Evolution of Legislation and the Incidence of Elective Abortion in Spain: A Retrospective Observational Study (2011-2020).

BACKGROUND: According to the WHO, "unsafe abortion occurs when a pregnancy is terminated either by people lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both". AIM: To review the legislation that ensures access to elective abortion and the main indicators of elective abortion in Spain. METHODS: A retrospective observational study was conducted across all regions of Spain from 2011 to 2020. The regulations of each region on the creation of the clinical committee and the creation of the registry of conscientious objector professionals were identified. Data were collected on rates of elective abortions per 1000 women, type of health center where the intervention was performed, interval of weeks of gestation, and cause. RESULTS: After Law 2/2010 entered into force, the Spanish regions created a clinical committee; however, very few regions have a registry of conscientious objectors. During the study period, the average annual rate in Spain was 11.10 elective abortions per 1000 women between 15 and 44 years of age, showing a decreasing trend (annual percentage change of -1.92%). Only 10.67% of abortions were performed at public centers. In 90.18% of the cases, abortions were performed at the woman's request. CONCLUSION: Spain legislated late compared to most European Union countries. The current law is similar to that of other member states, allowing abortion at the woman's request in the first fourteen weeks and thereafter for medical reasons. Most abortions are performed at private centers, although many territorial inequalities are observed.

Excessive alcohol consumption and binge drinking in college students.

Background: Binge drinking (BD) refers to a pattern of alcohol consumption characterized by the consumption of large amounts of alcohol in a short period of time followed by periods of abstinence. This drinking pattern is prevalent worldwide, mainly among young people. Excessive alcohol consumption is the spectrum of consumption patterns that may have or have had health consequences, and includes the concepts of risky alcohol use, harmful alcohol use and alcohol dependence according to Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), the latter two are currently grouped into alcohol use disorder (AUD) according to the fifth edition of the DSM (DSM-5). Due to the high prevalence of BD among young people, especially university students, as well as the important consequences of its practice, a study was conducted to evaluate excessive alcohol consumption and its relationship with the practice of BD in university students. Methods: A cross-sectional study was conducted among students (aged 18-30 years) enrolled in the academic year 2018-2019 at the Faculty of Nursing at a university in northern Spain. Data collection included sociodemographic information, and alcohol use information, collected using a semi-structured questionnaire. To measure the excessive alcohol consumption, this study used the Alcohol Use Disorders Identification Test (AUDIT). Results: A total of 142 participants were included, of which 88.03% were women. Up to 38.03% were classified as BD. Up to 14.77% of non-BD participants and 66.67% of BD participants were classified as risky drinkers (AUDIT Total geq 8 in men or geq 6 in women) (p < 0.001). Up to 3.41% of the non-BD and 24.07% of the BD were drinkers with harmful alcohol use and probable alcohol dependence (AUDIT Total geq 13) (p < 0.001). A total of 5.68% of non-BD and 42.59% of BD were AUD drinkers (AUDIT Total geq 9 in males or geq 8 in females) (p < 0.001). In addition, statistically significant differences were found between the BD and non-BD groups in the responses to each of the AUDIT items, as well as in the total score and also in the scores of the three domains of the questionnaire. Conclusions: Excessive alcohol consumption is frequent among university students, especially among those who practice BD.

SARS-CoV-2 surveillance in indoor and outdoor size-segregated aerosol samples.

We aimed to determine the presence of SARS-CoV-2 RNA in indoor and outdoor size-segregated aerosol samples (PM10-2.5, PM2.5). Five outdoor daily samples were collected between November and December 2020 in an urban/industrial area with relatively high PM10 levels (Maliaño, Santander, Spain) by using a PM impactor (air flowrate of 30 L/min). In a non-hospital indoor sampling surveillance context, 8 samples in classrooms and 6 samples in the central library-Paraninfo of the University of Cantabria (UC) were collected between April and June 2021 by using personal PM samplers (air flowrate of 3 L/min). Lastly, 8 samples in the pediatric nasopharyngeal testing room at Liencres Hospital, 6 samples from different single occupancy rooms of positive patients, and 2 samples in clinical areas of the COVID plant of the University Hospital Marqués de Valdecilla (HUMV) were collected between January and May 2021. N1, N2 genes were used to test the presence of SARS-CoV-2 RNA by RT-qPCR. SARS-CoV-2 positive detection was only obtained from one fine fraction (PM2.5) sample, corresponding to one occupancy room, where a patient with positive PCR and cough was present. Negative results found in other sampling areas such as the pediatric nasopharyngeal testing rooms should be interpreted in terms of air sampling volume limitation and good ventilation.

Evolution of Legislation and Crimes Based on Sexual Identity or Orientation in Spain: A Retrospective Observational Study (2011-2021).

Respect for different sexual options and orientations prevents the occurrence of hate crimes against lesbian, gay, bisexual, trans and intersex (LGTBI) persons for this reason. Our aim was to review the legislation that protects the rights of LGTBI people and to quantify the victimization rates of hate crimes based on sexual identity and orientation. A retrospective observational study was conducted across all regions of Spain from 2011-2021. The laws on LGTBI rights in each region were identified. Hate crime victimization data on sexual identity and orientation were collected in annual rates per 100,000 inhabitants, annual percentage change and average change during the study period to assess the trend. The regulatory development of laws against discrimination against LGTBI individuals is heterogeneous across regions. Overall, in Spain there is an upward trend in the number of hate crime victimizations motivated by sexual identity or orientation. The effectiveness of data collection, thanks to better training and awareness of police forces regarding hate crimes and the processes of data cleansing and consolidation contributes to a greater visibility of hate crimes against LGTBI people.

Poorer cognitive function and environmental airborne Mn exposure determined by biomonitoring and personal environmental monitors in a healthy adult population.

BACKGROUND/AIM: In the Santander Bay (Cantabria, northern Spain), a ferromanganese alloy plant is located. Our objective was to characterize the Mn personal exposure of adult healthy volunteers living in this highly Mn exposed region, and to determine its association with a poorer cognitive function. METHODS: Cross-sectional study analyzing 130 consecutive participants. Cognitive function was assessed by Stroop Color Word, Verbal Fluency tests, Trail Making Test (TMT), Digit Span (WAIS III) and Rey Osterrieth Complex Figure (ROCF) tests and crude scores were standardized according to NEURONORMA norms. Exposure to Mn was assessed in terms of source distance, by Personal Environmental Monitors (PEMs) allowing the separation of fine (PM2.5) and coarse (PM10-2.5) particles (obtaining the bioaccessible fraction by in-vitro bioaccessibility tests), and by biomarkers (blood, hair and fingernails). Age, sex, study level and number of years of residence were predefined as confounding variables and adjusted Mean Differences (MDs) were obtained. RESULTS: Statistically significant lower scores (negative MDs) in all test were observed when living near the industrial emission source, after adjusting for the predefined variables. Regarding PEMs results, statistically significant lower scores in all Stroop parts were obtained in participants with higher levels of Total Mn in All fractions (PM10). For Verbal Fluency tests, negative MDs were obtained for both bioaccessible fractions. Digit Span Backward scores were lower for those with higher levels in the bioaccessible coarse fraction, and negative MDs were also observed for the ROCF Delayed part and the non-bioaccessible fine fraction. As regards to Mn in fingernails, adjusted MDs of -1.60; 95%CI (-2.57 to -0.64) and -1.45; 95%CI (-2.29 to -0.61) for Digit Span Forward and Backward parts were observed. CONCLUSIONS: Our results support an association between poorer cognitive function and environmental airborne Mn exposure.

Relationship of Binge Drinking with Impairments Affecting Memory and Executive Function among University Students: A Cross-Sectional Study in Northern Spain.

Binge drinking (BD) is a common practice among college students. Alcohol consumption may affect brain structures that continue to develop in early adulthood. The aim of this study was to analyze the relationship of BD with impairments affecting memory and executive function among university students. A cross-sectional study was conducted among students (aged 18-30 years) enrolled for the academic year 2018-2019 at the Faculty of Nursing of the University of Cantabria (Spain). Data collection included sociodemographic and academic information, together with alcohol and drug use information, collected by means of a semi-structured questionnaire. A battery of validated tests was used to gather neuropsychological variables. A total of 142 participants were included, of which 88.03% were women. Up to 38.03% were classified as BD. No differences were found in memory tests. Regarding executive function, better performance in the Stroop Color and Word Test was observed in non-BD but the results were not statistically significant. In conclusion, no relationship was found between memory and executive function and BD, although better performance in executive function, specifically inhibitory control, was observed in non-BD.

Biomonitoring and bioaccessibility of environmental airborne manganese in relation to motor function in a healthy adult population.

BACKGROUND/AIM: Santander, the capital of Cantabria, Spain (172,000 inhabitants) is 7 km from an industrial emission source (IES) of Mn located in a 10,000 inhabitants town (Maliaño) (annual air Mn arithmetic mean = 231.8 ng/m3; reference WHO guideline = 150 ng/m3). Our objective was to compare the motor function of adult healthy volunteers living in both places. METHODS: Cross-sectional study analyzing 130 consecutive participants. Exposure to Mn was assessed in terms of source distance from the IES, by Personal Environmental Monitors (PEMs) carried for 24 h by participants consisting of a portable impactor connected to a personal pump, and by biomarkers (blood, hair and fingernails). The impactor allowed the separation of fine (PM2.5) and coarse (PM10-2.5) particles and for each particle size in-vitro bioaccessibility tests with biologically active fluids were performed to separate the soluble (bioaccessible) from the insoluble (non-bioaccessible) fraction. Mean Differences (MDs) adjusted for age, sex, and study level, were obtained for motor function tests results. RESULTS: Regarding Grooved Pegboard, overall mean time to complete the test was 59.31 and 65.27 seconds (Standard Deviation = 10.11 and 11.69) for dominant and nondominant hands respectively. Statistically significant higher times (indicating worse function) were observed when living near the IES in both hands but MDs of only 1.22 and 2.05 seconds were obtained after adjusting for the predefined confounders (p = 0.373 and 0.221 respectively). Regarding Mn levels in their PEMs (in both bioaccessible and non-bioaccessible coarse&fine fractions) higher times were computed in participants with higher levels for the bioaccessible-fine fraction, with a MD that diminished but still yielded statistical significance after controlling for confounding: adjusted MD = 3.01 more seconds; 95%CI (0.44-5.38), p = 0.022. Poorer results were also observed for fingernails levels. Regarding Finger Tapping Test, no statistically significant differences were found with the exception of Mn fingernails levels. CONCLUSIONS: Our results suggest poorer motor function as assessed by Grooved Pegboard test in relation to "proximity to IES", "bioaccessible-fine fraction as determined by PEMs and "Mn fingernails levels". However, our findings were affected by confounding, and only the adjusted MD for the Mn bioaccessible-fine fraction remained of sufficient magnitude to maintain statistical significance.

Isolation of Candida auris in large hospitals in the Autonomous Community of Valencia; population-based study (2013-2017).

BACKGROUND: Candida auris is an emerging multidrug-resistant and highly virulent yeast that spreads easily among patients. AIMS: To describe the characteristics of candidemia caused by C. auris in the southeast of Spain (Autonomous Community of Valencia - ACV) through a 5-year population-based study. METHODS: An analysis of all the episodes of candidemia diagnosed in the ACV, with approximately 4,500,000 inhabitants, during 2013-2017, was done. Data were obtained from the Epidemiological Surveillance Valencian Network, a network that collects all the microbiological data from the hospitals in the study region. RESULTS: Based on the records, 1.9% of the isolates recovered from the positive blood cultures (corresponding to 1789 patients) were yeasts. This implies an annual rate of 7.09 cases/100,000 inhabitants. Of the 23 yeast species isolated, Candida albicans was the most frequent (37.3%), showing a higher frequency than Candida parapsilosis (28.4%) and Candida glabrata (15.6%) (p<0.0001). It is remarkable the emergence of C. auris during 2016 and 2017, as this species became the fourth more prevalent in 2016 (9.2%), and the third in 2017 (15.7%). Fungemia was more common in hospitals with >500 beds (63.3% versus 36.7% in small hospitals) (p<0.0001), and C. auris was mostly isolated in large hospitals (8.5% versus 0.3%); its incidence was higher in autumn and among the age group of 65-84 years. CONCLUSIONS: The information about the local epidemiology of candidemia is essential in order to decide the best empirical treatment approach. This study reports the novel presence of C. auris in large hospitals. This pathogen has usually resistance to several antifungals and causes severe fungemia, so the results of this work reveal the need to monitor the presence of this species systematically.

Impact of Environmental Airborne Manganese Exposure on Cognitive and Motor Functions in Adults: A Systematic Review and Meta-Analysis.

BACKGROUND/OBJECTIVE: Whether environmental exposure to Manganese (Mn) in adults is associated with poorer results in cognitive and motor function is unclear. We aimed to determine these associations through a meta-analysis of published studies. METHODS: A systematic review was conducted to identify epidemiological studies on a population ≥18 years old exposed to environmental airborne Mn, and in which results on specific tests to evaluate cognitive or motor functions were reported. We consulted Medline through PubMed, Web of Science and SCOPUS databases. We also performed a manual search within the list of bibliographic references of the retrieved studies and systematic reviews. To weight Mn effects, a random effects versus fixed effect model was chosen after studying the heterogeneity of each outcome. RESULTS: Eighteen studies met the inclusion criteria. Among them, eleven studies reported data susceptible for meta-analysis through a pooled correlation or a standardized means difference (SMD) approach between exposed and non-exposed groups. Regarding cognitive function, the results of the studies showed heterogeneity among them (I2 = 76.49%, p < 0.001). The overall effect was a statistically significant negative correlation in the random effects model (pooled r = -0.165; 95%CI: -0.214 to -0.116; p < 0.001). For SMD, the results showed a lower heterogeneity with a negative SMD that did not reach statistical significance under the fixed effects model (SMD = -0.052; 95%CI -0.108 to 0.004; p = 0.068). Regarding motor function, heterogeneity (I2 = 75%) was also observed in the correlation approach with a pooled r (random effect model) = -0.150; 95%CI: -0.219 to -0.079; p < 0.001. Moderate heterogeneity was observed according to the SMD approach (I2 = 52.28%), with a pooled SMD = -0.136; 95%CI: -0.188 to-0.084; p < 0.001, indicating worse motor function in those exposed. CONCLUSIONS: Correlation approach results support a negative effect on cognitive and motor functions (the higher the Mn levels, the poorer the scores). Regarding the SMD approach, results also support a worse cognitive and motor functions in those exposed, although only for motor function statistical significance was obtained.

A Review on the Environmental Exposure to Airborne Manganese, Biomonitoring, and Neurological/Neuropsychological Outcomes.

The occupational exposure to airborne manganese (Mn) has been linked for decades with neurological effects. With respect to its environmental exposure, the first reviews on this matter stated that the risk posed to human health by this kind of exposure was still unknown. Later, many studies have been developed to analyze the association between environmental Mn exposure and health effects, most of them including the measure of Mn in selected human biomarkers. This review aims at collecting and organizing the literature dealing with the environmental airborne Mn exposure (other routes of exposure were intentionally removed from this review), the biomonitoring of this metal in different body matrices (e.g., blood, urine, nails, hair), and the association between exposure and several adverse health effects, such as, e.g., neurocognitive, neurodevelopmental, or neurobehavioral outcomes. From the different exposure routes, inhalation was the only one considered in this review, to take into account the areas influenced by industrial activities closely related to the Mn industry (ferromanganese and silicomanganese plants, Mn ore mines, and their processing plants) and by traffic in countries where a fuel additive, methylcyclopentadienyl manganese tricarbonyl (MMT), has been used for years. In these areas, high air Mn levels have been reported in comparison with the annual Reference Concentration (RfC) given by the US EPA for Mn, 50 ng/m3. This review was performed using Scopus and MEDLINE databases with a keyword search strategy that took into account that each valid reference should include at least participants that were exposed to environmental airborne Mn and that were subjected to analysis of Mn in biomarkers or subjected to neurological/neuropsychological tests or both. Overall, 47 references matching these criteria were included in the discussion. Most of them report the measure of Mn in selected biomarkers (N = 43) and the assessment of different neurological outcomes (N = 31). A negative association is usually obtained between Mn levels in hair and some neurological outcomes, such as cognitive, motor, olfactory, and emotional functions, but not always significant. However, other biomarkers, such as blood and urine, do not seem to reflect the chronic environmental exposure to low/moderate levels of airborne Mn. Further studies combining the determination of the Mn exposure through environmental airborne sources and biomarkers of exposure and the evaluation of at least cognitive and motor functions are needed to better understand the effects of chronic non-occupational exposure to airborne Mn.

Relationship between Depressive Symptoms, Personality, and Binge Drinking among University Students in Spain.

Binge drinking (BD) is a common practice among college students. Alcohol consumption has been related to depressive symptoms and certain personality factors, although less is known about the relationship of these variables with BD. The aim of this study was to analyze the relationship of BD with depressive symptoms and personality in university students. We performed a cross-sectional study among students (aged 18-30 years) enrolled in the academic year 2018-2019 at the Faculty of Nursing of the University of Cantabria (Spain). Sociodemographic, academic, and alcohol and other drug use information was collected by means of a semi-structured questionnaire. The Beck Depression Inventory-II was used to measure depressive symptomatology and the Neo Five-Factor Inventory was used for personality. A total of 142 participants were included, 88.03% of which were women. Up to 38.03% were classified as BD. Concerning depressive symptoms, 7.41% of BD were at the moderate-severe level compared to 3.41% of non-BD (p = 0.7096). Regarding personality, the median score for extraversion of BD was 35 (Q1 = 29, Q3 = 40), 32 (Q1 = 28, Q3 = 36) in non-BD (p = 0.0062), conscientiousness scored 34 (Q1 = 30.5, Q3 = 38) points in non-BD, 31.50 (Q1 = 27, Q3 = 37) in BD (p = 0.0224). In conclusion, BD students have higher levels of extraversion and lower levels of responsibility than non-BD students. No significant differences were found between the level of depressive symptomatology between BD and non-BD students.

Prevalence of Seasonal Influenza Vaccination in Chronic Obstructive Pulmonary Disease (COPD) Patients in the Balearic Islands (Spain) and Its Effect on COPD Exacerbations: A Population-Based Retrospective Cohort Study.

To determine the prevalence of influenza vaccination in chronic obstructive pulmonary disease (COPD) patients and its effect on COPD exacerbations, we conducted a retrospective population-based cohort study analyzing real-life data. We included all registered COPD patients ≥40 years old using respiratory medication during the study period (2012-2013). Influenza vaccination during the 2012/2013 campaign was the parameter studied. Moderate and severe exacerbations during 2013 were the dependent outcome variables. Logistic regression adjusting for age, gender, concomitant asthma diagnosis, COPD severity, smoking status, number of moderate and severe exacerbations the previous year, and comorbidities was performed, and 59.6% of the patients received seasonal influenza vaccination. The percentage of patients with exacerbations was higher among those vaccinated. Influenza vaccination had a statistically significantly negative (non-protective) crude effect favoring the risk of severe exacerbations: OR: 1.20 (95% CI; 1.05-1.37). This association diminished and lost statistical significance after adjustment: aOR: 0.93 (95% CI; 0.74-1.18). The protective effect in the analysis restricted to the epidemic period was not significant: aOR: 0.82 (95% CI; 0.58-1.16). We concluded that prevalence of influenza vaccination was suboptimal. In contrast with most of the available evidence, our results did not support a protective effect of influenza vaccination on the risk of admission for COPD exacerbation.

Etiology of bloodstream infections at a population level during 2013-2017 in the Autonomous Community of Valencia, Spain / Etiología de las bacteriemias a nivel poblacional durante 2013-2017 en la Comunidad Autónoma de Valencia, España

INTRODUCTION: Bloodstream Infections has become in one of the priorities for the antimicrobial stewardship teams due to their high mortality and morbidity rates. Usually, the first antibiotic treatment for this pathology must be empirical, without microbiology data about the microorganism involved. For this reason, the population studies about the etiology of bacteremia are a key factor to improve the selection of the empirical treatment, because they describe the main microorganisms associated to this pathology in each area, and this data could facilitate the selection of correct antibiotic therapy. MATERIAL AND METHODS: This study describes the etiology of bloodstream infections in the Southeast of Spain. The etiology of bacteremia was analysed by a retrospective review of all age-ranged patients from every public hospital in the Autonomous Community of Valencia (approximately 5,000,000 inhabitants) for five years. RESULTS: A total of 92,097 isolates were obtained, 44.5% of them were coagulase-negative staphylococci. Enterobacteriales was the most prevalent group and an increase in frequency was observed along the time. Streptococcus spp. were the second microorganisms more frequently isolated. Next, the most prevalent were Staphylococcus aureus and Enterococcus spp., both with a stable incidence along the study. Finally, Pseudomonas aeruginosa was the fifth microorganism more frequently solated. CONCLUSIONS: These data constitute a useful tool that can help in the choice of empirical treatment for bloodstream infections, since the knowledge of local epidemiology is key to prescribe a fast and appropriate antibiotic therapy, aspect capital to improve survival

INTRODUCCIÓN: Las bacteriemias se han convertido en una de las prioridades de los Programas de Optimización de uso de Antimicrobianos (PROA) debido a sus altas tasas de morbimortalidad. Normalmente, el tratamiento antibiótico tiene que ser pautado de forma empírica, sin datos del microorganismo implicado. Por esto, los estudios poblacionales sobre la etiología de las bacteriemias son un factor clave para mejorar la elección del tratamiento empírico, ya que describen los principales microorganismos asociados a esta patología en cada área, lo que facilita en gran medida la selección del antibiótico correcto. MATERIAL Y MÉTODOS: Este estudio describe la etiología de las bacteriemias en el sureste de España durante los años 2013-2017. La etología fue analizada de forma retrospectiva estudiando los microorganismos implicados en todas las bacteriemias diagnosticadas en la Comunidad Valenciana (5.000.000 de habitantes). RESULTADOS: Se obtuvieron un total de 92.097 aislados clínicos, de los cuales un 44,5% fueron Staphylococcus coagulasa negativos. Las enterobacterias fueron el grupo más prevalente, su frecuencia se incrementó durante el estudio. Los cocos grampositivos, tipo Streptococcus, fueron los siguientes microorganismos que se aislaron de forma más frecuente, su frecuencia disminuyó a lo largo del periodo estudiado. A continuación, Staphylococcus aureus y Enterococcus spp. les siguieron en prevalencia, manteniéndose sus tasas estables a lo largo del estudio. Por último, el quinto microorganismo más prevalente fue Pseudomonas aeruginosa. CONCLUSIONES: Los datos obtenidos en este estudio constituyen una herramienta que puede facilitar la elección correcta del tratamiento empírico inicial que debe aplicarse en estos procesos

Binge Drinking in Spanish University Students: Associated Factors and Repercussions: A Preliminary Study.

Alcohol consumption is common among young people. We performed a preliminary cross-sectional study among students (aged 18-30 years) enrolled for the academic year 2018-2019 at the Faculty of Nursing, University of Cantabria (Spain). We collected information on psychological and sociographic factors, tobacco and cannabis uses, and levels of physical activity by AUDIT questionnaires and in person interviews. The aim of our study was to assess the potential of binge drinking (BD) to adversely affect memory and executive function. We recruited 103 students, of whom 85% were female. The alcohol use pattern of slightly more than one-half of the total population was classified as BD. Among BD students, one-fourth were smokers, and nearly one-third had tried cannabis. The mean onset for alcohol use was 15.11 years. Despite our relatively small sample size, our results show that there are strong relationships between BD and both smoking and cannabis use.

Association between advanced maternal age and maternal and neonatal morbidity: A cross-sectional study on a Spanish population.

BACKGROUND AND OBJECTIVE: Over recent decades, a progressive increase in the maternal age at childbirth has been observed in developed countries, posing a health risk for both women and infants. The aim of this study was to analyze the association between advanced maternal age (AMA) and maternal and neonatal morbidity. MATERIAL AND METHODS: A cross-sectional study of 3,315 births was conducted in the north of Spain in 2014. We compared childbirth between women aged 35 years or older, with a reference group of women aged between 24 and 27 years. AMA was categorized based on ordinal ranking into 35-38 years, 39-42 years, and >42 years to estimate a dose-response pattern (the older the age, the greater the risk). As an association measure, crude and adjusted Odds Ratios (OR) were estimated by non-conditional logistic regression and 95% Confidence Intervals (95%CI) were calculated. RESULTS: Repeated abortions were more common among women of AMA in comparison to pregnant women aged 24-27 years (reference group): adjusted OR = 2.68; 95%CI (1.52-4.73). A higher prevalence of gestational diabetes was also observed among women of AMA, reaching statistical significance when restricted to first time mothers: adjusted OR = 8.55; 95%CI (1.12-65.43). In addition, the possibility of an instrumental delivery was multiplied by 1.6 and the possibility of a cesarean by 1.5 among women of AMA, with these results reaching statistical significance, and observing a dose-response pattern. Lastly, there were associations between preeclampsia, preterm birth (<37 weeks) and low birthweight, however without reaching statistical significance. CONCLUSION: Our results support the association between AMA and suffering repeated abortions. Likewise, being of AMA was associated with a greater risk of suffering from gestational diabetes, especially among primiparous women, as well as being associated with both instrumental deliveries and cesareans among both primiparous and multiparous women.

Impact of Active Video Games on Body Mass Index in Children and Adolescents: Systematic Review and Meta-Analysis Evaluating the Quality of Primary Studies.

OBJECTIVE: To study the impact of active video games on Body Mass Index (BMI) in children and adolescents. DESIGN AND METHODS: A systematic review and meta-analysis. Data were pooled in meta-analysis using the method of random effects or fixed effects, as appropriate, after examination of statistical heterogeneity. Data sources and eligibility criteria for selecting studies. A comprehensive literature research was conducted in Medline (PubMed), ISI web of Knowledge, and SCOPUS up to April 2018, in relation to clinical trials (both controlled and non-controlled) in children and adolescents, whose intervention was based on active video games. RESULTS: The overall intragroup effect of the intervention based on active video games was in favor of the intervention, reaching statistical significance using the fixed effects model: (standardized mean difference (SMD) = -0.138; 95% CI (-0.237 to -0.038), p = 0.007 and was of borderline statistical significance in the random effects model: SMD= -0.191; 95% CI (-0.386 to 0.003), p = 0.053. The individual results of the determinations of the 15 included studies for this analysis showed a high heterogeneity among them (I2 = 82.91%). When the intervention was applied to children and adolescents with greater than or equal to 85 (overweight or obese) BMI percentile showed a greater effect in favor of the active video games: SMD= -0.483, p = 0.012. The overall intra-group effect in the control group was close to zero (SMD = 0.087). With respect to the non-standardized mean difference (MD) between groups, it was also in favor of active video games for both BMI (Kg/m2): DM = -0.317, 95% CI (-0.442 to -0.193), p = < 0.001 and BMI z-score: DM = -0.077, 95% CI (-0.139 to -0.016), p = 0.013. CONCLUSIONS: Our meta-analysis show a statistically significant effect in favor of using active video games on BMI in children and adolescents. The clinical relevance of this positive effect must be evaluated.