ABSTRACT
Objetivo: Estudio de la efectividad del cribado bioquímico y ecográfico en el segundo trimestre de la gestación para la detección prenatal de trisomía 21 en población de bajo riesgo de aneuploidía. Método: Estudio prospectivo de intervención de 8.894 gestaciones únicas de bajo riesgo de aneuploidía. Se realizó ecografía y extracción simultánea de sangre materna para determinación de alfafetoproteína (AFP) y fracción Beta de la gonadotropina coriónica (Beta-hCG) entre las 14 y 18 semanas. Se consideró como criterio de riesgo para ofrecer amniocentesis una estimación de riesgo superior a 1/270 combinando la edad materna y los valores de marcadores bioquímicos, valores séricos de AFP <= 0,4 múltiplos de la mediana (MoM), de Beta-hCG <= 0,2 MoM (riesgo de trisomía 18), o pliegue nucal superior al percentil 95 para la edad gestacional. Resultados: Las tasas de detección para la trisomía 21 fueron las siguientes: 65 por ciento para la bioquímica y edad materna (con un 11 por ciento de falsos positivos) y 45 por ciento para el pliegue nucal (con 5,3 por ciento de falsos positivos). Los resultados obtenidos con la aplicación de los criterios de riesgo proporcionados indistintamente por cualquiera de ambos parámetros, bioquímica o pliegue nucal, mostraron una tasa de detección del 75 por ciento con una tasa del 14,9 por ciento de falsos positivos. Conclusión: La aplicación simultánea e independiente de los marcadores bioquímicos (AFP y Beta-hCG) y del pliegue nucal para la estimación del riesgo de trisomía 21 en el segundo trimestre permitió detectar el 75 por ciento de fetos afectados, con una tasa de falsos positivos del 14,9 por ciento (AU)
Subject(s)
Adolescent , Adult , Pregnancy , Female , Humans , Aneuploidy , Pregnancy Complications/diagnosis , Down Syndrome/diagnosis , Prenatal Diagnosis/methods , Prospective Studies , alpha-Fetoproteins , Maternal Age , Amniocentesis , Mass Screening , Biomarkers, Tumor , Pregnancy Trimester, Second , Chorionic GonadotropinABSTRACT
The preparation and dissemination of policy statements are necessary but insufficient to prevent the inappropriate use of infant-feeding products in emergencies. The widespread failure of humanitarian agencies operating in the Balkan crisis to act in accordance with international policies and recommendations provides a recent example of the failure to translate infant-feeding policies into practice. This article explores the underlying reasons behind the failures which include: (1) the weak institutionalisation of policies; (2) the massive quantities of unsolicited donations of infant-feeding products: (3) the absence of monitoring systems; (4) inadequate co-ordination mechanisms; (5) the high costs of correcting mistakes; and (6) the cumulative effects of poor practice. Efforts to uphold best practice during the crisis are also documented. Finally, the article identifies actions that could be undertaken in advance of and during future emergencies to enhance the application of infant feeding policies in emergencies.
Subject(s)
Infant Nutritional Physiological Phenomena , International Cooperation , Organizational Policy , Refugees , Relief Work/organization & administration , Albania , Health Plan Implementation , Humans , Infant , Republic of North Macedonia , United Nations , YugoslaviaABSTRACT
The Public Nutrition approach, like that of Public Health, is context specific. It places an emphasis on populations rather than individuals and is inter-disciplinary in nature. Both approaches seek to understand the complex aetiology of a clinical outcome such as malnutrition within the widest possible framework. Public Nutrition uses the UNICEF conceptual framework and adapts and expands it. The authors of this article argue--through the examination of a number of case studies taken from the work of Concern Worldwide (hereafter referred to as Concern) in southern Sudan, Rwanda, Angola, Tanzania and DRC--that there are two critical constituents of the Public Nutrition approach. These are: a contextual analysis (including the use of surveillance information for programme design and advocacy) and community involvement at all stages of the project cycle. Some of the key obstacles to the adoption of the Public Nutrition approach are identified by illustrating two practical programme settings. For the Public Nutrition approach to be more widely used, the authors recommend a number of key strategies including the further dissemination of case studies and the clarification of the scope and boundaries of the approach. These strategies will enable Public Nutrition to evolve both as a practical programme framework as well as an academic discipline.
Subject(s)
Global Health , Health Policy , Nutritional Physiological Phenomena , Africa , Humans , Nutrition Disorders/prevention & control , Program DevelopmentABSTRACT
Tissues obtained from Stenella coeruleoalba stranded along the Spanish and Italian Mediterranean coasts from 1987 to 1994 were analysed for cadmium (Cd), copper (Cu), mercury (Hg), selenium (Se) and zinc (Zn). The age, length and weight of the dolphins were recorded. Hg levels were also assayed in skin biopsies from dolphins of the same species in the waters off northeastern Spain and in the Tyrrhenian and Ligurian Seas. Levels of all elements differed in muscle of stranded dolphins from the two areas. Hg was higher in tissues from animals stranded on the Italian coasts and in skin biopsies obtained in the Tyrrhenian and Ligurian Seas, than in the respective Spanish samples. This is probably related to Hg pollution from the natural weathering of cinnabar ores in central Italy. Se and Cd levels had similar accumulation patterns to those of Hg. Accumulation of Hg and Se is explained by the existence of a detoxification pathway involving both elements, however the reason for the similar Cd trend is unclear. Geographical differences in the accumulation pattern of these elements may reflect the existence of two different populations of Stenella coeruleoalba in the western Mediterranean.
