Pertussis vaccination during pregnancy: Antibody persistence in infants

Maternal pertussis vaccination is associated with higher levels of pertussis antibodies at birth. We assessed the persistence of pertussis antibodies until primary vaccination in infants whose mothers received Tdap (tetanus, diphtheria, acellular pertussis) vaccine during pregnancy. Infants were born at the Hospital Clinic of Barcelona (Spain) in November 2014. Anti-PT IgG was determined by ELISA at delivery, between the first and second month of life, and estimated at 2months of age. The study included 37 infants whose mothers received Tdap between 21 and 38weeks of gestation. Infants presented a decline in GMC of anti-PT IgG between peripartum and follow-up levels, 52.7 (95% CI 34.7-80.2) versus 7.5 (95% CI 4.2-13.3) at 2months of age (p<0.001). The median half-life of maternal antibodies was 47days. More than half (51.4%) the infants presented detectable anti-PT IgG before the start of primary infant vaccination

Menstrual health and period poverty among young people who menstruate in the Barcelona metropolitan area (Spain) : protocol of a mixed-methods study

The importance of menstrual health has been historically neglected, mostly due to taboos and misconceptions around menstruation and androcentrism within health knowledge and health systems around the world. There has also been a lack of attention on 'period poverty', which refers to the financial, social, cultural and political barriers to access menstrual products and education. The main aim of this research is to explore menstrual health and experiences of period poverty among young people who menstruate (YPM). This is a convergent mixed-methods study, which will combine a quantitative transversal study to identify the prevalence of period poverty among YPM (11-16 years old), and a qualitative study that will focus on exploring menstruation-related experiences of YPM and other groups (young people who do not menstruate (YNM); primary healthcare professionals; educators and policy-makers). The study will be conducted in the Barcelona metropolitan area between 2020 and 2021. Eighteen schools and 871 YPM will be recruited for the quantitative study. Sixty-five YPM will participate in the qualitative study. Forty-five YNM and 12 professionals will also be recruited to take part in the qualitative study. Socioeconomic and cultural diversity will be main vectors for recruitment, to ensure the findings are representative to the social and cultural context. Descriptive statistics will be performed for each variable to identify asymmetric distributions and differences among groups will be evaluated. Thematic analysis will be used for qualitative data analyses Several ethical issues have been considered, especially as this study includes the participation of underage participants. The study has received ethical approval by the IDIAPJGol Research Ethics Committee (19/178 P). Research findings will be disseminated to key audiences, such as YPM, YNM, parents/legal tutors, health professionals, educators, youth (and other relevant) organisations, general community members, stakeholders and policy-makers, and academia

Use and perceptions on reusable and non-reusable menstrual products in Spain: a mixed-methods study

Menstrual products are necessary goods for women and people who menstruate to manage menstruation. Understanding the use and perceptions of menstrual products is key to promote menstrual equity and menstrual health. This study aimed at assessing the use and perceptions on menstrual products among women and people who menstruate aged 18-55 in Spain. Methods. A mixed-methods study was conducted, including a cross-sectional nation-wide study (N=22,823), and a qualitative study (N=34). Results. Participants used a combination of products. Non-reusable products were the most used, while over half used reusable products. Usage changed when data were stratified by age, gender identification, completed education, country of birth and experiencing financial issues. It also varied between trans and cis participants. Menstrual products' use also shifted based on experiences of menstrual poverty and access to information and products. Overall, reusable products were perceived to be more acceptable than non-reusable. Barriers to use the menstrual cup were also identified, including experiences of menstrual inequity (e.g., menstrual poverty, lack of access to information or menstrual management facilities). Conclusion. Perceptions and choices of menstrual products need to be acknowledged, especially when designing and implementing menstrual policies to address menstrual inequity and menstrual health

Guia farmacoterapèutica: atenció a la salut sexual i reproductiva

Guia farmacoterapèutica; Atenció maternoinfantil; Atenció a la salut sexual i reproductivaGuía farmacoterapéutica; Atención maternoinfantil; Atención a la salud sexual y reproductivaPharmacotherapeutic guide; Maternal and child care; Sexual and reproductive health careAquest document, aprovat per la Comissió Farmacoterapèutica (CFT) de l’ICS, té com a objectiu adequar a la darrera evidència científica disponible els tractaments que es porten a terme en la pràctica clínica diària amb la finalitat d’orientar els professionals en la presa de decisions durant la tasca assistencial diària. És una eina d’orientació actualitzada i adaptable a la major part de les situacions que es produeixen en l’atenció maternoinfantil i en l’atenció a la salut sexual i reproductiva

Model d’atenció a l’endometriosi a Catalunya

Endometriosi; Planificació sanitària; Model d'atencióEndometriosis; Planificación sanitaria; Modelo de atenciónEndometriosis; Health planning; Attention modelEl Model d’atenció a l’endometriosi a Catalunya estableix les bases per a l’ordenació dels serveis assistencials que intervenen en el procés integral d’atenció a les dones afectades amb endometriosi, inclou aspectes clínics, aspectes assistencials i aspectes d’ordenació de circuits assistencials, que venen determinats per les actuacions necessàries per donar una atenció integral a les dones afectades

Nous mecanismes en la fisiopatologia de l’endometriosi profunda

[cat] L’endometriosi és una patologia ginecològica benigna, la fisiopatologia de la qual és en part desconeguda, que afecta fins a un 10% de les dones en edat reproductiva. Aquesta malaltia representa una gran càrrega econòmica i social, ja que les pacients pateixen, al llarg de la seva vida fèrtil, múltiples cirurgies i hospitalitzacions, baixes laborals i problemes reproductius. S’ha descrit la implicació de factors proinflamatoris, neoangiogènics i procoagulants a la seva persistència i progressió, pel que avui en dia l’endometriosi és considerada una malaltia inflamatòria crònica. L’endometriosi profunda representa el fenotip més agressiu de la malaltia, amb una major severitat de l’afectació cínica i un maneig terapèutic més complex. Per tot això, s’ha postulat que l’endometriosi profunda podria presentar mecanismes fisiopatològics específics que condicionarien un ambient inflamatori superior als altres fenotips de la malaltia i en podrien fer d’ella una entitat diferenciada. En els últims anys, hi ha cada vegada més evidència sobre la implicació de les micropartícules circulants (cMP), el factor tissular i les trampes extracel·lulars de neutròfils o neutrophil extracellular traps (NETs) en funcions relacionades amb l’hemostàsia, la immunitat, la inflamació i l’angiogènesi, i se n’han observat nivells elevats en malalties inflamatòries i trastorns protrombòtics. A més, múltiples estudis descriuen la generació de cMP en procediments quirúrgics degut al dany cel·lular generat i la seva possible relació amb complicacions postquirúrgiques secundàries a mecanismes inflamatoris i protrombòtics; en el cas del tractament quirúrgic de l’endometriosi ovàrica la seva elevació podria estar relacionada amb l’afectació de la reserva ovàrica i la generació d’adherències postquirúrgiques. Tenint en compte tot això, l’objectiu d’aquesta tesi doctoral és l’estudi de les cMP, el factor tissular i els NETs com a nous mecanismes fisiopatològics de l’endometriosi i, en concret, de l’endometriosi profunda, així com també la investigació de la implicació de les cMP com a marcadors de dany tissular secundari al tractament quirúrgic de l’endometriosi. La present tesi doctorat consta de quatre articles publicats a la literatura científica, els resultats globals dels quals han demostrat que les pacients amb endometriosi presenten nivells plasmàtics de cMP i NETs superiors a les pacients sense endometriosi, i que aquests nivells més elevats semblen atribuir-se al subgrup de pacients amb endometriosi profunda. Entre les pacients afectades d’endometriosi profunda, els nivells de cMP han demostrat ser superiors en aquelles amb una major quantitat de teixit endometrial ectòpic. Aquestes troballes reafirmen el concepte de l’endometriosi com una malaltia inflamatòria sistèmica i amplien el coneixement sobre la seva fisiopatologia. Tant les cMP com els NETs podrien, a més, contribuir a l’estat d’hipercoagulabilitat ja descrit en aquestes pacients, per la seva implicació en fenòmens proinflamatoris i protrombòtics. Els nivells superiors de cMP i NETs en el subgrup de pacients amb endometriosi profunda estaria en concordança amb teories recents que descriuen l’endometriosi profunda com una entitat diferenciada amb mecanismes fisiopatològics específics que justificarien la seva major agressivitat i severitat. Per tot això, es podrien considerar les cMP i els NETs com a dos nous mecanismes fisiopatològics de l’endometriosi profunda. Finalment, s’ha detectat un increment transitori superior de cMP posteriorment al tractament quirúrgic laparoscòpic de l’endometriosi ovàrica unilateral mitjançant la tècnica excisional (quistectomia mitjançant stripping) en comparació amb la vaporització mitjançant làser CO2, fet que podria estar en relació amb una major generació d’adherències postquirúrgiques i un major dany del teixit ovàric sa restant. Aquest fet aporta un major coneixement sobre els efectes secundaris de les diferents tècniques quirúrgiques disponibles en l’actualitat per al tractament de l’endometriosi ovàrica i ens permet, per tant, optimitzar el maneig quirúrgic de les pacients amb endometriosi[eng] Endometriosis is a benign gyneacologic condition, the pathogenesis of which is still under debate. It is now considered a chronic systemic inflammatory condition and several immunological, hormonal and inflammatory factors have been described. In the last few years, new pathogenic mechanisms of endometriosis related to inflammation and coagulation pathways have been described and it has been hypothesized that patients with endometriosis could be in an inflammatory and hypercoagulable state. Among the different subtypes of endometriosis, deep infiltrating endometriosis (DIE) is recognized as the most aggressive form of the disease. Furthermore, DIE could be considered as a specific entity since it seems to present specific pathogenic features in comparison to other endometriosis phenotypes. Higher levels of circulating cell-derived microparticles (cMP), neutrophil extracellular traps (NETs) and tissue factor have been observed in many inflammatory conditions, thrombotic diseases, and malignancy. In fact, these factors have been described to be involved in inflammation, blood coagulation and angiogenesis. Moreover, several recent studies have described the generation of cMP after surgical procedures as markers of cellular damage, and have characterized their potential contribution to postsurgical complications, such as inflammation and thrombosis. This work is composed of four articles that have been published in the scientific literature. Global results obtained from them show increased cMP and NETs plasmatic levels in endometriosis patients, and these levels seem to be attributed to the subgroup of patients with DIE. Among these patients, those with larger cumulative size of endometriotic implants showed higher cMP levels. These findings suggest an increased inflammatory and/or hypercoagulable systemic status in patients with DIE. Furthermore, the comparison between laser ablation and stripping for the surgical treatment of unilateral ovarian endometriomas showed higher but temporary cMP generation in the latter group compared with laser ablation. These results suggest that the stripping technique might trigger a more pronounced short-term inflammatory and procoagulant response, which may contribute to postsurgical complications and may negatively impact on ovarian reserve in these patients

Primary peritonitis due to Streptococcus pyogenes

Sr. Editor: la peritonitis de origen infeccioso habitualmente es secundaria a procesos patológicos del tracto gastrointestinal o genitourinario y suele ser polimicrobiana. Se denomina peritonitis primaria o espontánea aquélla en la que no se objetiva ninguna causa evidente. Generalmente es de etiología monomicrobiana y se observa en pacientes afectos de cirrosis hepática, síndrome nefrótico o inmunosupresión. Su hallazgo en personas sin ninguna comorbilidad es muy poco frecuente. Los microorganismos causales de peritonitis primaria en pacientes sanos son: Streptococcus pneumoniae, Streptococcus pyogenes, Neisseria meningitidis, Salmonella y Fusobacterium necrophorum. La peritontis primaria por S. pyogenes se observa especialmente en mujeres y puede evolucionar en pocas horas a un síndrome del shock tóxico estreptocócico (SSTE)con fallo multiorgánico secundario..

Self-reported menstrual alterations during the COVID-19 syndemic in Spain: a cross-sectional study

Introduction: Available evidence suggests that there might be an association between the stressors experienced during the COVID- 19 syndemic and changes in menstrual patterns. The aim of this study was to assess self-reported menstrual alterations during the COVID-19 syndemic among women and people who menstruate aged 18-55 in Spain. Materials and Methods: A cross-sectional online survey-based study was conducted (March-July 2021). Descriptive statistics were calculated and multivariate logistic regression models were constructed. This study was conducted as part of the 'Equity and Menstrual Health in Spain' research project. Results: Among participants (N=17,455), 39.4% reported menstrual alterations since the start of the syndemic. Participants selfreporting long COVID-19 presented higher odds of menstrual alterations (aOR: 1.34, 95% CI, 1.15-1.57). In participants with no history of COVID-19, the risk for self-reported menstrual alterations was significantly higher based on employment situation, among participants experiencing financial issues (eg, financial issues always/many times 25, being a carer, not having a gynecological condition and using hormonal contraception. Discussion and conclusions: Findings suggest an impact of the COVID-19 syndemic on menstrual patterns. Social inequities in reporting menstrual alterations were identified. While the risk of reporting menstrual alterations was higher among participants with long COVID-19, evidence is not conclusive. Further research on menstrual health in the context of COVID-19 is needed, also to inform policy and practice

Menstruation and social inequities in Spain: a cross-sectional online survey-based study

Abstract Background Available research suggests that menstrual inequity has an impact on (menstrual) health outcomes and emotional wellbeing. It is also a significant barrier to achieve social and gender equity and compromises human rights and social justice. The aim of this study was to describe menstrual inequities and their associations with sociodemographic factors, among women and people who menstruate (PWM) aged 18–55 in Spain. Methods A cross-sectional survey-based study was conducted in Spain between March and July 2021. Descriptive statistical analyses and multivariate logistic regression models were performed. Results A total of 22,823 women and PWM were included in the analyses (Mean age = 33.2, SD = 8.7). Over half of the participants had accessed healthcare services for menstruation (61.9%). The odds for accessing menstrual-related services were significantly higher among participants with university education (aOR: 1.48, 95% CI, 1.13–1.95). Also, 57.8% reported having had partial or no menstrual education pre-menarche, with odds being higher among participants born in non-European or Latin American countries (aOR: 0.58, 95% CI, 0.36–0.93). Lifetime self-reported menstrual poverty was between 22.2–39.9%. Main risk factors for menstrual poverty were identifying as non-binary (aOR: 1.67, 95% CI, 1.32–2.11), being born in non-European or Latin American countries (aOR: 2.74, 95% CI, 1.77–4.24), and not having a permit to reside in Spain (aOR: 4.27, 95% CI, 1.94–9.38). Completed university education (aOR: 0.61, 95% CI, 0.44–0.84) and no financial hardship < 12 months (aOR: 0.06, 95% CI, 0.06–0.07) were protective factors for menstrual poverty. Besides, 75.2% reported having overused menstrual products due to lack of access to adequate menstrual management facilities. Menstrual-related discrimination was reported by 44.5% of the participants. Non-binary participants (aOR: 1.88, 95% CI, 1.52–2.33) and those who did not have a permit to reside in Spain (aOR: 2.11, 95% CI, 1.10-4.03) had higher odds of reporting menstrual-related discrimination. Work and education absenteeism were reported by 20.3% and 62.7% of the participants, respectively. Conclusions Our study suggests that menstrual inequities affect a high number of women and PWM in Spain, especially those more socioeconomically deprived, vulnerabilised migrant populations and non-binary and trans menstruators. Findings from this study can be valuable to inform future research and menstrual inequity policies