Persistence of anxiety symptoms after elective caesarean delivery

Background In the UK, 11.8% of expectant mothers undergo an elective caesarean section (ELCS) representing 92 000 births per annum. It is not known to what extent this procedure has an impact on mental well-being in the longer term. Aims To determine the prevalence and postpartum progression of anxiety and depression symptoms in women undergoing ELCS in Wales. Method Prevalence of depression and anxiety were determined in women at University Hospital Wales (2015–16; n = 308) through completion of the Edinburgh Postnatal Depression Scale (EPDS; ≥13) and State-Trait Anxiety Inventory (STAI; ≥40) questionnaires 1 day prior to ELCS, and three postpartum time points for 1 year. Maternal characteristics were determined from questionnaires and, where possible, confirmed from National Health Service maternity records. Results Using these criteria the prevalence of reported depression symptoms was 14.3% (95% CI 10.9–18.3) 1 day prior to ELCS, 8.0% (95% CI 4.2–12.5) within 1 week, 8.7% (95% CI 4.2–13.8) at 10 weeks and 12.4% (95% CI 6.4–18.4) 1 year postpartum. Prevalence of reported anxiety symptoms was 27.3% (95% CI 22.5–32.4), 21.7% (95% CI 15.8–28.0), 25.3% (95% CI 18.5–32.7) and 35.1% (95% CI 26.3–44.2) at these same stages. Prenatal anxiety was not resolved after ELCS more than 1 year after delivery. Conclusions Women undergoing ELCS experience prolonged anxiety postpartum that merits focused clinical attention. Declaration of interest None

Reducing Uncertainties in Carbonate Clumped Isotope Analysis Through Consistent Carbonate-Based Standardization

About a decade after its introduction, the field of carbonate clumped isotope thermometry is rapidly expanding because of the large number of possible applications and its potential to solve long‐standing questions in Earth Sciences. Major factors limiting the application of this method are the very high analytical precision required for meaningful interpretations, the relatively complex sample preparation procedures, and the mass spectrometric corrections needed. In this paper we first briefly review the evolution of the analytical and standardization procedures and discuss the major remaining sources of uncertainty. We propose that the use of carbonate standards to project the results to the carbon dioxide equilibrium scale can improve interlaboratory data comparability and help to solve long‐standing discrepancies between laboratories and temperature calibrations. The use of carbonates reduces uncertainties related to gas preparation and cleaning procedures and ensures equal treatment of samples and standards. We present a set of carbonate standards of diverse composition, discuss how they can be used to correct for mass spectrometric biases, and demonstrate that their use significantly improves the comparability among four laboratories. We propose that the use of these standards or of a similar set of carbonate standards will improve the comparability of data across laboratories.publishedVersio

Rare variants in dynein heavy chain genes in two individuals with situs inversus and developmental dyslexia : a case report

Background Developmental dyslexia (DD) is a neurodevelopmental learning disorder with high heritability. A number of candidate susceptibility genes have been identified, some of which are linked to the function of the cilium, an organelle regulating left-right asymmetry development in the embryo. Furthermore, it has been suggested that disrupted left-right asymmetry of the brain may play a role in neurodevelopmental disorders such as DD. However, it is unknown whether there is a common genetic cause to DD and laterality defects or ciliopathies. Case presentation Here, we studied two individuals with co-occurring situs inversus (SI) and DD using whole genome sequencing to identify genetic variants of importance for DD and SI. Individual 1 had primary ciliary dyskinesia (PCD), a rare, autosomal recessive disorder with oto-sino-pulmonary phenotype and SI. We identified two rare nonsynonymous variants in the dynein axonemal heavy chain 5 gene (DNAH5): a previously reported variant c.7502G > C; p.(R2501P), and a novel variant c.12043 T > G; p.(Y4015D). Both variants are predicted to be damaging. Ultrastructural analysis of the cilia revealed a lack of outer dynein arms and normal inner dynein arms. MRI of the brain revealed no significant abnormalities. Individual 2 had non-syndromic SI and DD. In individual 2, one rare variant (c.9110A > G;p.(H3037R)) in the dynein axonemal heavy chain 11 gene (DNAH11), coding for another component of the outer dynein arm, was identified. Conclusions We identified the likely genetic cause of SI and PCD in one individual, and a possibly significant heterozygosity in the other, both involving dynein genes. Given the present evidence, it is unclear if the identified variants also predispose to DD and further studies into the association between laterality, ciliopathies and DD are needed.Peer reviewe

Virgin olive oil phenolic compounds modulate the HDL lipidome in hypercholesterolaemic subjects: a lipidomic analysis of the VOHF study

The lipidomic analysis of high-density lipoprotein (HDL) could be useful to identify new biomarkers of HDL function. Methods and results: A randomized, controlled, double-blind, crossover trial (33 hypercholesterolaemic subjects) is performed with a control virgin olive oil (VOO), VOO enriched with its own phenolic compounds (FVOO), or VOO enriched with additional phenolic compounds from thyme (FVOOT) for 3 weeks. HDL lipidomic analyses are performed using the Lipidyzer platform. VOO and FVOO intake increase monounsaturated-fatty acids (FAs) and decrease saturated and polyunsaturated FAs in triacylglyceride (TAG) species, among others species. In contrast, FVOOT intake does not induce these FAs changes. The decrease in TAG52:3(FA16:0) after VOO intake and the decrease in TAG52:5(FA18:2) after FVOO intake are inversely associated with changes in HDL resistance to oxidation. After FVOO intake, the decrease in TAG54:6(FA18:2) in HDL is inversely associated with changes in HDL cholesterol efflux capacity. Conclusion: VOO and FVOO consumption has an impact on the HDL lipidome, in particular TAG species. Although TAGs are minor components of HDL mass, the observed changes in TAG modulated HDL functionality towards a cardioprotective mode. The assessment of the HDL lipidome is a valuable approach to identify and characterize new biomarkers of HDL function.The VOHF project (AGL2009-13517-457 C03-01) and the AppleCOR Project (AGL2016-76943-C2) were made possible with the support of the Ministerio de Economía, Indústria y Competitividad, the Agencia Estatal de Investigación, and the European Regional Development Fund. U.C. has a Pla Estratègic de Recerca i Innovació en Salut (PERIS) postdoctoral grant (no. SLT002/16/00239; Catalunya, Spain) from the Generalitat de Catalunya. A.P. has a Torres Quevedo postdoctoral grant with the Subprograma Estatal de Incorporación, Plan Estatal de Investigación Científica Técnica y de Innovación. M.F. has a Sara Borrell postdoctoral contract (CD17/00233 to M.F.-St.Pau). O.C. has a JR17/00022 contract from Instituto de Salud Carlos III. CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM) is a project of Instituto de Salud Carlos III (Madrid, Spain). The NFOC-Salut group is a consolidated research group of the Generalitat de Catalunya, Spain (reference no. 2017 SGR 522)

Knowledge and consumption of salt in health professionals and the general population

Consumo de sal; Comportamiento; ConocimientoSalt consumption; Behavior; KnowledgeConsum de sal; Comportament; ConeixementObjetivo Identificar el consumo de sal, actitudes, comportamiento y conocimientos de los pacientes que acuden durante un mes al centro de salud y del personal sanitario basado en la ingesta de sal según categoría de los alimentos. Material y métodos Estudio observacional, descriptivo y transversal en una consulta de Atención Primaria mediante una encuesta multicomponente y autoadministrada con variables respecto a actitudes, comportamiento y conocimientos sobre el consumo de sal. Resultados Muestra 330 pacientes y 48 profesionales sanitarios. Análisis estadístico Programa SPSS versión 27. Descripción uni y bivariada. Contrastes bivariados entre variables cualitativas X2 de Pearson y U Mann-Whitney para las cuantitativas. Nivel de significación p< 0,05. El consumo de alimentos con alto y bajo contenido en sal es elevado en los dos colectivos, siendo mayor entre el personal sanitario (valor p = 0,000). Comportamientos y actitudes (valor p >0,05). Conocimientos: cantidad de sal recomendada (valor p= 0,001) y procedencia de la principal fuente de sal (valor p= 0,000). Conclusión El consumo de sal es alto tanto en sanitarios como en pacientes con una autopercepción baja de su consumo. No hay diferencias en actitudes ni comportamiento entre los dos grupos, pero sí en cuanto a conocimientos. Más del 70% de pacientes desconoce la ingesta diaria máxima de sal recomendada y solo un 25% sabe que la principal fuente de consumo de sal está en los alimentos procesados. Estos resultados apoyan el importante papel del profesional sanitario en cuanto a la educación de los pacientes sobre el consumo de sal para la prevención de la enfermedad cardiovascular.Aim To identify the salt consumption, attitudes, behavior and knowledge of patients attending a health center and health care staff during a month, based on salt intake according to food category. Material and methods Observational, descriptive and cross-sectional study carried out in a primary care clinic by means of a multicomponent, self-administered survey with several variables regarding attitudes, behavior and knowledge about salt consumption. Results Sample of 330 patients and 48 health professionals. Statistical analysis: SPSS program version 27. Univariate and bivariate description. Bivariate contrasts between qualitative variables Pearson's Chi-square and Mann-Whitney U for quantitative variables. Significance level p< 0.05. The consumption of foods with high and low salt content is high in both groups, being higher among health personnel (p-value = 0.000). Behavior and attitudes (p-value >0.05). Knowledge: recommended amount of salt (p-value = 0.001) and origin of the main source of salt (p-value = 0.000). Conclusion Salt consumption is high in both health professionals and patients with a low self-perception of salt consumption. There are no differences in attitudes or behavior between the two groups, but there are differences in knowledge. More than 70% of patients do not know the maximum recommended daily salt intake and only 25% know that the main source of salt consumption is in processed foods. These results support the important role of the health professional in educating patients about salt intake for the prevention of cardiovascular disease

Nodal-Stage Classification in Invasive Lobular Breast Carcinoma: Influence of Different Interpretations of the pTNM Classification

Purpose Application of current nodal status classification is complicated in lobular breast carcinoma metastases. The aim of this study was to define the optimal interpretation of the pTNM classification in sentinel node (SN) -positive patients to select patients with limited or with a high risk of non-SN involvement. Patients and Methods SN metastases of 392 patients with lobular breast carcinoma were reclassified according to interpretations of the European Working Group for Breast Screening Pathology (EWGBSP) and guidelines by Turner et al, and the predictive power for non-SN involvement was assessed. Results Reclassification according to definitions of EWGBSP and Turner et al resulted in different pN classification in 73 patients (19%). The rate of non-SN involvement in the 40 patients with isolated tumor cells according to Turner et al and with micrometastases according to EWGBSP was 20%, which is comparable to the established rate for micrometastases. The rate of non-SN involvement in the 29 patients with micrometastases according to Turner et al and with macrometastases according to EWGBSP was 48%, which is comparable to the established rate for macrometastases. Therefore, the EWGBSP method to classify SN tumor load better reflected the risk of non-SN involvement than the Turner et al system. Conclusion Compared with the guidelines by Turner et al, the EWGBSP definitions better reflect SN metastatic tumor load and allow better differentiation between patients with lobular breast carcinoma who have a limited or a high risk of non-SN metastases. Therefore, we suggest using the EWGBSP definitions in these patients to select high-risk patients who may benefit from additional local and/or systemic therapy

Describing Complexity in Palliative Home Care Through HexCom : A Cross-Sectional, Multicenter Study

Complexity has become a core issue in caring for patients with advanced disease and/or at the end-of-life. The Hexagon of Complexity (HexCom) is a complexity assessment model in the process of validation in health-care settings. Our objective is to use the instrument to describe differences in complexity across disease groups in specific home care for advanced disease and/or at the end-of-life patients, both in general and as relates to each domain and subdomain. Cross-sectional study of home care was conducted in Catalonia. The instrument includes 6 domains of needs (clinical, psychological/emotional, social/family, spiritual, ethical, and death-related), 4 domains of resources (intrapersonal, interpersonal, transpersonal, and practical), and 3 levels of complexity (High (H), Moderate (M), and Low (L)). Interdisciplinary home care teams assessed and agreed on the level of complexity for each patient. Forty-three teams participated (74.1% of those invited). A total of 832 patients were assessed, 61.4% of which were cancer patients. Moderate complexity was observed in 385 (47.0%) cases and high complexity in 347 (42.4%). The median complexity score was 51 for cancer patients and 23 for patients with dementia (p<0.001). We observed the highest level of complexity in the social/family domain. Patients/families most frequently used interpersonal resources (80.5%). This study sheds light on the high-intensity work of support teams, the importance of the social/family domain and planning the place of death, substantial differences in needs and resources across disease groups, and the importance of relationship wellbeing at the end-of-life