Depression and Cognition in Type 2 Diabetes from a Life Course Perspective

Background: Type 2 diabetes is linked to several complications which add to both physical and mental distress. Depression is a common co-morbidity of diabetes which can occur both as a cause and a consequence of type 2 diabetes. Depression has been shown to correlate with glucose regulation and treating depression might prove beneficial for glucose regulation as well as for mental well being. Another complication which might affect diabetes management is cognitive decline. Several risk factors and complications of diabetes might modify the risk for developing cognitive impairment, which is increased 1.5 times among subjects with type 2 diabetes. Type 2 diabetes, depression and impaired cognitive performance have all been linked to low birth weight. This thesis aimed to explore the effects and interactions of birth weight, depression and cognitive ability in relation to type 2 diabetes from a life course perspective. Subjects and methods: Studies I, II and V were part of the Helsinki Birth Cohort Study. 2003 subjects participated in an extensive clinical examination at an average age of 61 years. A standard glucose tolerance test (OGTT) was performed and depressive symptoms were assessed using the Beck Depression Inventory (BDI). In addition data was obtained from child welfare clinics and national registers. A subset of the cohort (n=1247) also performed a test on cognitive performance (CogState ®) at the average age of 64. Studies III and IV were randomised clinical trials where mildly depressed diabetic subjects were treated with paroxetine or placebo and the effect on metabolic parameters and quality of life was assessed. The first trial included 14 women and lasted 10 weeks, while the second trial included 43 subjects, both men and women, and lasted 6 months. Results: Type 2 diabetes was positively associated with the occurrence of depressive symptoms. Among diabetic subjects 23.6% had depressive symptoms, compared to 16.7% of subjects with normal glucose tolerance (OR = 1.77, p<0.001). Formal mediation analysis revealed that cardiovascular disease (CVD) is likely to act as a mediator in the association. Furthermore, low birth weight was found to modify the association between type 2 diabetes, CVD and depression. The association between BDI score and having type 2 diabetes or CVD was twice as strong in the subgroup with low birth weight (≤ 2500g) compared with the group with birth weight > 2500g (p for interaction 0.058). In the six months long randomised clinical trial (study IV) paroxetine had a transient beneficial effect on glycosylated haemoglobin A1c (GHbA1c) and quality of life when compared to placebo after three months of treatment. In study V we found that subjects with known diabetes had a consistently poorer level of cognitive performance than subjects with normal glucose tolerance in most of the tested cognitive domains. This effect was further amplified among those born with a small birth weight (p for interaction 0.002). Conclusions: Type 2 diabetes is associated with a higher occurrence of depressive symptoms compared to subjects with normal glucose tolerance. This association is especially strong among subjects with CVD and those born with a low birth weight. Treating depressed diabetic subjects with paroxetine has no long term effect on glucose regulation. Physicians should be aware of depression as an important co-morbidity of type 2 diabetes. Both depression and the cognitive decline often seen among diabetic subjects are increased if the subject is born with a low birth weight. Physicians should recognise low birth weight as an additional risk factor and modifier of diabetic complications.

Towards understanding the unusual Indian monsoon in 2009

The Indian summer monsoon season of 2009 commenced with a massive deficit in all-India rainfall of 48% of the average rainfall in June. The all-India rainfall in July was close to the normal but that in August was deficit by 27%. In this paper, we first focus on June 2009, elucidating the special features and attempting to identify the factors that could have led to the large deficit in rainfall. In June 2009, the phase of the two important modes, viz., El Nino and Southern Oscillation (ENSO) and the equatorial Indian Ocean Oscillation (EQUINOO) was unfavourable. Also, the eastern equatorial Indian Ocean (EEIO) was warmer than in other years and much warmer than the Bay. In almost all the years, the opposite is true, i.e., the Bay is warmer than EEIO in June. It appears that this SST gradient gave an edge to the tropical convergence zone over the eastern equatorial Indian Ocean, in competition with the organized convection over the Bay. Thus, convection was not sustained for more than three or four days over the Bay and no northward propagations occurred. We suggest that the reversal of the sea surface temperature (SST) gradient between the Bay of Bengal and EEIO, played a critical role in the rainfall deficit over the Bay and hence the Indian region. We also suggest that suppression of convection over EEIO in association with the El Nino led to a positive phase of EQUINOO in July and hence revival of the monsoon despite the El Nino. It appears that the transition to a negative phase of EQUINOO in August and the associated large deficit in monsoon rainfall can also be attributed to the El Nino.

The neuronal cell adhesion molecule ICAM-5

The neuronal cell adhesion molecule ICAM-5 ICAM-5 (telencephalin) belongs to the intercellular adhesion molecule (ICAM)-subgroup of the immunoglobulin superfamily (IgSF). ICAMs participate in leukocyte adhesion and adhesion-dependent functions in the central nervous system (CNS) through interacting with the leukocyte-specific b2 integrins. ICAM-5 is found in the mammalian forebrain, appears at the time of birth, and is located at the cell soma and neuronal dendrites. Recent studies also show that it is important for the regulation of immune functions in the brain and for the development and maturation of neuronal synapses. The clinical importance of ICAM-5 is still under investigation; it may have a role in the development of Alzheimer s disease (AD). In this study, the role of ICAM-5 in neuronal differentiation and its associations with a-actinin and N-methyl-D-aspartic acid (NMDA) receptors were examined. NMDA receptors (NMDARs) are known to be involved in many neuronal functions, including the passage of information from one neuron to another one, and thus it was thought important to study their role related to ICAM-5. The results suggested that ICAM-5 was able to induce dendritic outgrowth through homophilic adhesion (ICAM-5 monomer binds to another ICAM-5 monomer in the same or neighbouring cell), and the homophilic binding activity appeared to be regulated by monomer/multimer transition. Moreover, ICAM-5 binding to a-actinin was shown to be important for neuritic outgrowth. It was examined whether matrix metalloproteinases (MMPs) are the main enzymes involved in ICAM-5 ectodomain cleavage. The results showed that stimulation of NMDARs leads to MMP activation, cleavage of ICAM-5 and it is accompanied by dendritic spine maturation. These findings also indicated that ICAM-5 and NMDA receptor subunit 1 (NR1) compete for binding to a-actinin, and ICAM-5 may regulate the NR1 association with the actin cytoskeleton. Thus, it is concluded that ICAM-5 is a crucial cell adhesion molecule involved in the development of neuronal synapses, especially in the regulation of dendritic spine development, and its functions may also be involved with memory formation and learning.

Mehiläisten (Apis mellifera) kukkavierailut mansikalla (Fragaria x ananassa) ja vadelmalla (Rubus idaeus) sekä kukkavierailuihin vaikuttavat tekijät

Hyönteispölytys lisää monien ristipölytteisten viljelykasvien siemensatoa sekä parantaa sadon laatua. Marjakasveilla, kuten mansikalla ja vadelmalla marjojen koko suurenee sekä niiden laatu paranee onnistuneen pölytyksen seurauksena. Aiempien havaintojen mukaan mansikan kukat eivät pääsääntöisesti houkuttele mehiläisiä, kun taas vadelma on yksi mehiläisten pääsatokasveista. Tutkimuksen tarkoituksena oli selvittää, miten tehokkaasti mehiläiset vierailevat mansikalla sekä vadelmalla, keskittyen kukkakohtaisiin käynteihin tuntia kohti. Mehiläisiä voidaan käyttää Gliocladium catenulatum-vektoreina torjuttaessa mansikan ja vadelman harmaahometta (Botrytis cinerea). Kukkavierailujen perusteella arvioidaan, onko vektorilevitys riittävän tehokas torjumaan harmaahometta ja miten hyvin mehiläisiä voidaan käyttää pölytyspalveluihin, etenkin mansikalla. Havainnot kerättiin kuudelta eri tilalta Sisä-Savosta kesällä 2007. Kukkavierailuja laskettiin mansikan ja vadelman kukinnan aikana erilaisissa sääolosuhteissa, eri kellonaikoina ja eri etäisyyksillä mehiläispesistä. Kukat valittiin satunnaisesti, ja valintaperusteena oli kukan avonaisuus. Tarkkailuaika riippui mehiläisten lentoaktiivisuudesta. Mansikan koko havaintojakson keskiarvoksi tuli 1,75 käyntiä kukkaa kohti tunnissa. Vadelmalla vastaava luku oli 4,27, joten keskiarvojen perusteella vadelma oli houkuttelevampi kuin mansikka. Kasvukauden vaiheella ei ollut eroja vierailuihin kummallakaan kasvilla, mutta vuorokaudenajan suhteen vierailuja oli enemmän aamupäivällä kuin iltapäivällä. Lämpötila korreloi positiivisesti vierailutiheyden kanssa kummallakin kasvilla. Sääolosuhteet rajoittivat havaintojen keräämistä ja kesä oli erittäin sateinen. Mehiläiset vierailivat kukissa riittävästi haastavissakin sääolosuhteissa niin, että harmaahometorjunta onnistui. Vektorilevitystä suunnitellessa, etenkin mansikalla, tulee ottaa huomioon pesien sijoittelu sekä riittävä lukumäärä. Pesien ravinnontarpeen tulee olla suuri, jotta mehiläiset keräisivät ravintoa kukista mahdollisimman tehokkaasti. Pesiin voidaan lisätä tarvittaessa avosikiöitä tai poistaa siitepölyvarastoja ravinnonkeruuaktiivisuuden lisäämiseksi. Lisätutkimusta tarvitaan pesien sijoittelun, kilpailevien kasvien sekä mansikkalajikkeiden houkuttelevuuden vaikutuksesta vierailutiheyteen. Suomalaisten mansikkalajikkeiden meden sekä siitepölyneritystä olisi myös hyvä selvittää.

Perinatal mortality and maternal health in rural China

Background and context Since the economic reforms of 1978, China has been acclaimed as a remarkable economy, achieving 9% annual growth per head for more than 25 years. However, China's health sector has not fared well. The population health gains slowed down and health disparities increased. In the field of health and health care, significant progress in maternal care has been achieved. However, there still remain important disparities between the urban and rural areas and among the rural areas in terms of economic development. The excess female infant deaths and the rapidly increasing sex ratio at birth in the last decade aroused serious concerns among policy makers and scholars. Decentralization of the government administration and health sector reform impacts maternal care. Many studies using census data have been conducted to explore the determinants of a high sex ratio at birth, but no agreement has been so far reached on the possible contributing factors. No study using family planning system data has been conducted to explore perinatal mortality and sex ratio at birth and only few studies have examined the impact of the decentralization of government and health sector reforms on the provision and organization of maternal care in rural China. Objectives The general objective of this study was to investigate the state of perinatal health and maternal care and their determinants in rural China under the historic context of major socioeconomic reforms and the one child family planning policy. The specific objectives of the study included: 1) to study pregnancy outcomes and perinatal health and their correlates in a rural Chinese county; 2) to examine the issue of sex ratio at birth and its determinants in a rural Chinese county; 3) to explore the patterns of provision, utilization, and content of maternal care in a rural Chinese county; 4) to investigate the changes in the use of maternal care in China from 1991 to 2003. Materials and Methods This study is based on a project for evaluating the prenatal care programme in Dingyuan county in 1999-2003, Anhui province, China and a nationwide household health survey to describe the changes in maternal care utilization. The approaches used included a retrospective cohort study, cross sectional interview surveys, informant interviews, observations and the use of statistical data. The data sources included the following: 1) A cohort of pregnant women followed from pregnancy up to 7 days after birth in 20 townships in the study county, collecting information on pregnancy outcomes using family planning records; 2) A questionnaire interview survey given to women who gave birth between 2001 and 2003; 3) Various statistical and informant surveys data collected from the study county; 4) Three national household health interview survey data sets (1993-2003) were utilized, and reanalyzed to described the changes in maternity care utilization. Relative risks (RR) and their confidence intervals (CI) were calculated for comparison between parity, approval status, infant sex and township groups. The chi-square test was used to analyse the disparity of use of maternal care between and within urban and rural areas and its trend across the years in China. Logistic regression was used to analyse the factors associated with hospital delivery in rural areas. Results There were 3697 pregnancies in the study cohort, resulting in 3092 live births in a total population of 299463 in the 20 study townships during 1999-2000. The average age at pregnancy in the cohort was 25.9 years. Of the women, 61% were childless, 38% already had one child and 0.3% had two children before the current pregnancy. About 90% of approved pregnancies ended in a live birth while 73% of the unapproved ones were aborted. The perinatal mortality rate was 69 per thousand births. If the 30 induced abortions in which the gestational age was more than 28 weeks had been counted as perinatal deaths, the perinatal mortality rate would have been as high as 78 per thousand. The perinatal mortality rate was negatively associated with the wealth of the township. Approximately two thirds of the perinatal deaths occurred in the early neonatal period. Both the still birth rate and the early neonatal death rate increased with parity. The risk of a stillbirth in a second pregnancy was almost four times that for a first pregnancy, while the risk of early neonatal deaths doubled. The early neonatal mortality rate was twice as high for female as for male infants. The sex difference in the early neonatal mortality rate was mainly attributable to mortality in second births. The male early neonatal mortality rate was not affected by parity, while the female early neonatal mortality rate increased dramatically with parity: it was about six times higher for second births than for first births. About 82% early neonatal deaths happened within 24 hours after birth, and during that time, girls were almost three times more likely to die than boys. The death rate of females on the day of birth increased much more sharply with parity than that of males. The total sex ratio at birth of 3697 registered pregnancies was 152 males to 100 females, with 118 and 287 in first and second pregnancies, respectively. Among unapproved pregnancies, there were almost 5 live-born boys for each girl. Most prenatal and delivery care was to be taken care of in township hospitals. At the village level, there were small private clinics. There was no limitation period for the provision of prenatal and postnatal care by private practitioners. They were not permitted to provide delivery care by the county health bureau, but as some 12% of all births occurred either at home or at private clinics; some village health workers might have been involved. The county level hospitals served as the referral centers for the township hospitals in the county. However, there was no formal regulation or guideline on how the referral system should work. Whether or not a woman was referred to a higher level hospital depended on the individual midwife's professional judgment and on the clients' compliance. The county health bureau had little power over township hospitals, because township hospitals had in the decentralization process become directly accountable to the township government. In the township and county hospitals only 10-20% of the recurrent costs were funded by local government (the township hospital was funded by the township government and the county hospital was funded by the county government) and the hospitals collected user fees to balance their budgets. Also the staff salaries depended on fee incomes by the hospital. The hospitals could define the user charges themselves. Prenatal care consultations were however free in most township hospitals. None of the midwives made postnatal home visits, because of low profit of these services. The three national household health survey data showed that the proportion of women receiving their first prenatal visit within 12 weeks increased greatly from the early to middle 1990s in all areas except for large cities. The increase was much larger in the rural areas, reducing the urban-rural difference from more than 4 times to about 1.4 times. The proportion of women that received antenatal care visits meeting the Ministry of Health s standard (at least 5 times) in the rural areas increased sharply from 12% in 1991-1993 to 36% in 2001-2003. In rural areas, the proportion increase was much faster in less developed areas than in developed areas. The hospital delivery rate increased slightly from 90% to 94% in urban areas while the proportion increased from 27% to 69% in rural areas. The fastest change was found to be in type 4 rural areas, where the utilization even quadrupled. The overall difference between rural and urban areas was substantially narrowed over the period. Multiple logistic regression analysis shows that time periods, residency in rural or urban areas, income levels, age group, education levels, delivery history, occupation, health insurance and distance from the nearest health care facilities were significantly associated with hospital delivery rates. Conclusions 1. Perinatal mortality in this study was much higher than that for urban areas as well as any reported rate from specific studies in rural areas of China. Previous studies in which calculations of infant mortality were not based on epidemiological surveys have been shown to underestimate the rates by more than 50%. 2. Routine statistics collected by the Chinese family planning system proved to be a reliable data source for studying perinatal health, including still births, neonatal deaths, sex ratio at birth and among newborns. National Household Health Survey data proved to be a useful and reliable data source for studying population health and health services. Prior to this research there were few studies in these areas available to international audiences. 3.Though perinatal mortality rate was negatively associated with the level of township economic development, the excess female early neonatal mortality rate contributed much more to high perinatal mortality rate than economic factors. This was likely a result of the role of the family planning policy and the traditional preferences for sons, which leads to lethal neglect of female newborns and high perinatal mortality. 4. The selective abortions of female foetuses were likely to contribute most to the high sex ratio at birth. The underreporting of female births seemed to have played a secondary role. The higher early neonatal mortality rate in second-born as compared to first-born children, particularly in females, may indicate that neglect or poorer care of female newborn infants also contributes to the high sex ratio at birth or among newborns. Existing family planning policy proved not to effectively control the steadily increased birth sex ratio. 5. The rural-urban gap in service utilization was on average significantly narrowed in terms of maternal healthcare in China from 1991 to 2003. This demonstrates that significant achievements in reducing inequities can be made through a combination of socio-economic development and targeted investments in improving health services, including infrastructure, staff capacities, and subsidies to reduce the costs of service utilization for the poorest. However, the huge gap which persisted among cities of different size and within different types of rural areas indicated the need for further efforts to support the poorest areas. 6. Hospital delivery care in the study county was better accepted by women because most of women think delivery care was very important while prenatal and postnatal care were not. Hospital delivery care was more systematically provided and promoted than prenatal and postnatal care by township hospital in the study area. The reliance of hospital staff income on user fees gave the hospitals an incentive to put more emphasis on revenue generating activities such as delivery care instead of prenatal and postnatal care, since delivery care generated much profits than prenatal and postnatal care . Recommendations 1. It is essential for the central government to re-assess and modify existing family planning policies. In order to keep national sex balance, the existing practice of one couple one child in urban areas and at-least-one-son a couple in rural areas should be gradually changed to a two-children-a-couple policy throughout the country. The government should establish a favourable social security policy for couples, especially for rural couples who have only daughters, with particular emphasis on their pension and medical care insurance, combined with an educational campaign for equal rights for boys and girls in society. 2. There is currently no routine vital-statistics registration system in rural China. Using the findings of this study, the central government could set up a routine vital-statistics registration system using family planning routine work records, which could be used by policy makers and researchers. 3. It is possible for the central and provincial government to invest more in the less developed and poor rural areas to increase the access of pregnant women in these areas to maternal care services. Central government together with local government should gradually provide free maternal care including prenatal and postnatal as well as delivery care to the women in poor and less developed rural areas. 4. Future research could be done to explore if county and the township level health care sector and the family planning system could be merged to increase the effectiveness and efficiency of maternal and child care. 5. Future research could be done to explore the relative contribution of maternal care, economic development and family planning policy on perinatal and child health using prospective cohort studies and community based randomized trials. Key words: perinatal health, perinatal mortality, stillbirth, neonatal death, sex selective abortion, sex ratio at birth, family planning, son preference, maternal care, prenatal care, postnatal care, equity, China

Viherrevonhäntä ja kananhirssi vieraslajeina Suomessa

Kasvit ovat kautta aikojen levinneet uusille elinpaikoille. Kasvin asettumista uuteen paikkaan voidaan tarkastella prosessina, jossa on erilaisia vaiheita ja eri vaiheissa eri tekijät ovat tärkeitä. Ilmasto ja erityisesti lämpötila vaikuttavat kasvien levinneisyyteen ja leviämiseen uusille paikoille ja siksi ilmaston lämpenemisen ennustetaan siirtävän kasvien levinneisyysalueita kohti pohjoista. On mahdollista, että Suomeenkin leviäisi etelämmästä muiden kasvien ohella haitallisia rikkakasvilajeja, kuten esimerkiksi viherrevonhäntä (Amaranthus retroflexus L.) ja kananhirssi (Echinochloa crus-galli L. Beauv.). Tämän tutkimuksen tarkoituksena oli selvittää, selviävätkö viherrevonhäntä ja kananhirssi Suomessa pelto-olosuhteissa ja pohtia niiden vakiintumisen ja leviämisen mahdollisuuksia. Toinen tarkoitus oli selvittää ilmaston lämpenemisen vaikutusta näiden rikkakasvien kasvuun. Tutkimus suoritettiin kenttä- sekä kasvihuonekokeena. Viherrevonhäntä kasvoi pellolla hyvin huolimatta myöhäisestä itämisestä, mutta kananhirssi iti ja kasvoi pellolla huonosti. Kasvihuoneessa molemmat kasvoivat hyvin. Kilpailu vähensi viherrevonhännän ja kananhirssin vegetatiivista kasvua vain kasvihuoneessa, mutta siementuottoon kilpailu vaikutti sekä kasvihuoneessa että pellolla. Kasvihuoneessa korkeampi lämpötila ei vaikuttanut viherrevonhännän tai kananhirssin vegetatiiviseen kasvuun, mutta viherrevonhännän siementuotto parani lämpimämmässä. Lämpötilalla ei ollut vaikutusta kananhirssin siementuotantoon. Tutkimuksen tuloksista voidaan päätellä, että viherrevonhäntä voi hyvinkin kasvaa Suomessa jo nykyisissä lämpötiloissa, mutta siementuotto ei välttämättä olisi varmaa. Viherrevonhäntä voisi näin ollen hyötyä tulevaisuuden pidemmästä kasvukaudesta. Kananhirssin osalta tulokset olivat ristiriitaiset ja ilmaston lämpenemisen vaikutuksia kananhirssiin on tämän tutkimuksen perusteella hankala arvioida.

Bioética personalista y familia

En este trabajo se aborda la visión del hombre como persona humana y el respeto que se le debe como tal desde el inicio de su vida en la concepción hasta su fin natural. Los atentados que pueden y podrán cometerse contra la vida constituyen otros tantos atentados también contra la institución familiar, lugar natural del nacimiento y desarrollo de la vida de un nuevo ser humano. El respeto por el hombre en cuanto persona es una de las exigencias que no admiten discusión; de ella dependen la dignidad y también el bienestar y la subsistencia de la Humanidad.

Antiguo Oriente: Cuadernos del Centro de Estudios de Historia del Antiguo Oriente, 2006, n° 4 (número completo)

How old is the Kingdom of Edom? A review of new evidence and recent discussion / Eveline Van Der Steen ; Piotr Bienkowski -- A problem of pedubasts? / Dan´El Kahn -- Le ciel selon l´Hymne Orphique à Ouranos et selon des textes funéraires égyptiens (PT, CT, BD): une brève comparaison préliminaire / Amanda–Alice Marvelia -- An epigraphic reanalysis of Two Stelae from Firs Intermediate Period Dendera in the Cairo Museum / Tracy Musacchio -- Mass production in Mesopotamia / Morris Silver -- Iron Age “negative” pottery: a reassessment / Juan Manuel Tebes -- The Cordage from the 2001- Season of the excavations at Berenike (Egyptian Red Sea Coast): preliminary results / André J. Veldmeijer -- Article review. Carr, David M., Writing of the Tablet of the Heart: origins of scripture and literature / Itamar Singer -- Reseñas bibliográficas -- Política editorial

Einfluss von Größen und Fangzeit auf das Fettsäuremuster von Sardellen

Fatty acid composition of fish changes according to season, the catching area, the size, the sexuality, the physiological condition and the quantity of fat. The fatty acid composition was evaluated according to size and the catching season of anchovies Engraulis encrasicolus (L. 1758). It was observed that polyunsaturated fatty acids increasmed to highest level and saturated fatty acids decreased to lowest level in March. On the other hand, in April, it was observed that the saturated fatty acids increased to its highest level, monounsaturated fatty acids decreased to its lowest level.

Laichen von Dorschen in Gefangenschaft. Teil 1: Verlauf der Laichaktivitäten

Individuals of the western stock of Baltic cod were kept at captivity with different temperatures and salinities until natural spawning. Spawning activities up to 16 weeks were observed between February and June. This time interval agrees weIl with the spawning season of the wild cod stock. Also as in in-situ observations larger individuals started earlier with the spawning process than smaller ones and had significantly larger periods of spawning. Larger cods produced more batches and more eggs than smaller cods within this time interval. The comparison between the actual and potential absolut fecundity showed large differences. Only apart of the potential absolut fecundity, estimated in the phase of prespawning development of ovaries, was developed until their release. These analyses showed that larger cod were able to develop a larger part of the eggs within the ovaries up to the complete development. This result should be considered in the future during estimations of the population fecundity of the western Baltic spawning stock.

The River Endrick - then and now, monitoring by photography

A major survey of the River Endrick was carried out in 1959-60. This survey was repeated three decades later in 1989-90 and comparisons were made of the fauna at the two times of sampling. During both surveys, photographs were taken of all the sampling sites and the objective of the present paper is to compare some of these photographs and discuss the value of photography in studies of river ecology. The sites used for photographic comparison were not chosen originally for that purpose but as appropriate places on the river from source to mouth to study its ecology. The pairs of photos now available have proved of interest and value and some lessons have been learned in relation to the selection of sites for any future photographic studies. Ideally photos should be taken in more than one season of the year as much of the river can be obscured by riparian trees and shrubs during the vegetative season. The exact position from which each photograph is taken is also a major factor to be considered.

A enfermeira obstétrica frente às transformações de sua prática consequente ao movimento de humanização do campo obstétrico hospitalar

Este estudo de perspectiva histórico-social estuda as transformações das práticas das enfermeiras obstétricas consequente ao movimento de humanização do campo obstétrico hospitalar. Tem por objetivos: identificar o capital global das enfermeiras obstétricas; analisar as concepções das enfermeiras sobre a prática profissional no campo obstétrico hospitalar no contexto do movimento de humanização; discutir as transformações percebidas pelas enfermeiras obstétricas sobre sua prática. Utilizei como método a história oral. Os sujeitos foram 25 enfermeiras que vivenciaram no campo obstétrico hospitalar, antes e após a implementação do movimento de humanização. Os cenários foram seis maternidades municipais do Rio de Janeiro. A técnica de coleta de dados foi a entrevista semiestruturada. À luz da perspectiva histórica realizarei a análise dos dados, tendo como base os pressupostos de Pierre Bourdieu. A conjuntura obstétrica do nascimento das entrevistadas era a de transição do parto domiciliar para o ambiente hospitalar. O cenário do parto e nascimento de muitas delas foi uma instituição pública de saúde ou conveniada. As agentes são oriundas de famílias humildes, com pouco capital econômico e cultural. Ressalta-se que as condições de acumulação de capital destas enfermeiras, à época, foram proporcionais às oportunidades que tiveram no campo social em que se encontravam e do processo de socialização. Algumas, após o curso de graduação em enfermagem, buscaram a especialização para adquirir um certificado, que lhes aumentasse o volume de capital e as legitimasse para a realização da assistência ao parto normal. O contexto político onde muitas adquiriram o título de especialista era o de implementação do modelo humanizado no campo obstétrico do município do Rio de Janeiro, favorável para a redução de práticas intervencionistas à parturiente com o incentivo ao parto normal focado na autonomia e no empoderamento feminino. Desse modo, as enfermeiras perceberam que as lutas dos agentes no campo obstétrico para a implantação de um novo modo de agir na obstetrícia foram importantes no processo de mudança de suas práticas. Especificamente sobre as transformações de sua práticas elas evidenciaram que, com esse movimento social e político elas passaram a ver e a assistir a mulher, de forma mais próxima, mais humanizada através da aquisição de capital cultural eficiente, outra evidência destacada foi quanto à questão das lutas, houve o reconhecimento de que as lutas foram importantes no processo de mudança, pois com estas foi possível adquirir lucros simbólicos significativos que permitiram gerar mudanças de posição e de práticas obstétricas no campo hospitalar.

Práticas educativas durante a gestação na Estratégia de Saúde da Família: refletindo sobre limites e possibilidades

Estudo de natureza qualitativa que teve como objetivo analisar as práticas de Educação em Saúde desenvolvidas com gestantes atendidas pela Estratégia de Saúde da Família no município de Quissamã no Rio de Janeiro. Para a coleta de dados foi utilizada a técnica do grupo focal, sendo realizados três grupos em unidades com elevadas taxas de cesárea, a fim de refletir sobre a relação entre a participação nas atividades e a escolha pelo tipo de parto. Os sujeitos do estudo foram 18 mulheres que tiveram seus filhos no ano de 2008 e que participaram de qualquer atividade educativa desenvolvida pelas unidades. A análise de dados foi orientada pela análise de conteúdo de Bardin e das falas das mulheres emergiram 03 categorias e uma subcategoria. A investigação apontou que a participação nas práticas educativas ajuda nas escolhas durante a gestação, pois as mulheres sentem-se mais seguras e preparadas para o parto e o pós-parto. Contudo, a escolha pelo tipo de parto ainda é determinada pelos profissionais. O estudo indica que há uma disputa entre o projeto de assistência obstétrica delineado pela mulher e o projeto do profissional, de modo que a indicação médica continua a prevalecer. Apesar dos esforços dos profissionais da Estratégia de Saúde da Família do município investigado, as práticas educativas realizadas com as gestantes, ainda precisam ser desenvolvidas a fim de possuir um cunho emancipatório, na superação de uma prática transmissora de modo a empoderar a mulher para a sustentação de suas decisões. Observa-se que as atividades são orientadas por um planejamento, entretanto, a avaliação das ações não acontecem, de modo que se faz necessária a reflexão dos profissionais acerca das formas de avaliação das práticas desenvolvidas. A pesquisa recomenda a criação de comitês de avaliação das indicações de cesárea; o investimento na formação permanente dos profissionais, sobretudo em Educação e Saúde; e a reavaliação da metodologia de desenvolvimento dessas atividades com o intuito de se pensar em estratégias que possam envolver as mulheres na construção das práticas educativas, no sentido de empoderá-las para a tomada de decisão e para a defesa de seu projeto de parto.

Crenças e conhecimento de pais e profissionais de saúde sobre desenvolvimento de crianças com síndrome de Down até dois anos de idade

Este estudo apoia-se na abordagem sociocultural, em uma perspectiva interacionista da relação biologia cultura, beneficiando-se também do olhar da psicologia evolucionista para os fenômenos humanos. Estas abordagens, a partir de uma visão do homem como biologicamente cultural fazem-se relevantes para o estudo de crenças e conhecimento sobre o desenvolvimento de crianças com síndrome de Down (SD). Esta síndrome tem prevalência de um a cada 700 nascimentos, não importando classe social, racial ou local de nascimento dos pais, ou seja, é universal. A revisão da literatura revelou uma carência de estudos psicológicos sobre o contexto de desenvolvimento dessas crianças, inclusive as crenças de seus cuidadores e de profissionais de saúde. Sendo assim, o objetivo desse trabalho foi investigar crenças e conhecimento de dois grupos (pais e profissionais de saúde) sobre o desenvolvimento de crianças com síndrome de Down até dois anos de idade no Estado do Rio de Janeiro. Participaram da pesquisa 101 pessoas sendo 60 pais com filhos de até oito anos com síndrome de Down e 41 profissionais de saúde, médicos ou residentes do Instituto Fernandes Figueira, IFF/Fiocruz. Foram utilizados os seguintes instrumentos: Questionário com duas perguntas abertas sobre crenças sobre síndrome de Down que foram respondidas livremente pelos participantes; inventário sobre concepção de desenvolvimento infantil (ICDI); inventário sobre conhecimento de desenvolvimento infantil (KIDI) modificado, adaptado para crianças com síndrome de Down. Os dados foram analisados em aspectos qualitativos e quantitativos. A aplicação dos instrumentos foi realizada individualmente, em local conveniente para o participante ou no IFF/Fiocruz e após a assinatura do termo de consentimento. Os dados dos três instrumentos foram tratados e reduzidos. As respostas ao instrumento de crenças foram organizadas em categorias e comparadas. Escores nas diferentes subescalas do ICDI foram calculados e, em cada grupo (pais e profissionais) analisaram-se as concepções sobre desenvolvimento predominantes, estabelecendo-se comparações entre eles. Escores nas diferentes partes do KIDI foram ainda calculados (porcentagem de acertos). Foram feitas comparações intra e entre grupos. Os resultados foram tratados em cada um dos aspectos: crenças sobre SD, concepções e conhecimento sobre desenvolvimento. Os resultados obtidos mostram que as crenças dos pais estão distribuídas em oito categorias com três focos distintos (na criança, nos pais ou nos dois) e a dos profissionais em nove categorias, também, com três focos distintos (na SD, no médico e na criança e família). O resultado obtido no ICDI indica que os participantes valorizam mais as concepções de aprendizagem e interacionismo do que de maturação e que não há diferença significativa entre os grupos. Para o KIDI observou-se diferença significativa entre os grupos tanto no resultado geral de percentual de acertos como nos resultados em cada subescala. Espera-se que os resultados obtidos possam contribuir para a literatura sobre psicologia do desenvolvimento e síndrome de Down.

Vida como vontade de poder: perspectivismo, metafísica e niilismo no pensamento de Nietzsche

A presente dissertação tem como objetivo principal descrever, em suas especificidades e abrangência, o conceito de vontade de poder no pensamento nietzschiano, mostrando como a metafísica, em sua essência moral, pode ser entendida a partir desse pensamento. A partir do diálogo nietzschiano com pensadores da tradição, pretende-se analisar o conceito de metafísica e como ele possibilita o momento histórico denominado morte de Deus, que desencadeia a experiência do niilismo. Ao descrever o desenvolvimento do pensamento Ocidental, o texto busca evidenciar porque Nietzsche pode denominar a história da metafísica como vontade de verdade. A partir daí, se reconstrói a relação fundamental existente entre as noções de verdade e conhecimento nas nuances de cada época do pensamento metafísico, mostrando como tal processo culmina, no pensamento nietzschiano, com o questionamento acerca do próprio valor da verdade. Por outro lado, a dissertação pretende mostrar como a morte de Deus e o niilismo possibilitam, de certa maneira, o surgimento da própria filosofia nietzschiana, defendendo que o perspectivismo e a vontade de poder são pensamentos possibilitados pelo próprio desenvolvimento histórico da metafísica.