Management of excavated soil and dredging spoil waste from construction and demolition within the EU: Practices, impacts and perspectives.

Excavated soil and rock (ESR) and dredging spoils (DDS) account for 23 % of the total EU waste generation in 2020. This study performs a life cycle assessment and life cycle costing to quantify the potential environmental and cost savings resulting from increasing the level of ESR and DDS prepared for reuse and recycled in comparison to the business-as-usual practice. Scenarios for the waste management pathways based on the status quo, technical feasibility or normative impositions are assessed, including the potential contribution to achieving the European Green Deal goals. Results show that promoting preparing for reuse and recycling could lead to non-negligible GHG reductions (up to 3.6 Mt. CO2 eq.) and economic savings (EUR 12.3 billion) annually. Depending upon the scenario, 0.2 % to 1 % of the net annual GHG emissions reductions sought by the European Green Deal could be facilitated by scaling up improved circular management of ESR and DDS at the EU level. Finally, the study highlights the main barriers to scaling up to more circular (i.e., preparing for reuse and recycling) and better performing management options in Europe. The results provide new insights for the European Green Deal and circular economy policymaking for CDW.

Resultados perinatales del crecimiento intrauterino restringido. Cienfuegos, 2022

Fundamento: el crecimiento intrauterino restringido necesita un manejo intensivo prenatal para determinar el estado fetal y el tiempo del parto. Objetivo: describir los resultados perinatales del crecimiento intrauterino restringido. Métodos: estudio de serie de casos desarrollado en el Hospital de Cienfuegos, en el 2022. Se estudiaron las variables: tipo de crecimiento intrauterino retardado, resultados del ultrasonido Doppler en vasos maternos y fetales, enfermedades que complicaron el embarazo, tipo de parto, peso y tiempo gestacional al parto, resultados adversos perinatales. Se comparó la distribución de variables de importancia en la clínica con los resultados adversos perinatales. Resultados: el crecimiento restringido afectó al 4,7 % de los partos, el 25 % fue de inicio precoz; el 17,3 % presentó preeclampsia, el 41,3 % tuvo IPM ArUt >95 p. El 14,4 % de los fetos presentó alteraciones en los flujos del Doppler (ICP<5 p con 42 %); el 98 % tuvo crecimiento restringido grado I. El 19 % de las gestantes necesitó interrupción del embarazo en semana 34 o antes. Se realizó cesárea al 44,6 % y el 18,7 % de los recién nacidos vivos necesitó ingreso en UCIN; hubo tres muertes neonatales y dos muertes fetales tardías. Los resultados adversos perinatales fueron más frecuentes en fetos con ICP<5 p, el parto antes de las 34 semanas y el peso al nacer menor de 1500 g (p<0,05). Conclusiones: la alteración del índice cerebro placentario en el feto, nacer antes de las 34 semanas y peso inferior a 1500 g al nacer, eleva el riesgo adverso perinatal en los fetos/neonatos con crecimiento intrauterino restringido.

Foundation: restricted intrauterine growth requires intensive prenatal management to determine fetal status and delivery time. Objective: To describe the perinatal outcomes of restricted intrauterine growth. Methods: case series study developed at the Cienfuegos Hospital in 2022. The studied variables were: type of delayed intrauterine growth, results of Doppler ultrasound in maternal and fetal vessels, diseases that complicated the pregnancy, type of delivery, weight and gestational time to delivery, adverse perinatal outcomes. The distribution of clinically important variables was compared with adverse perinatal outcomes. Results: delayed growth affected 4.7% of births, 25% had early onset; 17.3% had preeclampsia, 41.3% had MPI ArUt >95 p. 14.4% of fetuses presented alterations in Doppler flows (ICP<5 p with 42%); 98% had restricted growth grade I. 19% of pregnant women needed termination of pregnancy at week 34 or before. A cesarean section was performed in 44.6% and 18.7% of live newborns required admission to the NICU; there were three neonatal deaths and two late fetal deaths. Adverse perinatal outcomes were more frequent in fetuses with ICP<5 p, delivery before 34 weeks and birth weight less than 1500 g (p<0.05). Conclusions: the alteration of the cerebroplacental index in the fetus, birth before 34 weeks and weight less than 1500 g at birth, increases the adverse perinatal risk in fetuses/neonates with restricted intrauterine growth.

Operational Framework to Quantify "Quality of Recycling" across Different Material Types.

Many pledges and laws are setting recycling targets without clearly defining quality of recycling. Striving to close this gap, this study presents an operational framework to quantify quality of recycling. The framework comprises three dimensions: the Virgin Displacement Potential (VDP); In-Use Stocks Lifetime (IUSL); and Environmental Impact (EI). The VDP indicates to what extent a secondary material can be used as a substitute for virgin material; the IUSL indicates how much of a certain material is still functional in society over a given time frame, and the EI is a measure of the environmental impact of a recycling process. The three dimensions are aggregated by plotting them in a distance-to-target graph. Two example calculations are included on poly(ethylene terephthalate) (PET) and glass. The results indicate that the recycling of bottle and container glass collected via a deposit-refund system has the lowest distance-to-target, at 1.05, and, thus, the highest quality of recycling. For PET bottles, the highest quality of recycling is achieved in closed-loop mechanical recycling of bottles (distance to optimal quality of 0.96). Furthermore, sensitivity analysis indicates that certain parameters, e.g., the collection rate for PET bottles, can reduce the distance-to-target to 0.75 when all bottles are collected for recycling.

Management practices for compostable plastic packaging waste: Impacts, challenges and recommendations.

The EU Green Deal aims at solving the challenges related to plastic production, (mis-)use, and pollution. While the bioplastic industry is identified as one of the possible avenues to tackle the problem, bioplastic waste collection and management practices are still far from full-development and harmonisation. To inform policy makers on the best practices and their feasibility, this study quantifies environmental and economic impacts of compostable plastic packaging (CPP) waste management schemes by means of Life Cycle Assessment and Costing. Results show that, with respect to climate change and financial costs, the scheme leading to the highest benefits is collecting CPP with conventional plastic waste followed by mechanical sorting and recycling (saving ca. 306 kg CO2eq. t-1 at a net income of 3.7 EUR t-1). The second best option is collecting CPP with bio-waste followed by biological treatment (saving ca. 69 kg CO2eq. t-1 at a cost of 197 EUR t-1). Collecting CPP with conventional plastics followed by sorting and biological treatment is to be avoided. The trend on the other impact categories generally follows climate change. Ideally, closed loop is therefore preferred, but conditioned by (i) having high share of CPP in municipal waste (else sorting is economically unfeasible), (ii) good citizen's behaviour at source-segregation, and (iii) an established market for secondary material. Currently, overall benefits are limited by the low amounts, suggesting that the management choice could ultimately be based on rather simple technical and economic feasibility criteria while regulatory and management efforts should be focused on other waste streams with greater implications on environment.

Is mid-trimester cervical length screening effective for reduction of threatened preterm labor?

OBJECTIVE: To assess the incidence of threatened preterm labor and preterm labor admissions and treatment of women with singleton gestations and no prior preterm birth before and after implementation of the universal mid-trimester transvaginal ultrasound cervical length screening. MATERIALS AND METHODS: A retrospective cohort study included of singleton gestations without a history of preterm birth presenting with threatened preterm labor between 24 0/7 and 36 6/7 gestational week in two study periods: before and after the implementation of the universal cervical length screening. Women with cervical length <25 mm were considered being at high risk for preterm birth and were prescribed a treatment with vaginal progesterone daily. The primary outcome was the incidence of threatened preterm labor. Secondary outcomes were the incidence of preterm labor. RESULTS: We have found a significant increase in the incidence of threatened preterm labor from 6.42% (410/6378) in 2011 to 11.61% (483/4158) in 2018 (p < 0.0001). Gestational age at triage consult was lower in than in 2011, although the rate of admission for threatened preterm labor was similar in both periods. There was a significant decrease in the incidence of preterm delivery <37 weeks from 25.60% in 2011 to 15.94% in 2018 (p < 0.0004). Although there was a reduction in preterm delivery ≤34 weeks, this reduction was not significant. CONCLUSION: The universal mid-trimester cervical length screening in asymptomatic women is not associated with a reduction in the frequency of threatened preterm labor or the admission rate for preterm labor, but reduces the rate of preterm births.

Malformaciones congénitas en hijos de gestantes epilépticas en la provincia de Cienfuegos (2008-2018)

Fundamento en la mujer embarazada la epilepsia es uno de los trastornos neurológicos más frecuentes, considerado de alto riesgo por las complicaciones que produce. La probabilidad de malformaciones congénitas es mayor en la descendencia de estas pacientes que en la de mujeres que no lo son. Objetivo determinar los factores de riesgo asociados a malformaciones congénitas en hijos de gestantes epilépticas. Métodos se realizó estudio descriptivo, de casos y controles no pareados, tomados del total de gestantes epilépticas registradas con fetos o recién nacidos en el periodo 2008-2018, en la provincia de Cienfuegos. La muestra fue un grupo de casos: gestantes epilépticas con fetos o recién nacidos con malformaciones congénitas (20); y un grupo control: tomado del total de gestantes epilépticas con recién nacidos sanos (40). Se requirió información del registro de malformaciones congénitas del departamento de Archivo, del hospital Dr. Gustavo Aldereguía Lima. Resultados la edad mayor de 35 años representó un riesgo cuatro veces mayor (OR=4,3) para la presencia de malformaciones congénitas en estas gestantes epilépticas. El antecedente de interrupción genética del embarazo resultó estadísticamente significativo (p= 0,006) y elevó 16 veces el riesgo de tener una malformación. Las malformaciones cardiovasculares fueron las más frecuentes, seguidas de las renales y nerviosas. Según su clasificación y presentación, prevalecieron las mayores y las aisladas, respectivamente. Conclusión los factores de riesgos asociados a malformaciones congénitas en hijos de madres epilépticas fueron: edad materna mayor de 35 años, antecedentes de embarazo previo con malformación y de interrupción genética del embarazo.

Background in pregnant women, epilepsy is one of the most frequent neurological disorders, considered high risk due to the complications it produces. The probability of congenital malformations is higher in the descendant of these patients than in women who are not. Objective to determine the risk factors associated with congenital malformations in children of epileptic pregnant women. Methods a descriptive study of unpaired cases and controls was carried out, taken from the total number of epileptic pregnant women registered with fetuses or newborns in the period 2008-2018, in the Cienfuegos province. The sample was a group of cases: epileptic pregnant women with fetuses or newborns with congenital malformations (20); and a control group: taken from the total of epileptic pregnant women with healthy newborns (40). Information was required from the congenital malformations registry from the Archive department, of the Dr. Gustavo Aldereguía Lima hospital. Results age over 35 years represented a four times higher risk (OR=4.3) for the presence of congenital malformations in these epileptic pregnant women. The history of genetic termination of pregnancy was statistically significant (p= 0.006) and increased the risk of having a malformation 16 times. Cardiovascular malformations were the most frequent, followed by renal and nervous. According to their classification and presentation, the largest and isolated prevailed, respectively. Conclusion the risk factors associated with congenital malformations in children of epileptic mothers were: maternal age over 35 years, history of previous pregnancy with malformation and genetic interruption of pregnancy.

Tourism under a life cycle thinking approach: A review of perspectives and new challenges for the tourism sector in the last decades.

Sustainable tourism should be promoted as a new system for the sustainable management of resources from a socioeconomic and environmental point of view. For this purpose, it is necessary to develop a tool capable of assessing the impacts associated with the sector and to identify which actions are currently being addressed in order to achieve the desired sustainability. This timely study aims to describe the current framework of Life Cycle Assessment (LCA) and its application to the tourism sector. To address these questions, a total of 83 documents (77 reviews and 6 international reports) were evaluated, assessing the geographical distribution, the temporal evolution of the publications, as well as the most relevant characteristics of the tourism industry articles were evaluated such as, life cycle inventory (LCI), system boundaries, functional unit (FU), methods, environmental indicators and impact categories considered. The study identifies key recommendations on the progression of LCA in tourism sector. As important results, it stands out that 94 % of articles were from the last decade and 21 % of the articles reviewed cover sustainable tourism term, considering the three dimensions. This review showed that in LCA studies the most common method was CML 2001; the most widely used environmental indicator was the Carbon Footprint (CF) and the Global Warming Potential (GWP) was the impact category used in all the studies. Hence, LCA is a highly effective tool capable of assessing direct and indirect carbon emissions in tourism as well as the socioeconomic and environmental impacts generated in this sector. COVID-19 pandemic is also an object of discussion in the framework of the sustainable tourism together with advocating support for the eco-labelling and digitalisation of the tourism experiences as valuable tools to minimize environmental negativities, to promote mechanisms to access green markets and to frame successful synergies.

Climate change mitigation potential of transitioning from open dumpsters in Peru: Evaluation of mitigation strategies in critical dumpsites.

Waste management is a critical policy towards the reduction of environmental impacts to air, soil and water. Many Latin American countries, however, lack a correct waste management system in many cities and rural areas, leading to the accumulation of unmanaged waste in illegal or unregulated dumpsites. The case of Peru is of interest, as it hosts 5 of the 50 largest dumpsites in the world. An erratic waste management compromises climate actions for Peru to commit with the Paris Agreement, as no correct closure systems are established for these dumpsites. Therefore, the main objective of this study is to assess the contribution of the past and present biodegradable waste produced and disposed of in the most critical open dumpsters to the overall annual greenhouse gas (GHG) emissions of Peru using the IPCC model. Thereafter, the climate change mitigation potential of possible dumpsite closure strategies based on a selection of technologies, including economic feasibility, were estimated. Results show that cumulative GHG emissions in 2018 for the 24 critical dumpsites evaluated added up to 704 kt CO2 eq. and a cumulative value of 4.4 Mt CO2 eq. in the period 2019-2028, representing over 40 % of solid waste emissions expected by 2030. Mitigation potentials for these emissions tanged from 91 to 970 kt CO2 eq. in the ten-year period depending on the mitigation strategies adopted. The costs of these strategies are also discussed and are expected to be of utility to complement Peru's waste management commitments in the frame of the Paris Agreement.

Towards a Water-Energy-Food (WEF) nexus index: A review of nutrient profile models as a fundamental pillar of food and nutrition security.

The Water-Energy-Food (WEF) nexus approach should be promoted as a tool for sustainable management of resources through the interconnection of these three fundamental pillars. Particularly, food security must ensure healthy and balanced diets for everyone, but selecting individual indicators to assess all slants covered by this element is not an easy task. Hence, the objective of this paper is two-fold, to review nutrient profiling (NP) models that allow to categorize foods and evaluate diets based on their nutritional quality, and to choose the most appropriate model to be used within a WEF nexus index. To address this issue, a total of 159 documents were assessed, appraising the geographic distribution, and time evolution of the publications, as well as the characteristics and potential applications of the NP systems. The review concludes that the NRF9.3. model is the most liable option to be used in a WEF nexus index, presenting the best characteristics by means of the definition of scores and thresholds, and the use of an 'across-the-board' criteria and a reference quantity of 100 kcal, alongside offering higher ability to assess diets and foods than the other competitive model (HEI) through the evaluation of nutrients to encourage instead of foods. A secondary outcome of the review is the identification of the NP models as a useful tool to enable institutions with information to establish policies in the field of public health and facilitating the decision-making process according to the current healthy claims.

Techno-economic and environmental assessment of methane oxidation layer measures through small-scale clean development mechanism - The case of the Seychelles.

Unclosed coastal landfills in small island developing states are major sources of greenhouse gases and other environmental impacts. This is a major problem for sustainable waste management systems mainly due to the lack of economic resources. The clean development mechanism (CDM) appears as a possibility to facilitate sustainable financing. Implementing a methane oxidation layer (MOL) emerges as a feasible technical option for this kind of small landfills since landfill gas extraction is usually not viable. This paper presents a techno-economic and environmental assessment of MOL implementation in the Providence landfill (Seychelles) as a small-scale CDM measure. Results show that the MOL measure could avoid by 2030 between 94 and 20 kt CO2 eq. Concerning profitability, results clearly show that it depends on the existence of stabilized biomass material within the island. Thus, the MOL measure starts to be profitable in some scenarios for certified emission reductions (CER) prices higher than 26 €/t CO2 eq. that seem possible depending on the emissions' market development. When not profitable under CDM, the MOL measure might be used to reduce CO2 emissions from the domestic climate effort under the Paris Agreement since the unitary abatement costs is between 10 and 423 €/t CO2 eq. Moreover, the MOL measure contributes to the sustainable development goals (SDG) achievement - mainly SDG8, SDG13, and SDG14. Finally, results call for a prompt action in Seychelles since the sooner the MOL is implemented after the landfill is closed, the more profitable.

Regionalized Strategies for Food Loss and Waste Management in Spain under a Life Cycle Thinking Approach.

Food loss and waste (FLW) has become a central concern in the social and political debate. Simultaneously, using FLW as a bioenergy source could significantly contribute to closing the carbon cycle by reintroducing energy into the food supply chain. This study aims to identify best strategies for FLW management in each of the 17 regions in Spain, through the application of a Life Cycle Assessment. To this end, an evaluation of the environmental performance over time between 2015 and 2040 of five different FLW management scenarios implemented in a framework of (i) compliance and (ii) non-compliance with the targets of the Paris Agreement was performed. Results revealed savings in the consumption of abiotic resources in those regions in which thermal treatment has a strong presence, although their greenhouse gas (GHG) emissions in a scenario of compliance with climate change targets are higher. In contrast, scenarios that include anaerobic digestion and, to a lesser extent those applying aerobic composting, present lower impacts, including climate change, suggesting improvements of 20-60% in non-compliance and 20-80% in compliance with Paris Agreement targets, compared to the current scenarios.

Multi-Objective Optimization of Nutritional, Environmental and Economic Aspects of Diets Applied to the Spanish Context.

Current food consumption patterns must be revised in order to improve their sustainability. The nutritional, environmental, and economic consequences of these dietary patterns must be taken into consideration when diet guidelines are proposed. This study applied a systematic optimization methodology to define sustainable dietary patterns complying with nutritional, environmental, and economic issues. The methodology was based on a multi-objective optimization model that considered a distance-to-target approach. Although the three simultaneous objectives (maximal nutritional contribution, minimal greenhouse gas emissions, and minimal costs) could be divergent, the proposed model identified the optimal intake of each food product to achieve the maximal level of nutritional, environmental, and economic diets. This model was applied to six different eating patterns within the Spanish context: one based on current food consumption and five alternative diets. The results revealed that dietary patterns with improved nutritional profiles and reduced environmental impacts could be defined without additional costs just by increasing the consumption of vegetables, fruits, and legumes, while reducing the intake of meat and fish.

Valor predictivo del test angiogénico (ratio sFlt/PIGF) en los trastornos hipertensivos del embarazo. Resultados perinatales en Cienfuegos / Predictive value of the angiogenic test (sFlt / PIGF ratio) in hypertensive disorders of pregnancy. Perinatal results in Cienfuegos

RESUMEN Fundamento: La preeclampsia es causa principal de morbimortalidad y discapacidad materna y perinatal, por lo que resulta importante su diagnóstico y prevención. Objetivo: constatar el valor predictivo del test angiogénico (ratio sFlt/PIGF) en los trastornos hipertensivos del embarazo. Métodos: se realizó un estudio descriptivo de corte transversal, en el Servicio de Ginecología y Obstetricia, del Hospital Dr. Gustavo Aldereguía Lima, de Cienfuegos, de enero de 2017 a diciembre de 2018. Se trabajó con 125 gestantes con sospecha de preeclampsia, del total de ingresadas con tensión arterial elevada. Se dividieron en dos grupos de acuerdo a los valores diagnósticos del test angiogénico de la Roche (ratio sFlt/PIGF), y se compararon los resultados perinatales y las complicaciones maternas. Se utilizó el estadígrafo Chi cuadrado (p <0,05) y se calculó la razón de riesgo (IC 95%). Resultados: el test angiogénico fue positivo con más frecuencia en aquellas gestantes que desarrollaron una preeclamsia eclampsia, con 90,7 % vs 9,3 % en las que no desarrollaron preeclamsia eclampsia (p=0,000); así como en las de menos de 34 semanas de edad gestacional que desarrollaron preclampsia (72 %), con una elevada sensibilidad y especificidad. El uso del test en el seguimiento de las pacientes se asoció a una tendencia a la prolongación del embarazo. Su positividad se relacionó más a complicaciones maternas, fetales y neonatales. Conclusión: un valor positivo del test implica un aumento del riesgo de desarrollo de la preeclamsia eclampsia y de complicaciones maternas, así como resultados adversos perinatales. El test angiogénico mostró utilidad en el diagnóstico y pronóstico de la enfermedad.

ABSTRACT Background: Preeclampsia is the main cause of morbidity, mortality, maternal and perinatal disability, making its diagnosis and prevention important. Objective: to validate the predictive value of the angiogenic test (sFlt / PIGF ratio) in hypertensive disorders of pregnancy. Methods: a descriptive cross-sectional study was carried out at the Gynecology and Obstetrics Service, Dr. Gustavo Aldereguía Lima Hospital, Cienfuegos, from January 2017 to December 2018. 125 pregnant women with suspected pre-eclampsia, from the Total number of patients admitted with high blood pressure were studied. They were divided into two groups according to the diagnostic values of the Roche angiogenic test (sFlt / PIGF ratio), and perinatal results and maternal complications were compared. The Chi square statistic (p <0.05) was used and the risk ratio (95% CI) was calculated. Results: the angiogenic test was positive more frequently in those pregnant women who developed eclampsia preeclamsia, with 90.7% vs. 9.3% in those who did not develop eclampsia preeclamsia (p = 0.000); as well as those less than 34 weeks of gestational age who developed pre-eclampsia (72%), with high sensitivity and specificity. The use of the test in the follow-up of the patients was associated with a tendency to prolong the pregnancy. Its positivity was more related to maternal, fetal and neonatal complications. Conclusion: a positive value of the test implies an increased risk of developing preeclamsia eclampsia and maternal complications, as well as adverse perinatal results. The angiogenic test showed utility in the diagnosis and prognosis of the disease.

Malformaciones congénitas cardiovasculares. Cienfuegos, 2008-2017 / Congenital cardiovascular malformations. Cienfuegos, 2008-2017

RESUMEN Fundamento: Las malformaciones congénitas cardiovasculares contribuyen de forma importante a la mortalidad infantil, por lo que el estudio de su comportamiento resulta de interés. Objetivo: caracterizar el comportamiento de las malformaciones congénitas cardiovasculares. Métodos: se realizó un estudio descriptivo, en el Hospital Dr. Gustavo Aldereguía Lima, de Cienfuegos, en el periodo 2008-2017. Fueron incluidas las 138 gestantes registradas con fetos o recién nacidos con malformaciones congénitas cardiovasculares. La información se obtuvo del Registro cubano de malformaciones congénitas, del Registro cubano de malformaciones congénitas prenatales, y de los departamentos de archivo y de estadísticas del hospital. Se analizó la tendencia de las malformaciones en el periodo, los factores maternos más frecuentes, así como los tipos de anomalías detectadas. Resultados: las cardiopatías congénitas predominaron en los años 2010 y 2011, así como en los municipios de Cienfuegos y Cumanayagua. Los factores maternos más frecuentes fueron la edad materna normal, la primiparidad, las enfermedades crónicas, el uso de antibióticos, y las infecciones en el primer trimestre de la gestación, sobre todo las vaginales. La cardiopatía congénita que más se presentó fue la comunicación interventricular. Conclusión: Las malformaciones congénitas cardiovasculares se presentaron con más frecuencia en productos de madres primíparas, y en edades ideales para la concepción. La presencia de enfermedades crónicas, el uso de medicamentos y las infecciones agudas en el primer trimestre del embarazo, estuvieron presentes, pero no fueron prevalentes.

ABSTRACT Foundation: Congenital cardiovascular malformations contribute significantly to infant mortality, so the study of their behavior is of interest. Objective: to characterize the behavior of congenital cardiovascular malformations. Methods: a descriptive study was carried out at the Dr. Gustavo Aldereguía Lima Hospital, in Cienfuegos, in the period 2008-2017. The 138 pregnant women registered with fetuses or newborns with congenital cardiovascular malformations were included. The information was obtained from the Cuban Registry of Congenital Malformations, the Cuban Registry of Prenatal Congenital Malformations, and from the hospital's record and statistic departments. Trend of malformations during the period, most frequent maternal factors, as well as the types of detected anomalies were analyzed. Results: Congenital heart disease prevailed in 2010 and 2011, as well as in the municipalities of Cienfuegos and Cumanayagua. The most frequent maternal factors were normal maternal age, primiparity, chronic diseases, use of antibiotics, and infections in the first trimester of pregnancy, especially vaginal infections. The most common congenital heart disease was interventricular communication. Conclusion: Congenital cardiovascular malformations occurred more frequently in products of primiparous mothers, and at ideal ages for conception. Presence of chronic diseases, use of medications and acute infections in the first trimester of pregnancy were present, but not prevalent.

Diabetes y malformaciones congénitas. Cienfuegos, 2005-2015 / Diabetes and congenital malformations. Cienfuegos, 2005-2015

RESUMEN Fundamento: la diabetes constituye el trastorno metabólico que más repercusión tiene sobre la salud materna y su descendencia, con mayor énfasis en las malformaciones congénitas. Objetivo: describir las malformaciones congénitas en hijos de madres diabéticas en la provincia de Cienfuegos. Métodos: estudio de serie de casos realizado en Cienfuegos, desde enero de 2005 a diciembre de 2015, sobre fetos y neonatos con malformaciones congénitas hijos de madres diabéticas. Los datos se obtuvieron del modelo del Registro Cubano de Malformaciones Congénitas y Prenatales y otros documentos del departamento de archivos del Hospital Materno de Cienfuegos y del Centro Provincial de Genética Médica. Se analizaron variables sociodemográficas, maternas, tipo de malformación y el diagnóstico pre y posnatal según el caso. Resultados: la incidencia de malformaciones en hijos de madres diabéticas fue del 3,4 %; predominaron las malformaciones mayores, dentro de ellas, las cardiovasculares. No existieron diferencias en la aparición de malformaciones entre la diabetes mellitus pregestacional y la gestacional. Los factores de riesgo más frecuentes fueron: el sobrepeso materno, las enfermedades no transmisibles y el uso de medicamentos en el embarazo. Conclusiones: en los hijos de madres diabéticas predominaron las malformaciones congénitas cardiovasculares y se relacionaron con el sobrepeso y la comorbilidad materna.

ABSTRACT Foundation: diabetes is the metabolic disorder with the greatest impact on maternal health and its offspring, with greater emphasis on congenital malformations. Objective: to describe congenital malformations in children of diabetic mothers in the province of Cienfuegos. Methods: case series study conducted in Cienfuegos, from January 2005 to December 2015, on fetuses and neonates with congenital malformations, children of diabetic mothers. The data were obtained from the model of the Cuban Registry of Congenital and Prenatal Malformations and other documents of the archives department of the Maternity Hospital of Cienfuegos and the Provincial Center of Medical Genetics. We analyzed socio- demographic, maternal variables, type of malformation and pre and postnatal diagnosis according to the case. Results: the incidence of malformations in children of diabetic mothers was 3.4%; Major malformations predominated, including cardiovascular malformations. There were no differences in the appearance of malformations between pre-gestational and gestational diabetes mellitus. The most frequent risk factors were: maternal overweight, non-communicable diseases and the use of drugs in pregnancy. Conclusions: congenital cardiovascular malformations predominated in children of diabetic mothers and were related to overweight and maternal comorbidity.

Análisis de la tasa de cesáreas en el Hospital Universitario Cruces (Vizcaya) mediante el empleo de la clasificación de Robson / Use of the Robson 10-group classification to assess cesarean section rates in Cruces Hospital (Vizcaya)

OBJETIVO: valorar la frecuencia de las cesáreas realizadas en nuestro hospital empleando la clasificación estandarizada de Robson e identificar qué indicaciones son las que más contribuyen a la tasa global de cesáreas en nuestro centro. MATERIAL Y MÉTODOS: estudio retrospectivo, observacional sobre el total de cesáreas realizadas en el Hospital Universitario Cruces en un periodo de tres años (2015-2017). Para la inclusión de las gestantes en algunos de los 10 grupos de Robson hemos tenido en cuenta la paridad, edad gestacional, inicio del parto, presentación fetal y el número de fetos. RESULTADOS: durante este tiempo se han atendido un total de 15.112 partos; de los que 1.935 fueron cesárea (12,80%). El grupo que mayor incidencia tiene sobre el total de cesáreas realizadas es el grupo 2 (nulíparas, gestación única, presentación cefálica, ≥ 37 semanas, trabajo de parto inducido o cesárea antes del inicio del trabajo de parto) con una tasa del 30,64%, seguido del grupo 1 (nulíparas, gestación única, presentación cefálica, ≥ 37 semanas, trabajo de parto espontáneo) con un 19,22%. Al margen del grupo 9 (que incluye las cesáreas en presentaciones transversas), los grupos con un mayor porcentaje de cesáreas son el 6 (nulíparas, gestación única, presentación podálica) y 7 (multípara, gestación única, presentación podálica, incluidas las gestantes con cesárea anterior) con un 56,83% y 54,54% respectivamente. CONCLUSIONES: la clasificación de Robson es una buena herramienta para auditar clínicamente la tasa de cesáreas. Es fácil de implementar y permite evaluar el impacto del cambio en el manejo para cambiar dicha tasa. En nuestro centro, la protocolización adecuada de la atención a las presentaciones podálicas, gestaciones múltiples y cesáreas anteriores representa el mayor reto

OBJECTIVE: To apply the Robson 10-group classification system to identify which indications are the ones that contribute most to the cesarean section rate in our hospital. MATERIAL AND METHODS: A historical cohort study was performed on women who delivered in a 3-year period (2015-2017) at the Cruces University Hospital. Five parameters (parity including previous cesarean, gestational age, labor onset, fetal presentation, and plurality), identifiable on presentation for delivery, were used to classify all women included into 1 of 10 groups. The Robson distribution, cesarean rate, and contribution of each Robson group were analyzed, and the distribution of other outcomes was calculated for each Robson group. RESULTS: Of 15,112 deliveries, 1,935 (12.80%) were cesarean sections. Robson groups 1 (30.65%) and 3 (29.91%) (spontaneous term births) were the largest groups. Robson group 2 (single cephalic nulliparous women full-term, induced labor or cesarean section antepartum) and group 1 (single cephalic nulliparous women full-term in spontaneous labor) were the major contributors to the overall cesarean rate at 30.64% and 19.22% respectively. Besides group 9 (transverse lie), groups with higher cesarean rates are 6 (single breech, nulliparous) and 7 (single breech, multiparous, including previous cesarean section), with 56.83% and 54.54% respectively. CONCLUSIONS: The Robson classification is a good tool to clinical audit cesarean section rates. Is easy to implement and interpret and allows to evaluate the impact of changes in management that may alter these rates. In our hospital breech presentations, multiple pregnancy and previous cesarean section are the main challenges

Glucemia en ayunas alterada versus prueba de tolerancia a la glucosa alterada. Resultados perinatales. Cienfuegos, 2016 / Impaired fasting glycemia versus impaired glucose tolerance test. Perinatal results. Cienfuegos, 2016

RESUMEN Fundamento: Las cifras de glucemia materna alteradas pueden causar morbimortalidad perinatal. El estudio de la glucemia en ayunas alterada en gestantes es un tópico que reviste gran importancia, dada su repercusión en los resultados perinatales; y requiere de nuevos análisis, en correspondencia con los criterios actuales. Objetivo: comparar los resultados perinatales de gestantes con glucemia en ayunas alterada, con los de aquellas que presentaron una prueba de tolerancia a la glucosa alterada. Métodos: se realizó un estudio descriptivo, en el servicio de Obstetricia del Hospital Dr. Gustavo Aldereguía Lima, de Cienfuegos, de enero a diciembre de 2016. Se trabajó con 144 gestantes con diagnóstico de diabetes mellitus gestacional, según criterios de la Organización Mundial de la Salud, y se dividieron según los criterios diagnósticos en: pacientes con glucemia en ayunas alterada y pacientes con prueba de tolerancia a la glucosa alterada. Se compararon ambos grupos en cuanto a variables clínicas y resultados perinatales. Se utilizó el Chi cuadrado (p<0,05) y se calculó la razón de riesgo (IC 95 %). Resultados: los grupos comparados exhibieron resultados similares en cuanto a edad, índice de masa corporal, tiempo de embarazo al diagnóstico, paridad, tratamiento, edad gestacional al parto; así como en los resultados perinatales: tasa de inducción del parto y cesárea, malformaciones congénitas, macrofeto y bajo peso, asfixia neonatal, ventilación neonatal e ingreso en cuidados intensivos neonatales. Conclusión: las gestantes con glucemia en ayunas alterada mostraron características clínicas y resultados perinatales similares a las gestantes con prueba de tolerancia a la glucosa alterada.

ABSTRACT Foundation: Impaired maternal glycemia figures can cause perinatal morbidity and mortality. The study of impaired fasting blood glucose in pregnant women is of relevant importance, due to its impact on perinatal outcomes; and it requires new analyzes, in correspondence with the current criteria. Objective: to compare perinatal results of pregnant women with impaired fasting glycaemia, with those of those who presented an impaired glucose tolerance test. Methods: a descriptive study was carried out in the obstetrics department of the Dr. Gustavo Aldereguía Lima Hospital, in Cienfuegos, from January to December 2016. A number of 144 pregnant women diagnosed with gestational diabetes mellitus, according to criteria of the World Health Organization were studied and were divided according to the diagnostic criteria in: patients with impaired fasting blood glucose and patients with impaired glucose tolerance test. Both groups were compared in terms of clinical variables and perinatal results. Square Chi was used (p <0.05) and the risk ratio was calculated (95 % CI). Results: the groups compared showed similar results in terms of age, body mass index, time of pregnancy at diagnosis, parity, treatment, gestational age at birth; as well as in the perinatal results: rate of labor induction and cesarean section, congenital malformations, fetal microsomia and low weight, neonatal asphyxia, neonatal ventilation and admission to neonatal intensive care. Conclusion: pregnant women with impaired fasting blood glucose showed clinical characteristics and perinatal results similar to pregnant women with impaired glucose tolerance test.

Techno-economic and profitability analysis of food waste biorefineries at European level.

Food waste represents a potential source to produce value-added materials replacing the use of virgin ones. However, the use of food waste as feedstock in biorefineries is still at an early stage of development and studies assessing its economic viability at large scale are lacking in the literature. This paper presents a techno-economic and profitability analysis of four food waste biorefineries that use wastes from tomato, potato, orange, and olive processing as feedstock. The study includes the assessment of potentially available quantities of those waste flows in Europe. Due to the low technology readiness level of this kind of biorefineries, a screening methodology to estimate the investment and manufacturing costs as well as two profitability ratios (the return on investment and the payback time) was adopted. Results show that not all the waste feedstocks have the same potential. The most profitable options are those related to implementing fewer plants, namely concentrating the production and capitalising on economies of scale while being at risk of increasing externalities, e.g. due to logistics of the feedstocks.

Prioritizing and optimizing sustainable measures for food waste prevention and management.

Food waste has gained prominence in the European political debate thanks to the recent Circular Economy package. Currently the waste hierarchy, introduced by the Waste Framework Directive, has been the rule followed to prioritize food waste prevention and management measures according to the environmental criteria. But when considering other criteria along with the environmental one, such as the economic, other tools are needed for the prioritization and optimization. This paper addresses the situation in which a decision-maker has to design a food waste prevention programme considering the limited economic resources in order to achieve the highest environmental impact prevention along the whole food life cycle. A methodology using Life Cycle Assessment and mathematical programing is proposed and its capabilities are shown through a case study. Results show that the order established in the waste hierarchy is generally followed. The proposed methodology revealed to be especially helpful in identifying "quick wins" - measures that should be always prioritized since they avoid a high environmental impact at a low cost. Besides, in order to aggregate the environmental scores related to a variety of impact categories, different weighting sets were proposed. In general, results show that the relevance of the weighting set in the prioritization of the measures appears to be limited. Finally, the correlation between reducing food waste generation and reducing environmental impact along the Food Supply Chain has been studied. Results highlight that when planning food waste prevention strategies, it is important to set the targets at the level of environmental impact instead of setting the targets at the level of avoided food waste generation (in mass).

Towards more sustainable management of European food waste: Methodological approach and numerical application.

Trying to respond to the latest policy needs, the work presented in this article aims at developing a life-cycle based framework methodology to quantitatively evaluate the environmental and economic sustainability of European food waste management options. The methodology is structured into six steps aimed at defining boundaries and scope of the evaluation, evaluating environmental and economic impacts and identifying best performing options. The methodology is able to accommodate additional assessment criteria, for example the social dimension of sustainability, thus moving towards a comprehensive sustainability assessment framework. A numerical case study is also developed to provide an example of application of the proposed methodology to an average European context. Different options for food waste treatment are compared, including landfilling, composting, anaerobic digestion and incineration. The environmental dimension is evaluated with the software EASETECH, while the economic assessment is conducted based on different indicators expressing the costs associated with food waste management. Results show that the proposed methodology allows for a straightforward identification of the most sustainable options for food waste, thus can provide factual support to decision/policy making. However, it was also observed that results markedly depend on a number of user-defined assumptions, for example on the choice of the indicators to express the environmental and economic performance.