Predicting preterm birth in maternity care by means of data mining

Worldwide, around 9% of the children are born with less than 37 weeks of labour, causing risk to the premature child, whom it is not prepared to develop a number of basic functions that begin soon after the birth. In order to ensure that those risk pregnancies are being properly monitored by the obstetricians in time to avoid those problems, Data Mining (DM) models were induced in this study to predict preterm births in a real environment using data from 3376 patients (women) admitted in the maternal and perinatal care unit of Centro Hospitalar of Oporto. A sensitive metric to predict preterm deliveries was developed, assisting physicians in the decision-making process regarding the patients’ observation. It was possible to obtain promising results, achieving sensitivity and specificity values of 96% and 98%, respectively.

Postpartum Depression: Is it a condition affecting the mother-infant interaction and the development of the child across the first year of life?

Noting that maternal depression is common during a baby's first year, this study examined the interaction of depressed and non-depressed mother-child dyads. A sample of 26 first-time mothers with postpartum depression at the third month after birth and their 3-month-old infants was compared to a sample of 25 first-time mothers with no postpartum depression at the third month after birth and their 3-month-old infants. The observations were repeated at 6 months and again at 12 months postpartum. The samples were compared for differences in mother interaction behavior, mother's infant care, mother's concern with the baby, infant behavioral difficulties, infant mental and motor development, and infant behavior with the observer. Among the findings are the following: (1) depressed mothers' interaction behavior and care of their infants are less adequate than the non-depressed mothers' interaction behavior and care of their infants at 3, 6, and 12 months postpartum; (2) infants' interaction behaviors during feeding and face-to-face interaction with depressed mothers are less adequate than infants' interactions with non-depressed mothers at 3, 6, and 12 months postpartum; (3) mother-infant interactions are less adequate in the depressed mother dyads than the non-depressed dyads at 3, 6, and 12 months postpartum; (4) depressed mothers are less concerned about their infants than non-depressed mothers at 3, 6, and 12 months postpartum; (5) infants of depressed mothers have more behavioral difficulties at 3, 6, and 12 months postpartum than infants of non-depressed mothers; (6) infants of depressed mothers had lower mental and motor development rates at 6 and 12 months postpartum than infants of non-depressed mothers; and (7) infants of non-depressed mothers behaved in a more positive way with the observer than the infants of depressed mothers. (AS)

Child abuse monitor system model: a health care critical knowledge monitor system

The Childhood protection is a subject with high value for the society, but, the Child Abuse cases are difficult to identify. The process from suspicious to accusation is very difficult to achieve. It must configure very strong evidences. Typically, Health Care services deal with these cases from the beginning where there are evidences based on the diagnosis, but they aren’t enough to promote the accusation. Besides that, this subject it’s highly sensitive because there are legal aspects to deal with such as: the patient privacy, paternity issues, medical confidentiality, among others. We propose a Child Abuses critical knowledge monitor system model that addresses this problem. This decision support system is implemented with a multiple scientific domains: to capture of tokens from clinical documents from multiple sources; a topic model approach to identify the topics of the documents; knowledge management through the use of ontologies to support the critical knowledge sensibility concepts and relations such as: symptoms, behaviors, among other evidences in order to match with the topics inferred from the clinical documents and then alert and log when clinical evidences are present. Based on these alerts clinical personnel could analyze the situation and take the appropriate procedures.

Predicting type of delivery by identification of obstetric risk factors through data mining

In Maternity Care, a quick decision has to be made about the most suitable delivery type for the current patient. Guidelines are followed by physicians to support that decision; however, those practice recommendations are limited and underused. In the last years, caesarean delivery has been pursued in over 28% of pregnancies, and other operative techniques regarding specific problems have also been excessively employed. This study identifies obstetric and pregnancy factors that can be used to predict the most appropriate delivery technique, through the induction of data mining models using real data gathered in the perinatal and maternal care unit of Centro Hospitalar of Oporto (CHP). Predicting the type of birth envisions high-quality services, increased safety and effectiveness of specific practices to help guide maternity care decisions and facilitate optimal outcomes in mother and child. In this work was possible to acquire good results, achieving sensitivity and specificity values of 90.11% and 80.05%, respectively, providing the CHP with a model capable of correctly identify caesarean sections and vaginal deliveries.

Mothers' beliefs concerning severity and need for intervention in child maltreatment

Dissertação de mestrado integrado em Psicologia Clínica e da Saúde

Autoimmune diseases and pregnancy: analysis of a series of cases

BACKGROUND: An autoimmune disease is characterized by tissue damage, caused by self-reactivity of different effector mechanisms of the immune system, namely antibodies and T cells. All autoimmune diseases, to some extent, have implications for fertility and obstetrics. Currently, due to available treatments and specialised care for pregnant women with autoimmune disease, the prognosis for both mother and child has improved significantly. However these pregnancies are always high risk. The purpose of this study is to analyse the fertility/pregnancy process of women with systemic and organ-specific autoimmune diseases and assess pathological and treatment implications. METHODS: The authors performed an analysis of the clinical records and relevant obstetric history of five patients representing five distinct autoimmune pathological scenarios, selected from Autoimmune Disease Consultation at the Hospital of Braga, and reviewed the literature. RESULTS: The five clinical cases are the following: Case 1-28 years old with systemic lupus erythematosus, and clinical remission of the disease, under medication with hydroxychloroquine, prednisolone and acetylsalicylic acid, with incomplete miscarriage at 7 weeks of gestation without signs of thrombosis. Case 2-44 years old with history of two late miscarriages, a single preterm delivery (33 weeks) and multiple thrombotic events over the years, was diagnosed with antiphospholipid syndrome after acute myocardial infarction. Case 3-31 years old with polymyositis, treated with azathioprine for 3 years with complete remission of the disease, took the informed decision to get pregnant after medical consultation and full weaning from azathioprine, and gave birth to a healthy term new-born. Case 4-38 years old pregnant woman developed Behcet's syndrome during the final 15 weeks of gestation and with disease exacerbation after delivery. Case 5-36 years old with autoimmune thyroiditis diagnosed during her first pregnancy, with difficult control over the thyroid function over the years and first trimester miscarriage, suffered a second miscarriage despite clinical stability and antibody regression. CONCLUSIONS: As described in literature, the authors found a strong association between autoimmune disease and obstetric complications, especially with systemic lupus erythematosus, antiphospholipid syndrome and autoimmune thyroiditis.

Fine time scaling of purifying selection on human nonsynonymous mtDNA mutations based on the worldwide population tree and mother-child pairs

A high-resolution mtDNA phylogenetic tree allowed us to look backward in time to investigate purifying selection. Purifying selection was very strong in the last 2,500 years, continuously eliminating pathogenic mutations back until the end of the Younger Dryas (∼11,000 years ago), when a large population expansion likely relaxed selection pressure. This was preceded by a phase of stable selection until another relaxation occurred in the out-of-Africa migration. Demography and selection are closely related: expansions led to relaxation of selection and higher pathogenicity mutations significantly decreased the growth of descendants. The only detectible positive selection was the recurrence of highly pathogenic nonsynonymous mutations (m.3394T>C-m.3397A>G-m.3398T>C) at interior branches of the tree, preventing the formation of a dinucleotide STR (TATATA) in the MT-ND1 gene. At the most recent time scale in 124 mother-children transmissions, purifying selection was detectable through the loss of mtDNA variants with high predicted pathogenicity. A few haplogroup-defining sites were also heteroplasmic, agreeing with a significant propensity in 349 positions in the phylogenetic tree to revert back to the ancestral variant. This nonrandom mutation property explains the observation of heteroplasmic mutations at some haplogroup-defining sites in sequencing datasets, which may not indicate poor quality as has been claimed.

Lower NPAS3 expression during the later stages of abnormal lung development in rat congenital diaphragmatic hernia

Purpose Congenital diaphragmatic hernia (CDH) is characterized by a developmental defect in the diaphragm, pulmonary hypoplasia and pulmonary hypertension. NPAS3 is a PAS domain transcription factor regulating Drosophila tracheogenesis. NPAS3 null mice develop pulmonary hypoplasia in utero and die after birth due to respiratory failure. We aimed to evaluate NPAS3 expres- sion during normal and abnormal lung development due to CDH. Methods CDH was induced by administering 100 mg/ml nitrofen to time-pregnant dams on embryonic day (E) 9 of gestation. Lungs were isolated on E15, E18 and E21 and NPAS3 localization was determined by immunohisto- chemistry and quantified using Western blotting. Results We found that only E21 hypoplastic CDH lungs have reduced expression of NPAS3 in the terminal sac- cules. Western blotting confirmed the down-regulation of NPAS3 protein in the nitrofen-induced hypoplastic lungs. Conclusions We demonstrate for the first time that ni- trofen-induced hypoplastic CDH lungs have reduced NPAS3 expression in the terminal saccules during the later stages of abnormal lung development. Our findings suggest that NPAS3 is associated with pulmonary hypoplasia in CDH.

The Portuguese programme ‘one laptop per child’ and its impact on families: a study on parents’ and children’s perspectives

This paper intends to present and reflect upon some of the findings emerging from a research project entitled “Navigating with ‘Magalhães’: Study on the Impact of Digital Media on Schoolchildren” that was conducted at the Communication and Society Research Centre at the University of Minho, Braga, Portugal. The project focused on the politics of the governmental programme “One Laptop per Child” part of the Portuguese Technological Plan for Education, and the uses of the “Magalhães” computer, and other media, by children aged 8-10 years. This paper analyses the impact of this particular public policy on digital literacy of young children based mostly on the perspectives of parents and their modes of mediation. It also debates parents’ and children’s perspectives on parental rules on computer and Internet usage. It ends by concluding that the impact of this programme occurred mainly at the level of access rather than the social and educational uses and practices. It also highlights the importance of family in the way children access and use ICT.

The Portuguese programme one laptop per child: political, educational and social impact

In 2008, the XVII Portuguese Constitutional Government launched the ‘e.escolinha’ programme, within the Technological Plan for Education, which set out the distribution of a computer, called ‘Magalhães’, designed for chil-dren attending the 1st cycle of basic education. Suspended in 2011 by the XIX Government, this programme has allowed, however, almost 500 000 children to have access to a personal computer. It was expected that this political measure would “revolutionise” the national education system by bringing changes to the pedagogical practices of teachers and the learning processes of children and by achieving educational success, in general. Based on documental analysis and on a set of interviews with key decision-makers in conceiving, implementing and monitoring this governmental initiative, the fi rst part of this chapter presents and analyses the ‘e.escolinha’ initiative and the policies be-hind that governmental programme, seeking to disassemble those objectives and provide some insights into the relationship between discourses, rhetoric, and reality. After that, the chapter focuses on children’s uses and practices with the ‘Magalhães’ laptop, at school and at home. Based on the results of questionnaires fi lled in by approximately 1500 children from 32 First Cycle public schools of the municipality of Braga (north of Portugal) and also from questionnaires applied to their parents and teachers, this chapter intends to analyse the real impact of this initiative for children, family and school. It also seeks to discuss the contribution of this educational policy to children’s digital literacy and also to their own and their families’ social and digital inclusion. To understand if it represented an added value to teachers’ pedagogical practice is another of its aims. The fi ndings point out a major focus on technology and access rather than on uses and competences or even on social, educational and cultural change. In fact, a major conclusion is the existence of a strong gap between the policy and the practices, typical of a top-down policy design. This study is an integrant part of a research project titled “Navigating with ‘Magalhães’: Study on the Impact of Digital Media in Schoolchildren” conducted at the University of Minho, Portugal, financed by the Portuguese Foundation for Science and Technology [PTDC/CCI-COM/101381/2008] and co-funded by the European Regional Development Fund [COMPETE: FCOMP-01-0124-FEDER-009056].

Plataforma de apoio à decisão nos cuidados de ginecologia e obstetrícia

Dissertação de mestrado integrado em Engenharia Biomédica (área de especialização em Informática Médica)

A cumulative risk model of child physical maltreatment potential: findings from a community-based study

"Published online before print November 20, 2015"

Childhood history of abuse and child abuse potential: the role of parent’s gender and timing of childhood abuse

It has been suggested that being physically abused leads to someone becoming a perpetrator of abuse which could be associated to parents' gender, timing of the physical abuse and specific socio-demographic variables. This study aims to investigate the role the parents' gender, timing of childhood abuse and socio-demographic variables on the relationship between parents' history of childhood physical abuse and current risk for children. The sample consisted of 920 parents (414 fathers, 506 mothers) from the Portuguese National Representative Study of Psychosocial Context of Child Abuse and Neglect who completed the Childhood History Questionnaire and the Child Abuse Potential Inventory. The results showed that fathers had lower current potential risk of becoming physical abuse perpetrators with their children than mothers although they did not differed in their physical victimization history. Moreover, the risk was higher in parents (both genders) with continuous history of victimization than in parents without victimization. Prediction models showed that for fathers and mothers separately similar socio-demographic variables (family income, number of children at home, employment status and marital status) predicted the potential risk of becoming physical abuses perpetrators. Nevertheless, the timing of victimization was different for fathers (before 13 years old) and mothers (after 13 years old). Then our study targets specific variables (timing of physical abuse, parents' gender and specific socio-demographic variables), which may enable professionals to select groups of parents at greater need of participating in abuse prevention programs.

Parents' physical victimization in childhood and current risk of child maltreatment: the mediator role of psychosomatic symptoms

Objective: To test the potential mediation effect of psychosomatic symptoms on the relationship between parents' history of childhood physical victimization and current risk for child physical maltreatment. Methods: Data from the Portuguese National Representative Study of Psychosocial Context of Child Abuse and Neglect were used. Nine-hundred and twenty-four parents completed the Childhood History Questionnaire, the Psychosomatic Scale of the Brief Symptom Inventory, and the Child Abuse Potential Inventory. Results: Mediation analysis revealed that the total effect of the childhood physical victimization on child maltreatment risk was significant. The results showed that the direct effect from the parents' history of childhood physical victimization to their current maltreatment risk was still significant once parents' psychosomatic symptoms were added to the model, indicating that the increase in psychosomatic symptomatology mediated in part the increase of parents' current child maltreatment risk. Discussion: The mediation analysis showed parents' psychosomatic symptomatology as a causal pathway through which parents' childhood history of physical victimization exerts its effect on increased of child maltreatment risk. Somatization-related alterations in stress and emotional regulation are discussed as potential theoretical explanation of our findings. A cumulative risk perspective is also discussed in order to elucidate about the mechanisms that contribute for the intergenerational continuity of child physical maltreatment.

Fathers’ emotional involvement with the neonate: impact of the umbilical cord cutting experience

Aims. This paper is a report on a study analysing the effect of the umbilical cord cutting experience on fathers’ emotional involvement with their infants. Background. Participation in childbirth offers an opportunity for father and mother to share the childbirth experience, so it is vital that midwives improve the fathers’ participation in this event. Design. A quasi-experimental study with a quantitative methodology was implemented. Methods. One hundred and five fathers were recruited as part of a convenience sample in a Maternity Public Hospital in a Metropolitan City in Portugal, between January and May of 2008. The Bonding Scale, the Portuguese version of the ‘Mother-to-Infant Bonding Scale’ was used to evaluate the fathers’ emotional involvement with the neonate at different moments: before childbirth, first day after childbirth and first month after childbirth. After childbirth, the fathers were divided into three separate groups depending on their umbilical cord cutting experience. Results. The results demonstrate that the emotional involvement between father and child tends to increase during the first days after childbirth and to decrease when evaluated 1 month after birth, for fathers who did not cut the umbilical cord. However, fathers who cut the umbilical cord demonstrate an improvement in emotional involvement 1 month later. Conclusion. Results suggest that the umbilical cord cutting experience benefits the father’s emotional involvement with the neonate, supporting the benefits of his participation and empowerment in childbirth.