907 resultados para postnatal


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The dentate gyrus is one of only two regions of the mammalian brain where substantial neurogenesis occurs postnatally. However, detailed quantitative information about the postnatal structural maturation of the primate dentate gyrus is meager. We performed design-based, stereological studies of neuron number and size, and volume of the dentate gyrus layers in rhesus macaque monkeys (Macaca mulatta) of different postnatal ages. We found that about 40% of the total number of granule cells observed in mature 5-10-year-old macaque monkeys are added to the granule cell layer postnatally; 25% of these neurons are added within the first three postnatal months. Accordingly, cell proliferation and neurogenesis within the dentate gyrus peak within the first 3 months after birth and remain at an intermediate level between 3 months and at least 1 year of age. Although granule cell bodies undergo their largest increase in size during the first year of life, cell size and the volume of the three layers of the dentate gyrus (i.e. the molecular, granule cell and polymorphic layers) continue to increase beyond 1 year of age. Moreover, the different layers of the dentate gyrus exhibit distinct volumetric changes during postnatal development. Finally, we observe significant levels of cell proliferation, neurogenesis and cell death in the context of an overall stable number of granule cells in mature 5-10-year-old monkeys. These data identify an extended developmental period during which neurogenesis might be modulated to significantly impact the structure and function of the dentate gyrus in adulthood.

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Aujourd’hui, la satisfaction des utilisateurs des services de santé est reconnue comme une mesure de la qualité des soins. Au Québec, le congé précoce en obstétrique constitue la norme pour les mères ayant donné naissance à un bébé en santé. Selon la littérature, cette pratique n’entraîne pas de répercussions négatives pour la santé des mères et de leur nouveau-né à condition qu’un suivi adéquat soit assuré. D’autre part, bien qu’il semble que la diminution de la durée du séjour hospitalier soit appréciée par les mères, peu de données sont disponibles relativement aux caractéristiques menant à l’appréciation du suivi postnatal. Objectifs : Cette étude s’intéresse principalement à la première visite à domicile effectuée par une infirmière suite au congé précoce en obstétrique. Dans un premier temps, elle vise à tracer un portrait des mères en fonction du délai de la première visite à domicile et, dans un second temps, à connaître les facteurs associés à l’appréciation, par les mères, du délai de cette visite. Méthode : Les données de cette étude ont été recueillies au Québec, entre janvier 2002 et janvier 2003, lors d’une enquête téléphonique effectuée auprès de mères de bébés nés en santé, un mois suivant leur accouchement vaginal sans complication (n=1548). Pour nos analyses, nous avons retranché les mères ayant eu une durée de séjour de plus de 60 heures, une grossesse de moins de 37semaines et un bébé pesant moins de 2500 g à la naissance. Notre échantillon se compose donc de 1351 mères. Résultats : 86,2 % des mères ont reçu une offre de visite à domicile. La majorité (80.2 %) des mères ont reçu la visite dans les trois premiers jours suivant leur retour à la maison, dont près du tiers (28,1 %), dans les 24 premières heures. Comparativement aux mères visitées au deuxième ou troisième jour suivant le congé, celles visitées dans les 24 premières heures ont jugé la durée de séjour hospitalier trop courte (p=0,018) et reçu un appel de l’infirmière qui a duré plus longtemps (p=0, 009). De plus, au moment du congé, elles perçoivent leur bébé en moins bonne santé (p=0,029). Elles ont aussi accouché d’un bébé plus petit (p=0,052) qui a tendance à avoir présenté des signes d’ictères pendant le séjour hospitalier (p=0,100). D’autre part, la majorité des mères (86,4 %) disent que le délai de la première visite à domicile est adéquat alors que 11,6 % le jugent trop court et 2,3 % trop long. Pour les mères visitées au premier jour, l’analyse multivariée révèle que certaines caractéristiques et certains besoins sont associés à la perception que le délai de la visite est trop court : une seule visite postnatale, un revenu familial de plus de 40 000 $, la perception que la durée de séjour est trop longue et le fait de ne pas allaiter. Pour les mères qui reçoivent la visite au deuxième et troisième jour, ce sont, seulement, le fait d’avoir été au rendez-vous médical et le fait d’avoir reçu une seule visite qui sont associés à la perception que le délai de la visite est trop court. Pour conclure, au Québec, le programme de suivi postnatal universel semble en mesure d’offrir une visite à domicile dans les délais prescrits à une majorité de mères. Les résultats de cette étude suggèrent que le délai de la première visite à domicile n’est pas optimal pour toutes les mères et permettent d’envisager que certaines mères auraient souhaité recevoir une seconde visite plus tardivement au cours de la période postnatale. D’autres recherches devront être effectuées afin de parfaire nos connaissances relativement au moment idéal pour réaliser les interventions postnatales.Mots clefs : Satisfaction, appréciation des utilisateurs, qualité des soins, programme universel, suivi postnatal, congé précoce en obstétrique, visite à domicile, délai de la visite, provision des services.

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Tesis (Doctor en Ciencias con Orientación terminal en Morfología) U.A.N.L., 2006

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Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

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Introducción La Malformación Adenomatoide Quística Pulmonar es una patología que se desarrolla durante estadíos tempranos de desarrollo embriológico y su pronóstico depende del tamaño de la lesión pulmonar. Existen muy pocos estudios que caractericen esta patología, ninguno en nuestro país. Metodología Se realizó una serie de casos para describir el resultado postnatal de los casos registrados en la Clínica Colombia entre 2005 hasta 2013. Resultados: Se incluyeron un total de 20 casos. La malformación más frecuente fue MAQ III con 45% de los casos, de localización izquierda (75%), el 65% nacieron después de la semana 35 y con un peso mayor de 2500 g. Tan solo 30 % desarrollaron hidrops asociado. Hubo una mortalidad de 35% (7 casos). Discusion La MAQ es un patología infrecuente que genera una alta morbimortalidad en la vida perinatal. Se requieren estudios con muestras más amplias para determinar los factores pronósticos para la ocurrencia de los desenlaces adversos como la necesidad de cirugía de urgencia, deterioro respiratorio o mortalidad.

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The aim of this study was to assess which behavioral characteristics of the newborn infant are associated with an increased risk of postnatal depression (PND) in the mother. A total of 497 mothers from a prospective cohort study were recruited during the last trimester of pregnancy. Infants were evaluated at 3 days with the Brazelton Neonatal Behavioral Scale. Maternal PND was assessed at 6 weeks postpartum with the Edinburgh Postnatal Depression Scale. Behavioral characteristics of the infant predicted the occurrence of PND, independent of other risk factors for PND: The lower the infants' orientation performance, the higher the risk that the mother would present with PND 6 weeks after delivery. As orientation capacities play a key role in the interactional skills developed between mothers and their infants, an infant who is difficult to engage in interaction may contribute to the risk of PND.

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A representative community sample of primiparous depressed women and a nondepressed control group were assessed while in interaction with their infants at 2 months postpartum. At 3 months, infants were assessed on the Still-face perturbation of face to face interaction, and a subsample completed an Instrumental Learning paradigm. Compared to nondepressed women, depressed mothers' interactions were both less contingent and less affectively attuned to infant behavior. Postnatal depression did not adversely affect the infant's performance in either the Still-face perturbation or the Instrumental Learning assessment. Maternal responsiveness in interactions at 2 months predicted the infant's performance in the Instrumental Learning assessment but not in the Still-face perturbation. The implications of these findings for theories of infant cognitive and emotional development are discussed.

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Objective: Postnatal depression in women is associated with adverse effects on both maternal health and children's development. It is unclear whether depression in men at this time poses comparable risks. The present study set out to assess the association between depression in men in the postnatal period and later psychiatric disorders in their children and to investigate predisposing factors for depression in men following childbirth. Method: A population-based cohort of 10,975 fathers and their children from the Avon Longitudinal Study of Parents and Children (ALSPAC) was recruited in the prenatal period and followed for 7 years. Paternal depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale and later child psychiatric disorder (DSM-IV) with the Development and Well-Being Assessment. Results: Depression in fathers in the postnatal period was significantly associated with psychiatric disorder in their children 7 years later (adjusted OR 1.72, 95% CI 1.07-2.77), most notably oppositional defiant/conduct disorders (adjusted OR 1.94, 95% CI 1.04-3.61), after adjusting for maternal depression and paternal educational level. A history of severe depression and high prenatal symptom scores for depression and anxiety were the strongest predictors of paternal depression in the postnatal period. Conclusions: Depression in fathers in the postnatal period is associated with later psychiatric disorders in their children, independently of maternal postnatal depression. Further research into the risks associated with paternal psychopathology is required because this could represent an important opportunity for public health intervention.

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Background: Depression in fathers in the postnatal period is associated with an increased risk of behavioural problems in their offspring, particularly for boys. The aim of this study was to examine for differential effects of depression in fathers on children's subsequent psychological functioning via a natural experiment comparing prenatal and postnatal exposure. Methods:In a longitudinal population cohort study (the Avon Longitudinal Study of Parents and Children (ALSPAC)) we examined the associations between depression in fathers measured in the prenatal and postnatal period (measured using the Edinburgh Postnatal Depression Scale), and later behavioural/emotional and psychiatric problems in their children, assessed at ages 31/2 and 7 years. Results: Children whose fathers were depressed in both the prenatal and postnatal periods had the highest risks of subsequent psychopathology, measured by total problems at age 31/2 years (Odds Ratio 3.55; 95% confidence interval 2.07, 6.08) and psychiatric diagnosis at age 7 years (OR 2.54; 1.19, 5.41). Few differences emerged when prenatal and postnatal depression exposure were directly compared, but when compared to fathers who were not depressed, boys whose fathers had postnatal depression only had higher rates of conduct problems aged 31/2 years (OR 2.14; 1.22, 3.72) whereas sons of the prenatal group did not (OR 1.41; .75, 2.65). These associations changed little when controlling for maternal depression and other potential confounding factors. Conclusions: The findings of this study suggest that the increased risk of later conduct problems, seen particularly in the sons of depressed fathers, maybe partly mediated through environmental means. In addition, children whose fathers are more chronically depressed appear to be at a higher risk of emotional and behavioural problems. Efforts to identify the precise mechanisms by which transmission of risk may occur should be encouraged to enable the development of focused interventions to mitigate risks for young children.

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Objectives: This study reports the cost-effectiveness of a preventive intervention, consisting of counseling and specific support for the mother-infant relationship, targeted at women at high risk of developing postnatal depression. Methods: A prospective economic evaluation was conducted alongside a pragmatic randomized controlled trial in which women considered at high risk of developing postnatal depression were allocated randomly to the preventive intervention (n = 74) or to routine primary care (n = 77). The primary outcome measure was the duration of postnatal depression experienced during the first 18 months postpartum. Data on health and social care use by women and their infants up to 18 months postpartum were collected, using a combination of prospective diaries and face-to-face interviews, and then were combined with unit costs ( pound, year 2000 prices) to obtain a net cost per mother-infant dyad. The nonparametric bootstrap method was used to present cost-effectiveness acceptability curves and net benefit statistics at alternative willingness to pay thresholds held by decision makers for preventing 1 month of postnatal depression. Results: Women in the preventive intervention group were depressed for an average of 2.21 months (9.57 weeks) during the study period, whereas women in the routine primary care group were depressed for an average of 2.70 months (11.71 weeks). The mean health and social care costs were estimated at 2,396.9 pound per mother-infant dyad in the preventive intervention group and 2,277.5 pound per mother-infant dyad in the routine primary care group, providing a mean cost difference of 119.5 pound (bootstrap 95 percent confidence interval [Cl], -535.4, 784.9). At a willingness to pay threshold of 1,000 pound per month of postnatal depression avoided, the probability that the preventive intervention is cost-effective is .71 and the mean net benefit is 383.4 pound (bootstrap 95 percent Cl, -863.3- pound 1,581.5) pound. Conclusions: The preventive intervention is likely to be cost-effective even at relatively low willingness to pay thresholds for preventing 1 month of postnatal depression during the first 18 months postpartum. Given the negative impact of postnatal depression on later child development, further research is required that investigates the longer-term cost-effectiveness of the preventive intervention in high risk women.

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Background. Animal research shows that early adverse experience results in altered glucocorticoid levels in adulthood, either raised basal levels or accentuated responses to stress. If a similar phenomenon operates in humans, this suggests a biological mechanism whereby early adversity might transmit risk for major depression, glucocorticoid elevations being associated with the development of this disorder. Methods. We measured salivary cortisol at 8:00 Am and 8:00 Pm over 10 days in 13-year-old adolescents who had (n = 48) or bad not (n = 39) been exposed to postnatal maternal depression. Results: Maternal postnatal depression was associated with higher, more variable morning cortisol in offspring, a pattern previously found to predict major depression. Conclusions. Early adverse experiences might alter later steroid levels in humans. Because maternal depression confers added risk for depression to children, these alterations might provide a link between early events and later psychopathology.

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Background: We have previously reported higher and more variable salivary morning cortisol in 13-year-old adolescents whose mothers were depressed in the postnatal period, compared with control group adolescents whose mothers did not develop postnatal depression (PND). This observation suggested a biological mechanism by which intrafamilial risk for depressive disorder may be transmitted. In the current article, we examined whether the cortisol disturbances observed at 13 years could predict depressive symptornatology in adolescents at 16 years of age. Methods: We measured self-reported depressive symptoms in 16-year-old adolescents who had (n = 48) or had not (n = 39) been exposed to postnatal maternal depression and examined their prediction by morning and evening cortisol indices obtained via 10 days of salivary collections at 13 years. Results: Elevated morning cortisol secretion at 13 years, and particularly the maximum level recorded over 10 days of collection, predicted elevated depressive symptoms at 16 years over and above 13-year depressive symptom levels and other possible confounding factors. Morning cortisol secretion mediated an association between maternal PND and symptornatology in 16-year-old offspring. Conclusions: Alterations in steroid secretion observed in association with maternal PND may provide a mechanism by which risk for depression is transmitted from mother to offspring.

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The factor structure of the Edinburgh Postnatal Depression scale (EPDS) and similar instruments have received little attention in the literature. The researchers set out to investigate the construct validity and reliability of the EPDS amongst impoverished South African women. The EPDS was translated into isiXhosa (using Brislin's back translation method) and administered by trained interviewers to 147 women in Khayelitsha, South Africa. Responses were subjected to maximum likelihood confirmatory factor analysis. A single factor structure was found, consistent with the theory on which the EPDS was based. Internal consistency was satisfactory (a = 0.89).

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Transforming growth factor-β (TGF-β) is synthesised as an inactive precursor protein; this is cleaved to produce the mature peptide and a latency associated protein (LAP), which remains associated with the mature peptide until activation by LAP degradation. Isoform specific antibodies raised against the LAPs for TGF-β2and -β3were used to determine the myocardial levels of LAP (activatable TGF-β) and full length precursor (inactive TGF-β) forms during post-natal development in the rat. TGF-β2was present predominantly as the precursor in 2 day old myocardium. There was an age-dependent shift from precursor protein to LAP between 2 and 28 days. A corresponding increase in the level of mature (activatable) TGF-β2was found. TGF-β3was detected in significant quantities only as LAP. However, a four-fold increase in the expression of TGF-β3LAP was observed between 2 and 28 days. The substantial increases in activatable forms of TGF-β2and -β3that occur in myocardium during the first 28 days of life in the rat support a role for these proteins in post-natal cardiac development.

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Background: Postnatal depression (PND) is associated with poor cognitive functioning in infancy and the early school years; long-term effects on academic outcome are not known. Method: Children of postnatally depressed (N = 50) and non-depressed mothers (N = 39), studied from infancy, were followed up at 16 years. We examined the effects on General Certificate of Secondary Education (GCSE) exam performance of maternal depression (postnatal and subsequent) and IQ, child sex and earlier cognitive development, and mother–child interactions, using structural equation modelling (SEM). Results: Boys, but not girls, of PND mothers had poorer GCSE results than control children. This was principally accounted for by effects on early child cognitive functioning, which showed strong continuity from infancy. PND had continuing negative effects on maternal interactions through childhood, and these also contributed to poorer GCSE performance. Neither chronic, nor recent, exposure to maternal depression had significant effects. Conclusions: The adverse effects of PND on male infants’ cognitive functioning may persist through development. Continuing difficulties in mother–child interactions are also important, suggesting that both early intervention and continuing monitoring of mothers with PND may be warranted.