Efeitos da disrupção endócrina na gestação: uma revisão sistemática

Endocrine disruptors are ubiquitous natural and synthetic environmental pollutants that can mimic, block or disturb normal hormonal function. Environmental exposure to these pollutants is almost impossible to prevent due to their presence in the air, water, soil, food and in many other materials with which we come in contact daily, such as plastics. Foetuses are vulnerable during pregnancy because their organism is in a developmental stage, and any disruption may affect their health in the short and/or long term. There is some evidence that these substances disrupt tissue differentiation and growth processes, cause birth defects and affect the length of pregnancy. In this review we will focus on environmental epidemiology and related literature in order to update current knowledge based on the actual evidence of the effects of these substances on the aetiology of preterm delivery, miscarriages, low birth weight, malformations, cryptorchidism, hypospadias and micropenis. The difficulty in studying this topic is due to the high number of involved factors, which makes the available results inconclusive or even contradictory. Consequently, further research is necessary.Los alteradores endocrinos son contaminantes ambientales, naturales y sintéticos, ubicuos, que pueden mimetizar, bloquear o alterar funciones hormonales. La exposición ambiental a estos contaminantes es prácticamente imposible de evitar debido a que están presentes en el aire, en el agua, en los suelos, en los alimentos, y en muchos de los materiales con los que estamos en contacto diariamente, como los plásticos. La gestación supone una etapa de vulnerabilidad para el feto porque su organismo está en proceso de desarrollo y cualquier alteración puede afectar su salud a corto o largo plazo. Hay cierta evidencia de que estas sustancias alteran procesos de crecimiento y diferenciación de tejidos, producen malformaciones y afectan la duración del embarazo. Hasta el momento se conoce algo de sus efectos en la etiología de la criptorquidia, hipospadias y micropene, abortos espontáneos, partos prematuros y el bajo peso al nacimiento, efectos que serán revisados en este documento que quiere aportar una actualización del conocimiento, concentrándose en la epidemiología ambiental y la literatura relacionada. La dificultad para estudiar este tema por la cantidad de factores que intervienen hace que los resultados existentes no sean concluyentes o incluso contradictorios, por lo que es necesario que se siga investigando.Os disruptores endócrinos são contaminantes ambientais ubíquos, naturais e sintéticos, que podem mimetizar, bloquear ou alterar funções hormonais. A exposição ambiental a estes contaminantes é quase impossível de evitar porque estão presentes no ar, na água, no solo, nos alimentos e em muitos materiais de uso cotidiano como os plásticos. A gestação é uma etapa de vulnerabilidade para o feto porque o organismo está em processo de desenvolvimento e qualquer alteração pode afetar gravemente a sua saúde a curto ou longo prazo. Existe alguma evidência de que estas sustâncias alteram processos de crescimento e diferenciação de tecidos, produzem malformações e afetam a duração da gravidez. Neste momento já existe algum conhecimento sobre os seus efeitos na etiologia da criptorquidia, hipospadia, micropénis, aborto espontâneo, parto prematuro e baixo peso à nascença. Efeitos esses que serão revisados neste documento visando uma atualização do conhecimento, concentrando-se na epidemiologia ambiental e na literatura relacionada. A dificuldade para estudar este tema pela quantidade de fatores intervenientes faz com que os resultados existentes não sejam conclusivos ou até que sejam contraditórios, pelo que, será necessário que se continue investigando

Factors that influence treatment delay in patients with colorectal cancer

A prospective study was performed of patients diagnosed with colorectal cancer (CRC), distinguishing between colonic and rectal location, to determine the factors that may provoke a delay in the first treatment (DFT) provided.2749 patients diagnosed with CRC were studied. The study population was recruited between June 2010 and December 2012. DFT is defined as time elapsed between diagnosis and first treatment exceeding 30 days.Excessive treatment delay was recorded in 65.5% of the cases, and was more prevalent among rectal cancer patients. Independent predictor variables of DFT in colon cancer patients were a low level of education, small tumour, ex-smoker, asymptomatic at diagnosis and following the application of screening. Among rectal cancer patients, the corresponding factors were primary school education and being asymptomatic.We conclude that treatment delay in CRC patients is affected not only by clinicopathological factors, but also by sociocultural ones. Greater attention should be paid by the healthcare provider to social groups with less formal education, in order to optimise treatment attentio

Declared experiences of risky sexual behaviors in relation to alcohol consumption in the first year of college

Fundamentos: En universitarios, el consumo de alcohol de mayor riesgo (borracheras y binge drinking (BD), tiene consecuencias negativas sobre su desarrollo y probablemente facilita conductas sexuales de riesgo. El objetivo de este trabajo fue estudiar si las conductas sexuales de riesgo al consumir alcohol (CSRA) se asocian a los consumos de mayor riesgo. Métodos: Estudio multicéntrico transversal con datos del Proyecto uniHcos, de universitarios de 1er año de 11 universidades españolas, entre los cursos 2011-2012 y 2017- 2018. Datos recogidos mediante cuestionario autoadministrado. Se realizó un análisis uni y bivariable, evaluando la significación estadística de las diferencias de prevalencia con chi-cuadrado. Se utilizó media y desviación típica para variables cuantitativas y como estadístico de contraste t de Student. Resultados: 9.862 participantes (72,2% mujeres). El 90,3% consumió alcohol y el 60,9% tuvo borracheras en último año; el 49% tuvo BD en el último mes. El consumo en el último mes y las borracheras fueron mayores en hombres y < 21 años. Las CSRA fueron superiores entre los que se emborracharon (15,7% sexo sin protección, 1,9% abuso sexual y 0,7% aprovecharse sexualmente) y consumieron en BD (17,1%, 1,9% y 0,7%). Las mujeres con ambos consumos de riesgo presentaron más abusos sexuales (2,2%), y los hombres fueron quienes más se aprovecharon sexualmente de otros (borracheras:1,2%; BD: 1,3%). Conclusiones: El consumo de alcohol está por encima de grupos similares. El BD tiene un patrón similar por género y edad. Las CSRA se asocian a los consumos de mayor riesgo, no detectándose en este grupo diferencias por género en sexo sin protección, sí en otras CSRA.Objective: In college students, higher risk alcohol consumption (drunkenness and binge drinking-BD) has negative consequences on their development and and probably facilitates risk sexual behaviors. The objective was to study if risky sexual behaviors when consuming alcohol (RSBA) are associated with higher risk consumption. Methods: Cross-sectional multicenter study with UniHcos Project, 1st year university students from 11 universities in Spain, academic years 2011-2012 to 2017-2018 data. This data were collected by self-administered questionnaire. A uni and bivariate analysis was performed, evaluated the statistical significance of the differences in prevalence with chi-square. Mean and standard deviation were used for quantitative variables and Student's t test statistic was used. Results: 9,862 subjects (72.2% women). 90.3% reported having consumed alcohol and 60.9% had drunk the last year, 49% BD in last month. It was deteded in men, significantly higher consumption in the last month and drunkenness. Last month consumption and drunkenness were significantly higher in men and in <21 years. The RSBA were significantly higher among who were drunk (15.7% unprotected sex, 1.9% sexual abuse and 0.7% taking sexual advantage) and had BD (17.1%, 1.9% and 0.7 %). Women with both risk consumptions had more sexual abuse (2.2%), and men had greater behaviors of taking sexual advantage of someone (drunk: 1.2%; BD: 1.3%). Conclusions: Alcohol consumption was above similar groups. BD consumption was similar by gender and age. Risk sexual behaviors appear mainly in problematic consumption. Gender differences are not detected in alcohol consumers in unprotected sex but deteded in the rest.Financiación: El estudio ha sido financiado por el Plan Nacional Sobre Drogas del Ministerio de Salud, Servicios Sociales e Igualdad. Convocatoria de 2010 y de 2013. (Códigos: 2010/145 and 2013/034) y por el Instituto de Salud Carlos III a través de la convocatoria del FIS (Fondo de Investigación Sanitaria) de 2016 (PI16/01947)

Prevention of sexual violence through research as a pedagogical strategy in basic education

La violencia sexual es una problemática de salud pública que viene en aumento, convirtiéndose en un flagelo nacional, presentándose especialmente al interior del núcleo familiar, pero se manifiesta también en las diversas instituciones del colectivo social. El estudio busco prevenir la violencia sexual mediante la investigación como estrategia pedagógica en educación básica. Se guio bajo el enfoque de Investigación como estrategia pedagógica. Donde se utilizaron herramientas como diario de campo y observación participante. La unidad de análisis estuvo conformada por cuarenta (40) estudiantes de la IED Francisco de Paula Santander, Sede Simón Bolívar de Fundación-Magdalena. Los resultados evidenciaron que los alumnos no tenían conocimientos previos sobre violencia sexual, luego de la integración de la IEP al aula de clase desde el área de sociales se logró la apropiación y socialización de los conocimientos adquiridos a través del proceso de indagación por parte de los estudiantes con el apoyo docente.Sexual violence is a problem of public health that is increasing, becoming a national scourge, appearing especially within the family nucleus, but also manifested in the various institutions of the social collective. The study sought to prevent sexual violence through research as a pedagogical strategy in basic education. It was guided under the Research approach as a pedagogical strategy. Where tools were used as field diary and participant observation. The analysis unit consisted of forty (40) students of the IED Francisco de Paula Santander, Simón Bolívar campus of Fundación- Magdalena. The results showed that the students did not have previous knowledge about sexual violence, after the integration of the IEP into the classroom from the social area, the appropriation and socialization of the acquired knowledge was achieved through the process of inquiry by the students. students with teacher support

Detection methods predict differences in biology and survival in breast cancer patients

BackgroundThe aim of this study was to measure the biological characteristics involved in tumorigenesis and the progression of breast cancer in symptomatic and screen-detected carcinomas to identify possible differences.MethodsFor this purpose, we evaluated clinical-pathological parameters and proliferative and apoptotic activities in a series of 130 symptomatic and 161 screen-detected tumors.ResultsAfter adjustment for the smaller size of the screen-detected carcinomas compared with symptomatic cancers, those detected in the screening program presented longer disease-free survival (RR = 0.43, CI = 0.19-0.96) and had high estrogen and progesterone receptor concentrations more often than did symptomatic cancers (OR = 3.38, CI = 1.72-6.63 and OR = 3.44, CI = 1.94-6.10, respectively). Furthermore, the expression of bcl-2, a marker of good prognosis in breast cancer, was higher and HER2/neu expression was lower in screen-detected cancers than in symptomatic cancers (OR = 1.77, CI = 1.01-3.23 and OR = 0.64, CI = 0.40-0.98, respectively). However, when comparing prevalent vs incident screen-detected carcinomas, prevalent tumors were larger (OR = 2.84, CI = 1.05-7.69), were less likely to be HER2/neu positive (OR = 0.22, CI = 0.08-0.61) and presented lower Ki67 expression (OR = 0.36, CI = 0.17-0.77). In addition, incident tumors presented a shorter survival time than did prevalent ones (RR = 4.88, CI = 1.12-21.19).ConclusionsIncident carcinomas include a variety of screen-detected carcinomas that exhibit differences in biology and prognosis relative to prevalent carcinomas. The detection method is important and should be taken into account when making therapy decisions

Impacts of the Tropical Pacific/Indian Oceans on the Seasonal Cycle of the West African Monsoon

The current consensus is that drought has developed in the Sahel during the second half of the twentieth century as a result of remote effects of oceanic anomalies amplified by local land–atmosphere interactions. This paper focuses on the impacts of oceanic anomalies upon West African climate and specifically aims to identify those from SST anomalies in the Pacific/Indian Oceans during spring and summer seasons, when they were significant. Idealized sensitivity experiments are performed with four atmospheric general circulation models (AGCMs). The prescribed SST patterns used in the AGCMs are based on the leading mode of covariability between SST anomalies over the Pacific/Indian Oceans and summer rainfall over West Africa. The results show that such oceanic anomalies in the Pacific/Indian Ocean lead to a northward shift of an anomalous dry belt from the Gulf of Guinea to the Sahel as the season advances. In the Sahel, the magnitude of rainfall anomalies is comparable to that obtained by other authors using SST anomalies confined to the proximity of the Atlantic Ocean. The mechanism connecting the Pacific/Indian SST anomalies with West African rainfall has a strong seasonal cycle. In spring (May and June), anomalous subsidence develops over both the Maritime Continent and the equatorial Atlantic in response to the enhanced equatorial heating. Precipitation increases over continental West Africa in association with stronger zonal convergence of moisture. In addition, precipitation decreases over the Gulf of Guinea. During the monsoon peak (July and August), the SST anomalies move westward over the equatorial Pacific and the two regions where subsidence occurred earlier in the seasons merge over West Africa. The monsoon weakens and rainfall decreases over the Sahel, especially in August.Peer reviewe

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Prevalence of Malnutrition among Syrian Refugee Children from Lebanon

Today, the situation of Syrian refugees is one of the world’s worst humanitarian crises. To estimate the prevalence of malnutrition among pediatric populations of Syrian refugees, 176 Syrian refugee children, with stays of more than two years at three refugee camps (Zalhé, Deddeh, and Kfar Jouz) or from the town of Yohmor, Lebanon were authorized by their parents to participate in this study. The children were anthropometrically evaluated and height-for-age Z-score (HAZ), weight-for-age Z-score (WAZ), and weight-for-height (WHZ) Z-scores were obtained and compared with WHO standards. Furthermore, mid-upper arm circumference (MUAC) was analyzed for screening children 6–59 months old. According to the anthropometric measures, no child met the criteria for chronic, global, acute malnutrition (CGAM), severe acute malnutrition (SAM), or moderate acute malnutrition (MAM). In the total sample, 49.4% of participants were moderately thin, with girls presenting a higher prevalence of thinness than that of boys. Thus, the absence of high rates of malnutrition was verified despite the magnitude of the Syrian refugee’s problem. The data provided by this study identify the need to carry out further research to assess anthropometric growth and nutritional status among long-staying refugee children in order to prevent any health issues that may arise in the future

The Impact of <i>Moringa oleifera</i> Supplementation on Anemia and other Variables during Pregnancy and Breastfeeding: A Narrative Review

Moringa is a plant commonly used for its medical properties. However, studies have shown contradictory results. The aim of this review is to evaluate the possible association between the use of Moringa during pregnancy and breastfeeding in relation to the health status of both the mother and the baby. A search of the PubMed and EMBASE databases on the literature published during the period 2018–2023 was conducted up until March 2023. The population/exposure/comparison/outcome (PECO) approach was used to select studies on pregnant women, mother–child pairs, and the use of Moringa. Out of the 85 studies initially identified, 67 were excluded, leaving 18 for full-text evaluation. After assessment, 12 were finally included in the review. In the articles included in this work, Moringa is administered during pregnancy or in the postnatal period in the form of leaf powder (MOLP), as a leaf extract (MLE), as an ingredient associated with other supplements or in preparations. It appears to influence several variables during pregnancy and in the postnatal period such as the mother’s haematochemical profile, milk production, the child’s socio-personal development and the incidence of morbidity during the first 6 months of life. None of the studies analysed reported contraindications to the use of the supplement during pregnancy and lactation