Background: There is a growing evidence of the impact of the current European economic crisis on health. In Spain since 2008 there have been increasing levels of impoverishment and inequality, and important cuts in social services, including per capita spending on healthcare.
Aim:The objective is to evaluate the impact of the economic crisis on underweight at birth in Spain.
Results and conclusions:Results demonstrate a significant increase in the prevalence of underweight at birth as from 2008. All maternal-foetal categories were affected, including those which showed the lowest prevalence before the crisis. In the full adjusted logistic regression, year-on-year GDP per capita remains predictive on underweight at birth risk, in such a way that the fall in GDP between 2007 and 2012 determined an increase of the OR of underweight at birth by 6.63%. Previous trends in maternal socio-demographic profile and a direct impact of the crisis are discussed to explain the trends described.
Objecti¨es: To compare the tocolytic efficacy and maternal tolerance of nifedipine with ritodrine in the management of threatened preterm labor. Methods: Prospective randomized study of 52 singleton pregnancies with preterm labor between 26 and 34 week's gestation. The capacity to delay delivery 48 h, 7 days, until week 36 or until fetal weight reached 2500 g were the outcome variables assessed. Doppler ultrasound studies were performed on the fetal umbilical artery as control. Results: No significant differences were found in the delay of delivery, but significantly fewer maternal side-effects were found in the nifedipine group. Doppler ultrasound results were similar in both groups. Conclusions: Nifedipine is a valid and well-tolerated alternative among the tocolytic drugs, and apparently does not significantly alter fetal vascular blood flow. ᮊ 1998 International Federation of Gynecology and Obstetrics
The growth stress generated once grains coalesce in Volmer-Weber-type thin films is investigated by time-multiscale simulations comprising complementary modules of (i) finite-element modeling to address the interactions between grains happening at atomic vibration time scales ($ 0:1 ps), (ii) dynamic scaling to account for the surface stress relaxation via morphology changes at surface diffusion time scales ($ s-ms), and (iii) the mesoscopic rate equation approach to simulate the bulk stress relaxation at deposition time scales ($ sec-h). On the basis of addressing the main experimental evidence reported so far on the topic dealt with, the simulation results provide key findings concerning the interplay between anisotropic grain interactions at complementary space scales, deposition conditions (such as flux and mobility), and mechanisms of stress accommodation-relaxation, which underlies the origin, nature and spatial distribution, and the flux dependence of the postcoalescence growth stress.
Investigation of the morphology evolution of annealed polycrystalline Au(111) films by atomic force microscopy and x-ray diffraction leads to a continuous model that correlates such an evolution to local interactions between grains triggering different mechanisms of stress accommodation (grain zipping and shear strain) and relaxation (gap filling and grain rotation). The model takes into consideration findings concerning the in-plane reorientation of the grains during the coalescence to provide a comprehensive picture of the grain-size dependence of the interactions (underlying the origin of the growth stress in polycrystalline systems); and in particular it sheds light on the postcoalescence compressive stress as a consequence of the kinetic limitations for the reorientation of larger surface structures.
Results support the consideration of establishing parity and type of delivery-specific birthweight references. These new charts enable a better evaluation of the impact of the demographic, reproductive and obstetric trends currently in Spain on fetal growth.
Based on previous findings showing both better birth outcomes in migrant than in Spanish women and different rates of medical intervention according to mother's origin, we hypothesize that mode of delivery decisions to solve similar problems differ according to ethnic origin. Ethnic differences for maternal characteristics, medical intervention, and mode of delivery were evaluated in 16,589 births from a Maternity Hospital in Madrid (Spain). Multinomial logistic regression analysis was used to evaluate the effect of mother's ethnic origin on the mode of delivery, adjusting for mother's age, parity, gestational age, birth weight, and epidural anesthesia. Compared with the Spanish mothers, the risk of having a Caesarean section is significantly higher in Latin Americans and significantly lower for the Chinese. Both low birth weight and macrosomic deliveries are at higher risk for Caesarean section. The interventionist system characterizing Spain is being extended to all ethnic groups and, at the same time, different medical interventions are applied to similar problems depending on women's ethnic origin. Obstetric interventions might be contributing to the increasing trend of low birth weight and late preterm/early full term deliveries (37-38 weeks) observed in Spain. Behavioral and cultural values of the women and of the health care providers may contribute to systematic differences in labor management and mode of delivery.
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