Association between affective disorders presenting before and during pregnancy and pre-term birth, considering socio-demographic factors, obstetric factors, health conditions, and use of medication / Asociación entre los trastornos afectivos que se presentan antes y durante el embarazo y el parto prematuro, teniendo en cuenta los factores sociodemográficos, los factores obstétricos, las condiciones de salud y el uso de medicamentos

Objective: To study the relationship between maternal affective disorders (AD) before and during pregnancy, and pre-term birth. Design: Retrospective observational study. Location: Sexual and reproductive health units at the Institut Català de la Salut (ICS) in Catalonia, Spain. Participants: Pregnant women with a result of live-born child from 1/1/2012 to 30/10/2015. Interventions: Data were obtained from the ICS Primary Care electronic medical record. Main measurements: Diagnosis of AD before and during pregnancy, months of pregnancy, and possible confusion factors were collected. Descriptive statistical analysis (median, interquartile range, and absolute and relative frequency), bivariate analysis (Wilcoxon test and Chi-square test), and multivariate analysis (logistic regression) were performed. Results: 102,086 women presented valid information for the study. Prevalence of AD during pregnancy was 3.5% (4.29% in pre-term and 3.46% in term births; p < 0.004). Pregnant women with pre-term births presented a higher age, smoking habit, lower inter-pregnancy interval, and a lower socio-economic status. Pre-term birth was significantly associated to previous history of stress and dissociative disorder (SDD), anxiety, obsessive-compulsive disorder (OCD) and eating disorders (ED), and use of antidepressants. It was also associated to abuse of alcohol, smoking, and use of psychoactive substances, as well as SDD, ED, use of antipsychotics, and divorce during pregnancy. Multivariate analysis confirmed the relationship between pre-term birth and history of AD, SDD, ED, and smoking, but not with AD during pregnancy. Conclusions: Examining the previous history of SDD and ED in pregnant women, and SDD, and ED during pregnancy is highly relevant to avoid pre-term birth

Objetivo: Estudiar la relación entre diagnósticos de trastornos afectivos (TA) antes y durante el embarazo, y factores de confusión con prematuridad del neonato. Diseño: Estudio observacional retrospectivo. Emplazamiento: Servicios de atención sexual y reproductiva del Institut Català de la Salut (ICS) en Cataluña, España. Participantes: Embarazadas atendidas con resultado de hijo vivo del 1/1/2012 al 30/10/2015. Intervenciones: Datos recogidos en la base de datos de la historia clínica informatizada. Mediciones: Se recogió los diagnósticos de TA antes y durante el embarazo, meses de gestación y posibles factores de confusión. Se realizó análisis estadístico descriptivo (mediana y rango intercuartílico y frecuencias absoluta y relativa), bivariante (test de Wilcoxon y Chi-cuadrado) y multivariante (regresión logística). Resultados: Ciento dos mil ochenta y seis mujeres presentaban información válida para el estudio. La prevalencia de TA durante el embarazo fue del 3,5% (4,29% en prematuros y 3,46% en a término; p<0,004). Las embarazadas con partos prematuros presentan mayor edad, más tabaquismo, menor tiempo entre embarazos y menor nivel socioeconómico. La prematuridad se asoció a antecedentes previos de trastorno por estrés y disociativo (TED), de ansiedad y obsesivo-compulsivo, de conducta alimentaria (TCA) y uso de antidepresivos. También a abuso de alcohol, tabaco y sustancias psicoactivas; TED, TCA, uso de antipsicóticos y divorcio durante el embarazo. El análisis multivariante confirmó la relación de prematuridad con antecedentes de TA, TED, TCA y tabaquismo, pero no con TA durante el embarazo. Conclusiones: Es importante explorar antecedentes de TED y TA en la embarazada y los TED durante el embarazo, para disminuir la prematuridad

Association between affective disorders presenting before and during pregnancy and pre-term birth, considering socio-demographic factors, obstetric factors, health conditions, and use of medication.

OBJECTIVE: To study the relationship between maternal affective disorders (AD) before and during pregnancy, and pre-term birth. DESIGN: Retrospective observational study. LOCATION: Sexual and reproductive health units at the Institut Català de la Salut (ICS) in Catalonia, Spain. PARTICIPANTS: Pregnant women with a result of live-born child from 1/1/2012 to 30/10/2015. INTERVENTIONS: Data were obtained from the ICS Primary Care electronic medical record. MAIN MEASUREMENTS: Diagnosis of AD before and during pregnancy, months of pregnancy, and possible confusion factors were collected. Descriptive statistical analysis (median, interquartile range, and absolute and relative frequency), bivariate analysis (Wilcoxon test and Chi-square test), and multivariate analysis (logistic regression) were performed. RESULTS: 102,086 women presented valid information for the study. Prevalence of AD during pregnancy was 3.5% (4.29% in pre-term and 3.46% in term births; p<0.004). Pregnant women with pre-term births presented a higher age, smoking habit, lower inter-pregnancy interval, and a lower socio-economic status. Pre-term birth was significantly associated to previous history of stress and dissociative disorder (SDD), anxiety, obsessive-compulsive disorder (OCD) and eating disorders (ED), and use of antidepressants. It was also associated to abuse of alcohol, smoking, and use of psychoactive substances, as well as SDD, ED, use of antipsychotics, and divorce during pregnancy. Multivariate analysis confirmed the relationship between pre-term birth and history of AD, SDD, ED, and smoking, but not with AD during pregnancy. CONCLUSIONS: Examining the previous history of SDD and ED in pregnant women, and SDD, and ED during pregnancy is highly relevant to avoid pre-term birth.

Diagnóstico precoz de faringitis estreptocócica en pediatría: validación de una técnica antigénica rápida / Early diagnosis of streptococcal pharyngitis in paediatric practice: Validity of a rapid antigen detection test

ObjetivoEstudiar la validez de una técnica de diagnóstico antigénico rápido (TDAR) del estreptococo betahemolítico del grupo A para el diagnóstico de la faringitis aguda en comparación con el cultivo del exudado faríngeo.DiseñoEstudio observacional en una serie consecutiva de pacientes.EmplazamientoDos centros de atención primaria del área metropolitana de Barcelona.ParticipantesNiños entre 1–14 años que presentaban dolor faríngeo de menos de 5 días de evolución y que acudían a las consultas de pediatría.Mediciones principalesA todos los participantes se les recogieron 2 muestras de la faringe posterior y del área tonsilar, una para la realización de la TDAR y otra para el cultivo.ResultadosEn 211 pacientes estudiados la prevalencia de faringitis estreptocócica fue del 34,1%. La sensibilidad de la prueba fue del 90,3% (IC del 95%: 81,0–96,0) y la especificidad fue del 78,4% (IC del 95%: 70,6–84,9). El porcentaje de falsos negativos fue del 9,7% y el porcentaje de falsos positivos fue del 21,6%. Se observó un sesgo del espectro en el que la sensibilidad de la TDAR se incrementó con los criterios de Centor.ConclusionesEl valor diagnóstico de la TDAR para la faringitis estreptocócica en pacientes de pediatría atendidos en las consultas de atención primaria fue alto. Sin embargo, el porcentaje de falsos positivos y negativos fue muy alto y mostró una baja sensibilidad en pacientes con una clínica menos grave, por lo que la TDAR debe complementarse con la realización del cultivo, que además nos aportará información sobre la sensibilidad antibiótica(AU)

ObjectiveTo determine the validity of the rapid antigen test for the diagnoses of acute pharyngitis caused by group A beta-haemolytic Streptococcus (GABHS) compared with culture.DesignObservational study of a consecutive sample of paediatric patients.SettingTwo primary care centres (PCC) from the metropolitan area of Barcelona.ParticipantsChildren aged 1–14 years with sore throat of no more than 5 days duration were chosen at PCC.Principal measurementsOropharyngeal samples were collected from tonsillar bed and posterior pharynx. A rapid diagnostic test was performed, as well as a throat culture.ResultsA total of 211 patients were studied. The overall prevalence of pharyngitis due to Streptococcus was 34.1%. Compared with the throat culture, the sensitivity of the rapid test was 90.3% (95% CI: 81.0–96.0), the specificity was 78.4% (95% CI: 70.6–84.9). The percentage of false negatives was 9.7% and the false positives was 21.6%. Spectrum bias was present, inasmuch as the rapid test sensitivity increased with Centor scores.ConclusionsThe diagnostic value of a rapid antigen test for the diagnosis of streptococcal pharyngitis in paediatric patients at PCC is high. However, the percentage of false positives and negatives is too high, and also the sensitivity is too low in patients with fewer symptoms to support the use of rapid antigenic test without culture confirmation and bacterial sensitivity test(AU)

[Early diagnosis of streptococcal pharyngitis in paediatric practice: Validity of a rapid antigen detection test]. / Diagnóstico precoz de faringitis estreptocócica en pediatría: validación de una técnica antigénica rápida.

OBJECTIVE: To determine the validity of the rapid antigen test for the diagnoses of acute pharyngitis caused by group A beta-haemolytic Streptococcus (GABHS) compared with culture. DESIGN: Observational study of a consecutive sample of paediatric patients. SETTING: Two primary care centres (PCC) from the metropolitan area of Barcelona. PARTICIPANTS: Children aged 1-14 years with sore throat of no more than 5 days duration were chosen at PCC. PRINCIPAL MEASUREMENTS: Oropharyngeal samples were collected from tonsillar bed and posterior pharynx. A rapid diagnostic test was performed, as well as a throat culture. RESULTS: A total of 211 patients were studied. The overall prevalence of pharyngitis due to Streptococcus was 34.1%. Compared with the throat culture, the sensitivity of the rapid test was 90.3% (95% CI: 81.0-96.0), the specificity was 78.4% (95% CI: 70.6-84.9). The percentage of false negatives was 9.7% and the false positives was 21.6%. Spectrum bias was present, inasmuch as the rapid test sensitivity increased with Centor scores. CONCLUSIONS: The diagnostic value of a rapid antigen test for the diagnosis of streptococcal pharyngitis in paediatric patients at PCC is high. However, the percentage of false positives and negatives is too high, and also the sensitivity is too low in patients with fewer symptoms to support the use of rapid antigenic test without culture confirmation and bacterial sensitivity test.