Historical analysis of the Brazilian cervical cancer screening program from 2006 to 2013: a time for reflection

BACKGROUND: The Cervical Cancer Database of the Brazilian National Health Service (SISCOLO) contains information regarding all cervical cytological tests and, if properly explored, can be used as a tool for monitoring and managing the cervical cancer screening program. The aim of this study was to perform a historical analysis of the cervical cancer screening program in Brazil from 2006 to 2013. MATERIAL AND METHODS: The data necessary to calculate quality indicators were obtained from the SISCOLO, a Brazilian health system tool. Joinpoint analysis was used to calculate the annual percentage change. RESULTS: We observed important trends showing decreased rates of low-grade squamous intraepithelial lesions (LSIL) and high-grade squamous intraepithelial lesions (HSIL) and an increased rate of rejected exams from 2009 to 2013. The index of positivity was maintained at levels below those indicated by international standards; very low frequencies of unsatisfactory cases were observed over the study period, which partially contradicts the low rate of positive cases. The number of positive cytological diagnoses was below that expected, considering that developed countries with low frequencies of cervical cancer detect more lesions annually. CONCLUSIONS: The evolution of indicators from 2006 to 2013 suggests that actions must be taken to improve the effectiveness of cervical cancer control in Brazil.

A novel hanging spherical drop system for the generation of cellular spheroids and high throughput combinatorial drug screening

We propose a novel hanging spherical drop system for anchoring arrays of droplets of cell suspension based on the use of biomimetic superhydrophobic flat substrates, with controlled positional adhesion and minimum contact with a solid substrate. By facing down the platform, it was possible to generate independent spheroid bodies in a high throughput manner, in order to mimic in vivo tumour models on the lab-on-chip scale. To validate this system for drug screening purposes, the toxicity of the anti-cancer drug doxorubicin in cell spheroids was tested and compared to cells in 2D culture. The advantages presented by this platform, such as feasibility of the system and the ability to control the size uniformity of the spheroid, emphasize its potential to be used as a new low cost toolbox for high-throughput drug screening and in cell or tissue engineering.

Indicações clínico-epidemiológicas para investigação ecocardiográfica no período neonatal. Valor dos grupos de risco

OBJETIVO: Estudo ecocardiográfico em recém-nascidos (RN) de grupos de risco para cardiopatia congênita, a fim de se determinar a prevalência que justifique esse exame no período neonatal. MÉTODOS: Estudaram-se, de novembro/91 a abril/93, 156 RN do berçário anexo à Maternidade do HC-FMUSP, sendo RN de mães com cardiopatia congênita ou com diabetes mellitus, crianças de muito baixo peso, com malformações extracardíacas ou presença de sinais cardíacos, caracterizados por sopro, cianose ou arritmia, todos submetidos ao ecocardiograma. RESULTADOS: A prevalência encontrada foi de 21,8%, superior ao da população geral (0,8 a 1,2%), sendo que a maior entre os grupos, de 40,7%, ocorreu no grupo de malformações extracardíacas. CONCLUSÃO: Nossos dados justificam a realização de ecocardiograma em RN pertencentes a um destes grupos de risco para cardiopatia congênita.

Zebrafish embryos as in vivo model for toxicity evaluation: screening of nanoparticle formulations DODAB:MO and DODAC:MO

Dissertação de mestrado em Molecular Genetics

Breastfeeding is negatively affected by prenatal depression and reduces postpartum depression

Background. This prospective cohort study explored the effects of prenatal and postpartum depression on breastfeeding and the effect of breastfeeding on postpartum depression. Method. The Edinburgh Postpartum Depression Scale (EPDS) was administered to 145 women at the first, second and third trimester, and at the neonatal period and 3 months postpartum. Self-report exclusive breastfeeding since birth was collected at birth and at 3, 6 and 12 months postpartum. Data analyses were performed using repeated-measures ANOVAs and logistic and multiple linear regressions. Results. Depression scores at the third trimester, but not at 3 months postpartum, were the best predictors of exclusive breastfeeding duration (β =−0.30, t=−2.08, p<0.05). A significant decrease in depression scores was seen from childbirth to 3 months postpartum in women who maintained exclusive breastfeeding for53 months (F1,65 =3.73, p<0.10, ηp 2 =0.05). Conclusions. These findings suggest that screening for depression symptoms during pregnancy can help to identify women at risk for early cessation of exclusive breastfeeding, and that exclusive breastfeeding may help to reduce symptoms of depression from childbirth to 3 months postpartum.

Brazelton Neonatal Behavioral Assessment Scale: a psychometric study in a Portuguese sample

Background: The Neonatal Behavioral Assessment Scale (NBAS, Brazelton & Nugent, 1995) is an instrument conceived to observe the neonatal neurobehavior. Data analysis is usually performed by organizing items into groups. The most widely used data reduction for the NBAS was developed by Lester, Als, and Brazelton (1982). Objective: Examine the psychometric properties of the NBAS items in a sample of 213 Portuguese infants. Method: The NBAS was performed in the first week of infant life (3 days±2) and in the seventh week of life (52 days±5). Results: Principal component analyses yielded a solution of four components explaining 55.13% of total variance. Construct validity was supported by better neurobehavioral performance of 7-week-old infants compared with 1-week-old infants. Conclusion: Changes in the NBAS structure for the Portuguese sample are suggested compared to Lester factors in order to reach better internal consistency of the scale.

Comorbid depression and anxiety effects on pregnancy and neonatal outcome

The effects of comorbid depression and anxiety were compared to the effects of depression alone and anxiety alone on pregnancy mood states and biochemistry and on neonatal outcomes in a large multi-ethnic sample. At the prenatal period the comorbid and depressed groups had higher scores than the other groups on the depression measure. But, the comorbid group had higher anxiety, anger and daily hassles scores than the other groups, and they had lower dopamine levels. As compared to the non-depressed group, they also reported more sleep disturbances and relationship problems. The comorbid group also experienced a greater incidence of prematurity than the depressed, the high anxiety and the non-depressed groups. Although the comorbid and anxiety groups were lower birthweight than the non-depressed and depressed groups, the comorbid group did not differ from the depressed and anxiety groups on birth length. The neonates of the comorbid and depressed groups had higher cortisol and norepinephrine and lower dopamine and serotonin levels than the neonates of the anxiety and non-depressed groups as well as greater relative right frontal EEG. These data suggest that for some measures comorbidity of depression and anxiety is the worst condition (e.g., incidence of prematurity), while for others, comorbidity is no more impactful than depression alone.

Mother-to-infant emotional involvement at birth

Objectives. To study mother-to-infant emotional involvement at birth, namely factors (socio-demographics, previous life events, type of delivery, pain at childbirth, support from partner, infant characteristics, early experiences with the newborn, and mother’s mood) that interfere with the mother’s positive, negative and not clear emotions toward the newborn. Methods. The Bonding Scale (an extended Portuguese version of the ‘New Mother-to-Infant Bonding Scale’) and the Edinburgh Postnatal Depression Scale were administrated during the first after delivery days to 315 mothers recruited at Ju´lio Dinis Maternity Hospital (MJD, Porto, Portugal). Results. A worse emotional involvement with the newborn was observed when the mother was unemployed, unmarried, had less than grade 9, previous obstetrical/psychological problems or was depressed, as well as when the infant was female, had neonatal problems or was admitted in the intensive care unit. Lower total bonding results were significantly predicted when the mother was depressed and had a lower educational level; being depressed, unemployed and single predicted more negative emotions toward the infant as well. No significant differences in the mother-to-infant emotional involvement were obtained for events related to childbirth, such as type of delivery, pain and partner support, or early experiences with the newborn; these events do not predict mother’s bonding results either. Conclusion. The study results support the need for screening and supporting depressed, unemployed and single mothers, in order to prevent bonding difficulties with the newborn at birth.

Prenatal dopamine and neonatal behavior and biochemistry

Depressed pregnant women (N=126) were divided into high and low prenatal maternal dopamine (HVA) groups based on a tertile split on their dopamine levels at 20 weeks gestation. The high versus the low dopamine group had lower Center for Epidemiological Studies-Depression Scale (CES-D) scores, higher norepinephrine levels at the 20-week gestational age visit and higher dopamine and serotonin levels at both the 20- and the 32-week gestational age visits. The neonates of the mothers with high versus low prenatal dopamine levels also had higher dopamine and serotonin levels as well as lower cortisol levels. Finally, the neonates in the high dopamine group had better autonomic stability and excitability scores on the Brazelton Neonatal Behavior Assessment Scale. Thus, prenatal maternal dopamine levels appear to be negatively related to prenatal depression scores and positively related to neonatal dopamine and behavioral regulation, although these effects are confounded by elevated serotonin levels.

Prenatal serotonin and neonatal outcome: brief report

The purpose of the present study was to determine the relationships between prenatal serotonin levels and other biochemical values during pregnancy as well as their relationships to neonatal biochemical and behavioral variables. To address that question, the pregnant women were divided into the top and bottom tertiles based on their serotonin levels at 20 weeks gestational age.

Chronic prenatal depression and neonatal outcome

Four hundred and thirty pregnant women were recruited at approximately 22 weeks gestation at prenatal clinics. Of these, 86 (20%) were diagnosed as depressed. The women were seen again at approximately 32 weeks gestation and after delivery. Chronicity of depression was evidenced by continuing high depression scores in those women diagnosed as depressed. Comorbid problems were chronically high anxiety, anger, sleep disturbance, and pain scores. Less optimal outcomes for the depressed women included lower gestational age and lower birthweight of their newborns.

Estratégia cirúrgica na transposição das grandes artérias com septo interventricular intacto após o período neonatal

OBJETIVO: Analisar o resultado cirúrgico em portadores de transposição das grandes artérias com septo interventricular intacto, operados após o período neonatal. MÉTODOS: Entre janeiro de 1998 e março de 2004 foram atendidas 121 crianças com transposição das grandes artérias com septo interventricular intacto, sendo 29 (24%) após o período neonatal. A seleção para tratamento cirúrgico foi baseada na avaliação ecocardiográfica pelo cálculo da massa do ventrículo esquerdo e da configuração do septo interventricular. Das 29 crianças, 12 foram selecionadas para correção anatômica primária, 12 para correção em dois estágios, após preparo cirúrgico do ventrículo esquerdo e 5 submetidas a correção atrial. RESULTADOS: No grupo submetido à correção anatômica primária houve 1 (8,3%) óbito hospitalar por sepsis. No grupo de correção em dois estágios, 5 pacientes foram submetidos ao preparo lento, com correção 3-6 meses após o 1º estágio, ocorrendo 4 óbitos após o 1º estágio. Este fato determinou mudança no nosso protocolo, adotando-se a técnica de preparo rápido nos outros 7 pacientes, tendo todos atingido o 2º estágio. Das 8 crianças submetidas ao 2º estágio houve 1 óbito hospitalar e outro óbito tardio. A evolução clínica tardia das crianças de ambos os grupos é excelente. CONCLUSÃO: A seleção ecocardiográfica adequada da transposição de grandes artérias com septo interventricular intacto quando abordada após o período neonatal, permitiu uma orientação segura da escolha da melhor abordagem cirúrgica nestes pacientes.

Atriosseptostomia por cateter balão guiada pela ecocardiografia em unidade de terapia intensiva neonatal

FUNDAMENTO: A ecocardiografia bidimensional à beira do leito tem sido utilizada com sucesso para guiar a atriosseptostomia com cateter balão, agilizando o procedimento e evitando os riscos do transporte para o laboratório de hemodinâmica. OBJETIVO: Avaliar os resultados da atriosseptostomia com cateter balão à beira do leito em neonatos cianóticos. MÉTODOS: Entre jan/1997 e jul/2008, foram realizados 102 procedimentos de atriosseptostomia com cateter balão guiados pela ecocardiografia, sendo avaliados níveis de saturação, diâmetro da comunicação, saturação de oxigênio, resposta clínico-laboratorial e complicações relacionadas ao procedimento. RESULTADOS: De um total de 102 casos de Rashkind realizados à beira do leito, 98 preencheram os critérios de inclusão, sendo 90 neonatos do Grupo A (procedimento de Rashkind em fase pré-operatória) e 8 do Grupo B (procedimento em fase pós-operatória). Houve predomínio do sexo masculino (75%), a idade média foi de 8,3 ± 9,3 dias, o peso médio foi de 3.100 ± 1.100 g e a transposição das grandes artérias foi a cardiopatia congênita mais frequente (n = 74). Comparando-se os valores das saturações pré e pós-procedimento (65,9 ± 19,5% e 86 ± 9,7%) e o diâmetro da comunicação interatrial pré e pós-procedimento (2,3 ± 1,0 mm e 5,5 ± 1,3 mm) houve diferença estatisticamente significativa (p < 0,001). Comparando-se os valores das saturações e o diâmetro da comunicação interatrial nos grupos de sobreviventes e não sobreviventes não houve diferença estatisticamente significativa (p > 0,05). CONCLUSÃO: A atriosseptostomia com cateter guiada pela ecocardiografia reduz os riscos por possibilitar a efetiva paliação sem perda de tempo em neonatos cianóticos, além de apresentar menores custos hospitalares.

impact of prenatal stress and neonatal handling on the neuronal development of the rodent limbic system

Prenatal stress, rodent, limbic system, neuronal development, dendritic spines, sex difference

Glia going emotional : the impact of acute and repeated neonatal separations on astrocytes in the medial prefrontal cortex

Astrocytes, GFAP, glia, neonatal separation, medial prefrontal cortex, S100ß