Physical activity and pregnancy

SUMMARY : The traditional medical advice for pregnant women has been to reduce their physical activity (PA) levels. The advice was based on concerns that exercise could affect pregnancy outcomes by increasing core body temperature, by increasing the risk of maternal musculoskeletal injury and by altering the transplacental transport of oxygen and nutrients to maternal skeletal muscle rather than to the developing foetus. In the meantime, several studies have provided new information on adaptation of the pregnant woman and her foetus to moderate PA. New investigations have shown no adverse maternal or neonatal outcomes, abnormal foetal growth, increase in early pregnancy loss, or late pregnancy complications. Moreover, enrolment in moderate PA has proven to result in marked health benefits including improved maternal cardiovascular function, reduction of excessive weight gain and fat retention, less complicated labour, improved foetal stress tolerance and neurobehavioral maturation. In view of the beneficial effects, current recommendations encourage healthy pregnant women to engage in 30 minutes of moderate PA on most, if not all, days of the week. This thesis work addressed several questions. Firstly, it examined whether compliance with the recommended levels of PA during pregnancy results in better preparedness for the sudden physical exertion of labour and delivery. Secondly, it measured PA during pregnancy as compared to postpartum. Lastly, it assessed the influence of pre-pregnancy body mass index on gestational resting metabolic rate. Data collection was conducted on healthy women living in Switzerland during the third trimester of pregnancy and postpartum. Total and activity energy expenditure was assessed through 24-hour heart rate and accelerations recordings, and cardiovascular fitness through an individual step-test. Information related to pregnancy, labour and delivery was collected from medical records. The results indicate that a minimum 30 min of moderate PA per day during pregnancy are associated with better cardiovascular fitness and lower risk of operative delivery with no negative effects on maternal and foetal conditions (study 1). Despite these benefits, a substantial proportion of pregnant women (39%) living in Switzerland do not meet the PA recommendations. The decrease in activity related energy expenditure during pregnancy compared to postpartum was measured to be around 100 kcal/day (~13%), whereas the total energy expenditure was found to increase by 300 kcal/day (study 2). Thus, the energy cost of late pregnancy in Switzerland corresponds to 200 kca/day. These findings are based on average values of the study group. It should be noted, however, that large variations in individual energy expenditure may occur depending on the pre-pregnancy body mass index (study 3). When adjusted to body weight, gestational resting metabolic rate is significantly lower among women of high pre-pregnancy body mass index compared to women of normal or low pre-pregnancy body mass index. This can be explained by the fact that resting metabolic rate is primarily a function of fat-free mass, and when expressed per kg body weight, it decreases as the percentage of body fat increases. If energy intake is not modified appropriately in order to match lower energy cost per kg body weight in overweight and obese women it will result in positive energy balance, thus contributing to the current trend towards increasing adiposity in affluent society. The results of these studies go beyond the current state of knowledge on PA and pregnancy (study 4) and provide valid evidence to guide clinical practice. In view of the current epidemic of sedentary behaviour and obesity related pathology, the findings contribute new and reliable information to public health policies regarding the effects of PA in pregnancy, an important period of life for both mother and infant.

Yellow fever impact on brown howler monkeys (Alouatta guariba clamitans) in Argentina: a metamodelling approach based on population viability analysis and epidemiological dynamics

In South America, yellow fever (YF) is an established infectious disease that has been identified outside of its traditional endemic areas, affecting human and nonhuman primate (NHP) populations. In the epidemics that occurred in Argentina between 2007-2009, several outbreaks affecting humans and howler monkeys (Alouatta spp) were reported, highlighting the importance of this disease in the context of conservation medicine and public health policies. Considering the lack of information about YF dynamics in New World NHP, our main goal was to apply modelling tools to better understand YF transmission dynamics among endangered brown howler monkey (Alouatta guariba clamitans) populations in northeastern Argentina. Two complementary modelling tools were used to evaluate brown howler population dynamics in the presence of the disease: Vortex, a stochastic demographic simulation model, and Outbreak, a stochastic disease epidemiology simulation. The baseline model of YF disease epidemiology predicted a very high probability of population decline over the next 100 years. We believe the modelling approach discussed here is a reasonable description of the disease and its effects on the howler monkey population and can be useful to support evidence-based decision-making to guide actions at a regional level.

Trends in socioeconomic inequalities in preventable mortality in urban areas of 33 Spanish cities, 1996-2007 (MEDEA project).

Abstract Background: Preventable mortality is a good indicator of possible problems to be investigated in the primary prevention chain, making it also a useful tool with which to evaluate health policies particularly public health policies. This study describes inequalities in preventable avoidable mortality in relation to socioeconomic status in small urban areas of thirty three Spanish cities, and analyses their evolution over the course of the periods 1996–2001 and 2002–2007. Methods: We analysed census tracts and all deaths occurring in the population residing in these cities from 1996 to 2007 were taken into account. The causes included in the study were lung cancer, cirrhosis, AIDS/HIV, motor vehicle traffic accidents injuries, suicide and homicide. The census tracts were classified into three groups, according their socioeconomic level. To analyse inequalities in mortality risks between the highest and lowest socioeconomic levels and over different periods, for each city and separating by sex, Poisson regression were used. Results: Preventable avoidable mortality made a significant contribution to general mortality (around 7.5%, higher among men), having decreased over time in men (12.7 in 1996–2001 and 10.9 in 2002–2007), though not so clearly among women (3.3% in 1996–2001 and 2.9% in 2002–2007). It has been observed in men that the risks of death are higher in areas of greater deprivation, and that these excesses have not modified over time. The result in women is different and differences in mortality risks by socioeconomic level could not be established in many cities. Conclusions: Preventable mortality decreased between the 1996–2001 and 2002–2007 periods, more markedly in men than in women. There were socioeconomic inequalities in mortality in most cities analysed, associating a higher risk of death with higher levels of deprivation. Inequalities have remained over the two periods analysed. This study makes it possible to identify those areas where excess preventable mortality was associated with more deprived zones. It is in these deprived zones where actions to reduce and monitor health inequalities should be put into place. Primary healthcare may play an important role in this process. Keywords: Preventable avoidable mortality, Causes of death, Inequalities in health, Small area analysis

The Swiss Willensnation at Risk: Teachers in the Cultural Gap during the First World War

As a neutral and multilingual country, Switzerland struggled with major domestic political conflicts during the First World War due to the two cultures of the French-speaking and German-speaking parts of the country. The divided cultural loyalties ('fossé moral', 'Röstigraben'), consisting of Swiss-Germans supporting Germany and Swiss-French supporting France, were discussed intensively in both of the main teachers' journals in Switzerland. Teachers felt the need to react and to promote unity from the beginning of the war. Despite the fact that the cantons are responsible for public education and, therefore, for the education of their students, teachers considered themselves called to educate their students to be national citizens rather than to be members of a language group. This threefold citizenship - communal, cantonal and national - was not scrutinised, but national unity became crucial due to the critical political circumstances. How did teachers promote and constitute citizenship for themselves and for their students in a nation united by free will during the First World War, a time of severe internal political conflicts?

Euromelanoma: a dermatology-led European campaign against nonmelanoma skin cancer and cutaneous melanoma: past, present and future.

Euromelanoma is a dermatologist-led skin cancer prevention programme conducting an annual screening and public education campaign in over 20 European countries. Within its 10-year history, Euromelanoma has screened over 260,000 individuals across Europe, detecting a significant number of cutaneous melanomas and nonmelanoma skin cancers, identifying high-risk individuals for further surveillance and promoting awareness on the suspicious features of melanoma and the hazardous effects of ultraviolet exposure. In this review article, we summarize the history of the Euromelanoma campaign, present its organizational structure and discuss the results of the campaign in individual countries and on a European scale. Euromelanoma has had a significant impact on melanoma prevention and early diagnosis in participating countries and, despite many challenges, has positively influenced public health attitudes towards regular mole examination and the implementation of preventive measures against skin cancer.

Improving the organisation and commercialisation of small coffee and cocoa producers in the Northern Amazon Region of Ecuador

Coffee and cocoa represent the main sources of income for small farmers in the Northern Amazon Region of Ecuador. The provinces of Orellana and Sucumbios, as border areas, have benefited from investments made by many public and private institutions. Many of the projects carried out in the area have been aimed at energising the production of coffee and cocoa, strengthening the producers’ associations and providing commercialisation infrastructure. Improving the quality of life of this population threatened by poverty and high migration flows mainly from Colombia is a significant challenge. This paper presents research highlighting the importance of associative commercialisation to raising income from coffee and cocoa. The research draws on primary information obtained during field work, and from official information from the Ministry of Agriculture. The study presents an overview of current organisational structures, initiatives of associative commercialisation, stockpiling of infrastructure and ownership regimes, as well as estimates for both ‘robusta’ coffee and national cocoa production and income. The analysis of the main constraints presents different alternatives for the implementation of public land policies. These policies are aimed at mitigating the problems associated with the organisational structure of the producers, with processes of commercialisation and with environmental aspects, among others.

Barriers in health care to breast cancer: perception of women

Identifying the barriers in the access to health care to breast cancer perceived by women undergoing chemotherapy.Method: An exploratory descriptive study. The sample consisted of 58 women with breast cancer receiving chemotherapy and registered in the public oncology ambulatory of Aracaju-Sergipe. Data collection was carried out between October 2011 and March 2012 by semistructured interviews, and data were processed using the SPSS, version 17.Results: Among the interviewed women, 37 (63.8%) reported at least a barrier in the trajectory of care for breast cancer. The organizational and health services barriers were the most reported in the periods of investigation and treatment of breast cancer.Conclusion: In face of these findings, the barriers should be considered in public health policies and programs for the control of breast cancer in Sergipe.



A transnacionalização das políticas educativas : itinerários da cooperação portuguesa em Cabo Verde, Guiné-Bissau e S. Tomé e Príncipe (1974-2002)

The main focus of the present investigation is on the transnationalization of the education policies in Cape Verde, Guine-Bissau and San Tome and Prince from 1974 to 2002 and it deals mostly with the role played by the Portuguese co operants in this field, namely teachers, teacher trainers and education technicians. Our investigation is based mostly on the theoretical and empiric analysis of the problematic of the transnatio nalizaton of the education policies, bearing in mind the concepts formulated by several renowned authors like those by Stone(2001, 2004) as well as by Dolowitz and Marsch (2002) concerning the area of knowledge transfer. The concept transnationalization we have used throughout this dissertationshould be interpreted as a carrefour , that is, a crossroad of technical knowledge, resulting from the way the different mediators have shared their expertise and who gradually contributed to the implementation of the new education systems and the consolidation of the education policies of the countries just mentioned before. We have also analyzed specific points of reference connected both with globalization and organization sociology theories since the school is the main scope of action where the participants interact using diversified strategies due to their different interests and aims. Those schools are more and more confronted with education policies resulting from neoliberal assumptions therefore we label them terminals of the education policy journeys. The naturalist paradigm, which includes a qualitative and interpretative approach, answers for the design of this investigation, whose main strategy is the Oral History. The primary sources analyzed and the interviews made have enabled us to build our knowledge based on the grounded theory method (Glasser and Strauss, 1967), supported by the informatic programme Atlas TI. We conclude that despite the weaknesses and fragilities of the Portuguese cooperation, this is the right arena for a more convergent transference of values and education (al) systems; it is a kind of hybrid territory where the knowledge transfer suits the local reality, independently of all the dilemmas resulting from globalization.

Aspectes econòmics de l'evolució del sistema públic d'ensenyament superior a Catalunya, 1985-1992

L'educació superior espanyola ha sofert un procés d'expansió generalitzat a partir de la segona meitat de la decada deis vuitanta. Malgrat aixo, aquesta expansió no pot ser analitzada conjuntament, ates que durant el mateix període es fan efectives les transferencies de competencies en materia d'educació a set comunitats autonomes que comencen a dur a terme polítiques universitaries no sempre concurrents. En aquest article abordarem el model catala d'expansió úniversitaria i el seu finançament, fent emfasi en els problemes derivats dé l'expansió i les seves possibles solucions. Per fer-ho, utilitzarem la següent estructura: en primer lloc, en l'apartat 2 es descriuen els elements basics del procés d'expansió (especialment la creació de les cinc noves universitats) i la situació resultant tal i com es presenta en l'actualitat. Sense aquestes descripcibns no cobrarien sentit les analisis més específiques sobre el finançament, que es presenten en els apartats 3 i 4.

09028-014 Tributary B to Fourmile Creek Final Report

The city of Ankeny is submitting this WIRB application for development of green urban stormwater practices on city and private property in the Fourmile Creek watershed. The stormwater project proposed includes stream restoration of the SE Tributary to Fourmile Creek (Tributary B), including weirs, bank shaping, toe protection, trees, and native plantings. The project also includes the creation of a native buffer along the stream channel in the city’s Summerbrook Park, installing four native planting beds, installing a pervious surface trail, installing a series of rain gardens/biorentention cells, and installing educational signage. Polk County Soil and Water Conservation District has committed $17,000 towards the native buffer and rain garden/biorentention cell. The city of Ankeny was also awarded a $100,000 I-JOBS grant from IDNR to complete the stormwater retrofit practices. The largest component of this project is public education. Our vision for this project is to take the entire 281 acre watershed and address it as a whole. We want to make a collaborative watershed that not only addresses the water entering the stream channel through adjacent properties, but takes each individual parcel within the watershed and strives to reduce contributions to the stormwater system. The stormwater issues of concern for Tributary B include stormwater volume, sediment, and nutrients. The stream restoration, best management practices (BMP) at Summerbrook Park, and BMPs on private property should help decrease the volume of stormwater and reduce the amount of sediment and nutrients that enter Tributary B and ultimately Fourmile Creek.

Young innovative firms and R&D strategies: is the Spanish case different?

This paper analyzes the profile of Spanish young innovative companies (YICs) and the determinants of innovation and imitation strategies. The results for an extensive sample of 2,221 Spanish firms studied during the period 2004–2010 show that YICs are found in all sectors, although they are more concentrated in high-tech sectors and, in particular, in knowledge-intensive services (KIS). Three of every four YICs are involved in KIS. Our results highlight that financial and knowledge barriers have much impact on the capacity of young, small firms to innovate and to become YICs, whereas market barriers are not obstacles to becoming a YIC. Public funding, in particular from the European Union, makes it easier for a new firm to become a YIC. In addition, YICs are more likely to innovate than mature firms, although they are more susceptible to sectoral and territorial factors. YICs make more dynamic use of innovation and imitation strategies when they operate in high-tech industries and are based in science parks located close to universities. Keywords: innovation strategies, public innovation policies, barriers to innovation, multinomial probit model. JEL Codes: D01, D22 , L60, L80, O31

Rehabilitación del Parque Recreativo Cariari : propuesta de actividades de educación ambiental

El proyecto de rehabilitación del "Parque Recreativo Cariari" se enmarca en el proyecto más amplio "Proyecto Limón Ciudad Puerto". Se ubica en la zona más desfavorecida de Costa Rica, a nivel social y de infraestructuras. Nuestra labor en el proyecto de rehabilitación, se centra en la preparación de la propuesta de actividades de educación ambiental, aprovechando los recursos biológicos y geológicos del parque, así como las infraestructuras que incluirá una vez rehabilitado. Para la realización del proyecto fue necesaria una gran revisión bibliográfica, una serie de encuestas y reuniones con escuelas, profesores y la responsable del Ministerio de Educación Pública en la región. También se contactó con personal especializado con materias claves para los talleres. Además se acordó con universidades nacionales la realización de prácticas de sus estudiantes de los sectores de turismo ecológico y administración. Así, el resultado, son los 18 talleres, y la preparación de un hormiguero y un mariposario abierto, que se implementarán durante la rehabilitación del parque. De llevarse a cabo correctamente, se espera que transmitan a sus participantes la importancia ambiental de la zona, implicándolos en la conservación de esta. A nivel general, se espera que el parque sea vía de escape y ayude al progreso social y mejora de la calidad de vida de Limón.

05028-010 Urban Watershed of Dickinson Cty Lakes Final Report

The Dickinson SWCD is applying for $486,800 over three years from the Watershed Improvement Fund to enhance water quality in Dickinson County through an impairment-based, locally directed watershed improvement project dealing specifically with storm water runoff. The LID Project will provide a cost share incentive and technical expertise to individual and business owners in specially targeted districts who are willing to implement low impact development techniques such as rain gardens, bioswales, pervious paving to reduce storm water runoff from their properties. Goals for the project include: 1) Defining and prioritizing urban watersheds in the Iowa Great Lakes region for implementation of Low Impact Development Practices; 2) Providing technical expertise in the form of a graduate assistant/project manager to design and oversee construction; 3) Continuing public education of such practices and their local existence through project kiosk, brochures, County Naturalist programs, local cable television shows, tours and other interactions of the Clean Water Alliance with its 50 partners in the area concerned about water quality; and 4) Completing 125 separate projects over a three year period.

1240-017 Little Bear Creek Watershed Final Report

Little Bear Creek is a 21.79 mile Class A1 and B (WW2) warm water stream that encompasses approximately 29,202 acres in northern Poweshiek County. The lower 8.4 mile segment is listed as biologically impaired on both the IDNR 2008 303(d) list and 2010 303(d) draft list. A RASCAL assessment and landowner survey was completed through a development grant in 2011, and these assessments indicate that erosion and sediment delivery from cropland, lack of adequate buffers along the stream channel, and streambank conditions contribute significant sediment delivery to the stream, likely resulting in the impairment. An estimated 36,544 tons of sediment are delivered to the stream annually. A total of 11,075 acres (38%) of the watershed are high priority areas or land with sediment delivery rates greater than one. Our goal over 15 years is to install Best Management Practices (BMPs) and increase public education in order to reduce sediment and phosphorus delivery by 25% and decrease priority areas by 15%. More specific objectives for this WIRB project are to 1) Reduce annual sediment delivery by roughly 16.3% or 1,058 tons and associated phosphorus delivery by 1,375 pounds and 2) Develop an information and education program aimed at producers and residents within the headwaters of Grant and Chester townships, which account for 18% of the watershed's priority areas. The SWCD proposes to utilize 50% EQIP funds and 25% WIRB funds toward rural BMPs, and 75% WIRB funds toward urban BMPs received through this application.

Profile, cost and pattern of prescriptions for polymedicated patients in Catalonia (Spain).

OBJECTIVES: Polypharmacy is one of the main management issues in public health policies because of its financial impact and the increasing number of people involved. The polymedicated population according to their demographic and therapeutic profile and the cost for the public healthcare system were characterised. DESIGN: Cross-sectional study. SETTING: Primary healthcare in Barcelona Health Region, Catalonia, Spain (5 105 551 inhabitants registered). PARTICIPANTS: All insured polymedicated patients. Polymedicated patients were those with a consumption of ≥16 drugs/month. MAIN OUTCOMES MEASURES: The study variables were related to age, gender and medication intake obtained from the 2008 census and records of prescriptions dispensed in pharmacies and charged to the public health system. RESULTS: There were 36 880 polymedicated patients (women: 64.2%; average age: 74.5±10.9 years). The total number of prescriptions billed in 2008 was 2 266 830 (2 272 920 total package units). The most polymedicated group (up to 40% of the total prescriptions) was patients between 75 and 84 years old. The average number of prescriptions billed monthly per patient was 32±2, with an average cost of 452.7±27.5. The total cost of those prescriptions corresponded to 2% of the drug expenditure in Catalonia. The groups N, C, A, R and M represented 71.4% of the total number of drug package units dispensed to polymedicated patients. Great variability was found between the medication profiles of men and women, and between age groups; greater discrepancies were found in paediatric patients (5-14 years) and the elderly (≥65 years). CONCLUSIONS: This study provides essential information to take steps towards rational drug use and a structured approach in the polymedicated population in primary healthcare.