Social behavior differences between boys and girls with oppositional defiant disorder internalizing behaviors and diagnosis in girls

Oppositional defiant disorder (ODD) is one of the most common disorders in childhood, with a higher prevalence in boys than in girls, however, it is often comorbid with other childhood disorders such as: conduct disorder, anxiety, depression and attention deficit disorder and hyperactivity. It is a disorder that has a pattern of negative, hostile, defiant and aggressive behaviors toward authority figures, especially to parents and teachers. However, in pre-school age girls tend to change the externalizing behavior to more subtle and covert behaviors such as creating lies and gossip, therefore, it is important to evaluate these symptoms in clinic inter6views and not just the cardinal symptom of ODD. That is why it will take three scales to evaluate parents and teachers called Child Symptom Inventory 4 and Youth Self Report to 30 children with ODD in the city of Quito.El trastorno negativista desafiante (TND) es uno de los trastornos más comunes dentro de la infancia, con una prevalencia mayor en niños que en niñas, no obstante, a menudo es con mórbido con otros trastornos de la infancia como: trastorno de la conducta, ansiedad, depresión y trastorno de déficit de atención e hiperactividad. Es un patrón de conductas negativas, hostiles, desafiantes y agresivas hacia figuras de autoridad como padres y profesores. Sin embargo, en edad pre escolar las niñas tienden a cambiar este comportamiento de externalización hacia comportamientos más sutiles y encubierto como mentiras y creación de chismes, por ende, es importante evaluar estos síntomas dentro de consulta y no solo los síntoma cardinales de TND. Es por ello que se evaluara y tomará tres pruebas a padres y maestros denominadas Child Symtom Inventory 4 y Youth Self Report a 30 niños y niñas con TND en la ciudad de Quito

Predictive factors of compliance with a program of supervised exercise during pregnancy.

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Percepción de calidad de vida mediante el cuestionario Whoqol- Old en adultos mayores que asisten a la consulta externa del Hospital de Atención Integral del Adulto Mayor de Quito.

El presente trabajo tuvo como objetivo determinar la percepción de calidad de vida en aspectos propios de la vejez y su relación con variables sociodemográficas en adultos mayores de la consulta externa del Hospital de Atención Integral del Adulto Mayor. Metodología: Este es un estudio descriptivo transversal. Se incluyeron a 249 pacientes de la consulta externa del Hospital de Atención Integral del Adulto Mayor. Se utilizó un cuestionario de datos sociodemográficos, el cuestionario WHOQoL-OLD para calidad de vida. Resultados: Respecto a las características sociodemográficas de los pacientes estudiados se obtuvo una media de edad de 76,08, la mayoría de pacientes fueron de sexo femenino (65%), casados (46%), que conviven con sus parejas (27%) o hijos (27%), con instrucción primaria (54,6%), mestizos (80%). Las enfermedades mayormente reportadas fueron: Hipertensión Arterial (49.8%), alteraciones osteoarticulares (41%), alteraciones visuales (27.7%) y auditivas (26.9%). De acuerdo al puntaje global de calidad de vida se obtuvo una media de 85,5 sobre 120 puntos. El 85% de los adultos mayores percibe su calidad de vida como buena calidad y el 15% como medianamente buena. El coeficiente alfa de Cronbach para el instrumento fue de 0,72. Conclusiones: Existe una relación inversa débil y significativa (p≤0,05) entre edad y calidad de vida, y entre edad y las dimensiones de calidad de vida excepto la dimensión de conformidad con la muerte. Los hombres puntúan mejor que las mujeres en las dimensiones de intimidad y conformidad con la muerte (p≤0,05). Los adultos mayores que viven con sus parejas o con su pareja e hijos tienen mejor percepción de calidad de vida que los que viven solos, con sus hijos o con otro familiar. Los adultos mayores separados, viudos y solteros tienen menor percepción de calidad de vida. La mayor escolaridad se asocia con puntajes más altos en calidad de vida, sin significancia estadística. Las dimensiones de intimidad y participación social tienden a empeorar al disminuir la escolaridad (p≤0,5). Los adultos mayores que presentan alteraciones auditivas tienen una menor calidad de vida (p≤0,01)

Does exercise during pregnancy impact on maternal weight gain and fetal cardiac function? A Randomized controlled study.

OBJECTIVE: To evaluate the association between physical exercise during pregnancy and maternal gestational weight gain and fetal cardiac function. METHODS: This was a randomized controlled trial of women with a singleton pregnancy managed from the first trimester at the Hospital de Torrejón, Madrid, between November 2014 and June 2015. Women were randomized to either follow a supervised physical conditioning program, consisting of a 60-min session 3 days per week for the duration of pregnancy, or not attend any exercise program (controls). The primary outcome was maternal weight gain during pregnancy. Secondary outcomes included fetal cardiac function parameters evaluated at 20, 28 and 36 weeks' gestation, Cesarean section, preterm delivery, induction of labor and birth weight. A sample size of 45 in each group was planned to detect differences in maternal weight gain of at least 1 kg, with a power of > 80% and α of 0.05. RESULTS: During the study period, 120 women were randomized into the exercise (n = 75) and control (n = 45) groups. Following exclusions, the final cohort consisted of 42 women in the exercise group and 43 in the control group. Baseline characteristics (maternal age, prepregnancy body mass index, parity, conception by in-vitro fertilization, Caucasian ethnicity, physical exercise prior to pregnancy and smoker) were similar between the two groups. No differences were found between the groups in maternal weight at 20, 28, 36 and 38 weeks' gestation or in weight gain at 38 weeks. However, the proportion of women with weight loss ≥ 9 kg at 6 weeks postpartum was higher in the exercise compared with the control group (68.2% vs 42.8%; relative risk 1.593; P = 0.02). The ductus arteriosus pulsatility index (DA-PI) at 20 weeks (2.43 ± 0.40 vs 2.26 ± 0.33, P < 0.05) and the ejection fraction (EF) at 36 weeks (0.85 ± 0.13 vs 0.81 ± 0.11, P < 0.05) were higher in the exercise compared with the control group. All other evaluated fetal cardiac function parameters were similar between the two groups. CONCLUSIONS: Performing exercise during pregnancy is not associated with a reduction in maternal weight gain but increases weight loss at 6 weeks postpartum. Physical exercise during pregnancy is associated with increased fetal DA-PI at 20 weeks and EF at 36 weeks, which could reflect adaptive mechanismspre-print493 K

Application of a new protocol for providing obstetric care in an outpatient service during the COVID-19 pandemic in a public hospital in Madrid, Spain.

Objective: To evaluate the clinical implementation of a preventive COVID-19 protocol regarding re-organization of appointments and documented infections among health workers in an obstetric outpatient service. Methods: Descriptive analysis of the antenatal care at our obstetric outpatient service and infection rates among health care providers from March 19th to May 22nd, 2020. Appointments were divided into telephone calls or face-to-face examinations. A pre-consultation triage was implemented to identify suspected SARS-CoV2 infected women to reschedule them 14 days later or, if the consultation was non-delayable, to use complete Personal Protective Equipment (PPE). Firstly, the number of face-to-face appointments, telephone appointments, and COVID-19 diagnoses in pregnant women were analyzed. Secondly, the number of obstetricians and nurses diagnosed with SARS-CoV2 infection and their serologic status during universal screening in May 2020 were recorded. Results: One thousand eight hundred forty-two obstetric appointments were scheduled during this period, including 432 (23.5%) telephone appointments (96.53% according to clinical protocol, 1.62% symptomatic patients advised to stay at home, and 1.85% COVID-19 confirmed cases), and 1,410 (76.5%) face-to-face appointments (9.7% did not attend due to fear of getting the infection, 3.1% were lost-to-follow-up, 0.5% were rescheduled due to COVID-19 symptoms and 86.7% who did attend). Of the 1,223 women attending their hospital appointment, 3.6% screened positive at the triage (72.7% rescheduled and 27.3% seen with PPE). 43 rRT-PCR-SARS-CoV2 tests were performed, and two tested positive. No COVID-19 symptoms were reported among health workers at the outpatient obstetric service, and only one nurse presented immunoglobulin (Ig)G anti-SARS-CoV2. Conclusion: A prompt implementation of a preventive protocol in a hospital obstetric outpatient service, including triage, hygienic and preventive measurements, and rescheduling pregnancy appointments, reduces the percentage of health workers affected by SARS-CoV2.post-print369 K

Maternal physiological changes at rest induced by exercise during pregnancy: A randomized controlled trial.

Objective: to analyse maternal physiological changes in several areas (cardiovascular, metabolic, renal and hepatic) related to the regular practice of a supervised exercise program. Methods: This is an unplanned secondary analysis from a randomized controlled trial carried out in a single maternity unit in Madrid, Spain (NCT 02,756,143). From November 2014 to June 2015, 92 women were randomly assigned to perform a mild-moderate supervised exercise program during pregnancy (Intervention group, IG) or to continue with their routine pregnancy care (control group, CG). For the purpose of this study we collected clinical and analytical data (heart blood pressure, weight, blood glucose, AST, ALT, blood Creatinine and blood Uric acid) available from all obstetric visits and examined the differences between groups. Results: We did not find any differences in: pregnancy weight (IG: 11.4 ± 4.4 Kg vs. CG: 10.1 ± 5.3 Kg; p = 0.173); fasting glucose at 10+0–12+6 weeks (IG: 78.48±8.34 vs. CG: 76±13.26, p = 0.305) or at 34+0–36+4 weeks (IG: 73.25±10.27 vs CG: 73.45± 8.29,p = 0.920), and 50 gs glucose tolerance at 24+4–26+6weeks (IG: 116.23±35.07 vs CG: 116.36±25.98, p = 0.984); Aspartate-amino-transferase at 10+0–12+6 weeks (IG: 15.38±4.17 vs CG: 17.33±7.05, p = 0.124) and at 34+0–36+4 weeks (IG: 21.65±5.25 vs CG: 19.53±8.32, p = 0.165) or Alanine-amino- transferase at 10+0–12+6 weeks (IG: 27.50±10.63 vs CG: 28.27±11.77, p = 0.746) or at 34+0–36+4 weeks (IG: 22.93±9.23 vs CG: 20.84±13.49, p = 0.407); blood Creatinine concentrations at 34+0–36+4 weeks (IG: 0.595±0.401 vs CG: 0.575±0.100, p = 0.757) and blood uric acid concentrations at 34+0–36+4 weeks (IG: 3.526 ± 0.787 vs CG: 3.262±0.672, p = 0.218). Heart blood pressure was similar between groups except at 27+0–28+6 weeks, where systolic blood pressure was significantly lower in the CG in comparison to the IG (116.31±10.8 mmHg vs. 120.22 ± 10.3 mmHg, p = 0.010). Conclusion: Regular supervised exercise during pregnancy does not alter normal maternal physiologypre-print609 K

Risk Factors for Preeclampsia: Results from a Cohort of Over 5000 Pregnancies in Spain.

Objective: To determine the incidence of preeclampsia (PE) and preterm PE in Spain and to identify the risk factors for developing the disease. Methods: This is a multicenter prospective cohort study performed at six maternity units across Spain. Women with singleton pregnancies attending their first-trimester routine visit at the hospital were offered participation. Maternal and pregnancy characteristics, including mean arterial pressure, as well as ultrasound findings were recorded. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for subsequent development of PE. Results:A total of 5868 pregnancies were recruited for this study, including 174 (3.0%) cases of PE, 47 (0.8%) cases of preterm PE and 127 (2.2%) cases of term PE. Median maternal age was 33.9 years (interquartile range: 30.1 to 36.9) and median gestational age at the routine visit was 12.7 weeks (interquartile range: 12.3 to 13.0). However, 293 (5.0%) of the women were on aspirin treatment during pregnancy, likely reducing the true incidence of the disease. As expected, increasing body mass index (P<0.001), uterine artery pulsatility index (P=0.011) and mean arterial pressure (P<0.001), assisted conception (P=0.013), previous personal (P<0.001) or family history of PE (P=0.024) and chronic hypertension (P=0.001) were identified as independent risk factors for developing subsequent PE during pregnancy. Screening for PE by maternal factors alone leads to a detection rate of 36.8% (64/174) at 10.0% (587/5868) screen positive rate. Conclusion: In Spain, 3.0% of singleton pregnancies are complicated by PE and 0.8% require delivery before term due to its severity. Screening of PE by risk factors alone is only able to detect about 40% of total PE at 10% screen-positive rate.post-print255 K

Clinical and Economic Evaluation after Adopting Contingent Cell-Free DNA Screening for Fetal Trisomies in South Spain.

Contingent cell-free (cf) DNA screening on the basis of the first-trimester combined test (FCT) results has emerged as a cost-effective strategy for screening of trisomy 21 (T21). Objectives: To assess performance, patients’ uptake, and cost of contingent cfDNA screening and to compare them with those of the established FCT. Methods: This is a prospective cohort study including all singleton pregnancies attending to their FCT for screening of T21 at 2 university hospitals in South Spain. When the FCT risk was ≥1:50, there were major fetal malformations, or the nuchal translucency was ≥3.5 mm, women were recommended invasive testing (IT); if the risk was between 1:50 and 1:270, women were recommended cfDNA testing; and for risks bellow 1:270, no further testing was recommended. Detection rate (DR), false-positive rate (FPR), patients’ uptake, and associated costs were evaluated. Results: We analyzed 10,541 women, including 46 T21 cases. DR of our contingent strategy was 89.1% (41/46) at 1.4% (146/10,541) FPR. Uptake of cfDNA testing was 91.2% (340/373), and overall IT rate was 2.0%. The total cost of our strategy was €1,462,895.7, similar to €1,446,525.7 had cfDNA testing not been available. Conclusions: Contingent cfDNA screening shows high DR, low IT rate, and high uptake at a similar cost than traditional screening.pre-print133 K

Efficiency of the cerebroplacental ratio in Identifying high-risk late-term pregnancies

Background and Objectives: Over the last few years, great interest has arisen in the role of the cerebroplacental ratio (CPR) to identify low-risk pregnancies at higher risk of adverse pregnancy outcomes. This study aimed to assess the predictive capacity of the CPR for adverse perinatal outcomes in all uncomplicated singleton pregnancies attending an appointment at 40–42 weeks. Materials and Methods: This is a retrospective cohort study including all consecutive singleton pregnancies undergoing a routine prenatal care appointment after 40 weeks in three maternity units in Spain and the United Kingdom from January 2017 to December 2019. The primary outcome was adverse perinatal outcomes defined as stillbirth or neonatal death, cesarean section or instrumental delivery due to fetal distress during labor, umbilical arterial cord blood pH &lt; 7.0, umbilical venous cord blood pH &lt; 7.1, Apgar score at 5 min &lt; 7, and admission to the neonatal unit. Logistic mixed models and ROC curve analyses were used to analyze the data. Results: A total of 3143 pregnancies were analyzed, including 537 (17.1%) with an adverse perinatal outcome. Maternal age (odds ratio (OR) 1.03, 95% confidence interval (CI) 1.01 to 1.04), body mass index (OR 1.04, 95% CI 1.03 to 1.06), racial origin (OR 2.80, 95% CI 1.90 to 4.12), parity (OR 0.36, 95% CI 0.29 to 0.45), and labor induction (OR 1.79, 95% CI 1.36 to 2.35) were significant predictors of adverse perinatal outcomes with an area under the ROC curve of 0.743 (95% CI 0.720 to 0.766). The addition of the CPR to the previous model did not improve performance. Additionally, the CPR alone achieved a detection rate of only 11.9% (95% CI 9.3 to 15) when using the 10th centile as the screen-positive cutoff. Conclusions: Our data on late-term unselected pregnancies suggest that the CPR is a poor predictor of adverse perinatal outcomes

Informe del Comité Científico de la Agencia Española de Consumo, Seguridad Alimentaria y Nutrición (AECOSAN) sobre el riesgo del uso de semillas de Mucuna pruriens en productos de artesanía

El Comité Científico de la Agencia Española de Consumo, Seguridad Alimentaria y Nutrición (AECOSAN) ha evaluado el riesgo del uso de semillas de Mucuna pruriens en productos de artesanía. En este informe se describen sus distintos usos en dichos productos de artesanía y los usos divulgados por sus presuntas propiedades como planta medicinal, en alimentación humana, como antídoto en mordeduras de serpientes y como biomasa o cobertura vegetal. El contexto sociológico del empleo de Mucuna pruriens también se incluye en este informe. Igualmente se describen las características que identi can a Mucuna pruriens como especie vegetal, las propiedades farmacológicas y las propiedades toxicológicas descritas en estudios de toxicidad a dosis única y de toxicidad a dosis repetidas así como la evaluación del riesgo por ingesta accidental de sus semillas en productos de artesanía. Se concluye que el valor de la DL50 de Mucuna pruriens es superior a 2000 mg/kg p.c.. y se puede identi car un NOEL de 70 mg/kg p.c./dia (“dosis limite”) a partir de un estudio de toxicidad dosis repetida en conejos. Se ha estimado un valor TDLo (lowest published toxic dose, o toxic dose low) (dosis tóxica más baja publicada o dosis tóxica mínima) de L-dopa (humanos) de 4286 mg/kg p.c. El margen de seguridad calculado para la semilla de Mucuna pruriens consumida es amplio en relación con la posible exposición tanto en adultos como en niños. Sin embargo, hay que considerar también el riesgo ocasionado por la exposición accidental de las semillas de Mucuna pruriens debido a que pueden originar una oclusión respiratoria o digestiva en los niños, lo que representa un riesgo adicional. El contacto con semillas de Mucuna pruriens puede provocar prurito intenso y alergia de contacto en todos los grupos poblacionales. Los niños y mujeres gestantes presentan sensibilidad a la ingesta de semilla de Mucuna pruriens debido al contenido y acción farmacológica de la L-dopa (levodopa)