Increased MMA concentration and body mass index are associated with spontaneous abortion in Brazilian women A pilot study

Background: The pathophysiology of spontaneous abortion is complex and may involve the interaction of genetic and environmental factors. We evaluated the predictors of spontaneous abortion in Brazilian pregnant women. The effects of age, gestational age. body mass index (BMI), cigarette smoking, alcohol ingestion, use of multivitamins and concentrations of vitamins (folate, cobalamin and vitamin 136) and vitamin-dependent metabolites were analyzed. Methods: Study population included 100 healthy women that attended pre-natal care in 2 health centers of Sao Paulo, Brazil, and in whom pregnancy outcome was known. Folate and cobalamin status was measured in blood specimens collected between 4 and 16 weeks. The genotypes for 8 gene polymorphisms were evaluated by PCR-RFLP. Results: Eighty-eight women had normal pregnancy outcome (Group 1), while 12 experienced a miscarriage after blood collection (Group 2). Increased methylmalonic acid (MMA) concentrations were found in Group 2 (median [25th-75th percentile]=274 [149-425] nmol/l) relative to Group 1 (138 [98-185]) (P<0.01). No differences between the groups were observed for serum cobalamin, serum or red cell folate, and serum total homocysteine or allele frequencies for 8 polymorphisms. In a conditional logistic regression analysis including age, gestational age, serum creatinine, MMA, cystathionine, body mass index (BMI), cigarette smoking, alcohol ingestion and use of multivitamins the risk of abortion was significantly associated with MMA (OR [95% CI] = 3.80 [1.36, 10.62] per quartile increase in MMA), BMI (OR [95% CI] = 5.49 [1.29,23.39] per quartile) and gestational age (OR [95% CI] = 0.10 [0.01, 0.77] per increase of interval in gestational age). Conclusions: Increased serum MMA and BMI concentrations are associated with spontaneous abortion in Brazilian women. (C) 2009 Elsevier B.V. All rights reserved.

A experiência da pré-eclâmpsia vivenciada por gestantes e profissionais de saúde

The aim of this study is to understand the perceptions of pregnant women, mothers and health professional about preeclampsia and the relation between professional and patient. A qualitative approach was chosen, together with semi-structured interviews, participative observation and Test of Free Association of Words (TFAW). The data were collected in February and June 2007 at Maternidade-Escola Januário Cicco (MEJC), Natal, RN, Brazil with 61 pregnant women and 87 professionals, 20 of each group were interviewed. An interpretative and understanding perspective was used similar to that of Gadamer s hermeneutics and with the construction of themes and empirical categories. The pregnant women showed fear preeclampsia and its consequences, and to know very little about the subject and also a desire to know more. The changes that occurred with the illness were more related to the emotional order than to the healthy lifestyle they have adopted. Some lack of preparation of the basic units was observed, in order to meet and guide the pregnant women to the reference unit. Professionals knew the customers characteristics, about their fear and about their little knowledge on this illness. Nevertheless, they did not include them in the treatment. It was observed the absence of conversation over the illness between professionals and patients and also the inability of the former to deal with emotional issues. A new way of looking into the preeclampsia assistance is necessary. A way that focuses on the collective construction of intervention and approach strategies; one which includes subjective aspects in an hermeneutic perspective of health

Atuação do enfermeiro na rede básica de saúde frente a gestante com infecção do trato urinário

The Urinary Tract Infection (UTI) in pregnancy is important as a consequence of the high incidence during the gestation. It is the third most common clinical complication in pregnancy affecting 10-12% of women whether prevalence is increasing in the first trimester of pregnancy, it may also contribute to maternal and infant mortality. Due the relevance for the results of obstetric and neonatal complications from UTI, these complications must be prevented, because it can lead to health hazards to pregnant women and newborns, producing a direct effect on morbidity and perinatal mortality. On this basis, it was defined as objectives of this research the identification of the profile of nurses from the Family Health Strategy (FHS) in the East and West Health Districts from the city of Natal / RN before the women with UTI and to verify the nurse performance during prenatal consultations. This is an exploratory study with a quantitative approach using a sample of 40 nurses active workers during this survey, it was approved by the Research Ethics Committee of the Universidade Federal do Rio Grande do Norte Protocol n0 232/10 P-CEP/UFRN and opinion n0 080/2011. The tool for data collection was a structured interview. The data collected were organized into an electronic database application Microsoft ® Excel 2007, exported and analyzed using the Statistical Package for Social Sciences (SPSS) version 17.0, and coded, tabulated and presented through tables and charts into their respective percentage distributions, using the descriptive and inferential statistical analysis, chi-square test and significance level of 5% (distribution in relative and absolute frequencies) in the independent variables. Therefore, it was observed from these results that the longer action of nurses in the FHS from the East and Weast health districts of the city of Natal/RN contributed to the development of a greater number of activities to control the incidence of UTI in women who are attended in the prenatal care service, proven by significance in statistics

Estudo longitudinal de fatores relacionados à cárie dentária e oclusopatias na infância

Pós-graduação em Odontologia - FOA

Educação em saúde para atenção à gestante: paralelo de experiências entre Brasil e Portugal

Care practices have raised some questions concerning the attention given to women, specifically when it comes to issues of extreme importance in Public Health's approach of pre-natal care. The present study intends to discuss the scope and challenges of the integral care in maternal health, taking into consideration the experiences of one of the authors in the health scenarios from both Brazil and Portugal. A comparative analysis was conducted on the format of the pre-natal classes offered to groups of pregnant women, a frequent practice of Primary Care in both countries. The method of participant observation of two groups of pregnant women, one in each country was used. The organization of each group is presented and evaluated regarding its methodological and practical settings. The analysis of the experiences indicates that both groups can be considered as informative or educative, since the chosen methodology and structure was formed by lectures with predefined themes; there was reduced reflection and empowerment possibilities, due to the fragmented presentation form, and this could also mean diminished reflection on the changes of the feminine role. It is thus concluded that the need for offering care for women in different periods of their lives should include a continuous fight for an amplified and integral approach, with emphasis in the care network and in health promotion.

Pre and post-natal exposure to ambient level of air pollution impairs memory of rats: the role of oxidative stress

The aims of this study were to evaluate whether air pollution during pre-natal and post-natal phases change habituation and short-term discriminative memories and if oxidants are involved in this process. As secondary objectives, it was to evaluate if the change of filtered to nonfiltered environment could protect the cortex of rats against oxidative stress as well as to modify the behavior of these animals. Wistar, male rats were divided into four groups (n = 12/group): pre and post-natal exposure until adulthood to filtered air (FA); pre-natal period to nonfiltered air (NFA-FA); until (21st post-natal day) and post-natal to filtered air until adulthood (PND21); prenatal to filtered air until PND21 and post-natal to nonfiltered air until adulthood (FA-NFA); pre and post-natal to nonfiltered air (NFA). After 150 days of air pollution exposure, animals were tested in the spontaneous object recognition test to evaluate short-term discriminative and habituation memories. Rats were euthanized; blood was collected for metal determination; cortex dissected for oxidative stress evaluation. There was a significant increase in malondialdehyde (MDA) levels in the NFA group when compared to other groups (FA: 1.730 +/- 0.217; NFA-FA: 1.101 +/- 0.217; FA-NFA: 1.014 +/- 0.300; NFA: 5.978 +/- 1.920 nmol MDA/mg total proteins; p = 0.007). NFA group presented a significant decrease in short-term discriminative (FA: 0.603 +/- 0.106; NFA-FA: 0.669 +/- 0.0666; FA-NFA: 0.374 +/- 0.178; NFA: -0.00631 +/- 0.106 sec; p = 0.006) and an improvement in habituation memories when compared to other groups. Therefore, exposure to air pollution during both those periods impairs short-term discriminative memory and cortical oxidative stress may mediate this process.

Acessibilidade e longitudinalidade no pré-natal : análise de um grupo de puérperas atendidas no Hospital Universitário Cassiano Antônio de Moraes

A atenção primária visa garantir cobertura e acesso a cuidados de saúde abrangentes e aceitáveis pela população enfatizando a prevenção e a educação (STARFIELD, 2004). No Brasil a Estratégia Saúde da Família (ESF) é o modelo implantado pelo Ministério da Saúde (MS) com a finalidade de reestruturação da atenção primária e já abrange cerca de 50% da população. Segundo Starfield (2004) a atenção primária pode ser avaliada através de seus atributos essenciais: atenção de primeiro contato (utilização e acessibilidade), longitudinalidade, integralidade e coordenação de cuidados. No contexto da atenção à saúde brasileira, a mortalidade infantil é fato preocupante, principalmente a mortalidade que ocorre nos primeiros dias de vida. Este componente da mortalidade é intimamente relacionado à qualidade da atenção recebida no período gestacional. A atenção pré-natal deve incluir ações organizadas, amplas, integradas e com cobertura abrangente de promoção e prevenção da saúde, além de diagnóstico e tratamento adequado dos problemas que possam vir a ocorrer nesse período. O objetivo do presente estudo foi analisar o pré-natal de um grupo de puérperas quanto aos atributos da atenção primária acessibilidade e longitudinalidade. Para alcançar este objetivo foram realizadas 80 entrevistas com mulheres que realizaram pré-natal na atenção primária e 19 mulheres que realizaram pré-natal no Hospital Universitário Cassiano Antônio de Moraes (HUCAM). Utilizou-se parcialmente o questionário de avaliação da atenção primária PCATool. As puérperas também foram questionadas quanto à percepção da adequação do pré-natal realizado. A acessibilidade foi baixa para a maioria das entrevistadas. Nas puérperas que realizaram o pré-natal na Atenção primária a acessibilidade foi estatisticamente maior naquelas que realizaram pré-natal na ESF e naquelas que utilizaram as unidades de saúde do município de Vitória (ES). A longitudinalidade se relacionou ao tipo de unidade de saúde do pré-natal, ao número de consultas realizadas e ao índice de Ápgar no primeiro minuto. A percepção de um pré-natal adequado se relacionou com a utilização da ESF como serviço de pré-natal e à realização de seis ou mais consultas. Apesar de as puérperas do grupo que realizou o pré-natal no HUCAM perceberem o atendimento pré-natal como adequado, algumas questões revelaram fragilidades na assistência, principalmente quanto ao acesso ao serviço. A impossibilidade de receber atendimento pela equipe fora dos horários de funcionamento do ambulatório, a falta de um número de telefone no qual possam sanar dúvidas ou falar com o médico responsável pelo pré-natal, a percepção de dificuldade na marcação de consultas e a espera prolongada no dia do atendimento são pontos que devem ser melhorados nessa assistência.

Condutas de profissionais que realizam a consulta pré-natal na Estratégia Saúde da Família quanto à detecção, tratamento e acompanhamento da gestante com sífilis

The objective of this exploratory descriptive quantitative study was to analyze the behaviors in the detection, treatment and followup of the pregnant woman with syphilis, by health professionals that conduct the pre-natal consultation in the Family Health Strategy, as to the adherence to the recommendations of the Ministry of Health. The study was conducted in nine municipalites of the Trairi region in the state of Rio Grande do Norte. Data were collected during the months of July through September 2007, by means of a questionnaire with a population of 53 health professionals, 30 nurses and 23 physicians. Data were analyzed by descriptive statistics. The results were organized in three major items: knowledge of the health professionals about the symptomatology of syphilis and their actions in the detection of the disease; actions in the treatment of the pregnant woman with syphilis; and the actions of followup of the desease. We identified that 81,2% of the professionals have knowledge about the symptomatology of syphilis in the pregnant woman;79,2% request the VDRL exam in the adequate intervals and approximately 50% conduct the treatment in conformity with the recommendations of the Ministry of Health. For the followup care of the infected woman, 79,2% request a monthly VDRL examination, 69,8% explain the disease to the pregnant woman, and 20,7% affirm that they conduct a proper reception to the woman.We conclude that the majority of the health professionals have knowledge of the detection, treatment and followup of the pregnant woman with syphilis. However, the actions of some professionals diverge from the conduct procedures recommended by the Ministry of Health, as to the requesting of the examinations, medication prescription and notification of the iesease. This indicates the need for improved

Avaliação da assistência pré-natal no município de Botucatu-SP na perspectiva dos diferentes modelos de atenção básica

Pós-graduação em Enfermagem (mestrado profissional) - FMB

Influência do consumo alimentar na gestação sobre a retenção de peso pós-parto

OBJETIVO: Avaliar a influência da alimentação durante a gestação sobre a retenção de peso pós-parto. MÉTODOS: Foram acompanhadas 82 gestantes adultas e saudáveis que iniciaram o pré-natal em serviço público de saúde no Município de São Paulo, SP, entre abril e junho de 2005. As medidas de peso e estatura foram aferidas na primeira entrevista (até 16 semanas de gestação) e a medida de peso foi repetida em visita domiciliar 15 dias após o parto. O Recordatório de 24 horas foi usado para avaliar o consumo alimentar e foi aplicado nos três trimestres da gestação. Foi calculado o consumo médio de gordura saturada, fibras, açúcar adicionado, refrigerantes, alimentos processados, frutas, verduras e legumes, e a densidade energética da dieta. A retenção de peso foi obtida pela diferença entre a medida de peso pós-parto e a primeira medida realizada. A influência da alimentação sobre a retenção de peso pós-parto foi avaliada por meio de análise de regressão linear múltipla e foi realizado o teste para tendência linear. As variáveis utilizadas para ajuste do modelo foram: índice de massa corporal no início da gestação, estatura, renda familiar per capita, tabagismo, idade e escolaridade. RESULTADOS: O índice de massa corporal inicial médio foi de 24 kg/m² e a retenção média de peso foi de 1,9 kg. O aumento do consumo de gordura saturada (p = 0,005) e alimentos processados (p = 0,014) elevou de forma significativa a retenção de peso pós-parto, após ajuste pelas variáveis de controle. As demais variáveis de consumo alimentar não apresentaram relação significativa com a variável desfecho. CONCLUSÕES: O maior consumo de alimentos não saudáveis, como alimentos processados, e de gordura saturada influencia a elevação da retenção de peso pós-parto.

HIV/AIDS risk among female sex workers who use crack in Southern Brazil

OBJECTIVE: To understand the social context of female sex workers who use crack and its impact on HIV/AIDS risk behaviors. METHODODOLOGICAL PROCEDURES: Qualitative study carried out in Foz do Iguaçu, Southern Brazil, in 2003. Twenty-six in-depth interviews and two focus groups were carried out with female commercial sex workers who frequently use crack. In-depth interviews with health providers, community leaders and public policy managers, as well as field observations were also conducted. Transcript data was entered into Atlas.ti software and grounded theory methodology was used to analyze the data and develop a conceptual model as a result of this study. ANALYSIS OF RESULTS: Female sex workers who use crack had low self-perceived HIV risk in spite of being engaged in risky behaviors (e.g. unprotected sex with multiple partners). Physical and sexual violence among clients, occasional and stable partners was widespread jeopardizing negotiation and consistent condom use. According to health providers, community leaders and public policy managers, several female sex workers who use crack are homeless or live in slums, and rarely have access to health services, voluntary counseling and testing, social support, pre-natal and reproductive care. CONCLUSIONS: Female sex workers who use crack experience a plethora of health and social problems, which apparently affect their risks for HIV infection. Low-threshold, user-friendly and gender-tailored interventions should be implemented, in order to increase the access to health and social-support services among this population. Those initiatives might also increase their access to reproductive health in general, and to preventive strategies focusing on HIV/AIDS and other sexually transmitted infections.

RISK FACTORS OF HIV-1 VERTICAL TRANSMISSION (VT) AND THE INFLUENCE OF ANTIRETROVIRAL THERAPY (ART) IN PREGNANCY OUTCOME

In the absence of intervention, the rate of vertical transmission of HIV can range from 15-45%. With the inclusion of antiretroviral drugs during pregnancy and the choice of delivery route this amounts to less than 2%. However ARV use during pregnancy has generated several questions regarding the adverse effects of the gestational and neonatal outcome. This study aims to analyze the risk factors for vertical transmission of HIV-1 seropositive pregnant women living in Rio Grande and the influence of the use of ARVs in pregnancy outcome. Among the 262 pregnant women studied the rate of vertical transmission of HIV was found to be 3.8%. Regarding the VT, there was a lower risk of transmission when antiretroviral drugs were used and prenatal care was conducted at the referral service. However, the use of ART did not influence the outcome of pregnancy. However, initiation of prenatal care after the first trimester had an influence on low birth weight, as well as performance of less than six visits increased the risk of prematurity. Therefore, the risk factors analyzed in this study appear to be related to the realization of inadequate pre-natal and maternal behavior.

Exploring the Family Context Among Children Adopted From China: Perceptions of Pre-Adoption Factors, Post-Adoption Experiences, and the Quality of Parent-Child Relationships

Within the context of international adoption, previous research has focused on parentchild attachment relationships and various aspects of the adoption process. However, less is known about other aspects of parent-child relationships (e.g., cohesion, conflict) within internationally adoptive families. Additionally, there is a need for research that explores both parent and child perceptions of the process of adoption - including pre- and post-adoptive factors - and its connection to the quality of parent-child relationships. This research utilized a qualitatively-oriented methodology to conduct separate, in-depth interviews with 10 adoptive Canadian mothers and their adopted Chinese children (aged 9 to 11 years). Results highlight parent and child reports of mainly strong, positive relationships. Several pre-adoption experiences are examined, including institutionalization, age at the time of adoption, and parental stress/expectations. A key finding concerns the link that adoptive parents perceive between the quality of their child's pre-adoptive care (i.e., mainly early institutionalized care) and the quality of their relationship. Interestingly, this link is perceived in two different ways - either as a challenge for the parent-child relationship or as a means to strengthen it. Post-adoption experiences are also explored, including cultural socialization, creating a transracial family, discussing adoption, parental stress, and sibling involvement. A key finding involves parent and child reports that cultural socialization efforts (i.e., familiarizing children with Chinese culture) are linked to more positive parent-child relationships. The implications of these findings are discussed in relation to theory and practice within the context of international adoption.

The Acute Care Undergraduate TEaching (ACUTE) initiative: consensus development of core competencies in acute care for undergraduates in the United Kingdom

Background: The care of the acutely ill patient in hospital is often sub-optimal. Poor recognition of critical illness combined with a lack of knowledge, failure to appreciate the clinical urgency of a situation, a lack of supervision, failure to seek advice and poor communication have been identified as contributory factors. At present the training of medical students in these important skills is fragmented. The aim of this study was to use consensus techniques to identify the core competencies in the care of acutely ill or arrested adult patients that medical students should possess at the point of graduation. Design: Healthcare professionals were invited to contribute suggestions for competencies to a website as part of a modified Delphi survey. The competency proposals were grouped into themes and rated by a nominal group comprised of physicians, nurses and students from the UK. The nominal group rated the importance of each competency using a 5-point Likert scale. Results: A total of 359 healthcare professionals contributed 2,629 competency suggestions during the Delphi survey. These were reduced to 88 representative themes covering: airway and oxygenation; breathing and ventilation; circulation; confusion and coma; drugs, therapeutics and protocols; clinical examination; monitoring and investigations; team-working, organisation and communication; patient and societal needs; trauma; equipment; pre-hospital care; infection and inflammation. The nominal group identified 71 essential and 16 optional competencies which students should possess at the point of graduation. Conclusions: We propose these competencies form a core set for undergraduate training in resuscitation and acute care.

Avaliação toxicológica do sulfato de condroitina sobre o desenvolvimento pré-natal de ratos wistar.

O sulfato de condroitina (SC) é um agente protetor de cartilagem usado na terapêutica das osteoartrites/osteoartroses. Considerado nutracêutico (parte de alimento que propicia benefício médico), não é regulamentado pela FDA (Food and Drug Administration) nos Estados Unidos. No Brasil a ANVISA (Agência Nacional de Vigilância Sanitária) controla esses produtos. Na Europa, agências controladoras de medicamentos também controlam a liberação desses produtos para o comércio. O presente estudo foi realizado para avaliar a embriofeto-toxicidade potencial dessa substância. O estudo é parte de uma avaliação para verificação da segurança do SC. Para isso foi utilizado o segmento II, dos testes de toxicidade reprodutiva preconizado pelas normas da EPA (Environmental Protection Agency) e FDA. O SC nas dosagens de 200, 400 e 600 mg/kg de massa corporal foi administrado por via oral a ratas Wistar (N=14) entre os dias 6 e 15 de prenhez. Aos 21 dias de gestação (dia previsto para o parto) as fêmeas tratadas foram mortas e foi realizada histerectomia. O número de sítios de implantação, de fetos vivos e mortos, reabsorções e corpos lúteos foram registrados. Os fetos foram pesados, examinados quanto a malformações externas, e fixados em formol para posterior técnica de coloração por alizarina para avaliação esquelética. O desenvolvimento ponderal das ratas e seu consumo de água e ração também foram registrados para posterior avaliação de toxicidade materna. Não houve alteração nos índices de fertilidade e reprodutivos das mães entre os grupos. O desenvolvimento ponderal e consumos de água e ração também não foram alterados pelo tratamento com diferentes doses de SC, quando comparados com o grupo controle. Não foram encontradas alterações estatisticamente significativas (p<0,05) nos percentuais de malformações esqueléticas (200 mg/kg = 25,45%, 400 mg/kg = 19,44%, 600 mg/kg = 11,84%, controle = 12,76%). Os resultados verificados nesse trabalho permitem afirmar que o SC em doses de 200, 400 e 600 mg/kg, administrado no período de embriogênese, não é teratogênico para ratas Wistar. Também não ocorreram sinais de toxicidade materna.