic group from 48.4 to 88.9%. With rehabilitation therapy, FIM scores improved from 49.7 to 74.0 in the cervical group and from 79.8 to 97.3 in thoracic patients compared with 126 in controls. NK-cell-mediated lysis was depressed to 28.9% in 5 stroke patients and improved to 38.0% following rehabilitation therapy.

Antithyroid effects of coal-derived pollutants.

Endemic goiter in iodide-sufficient areas of the United States and Colombia has been linked to watersheds rich in coal and shale, which several reports suggest are the source of water-borne goitrogens. In this report the potential antithyroid activities of aqueous coal and shale extracts and of compounds identified in aqueous effluents from coal conversion processes were assayed in thyroid peroxidase (TPO) and thyroid slice systems. Aqueous extracts of coal and black shale were potent inhibitors of TPO or 125I organification by thyroid slices. The most abundant water-soluble compounds derived from coal are dihydroxy-phenols, thiocyanate, disulfides, and hydroxypyridines. The dihydroxyphenols resorcinol, 2-methylresorcinol, and 5-methylresorcinol (orcinol) were 26.7, 22.5, and 7.2 times more potent, respectively, than the antithyroid drug 6-propylthiouracil (PTU). Other dihydroxyphenols and thiocyanate were less potent but comparable in activity to PTU. All dihydroxypyridines and 3-hydroxypyridine produced inhibitory effects comparable to PTU. None of the disulfides inhibited TPO. The antiperoxidase effects of combinations of two dihydroxyphenols or one dihydroxyphenol and SCN were additive, whereas the effects of a combination of four dihydroxyphenols at threshold inhibitory concentrations were synergistic, resulting in net effects equivalent to or greater than the sum of the individual effects. Thus, antithyroid effects may be greatly amplified by exposure to multiple coal-derived goitrogens and could be many times that produced by any one of the contributing pollutants. These results demonstrate that potent water-borne goitrogens are derived from coal and shale and that their contamination of water supplies could pose a serious threat of thyroid disorders.

Screening for cervical cancer in Latin America: a case-control study.

The beneficial effect of cervical cytology in reducing the incidence of invasive cervical cancer is well accepted, but many issues regarding specific patterns of screening remain to be resolved, and preventive programmes need to be adapted to regional characteristics. In a case-control study conducted in Latin America, we investigated cytological screening histories of 759 cases of invasive cervical cancer and 1430 controls, with participation rates of 99% and 96%, respectively. Fifty per cent of the cases and 29% of the controls reported never having been screened. Screening was less common among older, less educated and less parous women; non-users of oral contraceptives and women without histories of venereal diseases. There was also evidence that older women and those with multiple partners had longer intervals between examinations. The relative risk (RR) associated with no prior screening was approximately 3 and was not modified by other risk factors. Women reporting a Pap smear within 24-47 months before interview had the same RR as those examined within 12-23 months. Women tested longer ago had higher risks, but still much lower than women never examined. There was evidence that one examination is associated with less reduction in risk than two, regardless of the interval since last Pap smear. Screening appeared to reduce risk of both squamous cell carcinomas and adenocarcinomas. As expected, cases presenting at advanced stages were less likely to have been screened and reported longer intervals since their last examination. These results support the need to concentrate limited resources in the groups that need screening most, mainly older and less educated women who have never been screened.

Epidemiology of iodine deficiency.

Iodine deficiency (ID) causes goiter, cretinism, neonatal hypothyroidism, irreversible mental retardation, and child and infant death. Over one billion people are at risk, most of them in developing countries. While ID is the primordial factor in these conditions, other environmental and host factors significantly modify the magnitude and clinical presentation of iodine deficiency disorders. The interactions and mechanisms by which these factors operate are complex and mostly unknown, requiring more investigation.

Neuroendocrine-immune interactions associated with loss and restoration of immune system function in spinal cord injury and stroke patients.

Both natural and adaptive immune responses were shown to be strikingly decreased in initial blood samples from 34 spinal cord injury and stroke patients. NK-cell function decreased to 24.8% (mean) 2 weeks after spinal cord injury in previously healthy young adults whose control group revealed a mean NK-cell function of 48.7%. This was accompanied at 2 weeks by increased plasma ACTH (mean of 17.0 pg/ml from 17 patients compared to a mean of 11.2 pg/ml from 12 controls) and urine free cortisol levels (mean of 152.1 micrograms/24 h from 9 patients compared to 53.6 micrograms/24 h from 15 controls). T-cell function and/or activation decreased to below normal values within 3 months after injury as revealed by lymphocyte transformation that was 32.8% of normal at 3 months. T-cell activation diminished as shown by a mean IL-2 receptor level of 179.3 units/ml in patients compared to 328.2 units/ml in controls. Serial monitoring of NK- and T-cell function revealed that specific physical rehabilitation therapy over a period of 6 months after injury restored NK- and T-cell function to near normal levels in most patients. This improvement was accompanied by a parallel rise in the patient's functional independence measurement scores. Results suggest critical neuroendocrine-immune system interactions in the restoration of immune function. Cortisol levels reverted to normal after 6 months of rehabilitation. Limited data suggest that natural immune system depression, NK-cell function, persists in spinal cord injury patients not receiving rehabilitation therapy (mean NK-cell lysis of 10.3%; p < 0.01).

A case-control study of nutrient status and invasive cervical cancer. I. Dietary indicators.

A study of 748 cases and 1,411 hospital and community controls in four Latin American countries evaluated the association between certain elements of diet and invasive cervical cancer. Subjects were interviewed about their adult consumption of 58 food items, including the major sources of putative protective agents (vitamin A, carotenoids, vitamin C, and folacin) as well as other behavioral and medical characteristics related to cervical cancer. Participation rates were above 95% for both cases and controls. After adjustment for age, study site, sexual and reproductive behavior, socioeconomic status, screening practices, and detection of human papillomavirus 16/18 by filter in situ hybridization, a slightly lower risk was observed for the highest quartiles of consumption of fruit and fruit juices, while no reductions in risk were associated with vegetables, foods of animal origin, complex carbohydrates, legumes, or folacin-rich foods. When nutrient indices were derived, significant trends of decreasing risk were observed for vitamin C (adjusted odds ratio (OR) = 0.69 for the highest vs. the lowest quartile; p for trend = 0.003), beta-carotene (OR = 0.68; p = 0.02), and other carotenoids (OR = 0.61; p = 0.003). Inclusion of vitamin C and beta-carotene in the same model attenuated the association with beta-carotene, while the association with vitamin C remained unchanged. The results are consistent with those of other investigations and provide support for a protective effect of vitamin C, carotenoids, and other substances found in the same fruits and vegetables against the development of invasive cervical cancer. However, the fact that the associations were driven by relation in two of the study sites and among women of higher socioeconomic status leaves open the possibility of selection bias or effects of unidentified aspects of dietary patterns.