SEOM clinical guidelines on cardiovascular toxicity (2018).

One of the most common side effects of cancer treatment is cardiovascular disease, which substantially impacts long-term survivor's prognosis. Cardiotoxicity can be related with either a direct side effect of antitumor therapies or an accelerated development of cardiovascular diseases in the presence of preexisting risk factors. Even though it is widely recognized as an alarming clinical problem, scientific evidence is scarce in the management of these complications in cancer patients. Consequently, current recommendations are based on expert consensus. This Guideline represents SEOM's ongoing commitment to progressing and improving supportive care for cancer patients.

Infant formula samples and breast feeding among Philippine urban poor.

An experiment was performed on the maternity wards of three public hospitals in Cebu City, Philippines to determine whether the distribution of free samples of infant formula reduced the likelihood that mothers would breast feed or caused mothers to terminate nursing early. Samples were given or withheld alternately for 2 week intervals to mothers as they left maternity wards. They were followed for 8 months in the first experiment (N = 273) and for 2 months in a replication (N = 284). We found that there were no statistically significant differences between those who received samples and those who did not in initiation or maintenance of breast feeding. Mothers in both groups frequently turned to mixed schedules, but these varied from day to day depending on money to buy other forms of milk, or on the mother's health, or her plan to be away from the baby for one or more feeding periods. After the baby reached an age of 2-3 months, mothers, with few exceptions, used diluted sweetened condensed milk as a supplement and/or substitute for their own milk. It was found that, while mothers recognize the nutritional, economic and health benefits of breast feeding, they may terminate early on the basis of folk beliefs. Receiving formula samples, however, had no measured effect on their breast feeding practices.

Early termination of breastfeeding among Philippine urban poor.

PIP: The research objective was to identify factors that caused mothers to terminate breastfeeding prematurely, i.e., before the infant reached his or her 1st birthday. Nursing for at least 1 year was a minimum goal of health authorities in the area of this research. The study was conducted in 2 urban poor areas and in 2 fringe squatter settlements of Cebu City, a metropolitan area of 500,000 people in the central Philippines. The data were collected by 2 women field workers. The 130 participants, who were within 3 months of delivery, pre- or postpartum were recruited in 1979. They were visited in their homes once a month by the worker who weighed the mother and the baby, inquired about their diets, and recorded breastfeeding experiences and plans. Special attention was given to any problems the mothers were having that might interfere with continued nursing. Other than encouraging mothers to use the local health center, workers did not intervene to support breastfeeding. The mothers were followed for at least the crucial 1st 6 months. Many were followed for a year or more. Of those who agreed to participate prior to delivery, and who composed 1/3 of the total group, some 95% initiated breastfeeding. Of the 3 who did not, 2 tried to nurse but gave up when the newborn showed persistent diarrhea. Between 10-20% of babies were on a mixed diet of breast and bottle feeding, some beginning as early as the 1st month when mothers returned to part-time work. Other mothers, feeling that the babies were not getting enough to eat, added bottles regularly. This pattern did not necessarily lead to the early termination of breastfeeding. With the exception of 2 instances when mothers decided that their babies were big enough to get along without breast milk, the mothers were forced by circumstances as they perceived them to wean the child. Almost all the terminations were abrupt, with the mother continuing to have an adequate supply of milk. The insufficient milk situation reported by 9 mothers is an exception. In most cases, stopping was a crisis, because the mothers felt that to continue would endanger the child while to stop would sacrifice the benefits of breastfeeding. The major reasons for early termination are discussed: diarrhea, insufficient milk, returning to work, mother sick or pregnant, infant refuses the breast or is not growing, and milk is salty or not good.^ieng

Maintenance and termination of breast feeding in rural and urban Philippine communities.

PIP: Three samples of Filipino mothers from urban and rural settings with at least 1 baby less than 2 years of age were interviewed. There was a unanimous preference for breastfeeding. About 90% succeeded in starting breastfeeding and at least half continued until the baby was at least 1 year old. Those who failed cited no milk or insufficient milk, or that the mother had an acute or chronic illness at the time of delivery, as reasons for termination of breastfeeding. Others found breastfeeding too painful to continue, and some became pregnant within 3 months of delivery. At 1 year of age, the child was considered old enough to take the same food as the family, and nursing was not encouraged. Another pregnancy was the most common cause for termination at almost every age interval. Folk beliefs and practices also contributed to unnecessary weaning from breastfeeding.^ieng

An evaluation of strategies to control vitamin A deficiency in the Philippines.

Xerophthalmia has been found to be an important cause of blindness in the Philippines. An earlier study had investigated its prevalence and epidemiology on the island of Cebu. The research now presented consists of an evaluation of the relative effectiveness of three different intervention strategies to control vitamin A deficiency in Cebu. These interventions were 1) a public health and horticulture intervention, 2) the provision of 200,000 IU of vitamin A to children every 6 months (the "capsule intervention"), and 3) the fortification of monosodium glutamate with vitamin A. A total of 12 areas or barangays were included. Each intervention was monitored in four different barangays, two urban and two rural, for almost 2 years. Similar examinations were performed before and after the interventions. The monosodium glutamate fortification was the only intervention that resulted both in a significant reduction in clinical signs of xerophthalmia and in a significant rise in serum vitamin A levels. Fortification is now being planned in three Philippine provinces.

Planning, implementation, and evaluation of a fortification program. Control of vitamin A deficiency in the Philippines.

In a three-year pilot project in the Philippines, the magnitude of vitamin A deficiency and its clinical manifestation (xerophthalmia) was determined, and three alternate programs for eliminating and preventing it in various ecologic zones were designed and implemented concurrently in separate areas in each ecologic zone. Results were evaluated, and costs and benefits of each program were determined. The results of the fortification program are reported. Monosodium glutamate (MSG) was selected as the ideal carrier was fortified at a level which provided 15,000 I.U. retinol palmitate to the average family each day. Significant increases in serum A, especially for children with more deficient vitamin A status, resulted. The program's economic benefits significantly outweighted the costs, and the MSG fortification program has been expanded to several additional pilot provinces in the Philippines.

Vitamin A deficiency in the Philippines: a study of xerophthalmia in Cebu.

An investigation of xerophthalmia was undertaken in four ecological zones in Cebu in the Philippines. One thousand seven hundred fifteen children aged 1 to 16 years were examined in 12 barrios. Clinical, biochemical and anthropometric data were collected from the children. Dietary and socioeconomic information was obtained from the households. Multivariate statistical techniques were used to examine factors possibly associated with xerophthalmia. Of children 47% had deficient or low serum vitamin A levels and 4.5% had clinical signs of xerophthalmia. Approximately 2% had both low serum vitamin A levels and clinical eye signs and were then defined as having active xerophthalmia. Vitamin A deficiency was more prevalent in males than females. Xerophthalmia was most common in the 4 to 6 year old age group. Diarrhea, roundworm infestation and measles were not positively correlated with xerophthalmia but whooping cough and tuberculosis were. Low intakes of carotene and vitamin A were associated with xerophthalmia but protein and fat intakes were not. A higher incidence of xerophthalmia occurred in children of working than nonworking mothers. Data on home production and use of vegetables and fruits are presented. The results of this study are being used to introduce three alternate intervention strategies to control xerophthalmia.