Background: Maternal diet has been associated with fetal growth outcomes; however, evidence is scarce on the role of dietary quality.

Postoperative pulmonary and non-pulmonary complications are common problems that increase morbidity and mortality in surgical patients, even though the incidence has decreased with the increased use of protective lung ventilation strategies. Previous trials have focused on standard strategies in the intraoperative or postoperative period, but without personalizing these strategies to suit the needs of each individual patient and without considering both these periods as a global perioperative lung-protective approach. The trial presented here aims at comparing postoperative complications when using an individualized ventilatory management strategy in the intraoperative and immediate postoperative periods with those when using a standard protective ventilation strategy in patients scheduled for major abdominal surgery. This is a comparative, prospective, multicenter, randomized, and controlled, four-arm trial that will include 1012 patients with an intermediate or high risk for postoperative pulmonary complications. The patients will be divided into four groups: (1) individualized perioperative group: intra- and postoperative individualized strategy; (2) intraoperative individualized strategy + postoperative continuous positive airway pressure (CPAP); (3) intraoperative standard ventilation + postoperative CPAP; (4) intra- and postoperative standard strategy (conventional strategy). The primary outcome is a composite analysis of postoperative complications. The Individualized Perioperative Open-lung Ventilatory Strategy (iPROVE) is the first multicenter, randomized, and controlled trial to investigate whether an individualized perioperative approach prevents postoperative pulmonary complications. Registered on 5 June 2014 with identification no. NCT02158923 .

Objective: To assess food and nutrient intakes and compliance with nutritional recommendations in pregnant women according to selected sociodemographic characteristics.Design: Cross-sectional study based on data from the INMA-Valencia cohort (Spain), which recruited pregnant women between 2004 and 2005. Information on maternal sociodemographics and anthropometry was collected. Dietary intake was assessed through an FFQ. Intakes of foods were compared with Spanish food-based dietary guidelines. Intake inadequacy for nutrients was assessed using the Dietary Reference Intakes of the US Institute of Medicine.Setting: Valencia, Spain.Subjects: We studied 822 pregnant women who had information on dietary intake during their first trimester of pregnancy.Results: More than 50 % of pregnant women did not meet the guidelines for cereals and legumes; reported intakes of carbohydrates, n-3 and n-6 fatty acids were below recommendations and exceeded the total fat intake according to dietary references. Dietary inadequacy for folate, Fe and vitamin E ranged from 99 % to 68 %. Vegetable intake was related to age only. Younger and less educated women showed lower intakes of protein and n-3 fatty acids and higher intakes of trans-fatty acids as well as greater inadequacy for micronutrients. Spanish women reported lower intakes of fruit and carbohydrates and higher intakes of protein, total fat, SFA, MUFA and n-3 fatty acids compared with their foreign-born counterparts.Conclusions: Women in the studied area have inadequate intakes of several nutrients relevant during pregnancy. Age, education and country of origin are factors significantly related to dietary intake and adequacy.

BACKGROUND: Primary nonadherence (not filling a first prescription) is an important yet unstudied aspect of adherence to oral anticoagulant (OAC) therapy. OBJECTIVE: To estimate the rates of primary nonadherence to OACs and determine associated factors in real-world practice. METHODS: This population-based retrospective cohort study set in the Valencia region of Spain (about 5 million inhabitants) included all patients with atrial fibrillation who were newly prescribed OACs during 2011-2014 (N = 18,715). Primary nonadherence was obtained by linking electronic prescription and dispensing data and assessed by type of OAC—vitamin K antagonists (VKAs) or non-VKA oral anticoagulants (NOACs). Covariates were obtained from diverse databases, including electronic medical records. Multivariate logistic regression models were used to assess characteristics associated with primary nonadherence, adjusting for a propensity score to minimize confounding by indication. RESULTS: Primary nonadherence to OACs was 5.62% (VK...

Fetal growth restriction is an important predictor of infant mortality and morbidity. Maternal iron status and iron supplementation during pregnancy have been related to fetal growth with contrasting results. Therefore, indication of iron supplementation, doses, and timing is still controversial. Current literature was reviewed in PubMed/MEDLINE using the following terms: “iron” or “iron deficiency” or “anemia” or “iron intake” or “iron supplementation” and “pregnancy” or “maternal” and “fetal growth” or “birth weight” or “pregnancy outcomes” or “birth outcomes.” The search was limited to studies in humans since 1991 assessing iron status or supplementation in the periconceptional period or at any time during pregnancy. Evidence suggests that iron deficiency in early pregnancy has an adverse effect on fetal growth. On the other hand, high levels of maternal iron markers have shown a deleterious effect at different stages of pregnancy. The mechanisms underlying such effect are unclear. It is important to acknowledge the need to assess markers of iron status adequately in order to reach reliable conclusions regarding their relationship with fetal growth. In regard to supplementation, it has been shown that low or moderate doses of iron in early pregnancy have a positive effect on fetal growth, regardless of maternal iron status. No such effect has been seen in trials of supplementation later in pregnancy, with low or high doses. Nevertheless, results should be interpreted with caution as some randomized controlled trials lack adequate methodology. Studies assessing the effect of iron supplementation in early pregnancy on fetal growth in iron-deficient and iron-sufficient women are needed in order to establish the most appropriate indications for doses and timing.

Aims: Acenocoumarol is a vitamin‐K antagonist (VKA) primarily used in certain countries (e.g. India, Netherlands, Spain). The half‐life of acenocoumarol is similar to that of non‐VKA oral anticoagulants (NOAC), unlike warfarin, and this could affect comparative effectiveness and safety (CES). However, data on CES for NOAC come almost exclusively from studies using warfarin as the comparator. We aimed to assess outcomes of NOAC and acenocoumarol in people with non‐valvular atrial fibrillation (NVAF) in real‐world clinical practice.Methods: This is a population‐based retrospective cohort study. All new users of oral anticoagulants from November 2011 to December 2015 with NVAF were included (n = 41,560). Data were obtained by linking several health electronic records of the Valencia region, Spain. Incidence rates were estimated. We used the inverse probability of treatment weighted Cox analysis to control for indication bias when assessing the risk of effectiveness and safety outcomes for each NOAC compared with acenocoumarol. Several sensitivity analyses were performed.Results: We did not find differences in the risk of mortality, ischaemic stroke or any gastrointestinal bleeding. However, we did find a decreased risk of intracranial haemorrhage for dabigatran (HR: 0.34, 95% CI 0.20–0.56) and rivaroxaban (HR: 0.55, 95% CI 0.35–0.85) as compared to acenocoumarol. In subanalyses, apixaban showed a higher risk of ischaemic stroke in high‐risk persons (≥75 years and CHA2DS2‐VASC score ≥ 2).Conclusions: No differences in clinical outcomes were found between NOAC and acenocoumarol overall, although dabigatran and rivaroxaban showed a lower risk of intracranial haemorrhage. Findings on the potential inferiority of specific NOAC in high‐risk subgroups should be studied further.