Glargine vs. NPH insulin therapy in pregnancies complicated by diabetes: An observational cohort study

Aims: The effects of glargine insulin therapy in pregnancies are not well established. We compared maternal and neonatal outcomes of women with pregestational and gestational diabetes treated with glargine or NPH insulin.Methods: A prospective cohort study was conducted analyzing outcomes from 56 women with pregestational and 82 with gestational diabetes treated with either insulin regimen.Results: Comparisons were performed among 138 women: 56 with pregestational and 82 with gestational diabetes. In relation to maternal complications, worsening of retinopathy and nephropathy, preeclampsia, micro and macroalbuminuria, and all kinds of hypoglycemia were found higher in women with pregestational diabetes NPH-treated vs. glargine-treated. In women with gestational diabetes NPH-treated, it was observed increased incidence of prepregnancy and new-onset pregnancy hypertension, micro and macroalbuminuria, as well as mild and frequent hypoglycemia, compared to glargine-treated. Among the neonatal outcomes, 1-min Apgar score <7, necessity of intensive care unit and fetal death in pregestational, while jaundice and congenital malformations in gestational diabetes, respectively, were more frequently observed in infants born to NPH-treated, compared to glargine-treated.Conclusions: Glargine use during pregnancy from preconception through delivery, showed to be safe since it is associated with decreased maternal and neonatal adverse outcomes compared with NPH insulin-treated patients. (C) 2010 Elsevier B.V. All rights reserved.

Oral cleft prevention program (OCPP)

Background: Oral clefts are one of the most common birth defects with significant medical, psychosocial, and economic ramifications. Oral clefts have a complex etiology with genetic and environmental risk factors. There are suggestive results for decreased risks of cleft occurrence and recurrence with folic acid supplements taken at preconception and during pregnancy with a stronger evidence for higher than lower doses in preventing recurrence. Yet previous studies have suffered from considerable design limitations particularly non-randomization into treatment. There is also well-documented effectiveness for folic acid in preventing neural tube defect occurrence at 0.4 mg and recurrence with 4 mg. Given the substantial burden of clefting on the individual and the family and the supportive data for the effectiveness of folic acid supplementation as well as its low cost, a randomized clinical trial of the effectiveness of high versus low dose folic acid for prevention of cleft recurrence is warranted.Methods/design: This study will assess the effect of 4 mg and 0.4 mg doses of folic acid, taken on a daily basis during preconception and up to 3 months of pregnancy by women who are at risk of having a child with nonsyndromic cleft lip with/without palate (NSCL/P), on the recurrence of NSCL/P. The total sample will include about 6,000 women (that either have NSCL/P or that have at least one child with NSCL/P) randomly assigned to the 4 mg and the 0.4 mg folic acid study groups. The study will also compare the recurrence rates of NSCL/P in the total sample of subjects, as well as the two study groups (4mg, 0.4 mg) to that of a historical control group. The study has been approved by IRBs (ethics committees) of all involved sites. Results will be disseminated through publications and presentations at scientific meetings.Discussion: The costs related to oral clefts are high, including long term psychological and socio-economic effects. This study provides an opportunity for huge savings in not only money but the overall quality of life. This may help establish more specific clinical guidelines for oral cleft prevention so that the intervention can be better tailored for at-risk women.

Tecendo destinos: a inserção de imigrantes alemães e seus descendentes na Colônia Riograndense

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Um estudo sobre intelectuais negros na academia entre 1970 e 1990: trajetória acadêmica de Florentina Silva Souza

Este estudo, a partir da descrição da trajetória acadêmica da professora Florentina da Silva Souza, apresenta como se deu a entrada dos pesquisadores negros na universidade nos cursos de Pós-Graduação. Buscou-se a partir da trajetória da pesquisadora compreender como os estudos desenvolvidos por intelectuais negros repercutem na luta contra a discriminação racial no Brasil, identificando algumas dificuldades encontradas pelos negros no espaço acadêmico ao trazer a questão racial como objeto central de suas análises. O recorte temporal da pesquisa centra-se no final da década de 1970 e as décadas de 1980 e 1990, período em que o Brasil entra em um processo de redemocratização, posterior a ditadura militar, momento em que o movimento negro se reorganizou e desenvolveu-se pressionando o governo para que a questão racial passasse a fazer parte da agenda política. Para descrever a trajetória acadêmica da professora Florentina da Silva Souza foi utilizado como aporte teórico às noções conceituais de Bourdieu (2008, 2009) mais especificamente habitus, campo e capital cultural, a fim de compreender as escolhas que direcionaram a vida da pesquisadora em termos profissionais. Como aporte metodológico, utilizou-se a Biografia e Contexto, desenvolvida por Giovanni Levi (2006), que ocorre quando se relaciona as particularidades da biografia e destaca-se a época, o meio ambiente, fatores capazes de justificar as atitudes de Florentina durante a trajetória como pesquisadora. Em síntese, constatou-se com este estudo que a experiência profissional de Florentina soma-se a de muitos negros de sua época e da atualidade que, apesar de ter ascendido socialmente e ingressado na universidade como professora pesquisadora, não a livrou de sofrer preconceitos, pois o lugar de subalternidade a que os negros foram submetidos, como demonstrado nas argumentações desta pesquisa, foi construído historicamente por meio de teorias que os colocavam como “seres inferiores”. Apesar de terem sido desqualificadas, essas teorias ainda persistem no imaginário social, trazendo como consequência o preconceito e a discriminação que se manifestaram nas diversas instâncias sociais do país.

Configuração do mesossistema entre professores e pais de alunos com deficiência

A relação entre a família e a escola tem sido vista como alicerce fundamental para o bom desempenho escolar, e desenvolvimento dos alunos. O presente estudo apresenta dados de uma pesquisa voltada para análise das relações estabelecidas entre as professoras e os pais de crianças com necessidades especiais que estão matriculadas em uma escola pública da rede municipal de Belém do Pará. Para tal, foram entrevistadas quatro responsáveis e quatro professoras dos respectivos alunos, sendo realizados, posteriormente, grupos focais diferentes para pais e professores. Os dados foram analisados qualitativamente, buscando-se investigar a relação em função de três variáveis específicas: o conteúdo, a qualidade e a freqüência dessa relação. Tais variáveis podem ser compreendidas quanto às atividades que os pais fazem junto com a escola, de que maneira realizam tais atividades e com que freqüências o fazem. A análise dos resultados mostrou que a participação familiar na realidade escolar ainda se encontra bastante distante do que poderia ser considerado o ideal, principalmente, quando se trata de inclusão escolar de crianças deficientes, apesar de estar contido no projeto político-pedagógico da escola que é papel da mesma, incentivar a participação da comunidade. Os dados também revelaram que os pais vão pouco à escola, limitandose somente a levar e buscar os alunos e que raramente conversam com as professoras sobre outros assuntos, ficando as trocas verbais predominantemente referentes a algum problema que o aluno tenha apresentado em sala de aula. Apesar dos resultados mostrarem uma realidade amplamente negativa, tanto as professoras quanto os responsáveis acreditam que deve haver participação contínua da família na escola, porém ambos não desenvolvem atividades que propiciem tal aproximação. Em apenas um dos casos, uma professora mostrou desenvolver atividades que trazem a família mais para perto do cotidiano escolar das crianças. Especificamente em relação aos pais de alunos com deficiências, a situação mostra-se bastante parecida aos pais de crianças ditas “normais”, porém além do distanciamento natural, ainda há barreiras atitudinais de preconceito e discriminação para com os alunos deficientes, o que reflete conseqüentemente na relação com estas famílias.

Maternal immunization with ovalbumin prevents neonatal allergy development and up-regulates inhibitory receptor FcγRIIB expression on B cells

Abstract Background Preconception allergen immunization prevents neonatal allergen sensitization in mice by a complex interaction between regulatory cells/factors and antibodies. The present study assessed the influence of maternal immunization with ovalbumin (OVA) on the immune response of 3 day-old and 3 week-old offspring immunized or non-immunized with OVA and evaluated the effect of IgG treatment during fetal development or neonatal period. Results Maternal immunization with OVA showed increased levels of FcγRIIb expression in splenic B cells of neonates, which were maintained for up to 3 weeks and not affected by additional postnatal OVA immunization. Maternal immunization also exerted a down-modulatory effect on both IL-4 and IFN-γ-secreting T cells and IL-4 and IL-12- secreting B cells. Furthermore, immunized neonates from immunized mothers showed a marked inhibition of antigen-specifc IgE Ab production and lowered Th2/Th1 cytokine levels, whereas displaying enhanced FcγRIIb expression on B cells. These offspring also showed reduced antigen-specific proliferative response and lowered B cell responsiveness. Moreover, in vitro evaluation revealed an impairment of B cell activation upon engagement of B cell antigen receptor by IgG from OVA-immunized mice. Finally, in vivo IgG transference during pregnancy or breastfeeding revealed that maternal Ab transference was able to increase regulatory cytokines, such as IL-10, in the prenatal stage; yet only the postnatal treatment prevented neonatal sensitization. None of the IgG treatments induced immunological changes in the offspring, as it was observed for those from OVA-immunized mothers. Conclusion Maternal immunization upregulates the inhibitory FcγRIIb expression on offspring B cells, avoiding skewed Th2 response and development of allergy. These findings contribute to the advancement of prophylactic strategies to prevent allergic diseases in early life.

Oral cleft prevention program (OCPP)

Background Oral clefts are one of the most common birth defects with significant medical, psychosocial, and economic ramifications. Oral clefts have a complex etiology with genetic and environmental risk factors. There are suggestive results for decreased risks of cleft occurrence and recurrence with folic acid supplements taken at preconception and during pregnancy with a stronger evidence for higher than lower doses in preventing recurrence. Yet previous studies have suffered from considerable design limitations particularly non-randomization into treatment. There is also well-documented effectiveness for folic acid in preventing neural tube defect occurrence at 0.4 mg and recurrence with 4 mg. Given the substantial burden of clefting on the individual and the family and the supportive data for the effectiveness of folic acid supplementation as well as its low cost, a randomized clinical trial of the effectiveness of high versus low dose folic acid for prevention of cleft recurrence is warranted. Methods/design This study will assess the effect of 4 mg and 0.4 mg doses of folic acid, taken on a daily basis during preconception and up to 3 months of pregnancy by women who are at risk of having a child with nonsyndromic cleft lip with/without palate (NSCL/P), on the recurrence of NSCL/P. The total sample will include about 6,000 women (that either have NSCL/P or that have at least one child with NSCL/P) randomly assigned to the 4 mg and the 0.4 mg folic acid study groups. The study will also compare the recurrence rates of NSCL/P in the total sample of subjects, as well as the two study groups (4mg, 0.4 mg) to that of a historical control group. The study has been approved by IRBs (ethics committees) of all involved sites. Results will be disseminated through publications and presentations at scientific meetings. Discussion The costs related to oral clefts are high, including long term psychological and socio-economic effects. This study provides an opportunity for huge savings in not only money but the overall quality of life. This may help establish more specific clinical guidelines for oral cleft prevention so that the intervention can be better tailored for at-risk women. ClinicalTrials.gov Identifier NCT00397917

The Repairing of Misconceptions through the Use of Inquiry-Based Activities

Misconceptions exist in all fields of learning and develop through a person’s preconception of how the world works. Students with misconceptions in chemical engineering are not capable of correctly transferring knowledge to a new situation and will likely arrive at an incorrect solution. The purpose of this thesis was to repair misconceptions in thermodynamics by using inquiry-based activities. Inquiry-based learning is a method of teaching that involves hands-on learning and self-discovery. Previous work has shown inquiry-based methods result in better conceptual understanding by students relative to traditional lectures. The thermodynamics activities were designed to guide students towards the correct conceptual understanding through observing a preconception fail to hold up through an experiment or simulation. The developed activities focus on the following topics in thermodynamics: “internal energy versus enthalpy”, “equilibrium versus steady state”, and “entropy”. For each topic, two activities were designed to clarify the concept and assure it was properly grasped. Each activity was coupled with an instructions packet containing experimental procedure as well as pre- and post-analysis questions, which were used to analyze the effect of the activities on the students’ responses. Concept inventories were used to monitor students’ conceptual understanding at the beginning and end of the semester. The results did not show a statistically significant increase in the overall concept inventory scores for students who performed the activities compared to traditional learning. There was a statistically significant increase in concept area scores for “internal energy versus enthalpy” and “equilibrium versus steady state”. Although there was not a significant increase in concept inventory scores for “entropy”, written analyses showed most students’ misconceptions were repaired. Students transferred knowledge effectively and retained most of the information in the concept areas of “internal energy versus enthalpy” and “equilibrium versus steady state”.

A constellation of factors associated with premature births among African American women

A cohort, cross-sectional, historical study design was used to study factors related to spontaneous premature birth outcomes among African American women. The cohort consisted of 4,294 mothers drawn from the 1988 National Maternal and Infant Health Survey conducted by the National Center for Health Statistics. The objectives of the study were: (1) to examine the distribution of gestational ages of African American infants for selected variables reported for their families and (2) to describe risk factors associated with birth at 20–31 weeks of gestational age and at 32–36 weeks of gestational age. Risk factors examined include maternal age, maternal marital status, maternal living arrangements, maternal education, maternal work status, household income, gestational bleeding, month prenatal began, adequacy of prenatal care, parity, previous viable preterm birth, and behavioral factors of attitude toward pregnancy, smoking, drug, and alcohol use during pregnancy. Frequency distributions, cross tabulations, stratified analysis, and logistic regression analysis were used. ^ Risk factors associated with a 50 percent or more increase in preterm birth were cocaine use, low maternal education, teenaged mother, prenatal care deficits or overuse, and bleeding during the second half of pregnancy. The other risk factors of not living with the baby's father, smoking cigarettes and having a mistimed pregnancy carried statistically significance but lower strength of association. ^ Health care services, educational systems, and community organizations can develop and evaluate comprehensive health education and information campaigns that address preventable risk factors during pregnancy. Although preterm birth cannot always be prevented, preconception care can help identify and modify maternal risk and promote optimum health before conception. Quality care should include continued risk assessment, health promotion, and interventions. ^

Pre-pregnancy obesity on the border and pregnancy complications: A secondary analysis comparing post-natal adult women in Matamoros, Mexico and Cameron County, Texas

Obesity during pregnancy is a serious health concern which has been associated with many adverse health outcomes for both the mother and the infant. In addition, data on the prevalence of obesity and its effects on pregnant women living in the border region are limited. This goal of this study was to examine the prevalence of preconception obesity among women living on each side of the Brownsville-Matamoros border who have just given birth, the relationship between obesity and pregnancy complications for the total population, and these associations by location. Study participants were drawn from a sample (n=947) from the Brownsville-Matamoros Sister City Project which included women from 10 border region hospitals (6 in Matamoros, 4 in Cameron County) who were recruited based on hospital log records indicating they had given birth to a live infant. De-identified data from verbal questionnaires administered within twenty-four hours after birth were analyzed to determine prevalence of preconception obesity on both sides of the border, and associated pregnancy outcomes for women residing in the United States and those in Mexico. Participants with missing height or weight data were excluded from analyses in this study, resulting in a final sample of 727 women. Significant associations were found between pre-pregnancy obesity and adverse pregnancy outcomes (OR=1.85, CI=1.30–2.64), hypertensive conditions (OR=2.76, CI=1.72–4.43), and macrosomia (OR=6.77, CI=1.13–40.57) using the total sample. Comparisons between the United States and Mexico sides of the border showed differences; associations between preconception obesity and adverse pregnancy outcomes were marginally significant among women in the United States (p=0.05), but failed to reach significance within this group for each individual complication. However, significant associations were found between obesity and preeclampsia (OR=3.61, CI=2.14–6.10), as well as obesity and the presence of one or more adverse pregnancy outcome (OR=2.29, CI=1.30–4.02), among women in Mexico. The results from this analysis provide new information specific to women on the Texas and Mexico border, a region that had not previously been studied. These significant associations between preconception obesity and adverse birth outcomes indicate that efforts to prevent obesity should focus on women of childbearing age, especially in Mexico.^

Religion and polygamy : evidence from the livingstonia mission in Malawi

In contrast to the prevailing preconception, Christian females engage in polygyny in most of sub-Saharan Africa. Based on individual-level data provided by the Demographic and Health Survey (2000, 2004, 2010) in Malawi, this study explores whether Christian identity reduces the likelihood that females enter into polygyny. To address the endogeneity associated with this identity, the analysis adopts an instrumental variable (IV) approach by exploiting the unique setting of a Christian mission dating back to the late 19th century. Exposure to the mission, measured by geographical distance to the influential mission station, Livingstonia, enabled the indigenous population to gradually convert to Christianity. This is particularly true for the local population not belonging to the Yao, an ethnic group that was largely proselytized into Islam because of their historical connection with the Arabs. Using the distance-ethnicity (non-Yao) interaction as an IV for women's Christian identity, with numerous historical, geographic, and climate controls, this study discovers that compared to those practicing other religions (Islam and other) or no religion, Christian females are indeed less likely to form polygynous unions. This study also provides some evidence suggesting that the Christianity effects are more evident in a society at a more primitive stage of development.

Becoming pregnant: exploring the perspectives of women living with diabetes

Background The risk of adverse pregnancy outcome for women with type 1 diabetes is reduced through tight diabetes control. Most women enter pregnancy with inadequate blood glucose control. Interview studies with women suggest the concept of ‘planned’ and ‘unplanned’ pregnancies is unhelpful. Aim To explore women's accounts of their journeys to becoming pregnant while living with type 1 diabetes. Design of study Semi-structured interviews with 15 women living with pre-gestational type 1 diabetes, between 20 and 30 weeks gestation and with a normal pregnancy ultrasound scan. Setting Four UK specialist diabetes antenatal clinics. Method Interviews explored women's journeys to becoming pregnant and the impact of health care. Analysis involved comparison of women's accounts of each pregnancy and a thematic analysis. Results Women's experiences of becoming pregnant were diverse. Of the 40 pregnancies described, at least one positive step towards becoming pregnant was taken by 11 women in 23 pregnancies but not in the remaining 17 pregnancies, with variation between pregnancies. Prior to and in early pregnancy, some women described themselves as experts in their diabetes but most described seeking and/or receiving advice from their usual health professionals. Three women described pre-conception counselling and the anxiety this provoked. Conclusion For women living with type 1 diabetes each pregnancy is different. The concept of planned and unplanned pregnancy is unhelpful for designing health care. Formal preconception counselling can have unintended consequences. Those providing usual care to women are well positioned to provide advice and support to women about becoming pregnant, tailoring it to the changing needs and situation of each woman.

Pregnancy loss in lesbian and bisexual women: An online survey of experiences

Background: Although pregnancy loss is a distressing health event for many women, research typically equates women’s experiences of pregnancy loss to ‘married heterosexual women’s experiences of pregnancy loss’. The objective of this study was to explore lesbian and bisexual women’s experiences of miscarriage, stillbirth and neonatal death. Methods: This study analysed predominantly qualitative online survey data from 60 non-heterosexual, mostly lesbian, women from the UK, USA, Canada and Australia. All but one of the pregnancies was planned. Most respondents had physically experienced one early miscarriage during their first pregnancy, although a third had experienced multiple losses. Results: The analysis highlights three themes: processes and practices for conception; amplification of loss; and health care and heterosexism. Of the respondents, 84% conceived using donor sperm; most used various resources to plan conception and engaged in preconception health care. The experience of loss was amplified due to contextual factors and the investment respondents reported making in impending motherhood. Most felt that their loss(es) had made a ‘significant’/‘very significant’ impact on their lives. Many respondents experienced health care during their loss. Although the majority rated the overall standard of care as ‘good’/‘very good’/‘outstanding’, a minority reported experiencing heterosexism from health professionals. Conclusions: The implications for policy and practice are outlined. The main limitation was that the inflexibility of the methodology did not allow the specificities of women’s experiences to be probed further. It is suggested that both coupled and single non-heterosexual women should be made more visible in reproductive health and pregnancy loss research.

Paternal low protein diet affects adult offspring cardiovascular and metabolic function in mice

Although the association between maternal periconceptional diet and adult offspring health is well characterised, our understanding of the impact of paternal nutrition at the time of conception on offspring phenotype remains poorly defined. Therefore, we determined the effect of a paternal preconception low protein diet (LPD on adult offspring cardiovascular and metabolic health in mice. Male C57BL/6 mice were fed either normal protein diet (NPD; 18% casein or LPD (9% casein for 7 wk before mating. At birth, a reduced male-to-female ratio (P = 0.03 and increased male offspring weight (P = 0.009 were observed in litters from LPD compared with NPD stud males with no differences in mean litter size. LPD offspring were heavier than NPD offspring at 2 and 3 wk of age (P <0.02. However, no subsequent differences in body weight were observed. Adult male offspring derived from LPD studs developed relative hypotension (decreased by 9.2 mmHg and elevated heart rate (P <0.05, whereas both male and female offspring displayed vascular dysfunction and impaired glucose tolerance relative to NPD offspring. At cull (24 wk, LPD males had elevated adiposity (P = 0.04, reduced heart-to-body weight ratio (P = 0.04, and elevated circulating TNF-α levels (P = 0.015 compared with NPD males. Transcript expression in offspring heart and liver tissue was reduced for genes involved in calcium signaling (Adcy, Plcb, Prkcb and metabolism (Fto in LPD offspring (P <0.03. These novel data reveal the impact of suboptimal paternal nutrition on adult offspring cardiovascular and metabolic homeostasis, and provide some insight into the underlying regulatory mechanisms.

Pre-conception care for women with diabetes: A public health issue

Pre-conception care is recognised to be an effective strategy for addressing many health behaviours, particularly for women with diabetes, who carry a higher risk of morbidity and mortality. However, there is a lack of evidence of the most effective approaches for promoting pre-conception health and encouraging women to access services. This article explores this challenging issue and suggests a number of strategies that health professionals may consider in relation to promoting health in this area.