Cristina Bernis

Characteristics of menstrual cycles in Moroccan girls: prevalence of dysfunctions and associated behaviours.

Population studies on normal and dysfunctional characteristics of menstrual cycles are scarce for western populations and practically non-existent for non-western ones. Recent data suggest that the type of menstrual cycle can be relevant for later gynaecological problems in several ways. The type of menstrual cycle is related to menarcheal age in a way that those with early maturation show more menstrual disorders which are the largest diagnosis category accounting for hysterectomies in adult women. On the other hand menstrual pain is often cited as the main single cause of school absenteeism among adolescent girls. The aim of this study is to describe characteristics of menstrual cycles, prevalence of main dysfunctions and their relationship to the age of maturity. The sample comprises 495 adolescent girls from Marrakech (Morocco) aged 12-19 years. At 13 years, 40% of these girls had reached menarche. The median age at menarche is 13.04. The prevalences of abdominal pain, premenstrual symptoms and irregularity are 69.60, 51.20 and 23.03 respectively. Abdominal pain is significantly more frequent in girls with early menarche.

Environmental contexts of menopause in Spain : comparative results from recent research

Objective:This study had two main objectives: (1) to detect the differences in basic aspects of the reproductive aging process (age at menopause, menopausal symptoms, the medicalization of aging) among women from the region of Madrid, who at the time of the study were living in three different environmental contexts (rural, semiurban, and urban), and (2) to identify the main factors responsible for these differences. Design:Data from two different research projects have been pooled for the DAMES project (Decesions At Menopause Study), and the Ecology of Reproductive Aging Project. The sample size was 1,142, women 45 to 55 years of age (103 rural, 744 semiurban, 295 urban). Results:Probit analysis was used to estimate median age at natural menopause in the three contexts. Rural women have a later onset of menopause (rural, 52.07 y; semiurban, 51.9 y; urban, 51.23 y) and significantly higher levels of the symptoms related to declines in estrogen, eg, hot flashes (rural, 56%; semiurban, 43%; urban, 46%; &khgr;2 = 6.717, P = 0.035) or loss of sexual desire (rural, 51%; semiurban, 44%; urban, 41%; &khgr;2 = 24.934, P = 0.001). Conversely, urban women suffer more from symptoms related to stress, eg, impatience (rural, 34%; semiurban, 25%; urban, 45%; &khgr;2 = 41.328, P < 0.001). The medicalization of menopause, measured in terms of both surgical menopause and the use of hormone therapy, is significantly higher in the urban population (surgical menopause: rural, 5.8%; semiurban, 8.7; urban, 10%; &khgr;2 = 16.009, P < 0.001). Despite these differences, levels of postmenopausal hormone therapy use are still somewhat lower than in other West European and North American populations. Two different logistic regression analyses were carried out to identify (1) factors associated with differences in ovarian aging, measured through menopausal status, and (2) factors associated with prevalence of hot flashes with respect to ovarian aging. Parity, body mass index, age, environmental context, and, slightly less so, smoking, alcohol consumption, age at menarche, and marital status all contribute significantly or nearly significantly and independently to the explanation of differences found. For the likelihood of having hot flashes, environmental context, age, education, age at menarche, menopausal status, and postmenopausal hormone therapy use all have a significant or borderline significant effect. Conclusions:Significant differences have been shown to exist in rural, semiurban and urban settings in the median age at menopause, in basic symptom frequency and type, and in the levels of medicalization of the process of reproductive aging. Within multivariate regression models, it has been shown that body mass index, age, and environmental context all contribute to differences in reproductive aging. The factors associated with ovarian aging and hot flashes are comparable to those in other industrialized populations, although standard interpretations should be expanded to include context-based realties, including (1) the higher levels of modernization of urban women that influence differential behavior with respect to risk factors at menopausal age; (2) the different ecological realities surrounding nutrition, physical activity, and social support that characterize womens period of development; and (3) the differential construction of their identity as women in terms of assertiveness, aesthetic perceptions, and the use of health services. Context does, indeed, matter.

Influence of body mass index and slimming habits on menstrual pain and cycle irregularity

Using a cross-sectional sample of 1147 urban adolescents, aged between 14 and 20 years, the variability of some menstrual cycle indicators was related to weight loss. Nearly 40% of the adolescents tried to lose weight and the results showed that attempting to lose weight is significantly associated with increased prevalence of menstrual irregularity and menstrual pain. This finding is independent of body mass index.

Nutritional and socio-economic factors associated with Plasmodium falciparum infection in children from Equatorial Guinea: results from a nationally representative survey

BackgroundMalaria has traditionally been a major endemic disease in Equatorial Guinea. Although parasitaemia prevalence on the insular region has been substantially reduced by vector control in the past few years, the prevalence in the mainland remains over 50% in children younger than five years. The aim of this study is to investigate the risk factors for parasitaemia and treatment seeking behaviour for febrile illness at country level, in order to provide evidence that will reinforce the EG National Malaria Control Programme.MethodsThe study was a cross-sectional survey of children 0 to 5 years old, using a multistaged, stratified, cluster-selected sample at the national level. It included a socio-demographic, health and dietary questionnaires, anthropometric measurements, and thick and thin blood smears to determine the Plasmodium infection. A multivariate logistic regression model was used to determine risk factors for parasitaemia, taking into account the cluster design.ResultsThe overall prevalence of parasitemia was 50.9%; it was higher in rural (58.8%) compared to urban areas (44.0%, p = 0.06). Age was positively associated with parasitemia (p < 0.0001). In rural areas, risk factors included longer distance to health facilities (p = 0.01) and a low proportion of households with access to protected water in the community (p = 0.02). Having had an episode of cough in the 15 days prior to the survey was inversely related to parasitemia (p = 0.04). In urban areas, the risk factors were stunting (p = 0.005), not having taken colostrum (p = 0.01), and that someone in the household slept under a bed net (p = 0.002); maternal antimalarial medication intake during pregnancy (p = 0.003) and the household socio-economic status (p = 0.0002) were negatively associated with parasitemia. Only 55% of children with fever were taken outside their homes for care, and treatment seeking behaviour differed substantially between rural and urban populations.ConclusionResults suggest that a national programme to fight malaria in Equatorial Guinea should take into account the differences between rural and urban communities in relation to risk factors for parasitaemia and treatment seeking behaviour, integrate nutrition programmes, incorporate campaigns on the importance of early treatment, and target appropriately for bed nets to reach the under-fives.

Nutritional status and its correlates in Equatorial Guinean preschool children: results from a nationally representative survey.

Background In Equatorial Guinea, as a result of the recent growth of the oil industry, there is an opportunity to address important public health problems through public and private initiatives. To propose effective nutrition and public health strategies, it is important first to have reliable information on the nutritional status of the population and the underlying factors affecting it. Objective To assess the nutritional status and the prevalence of anemia among Equatoguinean children in a nationally representative sample and to identify the risk factors associated with the nutritional problems detected. Methods The study was a cross-sectional survey using a multistaged, stratified, cluster-selected sample. The survey included a sociodemographic, health, and dietary questionnaire and measurement of hematocrit and anthropometric features, from which nutritional indicators based on the National Center for Health Statistics (NCHS) reference and the World Health Organization (WHO) standards were calculated. Logistic regression models were used for the multivariate analysis. A total of 552 children aged 0 to 60 months were surveyed. Results The overall prevalence of stunting (< −2 height-for-age z-scores [HAZ]) was 29.7% based on the NCHS reference and 35.2% based on WHO standards; the risk factors associated with stunting were age (p < .0001), low socioeconomic status (p = .01), and fishing by a member of the household (p = .003) The prevalence of mild anemia (hemoglobin < 110 g/L) was 69.3%, and that of moderate or severe anemia (hemoglobin < 80 g/L) was 8.3%. The only significant risk factor associated with moderate to severe anemia was low household socioeducational level (p = .01). Conclusions Stunting and anemia are public health problems in Equatorial Guinea. Integrated strategies, including fighting poverty and improving maternal education, should be undertaken.

Hour of birth and birth assistance: From a primate to a medicalized pattern?

Previous studies generally agree that in Homo sapiens births without medical intervention occur mostly at night, although with a less accentuated pattern than in other primate species. The present study has three main objectives: (a) to establish the hourly pattern of births in a modern medicalized population, (b) to explore the association between the hour of birth and maternal and fetal variables and mode of delivery, and (c) to evaluate the risk for medical intervention at different hours of the day.

The economic and nutrition transition in Equatorial Guinea coincided with a double burden of over- and under nutrition

We assess trends in childrens nutritional status in Equatorial Guinea, a country in socioeconomic transition. Nationally representative samples were conducted in 1997, at the start of the economic take off, and again in 2004. Children aged 0-60 months were included in the surveys (N=436, 552). Both surveys included a sociodemographic, dietary and health questionnaire, and anthropometric measurements from which height-for-age (HAZ); weight-for-age (WAZ) and weight-for-height (WHZ) Z-scores were calculated. Between 1997 and 2004, the prevalence of child overweight for all children increased from 21.8% to 31.7%, especially in urban areas (from 18.2% to 29.4%, p=0.01). Stunting prevalence among children >or=2 years old decreased (from 57.9% to 45.3%, p<0.02), but for all age groups remained very high (34.7% overall, 46.5% rural and 28.5% urban in 2004). The economic take off in Equatorial Guinea appeared to coincide with substantial increases in the prevalence of child overweight whereas the prevalence of stunting decreased even if it remained high. The results suggest that the country is undergoing a nutrition transition and acquiring the concomitant double burden of under and over nutrition.

The pattern of reproductive life in a Berber population of morocco

Reproductive patterns were studied from data collected in 1,450 Berber households in the province of Marrakesh, Morocco in 1984. Women aged 45-49 years had a mean of 8.9 pregnancies to achieve 5.7 living children. Social influences on fertility rates show the importance of tradition, particularly through time-dependent variables such as age at marriage, waiting time to first birth, interbirth intervals, and duration of breastfeeding. Birth control does not appear to affect the tempo of fertility; rather, its main use is to bring the reproductive period to a close. The comparison of two subsamples of women separated by a 25-year interval indicates an actual acceleration of the tempo of fertility by the reduction of waiting time to first birth and of interbirth intervals. The supposed ongoing process of demographic transition is not clearly observed in this population.

Is the economic crisis affecting birth outcome in Spain? Evaluation of temporal trend in underweight at birth (2003-2012).

Abstract Background: There is 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. Aim: The objective is to evaluate the impact of the economic crisis on underweight at birth in Spain. Method: Trends in underweight at birth were examined between 2003 and 2012. Underweight at birth is defined as a singleton, term neonatal weight lesser than -2 SD from the median weight at birth for each sex estimated by the WHO Standard Growth Reference. Using data from the Statistical Bulletin of Childbirth, 2 933 485 live births born to Spanish mothers have been analysed. Descriptive analysis, seasonal decomposition analysis and crude and adjusted logistic regression including individual maternal and foetal variables as well as exogenous economic indicators have been performed. Results and conclusions: Results demonstrate a significant increase in the prevalence of underweight at birth from 2008. All maternal-foetal categories were affected, including those showing 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. Previous trends in maternal socio-demographic profiles and a direct impact of the crisis are discussed to explain the trends described.

Maternal Characteristics and Temporal Trends in Birth Outcomes: Comparison between Spanish and Migrant Mothers

Low birth weight and preterm babies have been increasing in Spain since 1980, coinciding with important changes in the social and demographic structure of childbearing populations—including the contribution of a 25% of foreign mothers—and with increasing medical intervention in births. This study, based on 5,990,613 births, compares the temporary trends in reproductive patterns and birth outcomes in Spanish and foreign mothers during the period 1996–2009 and evaluates for the years 2007 to 2009 the relative contribution of mothers origin and Caesarean section to birth weight variability. Foreign mothers maintain their own reproductive pattern, whereas negative birth outcomes increase in all groups. Results from logistic regression analysis show that besides late maternity and primiparity also Caesarean section increases the risk for low birth weight. The reduction in Caesarean section rates between 2007 and 2009 might explain the reduction of low birth weight detected. A change of tendency simultaneously appears in most maternal and newborn characteristics, and in the mode of delivery in all ethnic groups since 2008. Coincidence in the timing of the change of trends points to a common factor. We suggest that the current world financial crisis could be this common cause, a hypothesis to be contrasted in future research.