Estudo do perfil clínico, metabólico, hormonal e inflamatório de crianças pré-púberes nascidas com baixo peso e sua relação com a prematuridade, retardo do crescimento intrauterino e ganho ponderal pós-natal

O baixo peso ao nascer (BPN) possui grande impacto na mortalidade neonatal, assim como no desenvolvimento de complicações futuras, como obesidade, hipertensão arterial sistêmica e resistência insulínica, condições relacionadas à doença cardiovascular aterosclerótica, principal causa de morbimortalidade no mundo. O objetivo desta pesquisa foi estudar o perfil clínico, metabólico, hormonal e inflamatório relacionado à doença cardiovascular em crianças pré-púberes de BPN, bem como avaliar a influência do BPN, prematuridade e restrição do crescimento intrauterino nas variáveis de interesse. Realizou-se estudo transversal com 58 crianças de dois a sete anos de BPN, sendo 32 prematuros adequados para idade gestacional (AIG), 17 prematuros pequenos para idade gestacional (PIG), 9 a termo PIG e 38 crianças de peso ao nascer adequado, nascidas no Hospital Universitário Pedro Ernesto da Universidade do Estado do Rio de janeiro, oriundas do Ambulatório de Pediatria Geral deste mesmo hospital. Frequências de perfil lipídico alterado, assim como medianas das variações no Z escore de peso e estatura do nascimento até o momento do estudo, do Z escore de índice de massa corporal (ZIMC), da circunferência da cintura, da pressão arterial sistólica e diastólica, do colesterol total, da lipoproteína de baixa densidade, da lipoproteína de baixa densidade, do triglicerídeo, da glicose, insulina, do Homeostasis Assessment for Insulin Resistance (HOMA-IR), da leptina, da adiponectina, da interleucina 6 e da proteína C reativa foram comparadas entre os dois grupos. No grupo de BPN, avaliou-se a correlação entre estas mesmas variáveis e peso de nascimento, idade gestacional, Z escores de peso e comprimento de nascimento e variações no Z escore de peso e comprimento até o primeiro ano, e até o momento do estudo, com ajuste para idade e sexo. O grupo de BPN apresentou maiores variações nos Z escore de peso (p-valor 0,0002) e estatura (p-valor 0,003) até o momento do estudo e menores níveis de adiponectina (p-valor 0,027). Não houve correlação entre as variáveis associadas ao risco cardiovascular e o grau de baixo peso, prematuridade ou crescimento intrauterino retardado. Os níveis de ZIMC (p-valor 0,0001), circunferência da cintura (p-valor 0,0008), pressão arterial diastólica (p-valor 0,046), insulina (p-valor 0,02), HOMA-IR (p-valor 0,016) e leptina (p-valor= 0,0008) se correlacionaram com a variação no Z escore de peso no primeiro ano. O ZIMC (p-valor 0,042) também se correlacionou com a variação do Z escore de comprimento no primeiro ano. Houve ainda correlação entre o ZIMC (p-valor 0,0001), circunferência da cintura (p-valor 0,0001), pressão arterial sistólica (p-valor 0,022), pressão arterial diastólica (p-valor 0,003), insulina (p-valor 0,007), HOMA-IR (p-valor 0,005) e leptina (p-valor 0,0001) com a variação no Z escore de peso até o momento do estudo. Os achados mostram que este grupo de crianças pré-púberes com BPN ainda não diferem do grupo de crianças nascidas com peso adequado exceto pelos níveis de adiponectina, sabidamente um protetor cardiovascular. Em relação às análises de correlação, nem o peso ao nascer, tampouco a prematuridade ou CIUR, influenciaram as variáveis de interesse. No entanto, fatores pós-natais como o ganho pondero-estatural se correlacionaram com o ZIMC, circunferência da cintura, pressão arterial sistólica e diastólica, insulina, HOMA-IR e leptina. Mais estudos são necessários para avaliar se os achados configuram risco cardiovascular aumentado neste grupo de pacientes.

A emergência da categoria da transexualidade na interseção com as técnicas biomédicas.

Refletindo sobre a emergência da categoria da transexualidade como a conhecemos na atualidade e seus desdobramentos sociais, políticos e subjetivos, especialmente a partir da segunda metade do século XX, procuramos nessa dissertação discutir o contexto que possibilitou o fenômeno da medicalização tecnológica dessa categoria. Ao desenvolvê-lo, essa pesquisa aponta atores da categoria médica e da militância que compuseram uma relação de negociação entre a demanda do indivíduo transexual e as possibilidades técnicas, legais e discursivas da biomedicina. Inicialmente, buscamos compreender como os profissionais médicos, psiquiatras e psicanalistas, pertencentes à ciência da sexologia a partir do fim do século XIX, incluíram em seus discursos e práticas os comportamentos sexuais considerados desviantes na época. O homossexualismo e o travestismo, representantes dessas perversões, constituíram categorias diagnósticas e identitárias de fundamental importância para a inauguração da transexualidade enquanto categoria nosológica médico-psiquiátrica e enquanto tipo humano, ou seja, uma forma subjetiva de experiência e identidade de gênero. Diante disso, e considerando o contexto sociocultural e o desenvolvimento biotecnológico hormonal e cirúrgico na época, temos a hipótese que a criação dessa categoria só foi possível devido à incorporação em indivíduos transexuais de procedimentos tecnocientíficos que possibilitaram que suas transformações anatomobiológicas construíssem o gênero desejado. A medicalização da transexualidade e sua regulação médico-jurídica, ao mesmo tempo em que são vetores de patologização e de estigma, possibilitaram o acesso à essas transformações corporais. Essa pesquisa problematiza o acesso à essas tecnologias, condicionado à obtenção do diagnóstico psiquiátrico, e aborda a relação interativa entre os aspectos discursivos e práticos da categoria médica e dos indivíduos transexuais e militância, assim como seus efeitos que iluminam essa questão. Finalmente, com o objetivo de ilustrar e compreender a interação entre a tecnologia e o corpo transexual, descrevemos e discutimos brevemente os principais procedimentos aplicados em homens transexuais e mulheres transexuais na transição de gênero.

Nutrição hiperproteica em recém-nascidos com muito baixo peso e evolução de índices antropométricos até a alta hospitalar: ensaio clínico randomizado

Apesar de diversos estudos sobre nutrição de prematuros terem sido realizados, ainda não existe consenso sobre a melhor estratégia nutricional a ser adotada. Atualmente a taxa de crescimento dessa população não é semelhante àquela encontrada no ambiente intrauterino. O presente estudo tem por objetivo avaliar se o maior aporte proteico enteral durante a internação hospitalar promove melhora dos índices antropométricos na alta hospitalar. Realizou-se um ensaio clínico randomizado com 117 prematuros nascidos entre janeiro de 2009 e julho de 2013 com peso ≤ 1500 gramas e idade gestacional≤32 semanas em uma unidade terciária de saúde, excluídos os nascidos com malformações graves, aferindo-se os índices antropométricos ao nascimento e na alta hospitalar. Randomizou-se os prematuros por meio de sorteio em dois grupos. O grupo 1 (n=53), foi submetido a um aporte protéico enteral diário de 4,5 gramas/kg/dia, enquanto o grupo 2 (n=64), recebeu 3,5 gramas/kg/dia. Avaliou-se se a nutrição enteral com aporte protéico maior que o comumente utilizado em unidades de terapia intensiva neonatais e também descrito na literatura, promove diferenças antropométricas na alta hospitalar. Na análise dos resultados, verificou-se diferença estatisticamente significativa para retorno ao peso de nascimento (p=0,02), crescimento de escore-Z em relação ao peso de nascimento (p=0,03) e crescimento escore-Z em relação ao comprimento de nascimento (p=0,02) quando comparados o grupo 1 ao 2. Não houve diferenças estatisticamente significativas nas incidências de enterocolite necrotizante (p=0,70, RR 0,88), déficit ponderal na alta (p=0,27, RR 0,70), restrição de crescimento na alta (p= 0,39, RR 0,82) e déficit de perímetro cefálico na alta (p=0,45, RR 0,67). Concluiu-se, apesar das limitações metodológicas do estudo, que os participantes do grupo 1 apresentaram menor decréscimo de escores-Z em relação ao peso de nascimento e ao comprimento de nascimento quando comparados ao grupo 2, além de necessidade de menor tempo para recuperação do peso de nascimento. Não houve diferença entre os grupos para tempo de internação hospitalar, assim como para intercorrências de interesse (enterocolite necrotizante, déficit ponderal na alta, restrição de crescimento na alta e déficit de perímetro cefálico na alta).

在盐胁迫下外源维生素浸种对小麦发芽及幼苗生长的影响

维生素(Vitamin)又称维他命，为“万年青”产品，是维持人体生命健康必需的一类低分子有机化合物质。维生素对人体健康的作用人们研究很多, 维生素可以增强人体对感染的抵抗力，降低出生缺陷及降低癌症和心脏病发病率等，一旦缺乏，肌体代谢就会失去平衡，免疫力下降，各种疾病，病毒就会趁虚而入；而维生素对作物影响的研究却很少。目前为止，尚无对用维生素浸种的方法来研究外源维生素是否对小麦种子萌发及幼苗生长起调节作用的报道，且对其在小麦抗逆性方面影响的研究甚少，对盐的胁迫抗性研究尚未有人报道。小麦（Triticum aestivum L.）属于拒盐的淡土性作物。盐害不利于小麦生长，严重影响小麦的产量和品质。本研究采用4 种不同维生素VB1、VC、VB6、VPP，分别对供试小麦品种川育12（红皮）、川育16（白皮）小麦浸种后，在一般自然条件下和逆境（盐胁迫条件）下，进行试验。探讨在正常情况下与在不同盐浓度条件下，各维生素及盐浓度对小麦发芽及幼苗生长的影响，并且比较两种不同皮色的小麦在相同盐胁迫条件下的差异表现，同时研究维生素处理的特异性，且哪种维生素对盐害缓解作用最佳。研究结果表明：在无盐胁迫（自然）条件下，对用4 种不同维生素VB1、VC、VB6、VPP 浸种小麦川育12、川育16 后的种子萌发及幼苗生长（幼苗的根长、根重、苗高、苗鲜重）的研究结果表明：4 种外源维生素浸种均对小麦发芽有调节作用，都能提高其最终发芽率。但是提高幅度有所差异。用VB6 浸种后的小麦提高幅度最多，VC 次之，VPP 提高幅度最小。同时，4 种外源维生素浸种对小麦种子的出芽速度及芽后长势也有一定的影响。VB6、VC 处理的小麦种子出芽速度最快，萌发后长势最好；VB1 出芽速度相对较慢，VPP 最慢,但都大于对照；VB1 处理长势略高于对照，VPP 处理的小麦长势则低于对照。从整体来看，VB6、VC处理促进效应明显， VB1 次之，而VPP 在某些方面无效甚至产生负效应。此外，相同的维生素处理对不同的品种的种子萌发、生长效果也存在差异，各种维生素作用于川育12 的效应均强于对川育16。进一步对幼苗根系TTC 还原力及幼苗叶片中硝酸还原酶活性进行测定、分析。研究发现：并非所有种类的维生素对幼苗根系TTC 还原力及幼苗叶片中硝酸还原酶活性的提高都有帮助。幼苗根系TTC 还原力在不同维生素处理下存在显著差异，而与小麦品种关系甚微。经VB6、VC 处理后，根系TTC 还原力测定值均显著高于对照，VB1 不明显，VPP 则略低于对照。VB6、VC 处理的幼苗叶片中硝酸还原酶的含量大于对照，VB1 与对照相差无几，而VPP 处理的川育12 幼苗叶片中的硝酸还原酶活性比对照CK 略高，而在川育16 中则略比对照CK 有所下降，呈现出抑制效应。综上结果表明：VB6、VC 具有促进种子发芽，幼苗生长及根系生长的作用，是较好的促生长剂；VPP 具有抑制作用，是较好的抑制剂，可进一步研究、开发利用。在盐胁迫条件下，对用4 种不同维生素VB1、VC、VB6、VPP 浸种川育12、川育16 后的种子萌发及幼苗生长（幼苗的根长、根重、苗高、苗鲜重）的研究结果表明：在不同盐浓度胁迫条件下， 各处理的种子萌发及幼苗生长均受到不同程度的抑制。随着盐浓度的增加, 发芽率、发芽指数和活力指数成下降趋势；幼苗的根长、根重、苗高、苗鲜重不断降低。4 种维生素处理间也表现出较大差异。VB6、VC 在每个处理中均保持对盐害的缓解作用，VB6 较VC 更易于促进发芽及幼苗生长。最终发芽率高，根系多、长、重，苗高高、重。而VB1、VPP 则表现出抑制作用。在高盐浓度150mM 时，4 种维生素浸种后的种子，其最终发芽率均不能达到40％，但VB6、VC 处理最终发芽率、苗重、根重均高于对照，VPP 最终发芽率、苗重、根重均低于对照。进一步对幼苗根系TTC 还原力及幼苗叶片中脯氨酸含量进行测定、分析。研究发现：不同盐浓度，不同维生素处理、不同品种间存在差异。随着盐浓度的增加（75mM，100mM，150mM），幼苗根系TTC 还原力活性成下降趋势，幼苗叶片中脯氨酸的积累量成上升趋势。VB6 处理脯氨酸含量增加最为明显，VC 次之，VPP 与对照接近，其变化幅度最小。经VB6、VC 处理后的幼苗根系还原强度，在不同盐浓度下，测定值均显著高于对照，VB1 不明显，VPP 则低于对照，产生负效应。此外，品种间表现不尽相同，相同的维生素处理，相同的盐浓度对不同的品种的种子萌发、生长效果也存在差异， 4 种维生素对川育16 的作用均强于川育12，但其影响趋势是一致的。说明VB6、VC 具有耐（抗）盐性，可以促进种子发芽和幼苗生长，是较好的耐（抗）盐拌种剂。 Vitamin is one kind of necessary low molecular compound for humans tosustain health and life. Lots of Studies have been done on the effectc of the vitaminsfor people. Vitamin can help people improve the body's natural resistance to disease,Drop the rate of birth defects、cacers and the incidence of the heart diseases. Ifpeople have less of them, the metabolism of the organism may throw off balance,immunity may drop off, and catch disease; Though the effects for Vitamin to thecrops are limited. up to now, there’s no one use soking seeds of wheats with vitaminsas a method, to study on how the effects will happen on the wheat seed germinationand seedling growth, and there are only few reserches on antireversion force forwheats ,none for the antireversion force in Sault stress condition.Wheat（Triticum aestivum L.）is sensitive to the salt, so the salt damage will doharm to wheat’s growth, it will have an unfavorable impact on the output and thequality of wheat.On this reaserch, we Soaking CHY12(red)、CHY16 (white) wheat seeds withVitamin C, B1, PP, B6 (50mg/L) as a pretreatment first. Then under two condition: one is in the normal environment the other is in different Salinity, we begin ourexperiments. Then disscuss on if the vitamin and salinity affect the wheat seedgermination and seedling growth, and what is the different between the two of them,the result shows that:Under the normal condition, after soaking seeds with VB1、VC、VB6、Vpp，we study on the their seed germination and the seeding growth(the root length andweights, The seedling heights and weights), it shows that all of those four kinds ofvitamin can adjust the seed germination, but different in The growth rate. VB6 isbest for increase, VC comes second,VPP is the worst. Meanwhile, those four vitaminalso have effect on the speed of the sprouting of the wheat. VB6、Vc can faster theseed germination most, and the seedlings are all doing well; VB1 do little effects onthe budding, Vpp is the worst, but all treatments are better than CK; but in Vi, VB1some what above the CK, while VPP lower than that. On the whole, the acceleratingeffect of VB6、VC are obvious, VB1 takes second place, but VPP in some aspects arenoneffective even have negative effect. Furthermore, different kind of seeds with thesame vitamin may different in seed germination and seedling growth, four vitaminson CHY16 is better than CHY12.More studies on TTC reductive capacity of roots and the activity of nitratereductase in the leaves, the reasult shows not all the vitamin can help the seedlings toimprove the TTC reductive capacity and the activity of nitrate reductase. TTCreductive capacity in different treatments shows significant differences,but notcorrelate to the variety of the wheat. The TTC reductive capacity of VB6、Vctreatments are all higher than CK, VB1 is nearly the same as CK, VPP is a littlelower than CK. Through the study of acivity of nitrate reductase, it shows that,VB6、VC are higher than CK ,VB1 is nearly the same as CK also, VPP is a little higher inthe CK of CHY12 but lower in CHY16. Through all the results above: VB6、Vc helpthe wheat seed germination, seedling growth and the growth of roots, is theperfectable factor of stimulating the growth; Vpp is a inhibition, that’ll be furtherreserch,and well develop and utilize in the future.Under the different Salinity condition, after soaking seeds with VB1、VC、VB6、Vpp，we study on the their seed germination and the seeding growth(the root lengthand weights, The seedling heights and weights), it shows that: under differentsalinity, the seed germination and the seedling growth of any treatment are inhibited.With the increase of the concentration, the germination rate, Vi、Gi all had fallen; theroot length and weight, the seedling heights and weights steadily sank down. There are also have pronounced difference between all treatments with four differentvitamins.VB6、VC in all treatments are alleviative the salt damage, VB6 is easier tocause to put forth buds than VC, and it’s quantitative value is the highest in theultimate germination rate, in root and seedlings’ hight and weight. Though the VPP、VB1 are seems to inhibite its growth. Under the high concentration150mM Nacl, theultimate germination rate in all treatments are below the 40%, but VB6、VC’squantitative values in any experiments are higher than CK,while VPP lower thanCK.Then we study on the TTC reductive capacity of roots and the content of Polinein leaves, the result shows that between the different salinity, different vitamintreatments, different varieties of the wheat have discrepancy.along with theincreasing concentraion of the salinity（75mM，100mM，150mM），TTC reductivecapacity of roots decreases, the accumulation of the content of Poline in leaves havean upward trend. The increase of VB6’s treatment are obviously, VC comessecond,VPP is nearly come up with CK, changes a little. In TTC reductive capacity of roots’s reserch, VB6、VC are higher than CK at any time,VB1 is not palpable,VPP is lower than CK, makes negative affect on wheat. In addition, varieties of thewheats are remain different, no matter it shows promoting or inhibiting, all fourvitamins have moreobvious effects on CHY16 than CHY12, but the tendency of theeffection are the same. It is say that VB6、VC can help wheat to standwith the saultwell, and promot in growth，they are the better reagent to mix with the seed.

Neonatal exposure to estradiol in female rats influences neuroactive steroid concentrations and behaviour in the adult rat

The gonadal steroids, in particular estradiol, exert an important action during perinatal period in the regulation of sexual dimorphism and neuronal plasticity, and in the growth and development of nervous system. Exposure of the developing female to estrogens during perinatal period may have long-lasting effects that are now regarded as “programming” the female neuroendocrine axis to malfunction in adulthood. The purpose of this study was to describe the effect of a single administration of a low dose (10 μg) of β-estradiol 3-benzoate (EB) to female rats on the day of birth on brain and plasma concentrations of the neuroactive steroid allopregnanolone, general behaviours and behavioral sensitivity to benzodiazepines. Neonatal administration of EB induces a dramatic reduction in the cerebrocortical and plasma levels of allopregnanolone and progesterone that were apparent in both juvenile (21 days) and adult (60 days). In contrast, this treatment did not affect 17β-estradiol levels. Female rats treated with β-estradiol 3-benzoate showed a delay in vaginal opening, aciclicity characterized by prolonged estrus, and ovarian failure. Given that allopregnanolone elicits anxiolytic, antidepressive, anticonvulsant, sedative-hypnotic effects and facilitates social behaviour, we assessed whether this treatment might modify different emotional, cognitive and social behaviours. This treatment did not affect locomotor activity, anxiety- and mood-related behaviours, seizures sensitivity and spatial memory. In contrast, neonatal β-estradiol 3-benzoate-treated rats showed a dominant, but not aggressive, behaviour and an increase in body investigation, especially anogenital investigation, characteristic of male appetitive behaviour. On the contrary, neonatal administration of β-estradiol 3-benzoate to female rats increases sensitivity to the anxiolytic, sedative, and amnesic effects of diazepam in adulthood. These results indicate that the marked and persistent reduction in the cerebrocortical and peripheral concentration of the neuroactive steroid allopregnanolone induced by neonatal treatment with β-estradiol 3-benzoate does not change baseline behaviours in adult rats. On the contrary, the low levels of allopregnanolone seems to be associated to changes in the behavioural sensitivity to the positive allosteric modulator of the GABAA receptor, diazepam. These effects of estradiol suggest that it plays a major role in pharmacological regulation both of GABAergic transmission and of the abundance of endogenous modulators of such transmission during development of the central nervous system.

Nutrition, growth and body composition in infancy

This thesis is presented in two parts. Data for this research is from the Cork BASELINE (Babies after SCOPE, Evaluating Longitudinal Impact using Neurological and Nutritional Endpoints) Birth Cohort Study (n = 2137). In this prospective birth cohort study, pediatric follow-up with in-person appointments were repeated from the time of birth through to 2, 6 and 12 months, and at 2 years. Body composition was measured by air displacement plethysmography at birth and at 2 months using the PEA POD Infant Body Composition Tracking System. This thesis provides the first extensive report on the study’s 2 year assessment. In part one, the aims were to investigate potential early-life risk factors for childhood overweight and obesity, including rapid growth and body composition in infancy and umbilical cord concentrations of leptin and high molecular weight (HMW) adiponectin. This research is the first to describe rapid growth in early infancy in terms of changes in direct measures of body composition. These are also the first data to examine associations between umbilical cord leptin and HMW adiponectin concentrations and changes in fat and lean mass in early infancy. These data provide additional insight into characterising the growth trajectory in infancy and into the role of perinatal factors in determining infant growth and subsequent overweight/obesity risk. In part two of this thesis, the aims were to quantify vitamin D intake and status at 2 years and to investigate whether 25-hydroxyvitamin D [25(OH)D] concentrations in early pregnancy and in umbilical cord blood are associated with infant growth and body composition. There was a low prevalence of vitamin D deficiency among Irish 2 year olds (n = 742) despite a high prevalence of inadequate intakes and high latitude (51°N). Maternal 25(OH)D concentrations at 15 weeks gestation and cord 25(OH)D concentrations at delivery were not associated with infant growth or adiposity.

Reminders, Refugees, and Ramadan: Characterizing Missed Immunization Appointments among Palestinian Refugees in Jordan

There are currently over two million Palestinian refugees residing in Jordan, 370,000 of whom reside in refugee camps. Due to conflict-affiliated disease outbreaks among children in the region, the UN Relief and Works Agency for Palestine Refugees (UNRWA) has identified incomplete vaccination as a critical public health issue and has invested in the development and implementation of a text message reminder service for preventing loss-to-follow-up. Childhood immunization rates in UNRWA catchment regions are generally high, yet little is known about risk factors for missed appointments, which impose a substantial administrative burden due to the need to contact patients for rescheduling. Stronger user characterization is necessary for improved targeting and minimized cost as we develop a more robust SMS system capable of scaling across all health facilities.

This mixed-methods study prospectively recorded 6 months of immunization history among a cohort of children born in June 2014 at Taybeh Health Center in Amman. Demographic information was collected at the time of birth, and caregivers of cohort members were invited to participate in interviews that assessed immunization knowledge, preferences, decision-making, and experience with the SMS reminder system. Patients were more likely to significantly delay appointments during the Ramadan holiday and for doses further from the child date of birth. Future policies that might bridge these gaps include targeting pre-appointment SMS reminders to high-risk patients, implementing holiday shifts in clinic hours, and regularly updating patient contact information.

Explaining young mortality

Stochastic modeling of mortality rates focuses on fitting linear models to logarithmically adjusted mortality data from the middle or late ages. Whilst this modeling enables insurers to project mortality rates and hence price mortality products it does not provide good fit for younger aged mortality. Mortality rates below the early 20's are important to model as they give an insight into estimates of the cohort effect for more recent years of birth. It is also important given the cumulative nature of life expectancy to be able to forecast mortality improvements at all ages. When we attempt to fit existing models to a wider age range, 5-89, rather than 20-89 or 50-89, their weaknesses are revealed as the results are not satisfactory. The linear innovations in existing models are not flexible enough to capture the non-linear profile of mortality rates that we see at the lower ages. In this paper we modify an existing 4 factor model of mortality to enable better fitting to a wider age range, and using data from seven developed countries our empirical results show that the proposed model has a better fit to the actual data, is robust, and has good forecasting ability.

Proton pump inhibitors and histamine-2-receptor antagonists and pancreatic cancer risk: a nested case-control study

Background: The relationship between use of proton pump inhibitors (PPIs) and histamine-2-receptor antagonists (H₂RAs) and pancreatic cancer risk has yet to be examined. Data from a range of studies suggest biologically plausible mechanisms, whereby these drugs (or the conditions for which they are prescribed) may affect pancreatic cancer risk. The objective of this study was to investigate the relationship between use of PPIs/H₂RAs and pancreatic cancer risk.

Methods: A nested case – control study was conducted within the UK general practice research database (GPRD). Cases had a diagnosis of exocrine pancreatic cancer and controls were matched to cases on general practice site, sex and year of birth. Exposure to PPIs and to H₂RAs since entry into GPRD until 2 years before the diagnosis date (corresponding date in controls) and in the 5 years before the diagnosis date were separately assessed. Conditional logistic regression analyses were used to generate odds ratios (ORs) and 95% confidence intervals (CIs) associated with PPI or H₂RA use compared with nonuse.

Results: Ever use of PPIs since entry into the GPRD (excluding the 2 years prior to diagnosis) was not associated with risk of pancreatic cancer; OR (95% CI) 1.02 (0.85 – 1.22). Neither the dose nor the duration of PPI or H₂RA use was associated with pancreatic cancer risk. No consistent patterns of association were seen when cumulative exposure (dose and duration) to these drugs was examined separately or together.

Conclusion: PPI/H₂RA use, in a UK population, was not associated with pancreatic cancer risk.

How well do midwives use skills and knowledge in examining newborns?

Physical examination of the newborn (PEN) was established as part of postnatal care in the late 1960s. The role of discharging babies within the first 72 hours of birth was traditionally undertaken by junior doctors. Currently midwives, nurses, advanced nurse practitioners, and health visitors are being trained to undertake the PEN (NHS Screening Programmes, 2010). However, only a fraction of midwives utilize their acquired skills in clinical practice. A survey by Townsend et al (2004) showed that 2% of babies in England were examined by midwives while 83% were examined by junior doctors.This study aimed to evaluate how well midwives who undertook the PEN course between 2002 and 2005 (n = 40) at a large London University utilized the skills acquired on the course. Questionnaires with a series of open and closed questions were sent out by post followed by phone and email reminders. The eight that responded were midwives. All respondents said they were appropriately trained and felt well prepared for their role to examine babies. However, they felt they were not provided with opportunities to use the skills. Guidelines based on this extended role are available in the workplace but only a few midwives seemed to have negotiated time to implement these and may need greater managerial support for the role.

Non-steroidal anti-inflammatory drug use and brain tumour risk:a case-control study within the Clinical Practice Research Datalink

Purpose: The aetiology of primary brain tumours is largely unknown; the role of non-steroidal anti-inflammatory drugs (NSAIDs) or aspirin use and glioma risk has been inconclusive, but few population-based studies with reliable prescribing data have been conducted, and the association with meningioma risk has yet to be assessed. Methods: The UK Clinical Practice Research Datalink was used to assess the association between aspirin and non-aspirin NSAID use and primary brain tumour risk using a nested case-control study design. Conditional logistic regression analysis was performed on 5,052 brain tumour patients aged 16 years and over, diagnosed between 1987 and 2009 and 42,678 controls matched on year of birth, gender and general practice, adjusting for history of allergy and hormone replacement therapy use in the glioma and meningioma models, respectively.

Results: In conditional logistic regression analysis, excluding drug use in the year preceding the index date, there was no association with non-aspirin NSAID use (OR 0.96, 95 % CI 0.81-1.13) or glioma risk comparing the highest category of daily defined dose to non-users; however, non-aspirin NSAID use was positively associated with meningioma risk (OR 1.35, 95 % CI 1.06-1.71). No association was seen with high- or low-dose aspirin use irrespective of histology.

Conclusions: This large nested case-control study finds no association between aspirin or non-aspirin NSAID use and risk of glioma but a slight increased risk with non-aspirin NSAIDs and meningioma. © 2013 Springer Science+Business Media Dordrecht.

Innovative interprofessional teaching session on labour and childbirth for undergraduate medical and midwifery students

There is an increasing recognition of the need to improve interprofessional relationships within clinical practice (Midwifery 2020, 2010). Evidence supports the assertion that healthcare professionals who are able to communicate and work effectively together and who have a mutual respect and understanding for one another’s roles will provide a higher standard of care (McPherson et al, 2001; Miers et al, 2005; Begley, 2008). The joint Royal College of Obstetrics & Gynaecologists(RCOG) / Royal College of Midwives (RCM) report (2008 Page 8) on clinical learning environment and recruitment recommended that “Inter-professional learning strategies should be introduced and supported at an early stage in the medical and midwifery undergraduate students' experience and continued throughout training.” Providing interprofessional education within a University setting offers an opportunity for a non-threatening learning environment where students can develop confidence and build collaborative working relationships with one another (Saxell et al, 2009).Further research supports the influence of effective team working on increased client satisfaction. Additionally it identifies that the integration of interprofessional learning into a curriculum improves students’ abilities to interact professionally and provides a better understanding of role identification within the workplace than students who have only been exposed to uniprofessional education (Meterko et al, 2004; Pollard and Miers, 2008; Siassakos, et al, 2009; Wilhelmsson et al, 2011; Murray-Davis et al, 2012). An interprofessional education indicative has been developed by teaching staff from the School of Nursing and Midwifery and School of Medicine at Queen’s University Belfast. The aim of the collaboration was to enhance interprofessional learning by providing an opportunity for medical students and midwifery students to interact and communicate prior to medical students undertaking their obstetrics and gynaecology placements. This has improved medical students placement experience by facilitating them to learn about the process of birth and familiarisation of the delivery suite environment and it also has the potential to enhance interprofessional relationships. Midwifery students benefit through the provision of an opportunity to teach and facilitate learning in relation to normal labour and birth and has provided them with an opportunity to build stronger and more positive relationships with another profession. This opportunity also provides a positive, confidence building forum where midwifery students utilise teaching and learning strategies which would be transferable to their professional role as registered midwives. The midwifery students were provided with an outline agenda in relation to content for the workshop, but then were allowed creative licence with regard to delivery of the workshop. The interactive workshops are undertaken within the University’s clinical education centre, utilising low fidelity simulation. The sessions are delivered 6 times per year and precede the medical students’ obstetric/gynaecology placement. All 4th year medical and final year midwifery students have an opportunity to participate. Preliminary evaluations of the workshops have been positive from both midwifery and medical students. The teaching sessions provided both midwifery and medical students with an introduction to inter professional learning and gave them an opportunity to learn about and respect each other’s roles. The midwifery students have commented on the enjoyable aspects of team working for preparing for the workshop and also the confidence gained from teaching medical students. The medical students have evaluated the teaching by midwifery students positively and felt that it lowered their anxiety levels going into the labour setting. A number of midwifery and medical students have subsequently worked with one another within the practice setting which has been recognised as beneficial. Both Schools have recognised the benefits of interprofessional education and have subsequently made a commitment to embed it within each curriculum.

From Angela's Ashes to the Celtic Tiger: Early Life Conditions and Adult Health in Ireland

We use data from the Irish census and exploit regional and temporal variation in infant mortality rates over the 20th century to examine effects of early life conditions on later life health. The urban mortality penalty collapsed in Ireland in the years right after World War II. Our main identification is public health interventions centered on improved sanitation and food safety, which we believed played a leading role in eliminating the Irish urban infant mortality penalty. Our estimates suggest that a unit decrease in mortality rates at time of birth reduces the probability of being disabled as an adult by about 12–18%

Factores que influenciam o peso e crescimento de cabritos da raça Murciana-granadina, em aleitamento artificial

A exploração caprina de leite tem evoluído no sentido de alguma intensificação, com recurso a raças de elevado potencial produtivo, de que é exemplo a raça Murciana- Granadina. O leite constitui a principal fonte de receita destas explorações. Complementarmente, vendem animais para carne e, as de melhor nível genético, animais para reprodutores. Analisaram-se os pesos de 241 cabritos da raça Murciana-Granadina, numa exploração comercial, com o objectivo de quantificar os pesos e crescimento de cabritos, e identificar os factores que os influenciam. Os cabritos foram aleitados artificialmente, em regime ad libitum, com leite de substituição comercial, dispondo ainda de concentrado comercial, feno de luzerna e palha. Os cabritos foram pesados ao nascimento e, posteriormente, semanalmente, até aos 60 dias de idade. Calcularam-se os respetivos pesos ajustados, bem como os ganhos médios diários, a diferentes idades padrão. Procedeu-se a uma análise de variância com um modelo linear que incluiu os efeitos da época de parto, tipo de parto, sexo e idade da cabra. Foram registados pesos superiores nos partos simples e duplos, relativamente aos triplos, e nos machos, relativamente às fêmeas. Os ganhos médios diários, a partir do mês de idade, registaram valores inferiores na época inverno-primavera, comparativamente com a época primavera-verão. Dairy goat farming has evolved towards intensification, with increased use of high milk-yielding breeds, including the Murciano-Granadina breed. Milk is the main source of farm income. Secondary income sources are the sale of animals for meat and, in genetically superior herds, the sale of breeding animals. The weights of 241 commercial farms artificially reared Murciano-Granadina kids were analyzed with the objective of quantifying weight and growth and identifying variation factors. Kids were artificially reared to weaning, on ad libitum commercial milk replacer, commercial concentrate, lucerne hay and straw. Kids were weighed at birth and at weekly intervals until 60 days of age. Age adjusted weights and growth-rates were calculated. A variance analysis was performed with a model including the effects of season of birth, number of kids per kidding, sex and age of dam. Single and twin-born kids had higher weights than triplets, and males had higher weights than females. Average daily gain after one month of age was lower for kids born in winter-spring than for those born in spring-summer

O impacto do perfil do utente da USF durante o seu internamento

RESUMO - Introdução: Através da elaboração do presente projeto de investigação pretendeu-se analisar o que poderá influenciar o custo total de um utente internado, inscrito numa USF, que foi seguidamente internado no setor hospitalar. Recorreu-se à base de dados de uma USF e de um hospital, ambos pertencentes à ARS Alentejo do ano de 2010. O objetivo central consiste em estudar a relação do volume de consultas da USF e se o tipo de admissão no hospital, sendo ela programada ou não programada, explica a variância o custo do internamento. Metodologia: Foi efetuado o cruzamento entre os dados dos utentes inscritos na USF e o total de internamento hospitalar, utilizando a sua data de nascimento e respetivo sexo. Após efetuado o cruzamento, através de um procedimento estatístico com base em SPSS, foram estipuladas pressupostos de forma a encontrar uma associação entre o custo do utente internado com as variáveis da base de dados da USF. De seguida, foi verificado se o tipo de admissão do internamento pode ou não influenciar o custo do internamento. Para efetuar tais correlações, optei por separar a amostra consoante alguns dos seus grupos mais frequentes, em que foi desagregado os internamentos referentes ao GCD 14 – Gravidez, Parto e Puerpério e dos utentes pertencentes ao escalão etários dos idosos (mais de 64 anos). Resultados: A variável da idade do utente é a que mais poderá explicar a variância do custo do internamento, apresentando sempre valores significativos para tal relação. As restantes pouco ou nada podem explicar a variância do custo do internamento. Quanto à tipologia de admissão, o facto de ser programado poderá explicar a diminuição dos dias de internamento, que concomitantemente poderá diminuir o custo do internamento, devido a forte correlação existente entre elas (r=0,666). Conclusão: A introdução da integração dos cuidados de saúde a nível primário e secundário poderá ser a solução base para a redução dos gastos desnecessários na saúde. Um maior acompanhamento do utente nos CSP poderá reduzir a frequência hospitalar, como verificamos que as variáveis da USF e o facto de a consulta ser programada podem explicar tal variância.