Breastfeeding avoidance following psychological intimate partner violence during pregnancy: a cohort study and multivariate analysis.

OBJECTIVE: To evaluate if the experience of psychological intimate partner violence (IPV) adversely affects breastfeeding rates. DESIGN: A cohort study. SETTING: Maternities in 15 public hospitals, drawn using cluster sampling of obstetric services in Andalusia, Spain. POPULATION: A total of 779 consecutive mothers receiving antenatal care including ultrasound and giving birth during February-June 2010. METHODS: Trained midwives gathered IPV data using the Index of Spouse Abuse validated in the Spanish language (score ranges: 0-100, higher scores reflect more severe IPV; cut-off: psychological IPV = 25). Sociodemographic data including lack of kin support, and obstetric and neonatal outcomes were collected. Multivariate logistic regression estimated adjusted odds ratios (aOR), with 95% confidence intervals (CI), of the relationship between psychological IPV and breastfeeding, controlling for sociodemographic characteristics and obstetric complications. MAIN OUTCOME MEASURE: Breastfeeding avoidance defined as lack of breastfeeding or pumping of breast milk to feed the new baby in the immediate post-partum period. RESULTS: Response rate was 92.2%. A total of 70% (n = 545) of women initiated breastfeeding. Psychological IPV, reported by 21.0% (n = 151), increased the odds of breastfeeding avoidance (aOR = 2.0; 95% CI = 1.2-3.3) adjusting for the presence of obstetric complications (aOR = 1.6; 95% CI = 1.0-2.4). CONCLUSIONS: Mothers with psychological IPV avoid breastfeeding. Clinicians should be aware of the risks to infant arising from this deficiency due to IPV in pregnancy. TWEETABLE ABSTRACT: Psychological intimate partner violence, reported by one in five mothers in this study, on average doubles the avoidance of breastfeeding.

Differences in morphological age-related dental changes depending on postmortem interval.

Morphological methods for age estimation from teeth have been developed and applied to samples without taking the postmortem interval into consideration. We studied differences in morphological age-related changes between fresh extracted teeth and teeth from human skeletal remains in order to develop appropriate dental age estimation methods according to the time after death. Forty-three permanent teeth from dental patients were compared to 37 teeth obtained from human skeletal remains with a postmortem interval from 21 to 37 years. Morphological age-related changes were investigated by measuring variables on intact and half-sectioned teeth. A new computer assisted image analysis procedure to avoid subjectivity was developed to measure variables in sectioned specimens. Dental color, translucency length, attrition, cementum apposition, and secondary dentin showed higher values in teeth from human skeletal remains than in fresh extracted teeth. Variables obtained by morphometric analysis of computer-generated images (tooth length, tooth width, root length, and root area) showed higher values in fresh extracted teeth than in teeth from skeletal remains. The postmortem interval affects age-related morphological changes, and therefore different methods should be used for teeth of unknown postmortem interval.

The application of dental methods of identification to human burn victims in a mass disaster.

This paper deals with the usefulness of dental identification in the case of 28 human burn victims of a bus accident in Spain. Postmortem forensic procedures for identification were used including general external examination, routine photographs and radiographs and complementary biological methods. Dental identification was also used and a description of the method is presented. Dental identification was established in 57% of the cases. When victims were less than 20 years of age, the success rate of identification by dental methods was higher (76% of victims in this age group). The assessment of dental age allowed the establishment of identity of four victims. We recommend that dental procedures be used in human identification after mass disasters. Odontological and radiographic procedures are powerful methods when dealing with burn victims.

Gelatinase A in human dentin as a new biochemical marker for age estimation.

Dentin proteins from 24-individual permanent molars from patients aged 15 to 73 years were sequentially extracted, with guanidinium chloride (G1-extract) and then with EDTA; after demineralization, the material was again extracted with guanidinium chloride (G2-extract). Extracts were analyzed by SDS-PAGE electrophoresis and the gels were processed for zymography to detect gelatinolytic activities. The patterns of gelatinase A distribution differed in the different dentin protein fractions, and the changes varied with age. Significant differences were detected in gelatinase A in G2-extracts between individual younger than 20 years old and the rest of the sample (chi2exp = 19.429; 1 d.f.; p < or = 0.001). The incidence of true and false positives and negatives, and sensitivity and specificity for the presence of gelatinase A in dentin extracts, were calculated. Determination of gelatinase A in human dentin may be a useful marker to estimate age, especially when other morphological methods are of limited usefulness.

The matrix metalloproteinase gelatinase A in human dentine.

A dentine protein extraction protocol was modified in order to identify matrix metalloproteinase gelatinolytic activities in the non-mineralized and mineralized phases of human dentine. Dentine proteins from 24 individual permanent molars from patients aged 15-73 years were sequentially extracted, first with guanidinium chloride (G1 extract), then EDTA (E extract), and after this demineralization step, again by guanidinium chloride (G2 extract) to dissociate collagen-associated proteins. Extracts were analysed by sodium dodecyl sulphate-polyacrylamide gel electrophoresis and the gels were processed by Western blotting and zymography to detect gelatinolytic activities. Active and latent forms of gelatinase A were identified in the non-mineralized dentine fraction (G1 extract) of 58% of the teeth. Other gelatinolytic species were also detected by zymography with apparent M(r) of 92, 54 and 30 kDa. Although gelatinase A was detected in the G1 extracts of teeth from all ages, indicating more recent synthesis and remodelling of the predentine, gelatinase A was never detected in any E extract or in the G2 extracts of patients older than 41 years. The presence of the active form of gelatinase A in mineralized human dentine implicates this enzyme in dentine mineralization.

Deoxypyridinoline crosslinks in human dentin and estimation of age.

A new biochemical method for estimation of dental age from human dentin is presented. An adaptation and modification of a dentin protein extraction protocol was developed by which deoxypyridinoline crosslinks were measured using an enzyme immunoassay technique. Deoxypyridinoline, a non-reducible collagen crosslink, was measured in human dentin samples from permanent individual molars. The measurement of this protein in dentin samples from 22 patients with ages ranging from 15 to 73 years old was carried out to obtain an estimate of age at death. By linear regression between deoxypyridinoline values and age, equations for age calculations were computed. The error between the estimated age and the known age at extraction was calculated. Our results show that this method produces an expected associated error on calibration averaging 14.9 years about the mean estimated values, at a 65% level of confidence. Values of sensitivities and specificities were calculated for deoxypyridinoline at different ages. We conclude that determination of deoxypyridinoline in human dentin extracts is a new and reliable procedure, potentially suitable for most forensic laboratories and which could be a useful tool to estimate human dental age. This method could be considered as an alternative method to calculate dental age, contributing to a more accurate estimation of chronological age when used in addition to other morphological or biochemical dental methods.

Methods for identification of 28 burn victims following a 1996 bus accident in Spain.

A car collided head-on with a bus containing 56 passengers plus the driver. A few seconds after the crash, the bus caught fire and 28 persons (15 male and 13 female) lost their lives. All the deceased were almost completely incinerated. To establish the identity of the victims, the judge in charge of the case designated a multidisciplinary Identification Commission. Postmortem procedures included a general external examination, routine photographs, dental examination, dental (intraoral and extraoral) and general radiographs (chest, ankle, etc.), and complementary biological methods for identification (e.g., DNA analysis). The antemortem information, including dental and medical records available, were transcribed onto the INTERPOL disaster victim identification forms. The detailed ante- and postmortem information were compared manually. In this disaster dental identity could be established in 57% of the victims, whereas dental evidence did not allow by itself the identification of 12 burned victims. Odontological examination and complementary radiographic procedures were found to be accurate, economic and rapid methods of identifying badly burned victims in this bus accident.