How an Interest in Mindfulness Influences Linguistic Markers in Online Microblogging Discourse.

Objectives: This study aimed to investigate the linguistic markers of an interest in mindfulness. Specifically, it examined whether individuals who follow mindfulness experts on Twitter use different language in their tweets compared to a random sample of Twitter users. This is a first step which may complement commonly used self-report measures of mindfulness with quantifiable behavioural metrics. Method: A linguistic analysis examined the association between an interest in mindfulness and linguistic markers in 1.87 million Twitter entries across 19,732 users from two groups, (1) a mindfulness interest group (n = 10,347) comprising followers of five mindfulness experts and (2) a control group (n = 9385) of a random selection of Twitter users. Text analysis software (Linguistic Inquiry and Word Count) was used to analyse linguistic markers associated with the categories and subcategories of mindfulness, affective processes, social orientation, and "being" mode of mind. Results: Analyses revealed an association between an interest in mindfulness and lexical choice. Specifically, tweets from the mindfulness interest group contained a significantly higher frequency of markers associated with mindfulness, positive emotion, happiness, and social orientation, and a significantly lower frequency of markers associated with negative emotion, past focus, present focus, future focus, family orientation, and friend orientation. Conclusions: Results from this study suggest that an interest in mindfulness is associated with more frequent use of certain language markers on Twitter. The analysis opens possible pathways towards developing more naturalistic methods of understanding and assessing mindfulness which may complement self-reporting methods.

Societal Preferences for Meningococcal B Vaccination in Children: A Discrete Choice Experiment in Spain.

INTRODUCTION: Immunization is the most effective strategy for the prevention of invasive meningococcal disease caused by Neisseria meningitidis serogroup B (MenB); however, parents need to weigh the risk-benefit and financial impact of immunizing their children against MenB in the absence of a national immunization program (NIP). This study aimed to explore societal preferences (of parents and pediatricians) regarding the attributes of a MenB vaccine in Spain. METHODS: A discrete choice experiment (DCE) based on cross-sectional surveys was carried out to determine preferences. A literature review and scientific committee determined the six attributes related to the MenB vaccine included in the DCE: vaccination age, cost, duration, percentage of protection, adverse events probability, and expert/authority recommendation. Data were analyzed using a mixed logit model. Relative importance (RI) of attributes was calculated and compared between parents and pediatricians. RESULTS: A total of 278 parents [55.8% female, mean age 40.4 (standard deviation, SD 7.3) years] and 200 pediatricians [73.0% female, mean age 45.8 (SD 12.9) years] answered the DCE. For parents, the highest RI was attributed to vaccine cost, expert/authority recommendation, and percentage of protection (26.4%, 26.1%, and 22.9%, respectively), while for pediatricians the highest RI was assigned to percentage of protection, expert/authority recommendation, and vaccination age (27.2%, 23.7%, and 22.6%, respectively). Significant differences between parents and pediatricians were found in the RI assigned to all attributes (p < 0.001), except for vaccine recommendation. CONCLUSION: In the decision regarding MenB vaccination, cost was a driver in parental decision-making but had a low RI for pediatricians and, conversely, vaccination age was highly valued by pediatricians but was the attribute with least importance for parents. Despite these differences, expert/authority recommendation and percentage of protection were essential criteria for both groups. These results provide relevant information about MenB vaccination, highlighting the importance of considering societal preferences for NIP inclusion.

Preferences for Renal Cell Carcinoma Pharmacological Treatment: A Discrete Choice Experiment in Patients and Oncologists.

INTRODUCTION: The purpose of this investigation was to explore patients' and oncologists' preferences for the characteristics of a pharmacological regimen for patients with advanced renal cell carcinoma (aRCC). MATERIAL AND METHODS: Cross-sectional observational study based on a discrete choice experiment (DCE) conducted in Spain. A literature review, a focus group with oncologists and interviews with patients informed the DCE design. Five attributes were included: progression survival gain, risk of serious adverse events (SAEs), health-related quality of life (HRQoL), administration mode, and treatment cost. Preferences were analyzed using a mixed-logit model to estimate relative importance (RI) of attributes (importance of an attribute in relation to all others), which was compared between aRCC patients and oncologists treating aRCC. Willingness to pay (WTP, payer: health system) for a benefit in survival or in risk reduction and maximum acceptable risk (MAR) in SAEs for improving survival were estimated from the DCE. Subgroup analyses were performed to identify factors that influence preference. RESULTS: A total of 105 patients with aRCC (77.1% male, mean age 65.9 years [SD: 10.4], mean time since RCC diagnosis 6.3 years [SD: 6.1]) and 67 oncologists (52.2% male, mean age 41.9 years [SD: 8.4], mean duration of experience in RCC 10.2 years [SD: 7.5]) participated in the study. The most important attribute for patients and oncologists was survival gain (RI: 43.6% vs. 54.7% respectively, p<0.05), followed by HRQoL (RI: 35.5% vs. 18.0%, respectively, p<0.05). MAR for SAEs was higher among oncologists than patients, while WTP (for the health system) was higher for patients. Differences in preferences were found according to time since diagnosis and education level (patients) or length of professional experience (oncologists). CONCLUSION: Patients' and oncologists' preferences for aRCC treatment are determined mainly by the efficacy (survival gain) but also by the HRQoL provided. The results of the study can help to inform decision-making in the selection of appropriate aRCC treatment.

Dietary Squalene Induces Cytochromes Cyp2b10 and Cyp2c55 Independently of Sex, Dose, and Diet in Several Mouse Models.

SCOPE: To investigate the effects of squalene, the main hydrocarbon present in extra virgin olive oil, on liver transcriptome in different animal models and to test the influence of sex on this action and its relationship with hepatic lipids. METHODS AND RESULTS: To this purpose, male C57BL/6J Apoe-deficient mice are fed a purified Western diet with or without squalene during 11 weeks and hepatic squalene content is assessed, so are hepatic lipids and lipid droplets. Hepatic transcriptomic changes are studied and confirmed by RT-qPCR. Dietary characteristics and influence of squalene doses are tested in Apoe-deficient on purified chow diets with or without squalene. These diets are also given to Apoa1 and wild-type mice on C57BL/6J background and to C57BL/6J xOla129 Apoe-deficient mice. Squalene supplementation increases its hepatic content without differences among sexes and hormonal status. The Cyp2b10 and Cyp2c55 gene expressions are significantly up-regulated by the squalene intake in all models, with independence of sex, sexual hormones, dietary fat content, genetic background and dose, and in Apoe-deficient mice consuming extra-virgin olive oil. CONCLUSION: Hepatic squalene increases the expression of these cytochromes and their changes in virgin olive oil diets may be due to their squalene content.

Patient-physician discrepancy in the perception of immune-mediated inflammatory diseases: rheumatoid arthritis, psoriatic arthritis and psoriasis. A qualitative systematic review of the literature.

INTRODUCTION: Recommendations on chronic diseases management emphasise the need to consider patient perspectives and shared decision-making. Discrepancies between patients and physicians' perspectives on treatment objectives, disease activity, preferences and treatment have been described for immune-mediate inflammatory diseases. These differences could result on patient dissatisfaction and negatively affect outcomes. OBJECTIVE: To describe the degree of patient-physician discrepancy in three chronic immune-mediated inflammatory diseases (rheumatoid arthritis [RA], psoriatic arthritis [PsA] and psoriasis [Ps]), identifying the main areas of discrepancy and possible predictor factors. METHODS: Qualitative systematic review of the available literature on patient and physician discrepancies in the management of RA, PsA and Ps. The search was performed in international (Medline/PubMed, Cochrane Library, ISI-WOK) and Spanish electronic databases (MEDES, IBECS), including papers published from April 1, 2008 to April 1, 2018, in English or Spanish, and conducted in European or North American populations. Study quality was assessed by the Oxford Centre for Evidence-Based Medicine criteria. RESULTS: A total of 21 studies were included (13 RA; 3 PsA; 4 Ps; 1 RA, Ps, and Axial Spondyloarthritis). A significant and heterogeneous degree of discrepancy between patients and physicians was found, regarding disease activity, treatment, clinical expectations, remission concept, and patient-physician relationship. In RA and PsA, studies were mainly focused on the evaluation of disease activity, which is perceived as higher from the patient's than the physician's perspective, with the discrepancy determined by factors such as patient's perception of pain and fatigue. In Ps, studies were focused on treatment satisfaction and patient-physician relationship, showing a lower degree of discrepancy in the satisfaction regarding these aspects. CONCLUSIONS: There is a significant degree of patient-physician discrepancy regarding the management of RA, PA, and Ps, what can have a major impact on shared decision-making. Future research may help to show whether interventions considering discrepancy improve shared decision-making.

Treatment decision-making in chronic lymphocytic leukaemia: Key factors for healthcare professionals. PRELIC study.

OBJECTIVE: To explore the preferences of Spanish healthcare professionals (haematologists and hospital pharmacists) for the treatment selection of active Chronic Lymphocytic Leukaemia (CLL) patients at first relapse, condition that mainly afflicts older adults. METHODS: A discrete choice experiment (DCE) was conducted among haematologists and hospital pharmacists. A literature review and a focus group informed the DCE design. CLL treatment settings were defined by seven attributes: four patient/disease-related attributes (age, functional status, comorbidities, and risk of the disease) and three treatment-related attributes (efficacy [hazard ratio of progression-free survival, HR-PFS], rate of discontinuations due to adverse events and cost). A mixed-logit model was used to determine choice-based preferences. Relative importance (RI) of attributes was calculated and compared between stakeholders. Willingness-to-pay (WTP) was estimated through the DCE. Besides, nine ad-hoc questions were posed, to explore more in depth CLL treatment decision making. RESULTS: A total of 130 participants (72 haematologists and 58 hospital pharmacists) answered the DCE. All attributes were significant predictors of preferences (p < 0.05) in the multinomial model. Higher RI was obtained for treatment-related attributes: the highest rated being 'cost' (23.8%) followed by 'efficacy' (20.9%). Regarding patient-related attributes, the highest RI was obtained for 'age' (18.1%). No significant differences (p > 0.05) in RI between haematologists and pharmacists were found. WTP for the treatment was higher for younger CLL patients. Ad-hoc questions showed that patient age and functional status influence treatment decisions. CONCLUSIONS: For healthcare professionals, 'cost' and 'efficacy' (treatment-related attributes) and age (patient-related attribute) are the main factors that determine CLL treatment selection at first relapse. WTP decreases as patient's age increases.

Pgc1a is responsible for the sex differences in hepatic Cidec/Fsp27ß mRNA expression in hepatic steatosis of mice fed a Western diet.

Hepatic fat-specific protein 27 [cell death-inducing DNA fragmentation effector protein C (Cidec)/Fsp27] mRNA levels have been associated with hepatic lipid droplet extent under certain circumstances. To address its hepatic expression under different dietary conditions and in both sexes, apolipoprotein E (Apoe)-deficient mice were subjected to different experimental conditions for 11 wk to test the influence of cholesterol, Western diet, squalene, oleanolic acid, sex, and surgical castration on Cidec/Fsp27 mRNA expression. Dietary cholesterol increased hepatic Cidec/Fsp27ß expression, an effect that was suppressed when cholesterol was combined with saturated fat as represented by Western diet feeding. Using the latter diet, neither oleanolic acid nor squalene modified its expression. Females showed lower levels of hepatic Cidec/Fsp27ß expression than males when they were fed Western diets, a result that was translated into a lesser amount of CIDEC/FSP27 protein in lipid droplets and microsomes. This was also confirmed in low-density lipoprotein receptor (Ldlr)-deficient mice. Incubation with estradiol resulted in decreased Cidec/Fsp27ß expression in AML12 cells. Whereas male surgical castration did not modify the expression, ovariectomized females did show increased levels compared with control females. Females also showed increased expression of peroxisome proliferator-activated receptor-γ coactivator 1-α (Pgc1a), suppressed by ovariectomy, and the values were significantly and inversely associated with those of Cidec/Fsp27ß. When Pgc1a-deficient mice were used, the sex differences in Cidec/Fsp27ß expression disappeared. Therefore, hepatic Cidec/Fsp27ß expression has a complex regulation influenced by diet and sex hormonal milieu. The mRNA sex differences are controlled by Pgc1a.

The Search for Dietary Supplements to Elevate or Activate Circulating Paraoxonases.

Low levels of paraoxonase 1 (PON1) have been associated with the development of several pathological conditions, whereas high levels have been shown to be anti-atherosclerotic in mouse models. These findings suggest that PON1 could be a good surrogate biomarker. The other members of the family, namely PON2 and PON3, the role of which has been much less studied, deserve more attention. This paper provides a systematic review of current evidence concerning dietary supplements in that regard. Preliminary studies indicate that the response to dietary supplements may have a nutrigenetic aspect that will need to be considered in large population studies or in clinical trials. A wide range of plant preparations have been found to have a positive action, with pomegranate and some of its components being the best characterized and Aronia melanocarpa one of the most active. Flavonoids are found in the composition of all active extracts, with catechins and genistein being the most promising agents for increasing PON1 activity. However, some caveats regarding the dose, length of treatment, bioavailability, and stability of these compounds in formulations still need to be addressed. Once these issues have been resolved, these compounds could be included as nutraceuticals and functional foods capable of increasing PON1 activity, thereby helping with the long-term prevention of atherosclerosis and other chronic ailments.

Diet and sexual hormones regulate hepatic synaptotagmin 1 mRNA in mice.

The expression of Synaptotagmin 1 (Syt1) has been found to be associated with the lipid droplets in liver. Here, we studied the expression of Syt1 in Apoe-deficient mice receiving cholesterol, Western diet, squalene, and oleanolic acid. We also studied the influence of sex and impact of surgical castration. Dietary cholesterol increased hepatic Syt1 expression, an effect that was enhanced when cholesterol was combined with saturated fat present in a Western diet. This potentiation was modified by the administration of 10 mg/kg oleanolic acid or 1 g/kg squalene. Females fed chow or Western diet showed higher levels of hepatic Syt1 expression as compared to male mice on the same diet. Surgical castration of males did not modify the Syt1 expression; however, ovariectomy led to decreased levels. The data show that hepatic Syt1 expression is influenced by diet and hormonal milieu.

PON1 and Mediterranean Diet.

The Mediterranean diet has been proven to be highly effective in the prevention of cardiovascular diseases. Paraoxonase 1 (PON1) has been implicated in the development of those conditions, especially atherosclerosis. The present work describes a systematic review of current evidence supporting the influence of Mediterranean diet and its constituents on this enzyme. Despite the differential response of some genetic polymorphisms, the Mediterranean diet has been shown to exert a protective action on this enzyme. Extra virgin olive oil, the main source of fat, has been particularly effective in increasing PON1 activity, an action that could be due to low saturated fatty acid intake, oleic acid enrichment of phospholipids present in high-density lipoproteins that favor the activity, and increasing hepatic PON1 mRNA and protein expressions induced by minor components present in this oil. Other Mediterranean diet constituents, such as nuts, fruits and vegetables, have been effective in modulating the activity of the enzyme, pomegranate and its compounds being the best characterized items. Ongoing research on compounds isolated from all these natural products, mainly phenolic compounds and carotenoids, indicates that some of them are particularly effective, and this may enhance the use of nutraceuticals and functional foods capable of potentiating PON1 activity.

Dietary squalene increases high density lipoprotein-cholesterol and paraoxonase 1 and decreases oxidative stress in mice.

BACKGROUND AND PURPOSE: Squalene, the main hydrocarbon in the unsaponifiable fraction of virgin olive oil, is involved in cholesterol synthesis and it has been reported to own antiatherosclerotic and antiesteatosic effects. However, the squalene's role on lipid plasma parameters and the influence of genotype on this effect need to be addressed. EXPERIMENTAL APPROACHES: Three male mouse models (wild-type, Apoa1- and Apoe- deficient) were fed chow semisynthetic diets enriched in squalene to provide a dose of 1 g/kg during 11 weeks. After this period, their plasma parameters and lipoprotein profiles were analyzed. KEY RESULTS: Squalene administration at a dose of 1 g/kg showed decreased reactive oxygen species in lipoprotein fractions independently of the animal background and caused an specific increase in high density lipoprotein (HDL)-cholesterol levels, accompanied by an increase in phosphatidylcholine and paraoxonase 1 and no changes in apolipoproteins A1 and A4 in wild-type mice. In these mice, the cholesterol increase was due to its esterified form and associated with an increased hepatic expression of Lcat. These effects were not observed in absence of apolipoprotein A1. The increases in HDL- paraoxonase 1 were translated into decreased plasma malondialdehyde levels depending on the presence of Apolipoprotein A1. CONCLUSIONS AND IMPLICATIONS: Dietary squalene promotes changes in HDL- cholesterol and paraoxonase 1 and decreases reactive oxygen species in lipoproteins and plasma malondialdehyde levels, providing new benefits of its intake that might contribute to explain the properties of virgin olive oil, although the phenotype related to apolipoproteins A1 and E may be particularly relevant.

Dietary oleanolic acid mediates circadian clock gene expression in liver independently of diet and animal model but requires apolipoprotein A1.

Oleanolic acid is a triterpene widely distributed throughout the plant kingdom and present in virgin olive oil at a concentration of 57 mg/kg. To test the hypotheses that its long-term administration could modify hepatic gene expression in several animal models and that this could be influenced by the presence of APOA1-containing high-density lipoproteins (HDLs), diets including 0.01% oleanolic acid were provided to Apoe- and Apoa1-deficient mice and F344 rats. Hepatic transcriptome was analyzed in Apoe-deficient mice fed long-term semipurified Western diets differing in the oleanolic acid content. Gene expression changes, confirmed by reverse transcriptase quantitative polymerase chain reaction, were sought for their implication in hepatic steatosis. To establish the effect of oleanolic acid independently of diet and animal model, male rats were fed chow diet with or without oleanolic acid, and to test the influence of HDL, Apoa1-deficient mice consuming the latter diet were used. In Apoe-deficient mice, oleanolic acid intake increased hepatic area occupied by lipid droplets with no change in oxidative stress. Bmal1 and the other core component of the circadian clock, Clock, together with Elovl3, Tubb2a and Cldn1 expressions, were significantly increased, while Amy2a5, Usp2, Per3 and Thrsp were significantly decreased in mice receiving the compound. Bmal1 and Cldn1 expressions were positively associated with lipid droplets. Increased Clock and Bmal1 expressions were also observed in rats, but not in Apoa1-deficient mice. The core liver clock components Clock-Bmal1 are a target of oleanolic acid in two animal models independently of the diets provided, and this compound requires APOA1-HDL for its hepatic action.

Cesárea y mortalidad perinatal: incidencia y tendencia 42 años (1969-2010) / Cesarean section and perinatal mortality: incidence and 42 years trend (1969-2010)

Determinar cuál ha sido la incidencia y tendencia de la cesárea y la mortalidad perinatal durante los 42 años de actividad asistencial, en el Hospital “Dr. Adolfo Prince Lara”, Puerto Cabello, Estado Carabobo. Estudio observacional, retrospectivo y epidemiológico con 27 033 cesáreas y 5 756 muertes perinatales sucedidas en 134 198 nacimientos desde 1969-2010. Se determinó sus incidencias, variaciones porcentuales y tasas, se graficó como serie cronológica, expresando sus porcentajes y tasas anualizadas respectivas, en el análisis estadístico de regresión se señaló la línea de tendencia individual, y finalmente se calculó su ecuación y coeficiente de determinación (R²). La incidencia de cesáreas para el período estudiado fue de 20,46 por 100 nacimientos o 1 cesárea cada 5 nacimientos; durante este lapso las cifras extremas o rangos fueron de 4,6 (1970 y 1972) y 43,15 (2010), con una variación porcentual de 737,86. El análisis muestra una línea de tendencia logarítmica global al ascenso sostenido; la fórmula de regresión logarítmica fue y = 11,642ln(x) - 12,188 y el R² = 0,7301, con utilidad pronóstica. La tasa de mortalidad perinatal fue de 41,5 por 1 000 nacidos; hubo cifras extremas de 26,1 (1982) y 59,32 (1975) con variación porcentual de 4,17 por ciento. El análisis señala valores con oscilaciones, hay una línea de tendencia con discreta disminución; la fórmula de regresión logarítmica fue y = -1,578ln(x) + 45,961 y el R² = 0,0322, sin utilidad pronóstica. La incidencia de cesárea en el hospital tiene tendencia progresiva al incremento, finalizando con cifras muy elevadas inaceptables. La tasa global mortalidad perinatal es alta, hay una discreta disminución no significativa, lo cual revela que la cesárea no ha aportado beneficios importantes en la disminución de la mortalidad perinatal. Se presentan estrategias para abatir la “epidemia” de cesáreas y combatir la elevada mortalidad perinatal con actividades intra y extra-hospitalarias

To determine what has been the incidence and trends of cesarean section and perinatal mortality (PM) during 42 years of medical service. Hospital “Dr. Adolfo Prince Lara”, Puerto Cabello, Estado Carabobo. Study observational epidemiological and retrospective of 27 033 cesarean sections and 5 756 perinatal deaths in 134,198 births occurred from 1969-2010. We determined their issues, percentage changes and rates were plotted as time series, expressing their percentage and annualized rates respectively, in the regression analysis statistical indicated the trend line individually, and finally calculated the equation and coefficient of determination (R ²). The incidence of caesarean section for that period were 20.46 cesarean per 100 births or 1 in 5 births, during this time the extreme figures or ranges were 4.6 (1970 and 1972) and 43.15 (2010), 737.86 a percentage change. The analysis shows an overall logarithmic trend line to the steady climb, the logarithmic regression formula was y = 11.642 ln (x) - 12.188 and R ² = 0.7301, with profit forecasts. PM rate was 41.5 per 1 000 births, extreme figures were 26.1 (1982) and 59.32 (1975), with 4.17 percent percentage change. The analysis indicates values with swings, there is a trend line with a slight decrease, the logarithmic regression formula was y = -1.578 ln (x) + 45.961 and R ² = 0.0322, forecasts useless. The incidence of caesarean section in the hospital tends to increase gradually, ending with very high figures unacceptable. The overall perinatal mortality is high, there is a slight non significant decrease, which reveals that cesarean section has not provided significant benefits in reducing the PM. Strategies are presented to bring down the “epidemic” of C-sections and combat high maternal mortality with intra-and extra-hospital activities

Morbilidad materna: hospitalización ante-parto / Maternal morbidity: ante partum hospitalization

Determinar la incidencia de admisiones antenatales en gestantes portadoras de enfermedades severas que implican un tratamiento intrahospitalario, revelando así la morbilidad materna, además de conocer sus repercusiones perinatales. Estudio observacional, descriptivo, analítico realizado durante el trienio 2008-2010. Hubo 5 815 nacimientos, 1 033 admisiones antenatales, 230 neonatos con morbilidad neonatal y 34 muertes feto-neonatales. Las embarazadas debían tener 20 semanas o más de gestación, hospitalizadas 2 días o más, fueron dadas de alta sin parir y luego regresaron para su asistencia obstétrica definitiva. Departamento de Obstetricia y Ginecología, Hospital "Dr. Adolfo Prince Lara", Departamento Clínico Integral de la Costa, Universidad de Carabobo. Puerto Cabello. Hubo una incidencia de 17,76 pacientes hospitalizadas antenatalmente por cada 100 nacimientos o 1 cada 5,6 nacimientos. Las patologías más frecuentes fueron las propias del embarazo (57,41 por ciento): la amenaza de parto prematuro (18,20 por ciento), preeclampsia (9,78 por ciento), hemorragia placentaria (6,68 por ciento), oligohidramnios (6,58 por ciento) y anemia (5,52 por ciento). Las patologías asociadas al embarazo (33,98 por ciento): infección urinaria (14,13 por ciento) y diabetes(9,49 por ciento) La morbilidad neonatal global fue 22,26 por ciento, aportada principalmente por patologías propias del embarazo: amenaza parto pretérmino (20,43 por ciento), preeclampsia (13,04 por ciento), y hemorragia placentaria (10 por ciento); de las asociadas: infección urinaria 14,35 por ciento y diabetes 14,35 por ciento. La mortalidad feto-neonatal fue de 3,3 por ciento, contribuyendo predominante prematurez y malformación fetal (29,41 por ciento), preeclampsia (26,47 por ciento), el desprendimiento prematuro de placenta y la placenta previa (17,65 por ciento). Hubo una incidencia elevada de admisiones antenatales, causadas por entidades que obligan a un diagnóstico precoz...

To determine the incidence of antenatal admissions in pregnant women carrying a severe illness involving hospital management, revealing maternal morbidity, in addition to knowing their impact perinatal outcomes. An observational, descriptive, analytical study, made during the 2008-2010 period. There were 5 815 births, 1 033 antenatal admissions, 230 infants with neonatal morbidity and 34 fetal and neonataldeaths. Pregnant women should take 20 weeks or more gestation, hospitalized 2 days or more, were discharged without giving birth and then returned for final delivery care. Department of Obstetrics and Gynecology, Hospital "Dr. Adolfo Prince Lara". Departamento Clinico de la Costa. University of Carabobo. Puerto Cabello, Estado Carabobo, Venezuela. There was an incidence of patients hospitalized antenatally 17.76 per 100 births or 1 in 5.6 children. The most frequent pathologies were typical of pregnancy (57.41 percent): preterm delivery threatens (18.20 percent), pre-eclampsia (9.78 percent), placental hemorrhage (6.68 percent), oligohydramnios (6.58 percent) and anemia (5.52 percent). Pregnancy-associated pathologies (33.98 percent): urinary tract infection (14.13 percent) and diabetes (9.49 percent). Neonatal morbidity rate was 22.26 percent, contributed mainly by pathologies of pregnancy: preterm delivery threatens (20.43 percent), pre-eclampsia (13.04 percent), and placental hemorrhage (10 percent), associated: urinary tract infection 14.35 percent and diabetes 14.35 percent. Feto-neonatal mortality was 3.3 percent, contributing predominant: prematurity and fetal malformation (29.41 percent), pre-eclampsia (26.47 percent), abruptio placenta and placenta previous (17.65 percent). There was a high incidence of antenatal admissions caused by entities that require early diagnosis and better management in order to lessen the economic impact and the serious repercussions hospital perinatal evidenced

Mortalidad perinatal: 40 años en un hospital distrital (1969-20089 / Perinatal mortalidad: 40 years in a county hopital (1969-2008)

Se estudia la evaluación y tendencia de la mortalidad perinatal, registrada en el Departamento de Obstetricia y Ginecología, Hospital "Dr. Adolfo Prince Lara", Departamento Clínico Integral de la Costa, Universidad de Carabobo, Puerto cabello-Estado Carabobo. Ocurrieron 130.977 nacimientos y 5.608 muertes perinatales, durante el lapso de 40 años (1969-2008). El número de muertes perinatales por lapso y su diferencia periódica, muestra una tendencia al aumento en los primeros 30 años (1969-1998), con una tasa de mortalidad perinatal elevada (entre 41 y 51 por mil nacidos) con tendencia al incremento. El lapso final de diez años (1999-2008), muestra un descenso en todas las cifras analizadas, la reducción de tasas fue de 5,74 por mil nacidos, con expresión porcentual de 13,76, y una tasa global promedio (1969-2008) de 41,36 por mil nacidos. Estos resultados nos señalan la realidad que en materia de salud hemos vivido, por lo tanto debemos analizar el servicio prestado con mucha responsabilidad. Se debera fortalecer actividades preventivas sanitarias de salud pública, elevar el estándar de vida de los pacientes, eventos que son responsabilidad del estado, a todo ello estamos dispuestos a acompañarlo

The evolution and trends of perinatal mortality were study in the Departamento de Obstetricia y Ginecología, Hospital "Dr. Adolfo Prince Lara", Departamento Clínico Integral de la Costa, Universidad de Carabobo. Puerto Cabello-Estado Carabobo. There were 130.977 births and 5.608 perinatal deaths registered during the period of 40 years (1969-2008). The number of perinatal deaths and the diference between regular periods, shows an increasing trend in the first 30 years (1969-1998), with a high perinatal mortality rate (between 41 and 51 per thousand births), with a tendency to increase. The final span of ten years (1999-2008), shows a decline in all figures analyzed, the reduction rate was 5.74 per thousand live births, with expression of 13.76 percent and the overall average (1969-2008) was 41.36 per thousand births. These results point to the fact that in health we have lived, so we must analyzed the service very seriously. There are health preventive public health standard of life of patients, and other events that are the responsibility of state, activities that we are willing to support

Mortalidad neonatal: enfrentando el futuro / Neonatal mortality: confronting the future

El objetivo fue estudiar la mortalidad neonatal de los años 2005 a 2008, conocer su ocurrencia, determinar características maternas, condiciones obstétricas y factores relacionados. Es un estudio observacional analítico de 164 neonatos. Para el lapso hubo 10180 recién nacidos vivos en el Departamento de Obstetricia y Ginecología. Departamento Clínico Integral de la Costa. Universidad de Carabobo. Hospital Dr. Adolfo Prince Lara, Puerto Cabello, Estado Carabobo. La mortalidad neonatal fue 16.11 por mil recién nacidos vivos o una muerte cada 62 nacidos vivos. Hubo predominio de madres de 24 años y menos (55,56%), en antecedentes familiares destacó la hipertensión arterial (30,86%) y diabetes (4,3%), en antecedentes personales la prematurez (16,1%). El diagnóstico de ingreso fue amenaza de parto prematuro 21,61%, trabajo de parto pre-término 19,14% y rotura prematura de membrana 19,75%. No realizaron control prenatal 64,2%; eran multigestas 63,6%, con edad de embarazo menor igual 36 a semanas 72,22% y resultado en parto normal 71,61%. Predominaron los fetos masculinos (53,66%), con peso menor igual 2.500 g (78,66%) y talla menor igual 49 cm (88,4%), el índice Apgar de 7 y menos (84,75%). El factor de muerte directo conocido prevaleciente en 164 casos fue la insuficiencia repiratoria (53,66%), seguida de sepsis (21,95%) y asfixia perinatal (19,51%).

El objetive was to study the neonatal mortality of the years 2005-2008, knowing its impact, determine the material characteristics, obstetric conditions and related factors. It is a observational and analytical study of 164 neonatal death. For the period there were 10.180 live births in the Department of Obstetrics and Gynecology, Hospital "Dr. Adolfo Prince Lara", Puerto Cabello, Estado Carabobo. The neonatal mortality was 16,11 per thousand live births, or one death every 62 births. There were more mothers 24 years or less (55.56%), in personal prematurity (16.1%). The initial diagnosis was premature labor 21.61%, labor preterm 19.14% and pre-term premature rupture of membranes 19.75%. No prenatal care 64.2%, were multiparous 63.6%, with gestational age minor igual 36 weeks 72.22%, and ended in normal delivery 71.61%. A predominance of male fetuses (53,66%) with weight minor igual 2500 g (78.66%) and height minor igual 49 cm (88.4%), Apgar Index of 7 or less (84.75%). Factor prevalent direct death in 164 cases was respiratory failure (53.66%), followed by sepsis (21.95%) and perinatal asphyxia (19.51%).

Tiene importancia el bajo peso neonatal / It is important the low birth weight

Estudiar la prevalencia del recién nacido de bajo peso, las características asociadas maternas y perinatales y su asistencia en el Departamento de Obstetricia y Ginecología. Departamento de Obstetricia y Ginecología. Hospital "Dr. Adolfo Prince Lara" Puerto Cabello. Estudio descriptivo retrospectivo, de 548 madres con 554 recién nacidos de bajo peso (< 2 500 g), incluyendo 6 gemelares, sucedidos durante los años 2006-2008. De un total de 7568 nacidos vivos, la prevalencia promedio fue 7,32 por ciento, o 1 cada 14 nacidos vivos. Las pacientes en su mayoría residencian en barrios 46,17 por ciento, con procedencia del Estado Carabobo 76,46 por ciento, además 90,9 por ciento solteras y concubinas, 35,77 por ciento de 20-24 años y 45,5 por ciento no controló el embarazo. En antecedentes familiares destacó la hipertensión arterial 54,09 por ciento y diabetes 25,91 por ciento, en antecedentes personales la hipertensión arterial (24,38 por ciento) y cesárea previa (23,67 por ciento). En la patología actual la rotura prematura de membrana (20,99 por ciento) y amenaza de parto prematuro (10,77 por ciento). El 49,82 por ciento fueron multigestas, con 72,08 por ciento embarazos pretérmino y 27,92 por ciento a término, resolviéndose con cesárea 38,5 por ciento; predominaron neonatos masculinos 55,96 por ciento, con peso entre 2000 y 2499 g (39,71 por ciento) y talla de 45-49 cm (64,98 por ciento); tuvieron índice Apgar 7 o menos el 54,96 por ciento. La morbilidad fue 55,61 por ciento; la mortalidad perinatal fue 32,49 por ciento, la fetal 19,85 por ciento y neonatal 12,63 por ciento. La sepsis y la prematurez fueron las patologías predominantes en la morbimortalidad. Los neonatos de bajo peso presentan una prevalencia elevada con notorias repercusiones en la salud perinatal, efectos causados principalmente por sepsis y prematurez. Esta patología compleja en su etiopatogenia amerita atención precoz de las embarazadas, estimular el control prental, mejorar la asistencia...

To study the prevalence of low birth weight, associated maternal and perinatal characteristics and assistance. Departamento de Obstetricia y Ginecología. Hospital "Dr. Adolfo Prince Lara" Puerto Cabello. Transversal design, retrospective descriptive study of 548 mothers with 554 infants of low birth weight (< 2 500 g), including 6 twin, occurred during the years 2006-2008. Of a total of 7568 live births, the average prevalence was 7.32 percent, or 1 every 14 live births. Patients most districts residing in 46.17 percent, with provenance 76.46 percent Carabobo state, besides 90.9 percent single and concubines, 35.77 percent aged 20-24, and 45.5 percent did not control pregnancy. In family history, hypertension and diabetes 54.09 percent and 25.91 percent, on a personal history, hypertension (24.38 percent) and cesarean section (23.67 percent), and the current condition, labor (37.23 percent), premature rupture of membranes (20.99 percent), preterm labor (10.77 percent). The 49.82 percent were multiparous, the 72.08 percent and 27.92 pre-term to term, cesarean resolved in 38.5 percent, 55.96 percent male dominated infants, weighing between 2000 and 2499 g (39,71 percent) and height of 45-49 cm (64.98 percent). Had Apgar Index 7 or less was 54.96 percent. The morbidity rate was 55.61 percent, the perinatal mortality was 32.49 percent, fetal 19.85 percent and 12.63 percent neonatal. Sepsis and prematurity were the predominant diseases in the morbidity and mortality. Low birth weight infants have a high prevalence with notable impact on perinatal health, effects mainly caused by sepsis and prematurity. This complex pathology merits attention in the pathophysiology of early pregnant women, prenatal stimulate and improve perinatal care and research...

Morbilidad materna extrema / Extreme maternal morbidity

Determinar la prevalencia de casos de patología obstétrica aguda severa (morbilidad materna extrema) y el tipo de patologías que con mayor frecuencia afectan nuestra población gestante. Departamento de Obstetricia y Ginecología. Hospital “Dr. Adolfo Prince Lara” Puerto Cabello. Estudio descriptivo, corte transversal de 168 pacientes que ingresaron a sala de partos durante el año 2007 con el diagnóstico de patología obstétrica aguda severa, en relación con 2404 nacidos vivos y 2465 partos atendidos. De ellas 141 eran mayores de 20 semanas de gestación. La prevalencia fue de 69,8 por mil nacidos vivos o 68,15 por mil partos atendidos, de otra forma 1 caso cada 14 nacidos vivos o partos asistidos. La mayoría de las pacientes tenían edades comprendidas entre 20-25 años (35,12 por ciento), provenían del medio urbano 38,69 por ciento, no eran casadas 95,33 por ciento, con grado de instrucción bachillerato 68,45 por ciento. En cuanto a su condición obstétrica predominaron las primigestas (39,88 por ciento), con embarazos del tercer trimestre (81,1 por ciento), y de estos con 36-38 semanas (45,86 por ciento); embarazos no controlados 32,62 por ciento. Las patologías más frecuentes fueron los trastornos hipertensivos (60,71 por ciento), representada especialmente por la preeclampsia severa (58,93 por ciento), seguida de las hemorrágicas (32,74 por ciento) y sepsis (6,55 por ciento); se resolvieron por cesárea segmentaria (90,78 por ciento), en 7 de estos casos fue necesario realizar histerectomía obstétrica; hubo 12,77 por ciento nacimientos muertos. Este tipo de patología presenta una prevalencia elevada, afectan a gestantes jóvenes y primigestas, causada predominantemente por patología hipertensiva con consecuencias severas para las madres y sus fetos y neonatos. De todo esto se deriva acciones para identificar precozmente estas patologías y prestarle la asistencia intensiva correspondiente

To determine the prevalence of cases of severe acute obstetric pathology (extreme maternal morbidity) and the type of disease that most often affect our pregnant population. Departamento de Obstetricia y Ginecologia. Hospital “Dr. Adolfo Prince Lara” Puerto Cabello. A descriptive study, cross-sectional of 168 patients admitted to the delivery room in 2007 with a diagnosis of severe acute obstetric pathology in relation to 2404 live births and 2465 births. Of these 141 were older than 20 weeks gestation. Department of Obstetrics and Gynecology. University of Carabobo. Hospital “Dr. Adolfo Prince Lara” Puerto Cabello. Estado Carabobo. Venezuela. The prevalence was 69.8 per thousand live births, or 68.15 per thousand births, otherwise 1 case every 14 live births or births attended. Most patients were aged 20-25 years (35.12 percent), came from urban areas (38.69 percent), were not married (95.33 percent), with high school education level (68.45 percent). As for her obstetric condition prevailed primigravid (39.88 percent), pregnancies in the third quarter (81.1 percent) and those with 36-38 weeks (45.86 percent), 32.62 percent controlled pregnancies. The most frequent pathologies were hypertensive disorders (60.71 percent), represented especially by severe pre-eclampsia (58.93 percent), followed by bleeding (32.74 percent) and sepsis (6.55 percent), resolved by cesarean section (90.78 percent), in 7 of these cases obstetric hysterectomy was performed; 12.77 percent were stillbirths. This type of pathology has a high prevalence, affecting young and primiparous pregnant, predominantly caused by hypertensive disease with severe consequences for mothers and their fetuses and neonates. From this flowed action to identify these conditions early and provide appropriate intensive care

Muerte fetal: evento actual / Fetal death: current event

El objetivo fue estudiar la mortalidad fetal, conocer su frecuencia, determinar características maternas, condiciones obstetricas y factores relacionados. Es un estudio observacional, descriptivo de 347 muertes fetales sucedidas entre 2005-2009. Para el mismo lapso se registraron 17406 nacimientos en el Departamento de Obstetricia y Ginecología. Hospital "Dr. Adolfo Prince Lara". Puerto Cabello-Estado Carabobo. La mortalidad fetal para el período fue 19,94 por mil nacidos o 1 por cada 50 nacimientos. Hubo predominio de pacientes de 24 años y menos (40,35%), en antecedentes familiares destacó la hipertensión arterial (18,44%) y diabetes e hipertensión arterial crónica (9,8%), en los personales la hipertensión arterial (17,58%). El diagnóstico de ingreso fue feto muerto 47,26%, rotura prematura de membrana 14,7% y patología hipertensiva 14,12%. No realizaron control prenatal 48,7%; eran multigestas 43,24%, con edad de embarazo menor igual 36 semanas 70,03%, y resuelto en parto vaginal 77,52%. Predominaron los fetos masculinos (57,06%), con peso menor igual 2500 g (75,5%) y talla menor igual 49 cm (65,13%). El factor de muerte directo conocido prevaleciente en 178 casos fue la insuficiencia placentaria (36,52%), desencadenada principalmente por patología hipertensiva; seguida de patología hemorrágica placentaria (25,28%), liderizada por desprendimiento normoplacentario. La tasa de mortalidad fetal se encuentra elevada, por lo cual se recomienda una estrategia de atención precoz del embarazo, enfatizar control de las patologías relacionadas: hipertensivas, diabetes, prematurez y hemorragias placentarias. La vigilancia intra-parto debe ser rutinaria, en especial en estas patologías

The objetive wasto study fetal mortality, to know its impact, to determine the maternal characteristics, obstetric conditions and related factors. It is an observational descriptive study of 347 fetal death accurred between 2005-2009. For the same period there were 17406 birth in the Department of Obstetrics and Gynecology Hospital "Dr. Adolfo Prince Lara". Puerto Cabello, Estado Carabobo. Fetal mortality for the period was 1994 per thousand births or 1 per 50 births. Most of them were patients of 24 years or less (40.35%), with family history of hypertension (18.44%) and diabetes and cronic arterial hypertension (9.8%); and personal history of hypertension (17.58%). The admission diagnosis was stillbirth 47.26%, premature rupture of membranes 14.7%, and hypertension disease 14.12%. No prenatal care 48.7%, were multiparous 43.24%. with gestational age < igual 36 weeks 70.03%. and vaginal delivery 77.52%. A predominance of male fetuses (57.06%), weight < igual 36 weeks 70.03, and vaginal delivery 77.52%. A predominance of male fetuses (57.06%), weightv< igual 2.500 g (75.5%) and heidht < igual 49 cm (63.13%). The known factor of prevalent direct death in 178 cases was placental insufficiency (36.52%), mosthy triggered by hipertensive pathology, , followed by placental hemorrhage (25.28%), lead by placental abruption. The fetal mortality rate is high, so it is recommended a strategy of early attention of pregnancy, and stress control of related conditions: hypertensive disorders, diabetes, pematurity and placental bleeding, Intrapartum monitoring should be routine, especially in these conditions