Elevation of Uterine Basal Tone and Fetal Heart Rate Abnormalities After Labor Analgesia A Randomized Controlled Trial

OBJECTIVE: To estimate the effects of combined spinal-epidural and traditional epidural analgesia on uterine basal tone and its association with the occurrence of fetal heart rate (FHR) abnormalities. METHODS: Seventy-seven laboring patients who requested pain relief during labor were randomly assigned to combined spinal-epidural (n=41) or epidural analgesia (n=36). Uterine contractions and FHR were recorded 15 minutes before and after analgesia. Uterine tone was evaluated with intrauterine pressure catheter. Primary outcomes were the elevation of baseline uterine tone and occurrence of FHR prolonged decelerations or bradycardia after analgesia. The influence of other variables such as oxytocin use, hypotension, and speed of pain relief were estimated using a logistic regression model. RESULTS: The incidence of all outcomes was significantly greater in the combined spinal-epidural group compared with epidural: uterine hypertonus (17 compared with 6; P=.018), FHR abnormalities (13 compared with 2; P<.01), and both events simultaneously (11 compared with 1; P<.01). Logistic regression analysis showed the type of analgesia as the only independent predictor of uterine hypertonus (odds ratio 3.526, 95% confidence interval 1.21-10.36; P=.022). For the occurrence of FHR abnormalities, elevation of uterine tone was the independent predictor (odds ratio 18.624, 95% confidence interval 4.46-77.72; P<.001). Regression analysis also found a correlation between decrease on pain scores immediately after analgesia and the estimated probability of occurrence of hypertonus and FHR abnormalities. CONCLUSION: Combined spinal-epidural analgesia is associated with a significantly greater incidence of FHR abnormalities related to uterine hypertonus compared with epidural analgesia. The faster the pain relief after analgesia, the higher the probability of uterine hypertonus and FHR changes. CLINICAL TRIAL REGISTRATION: Umin Clinical Trials Registry, http://www.umin.ac.jp/ctr/index.htm, UMIN000001186

Youth unemployment outflow rates and labor market programs: Australian evidence

A matching function methodology is used to investigate the macroeconomic effects of labor market program (LMP) commencements on youth unemployment outflows in Australia using unpublished data that classify commencements and outflows by duration of unemployment. The results indicate that LMPs have had significant effects on outflows from short-term unemployment. There is a net positive effect from LMP commencements on short-term unemployed female outflow rates. However; females experienced negative spillover effects from male LMP commencements. These spillover effects appear to be associated with wage subsidy programs and suggest the net impact Of such programs may have been overstated in previous studies.

The over-production of US sports and the new International Division of Cultural Labor

This article focuses on how US professional sports utilize the New International Division of Cultural Labor to supplement an overly costly local labor pool and over-supplied local market. We argue that while the classic problem of over-production is slowly eroding the sealed-off nature of US culture, the forces of its hyper-protectionist capitalism continue to characterize sports, precluding equal exchange.

Vitória da Alemanha constitucional e de direito social!

O poder judicial é hoje independente na RFA, sendo ainda o direito baseado no direito romano, com algumas referências germânicas. O Tribunal Federal Constitucional é uma instituição sagrada que prima pela reverência absoluta ao Estado de Direito social e controla a constitucionalidade. Existe ainda o Tribunal de Justiça Federal e os Tribunais Federais do Trabalho, o Social Federal, o Federal das Finanças e o Administrativo Federal. O sistema penal alemão é destinado à recuperação do criminoso. O Völkerstrafgesetzbuch/“Código Penal Internacional” dá aos tribunais alemães jurisdição universal caso a acusação por um tribunal do país onde o crime foi praticado, ou por um tribunal internacional, não for possível. Abstract: The judiciary is independent today in the Germany, still being the right based on Roman law with some Germanic references. The Federal Constitutional Court is a sacred institution that excels in absolute reverence for the rule of law and social controls constitutionality. There is also the Federal Court of Justice and the Federal Courts of Labor, the Federal Social, the Federal Finance Administration and the Federal. The German penal system is aimed at the criminal recovery. The Völkerstrafgesetzbuch / "International Criminal Code" gives German courts universal jurisdiction if prosecution by a court of the country where the crime was committed, or by an international court, is not possible.

Annotation taken, in the perspective of criminal and constitutional law, as well as in criminology, to the decision of the portuguese constitutional court, of January 13, 2011 – with respect to the problems of “consent” and “medical act”

1 – Summary of the decision taken by the Portuguese Constitutional Court, of January 13, 2011; 2 – Complete text of the decision of the Portuguese Constitutional Court, of January 13, 2011, Judge Maria João ANTUNES (Reporter), Judge Carlos Pamplona de OLIVEIRA, Judge José Borges SOEIRO, Judge Gil GALVÃO, Judge Rui Manuel Moura RAMOS (President) –in terms of the tribunalconstitucional.pt, August 1, 2011; 3 – Brief annotation to the problem of the “medical act”; 3.1 – Plus some conclusions on the brief annotation to the problem of the “medical act”; 3.2 – Brief annotation to the problem of “consent”– continuation of the previous comments; 4 – Conclusions. It must never be forgotten that “consent” does not stand as the only cause of exclusion of unlawfulness.

Obesity and gestational weight gain: cesarean delivery and labor complications

OBJECTIVE: To assess the association between pre-gestational obesity and weight gain with cesarean delivery and labor complications. METHODS: A total of 4,486 women 20-28 weeks pregnant attending general prenatal care clinics of the national health system in Brazil from 1991 to 1995 were enrolled and followed up through birth. Body mass index categories based on prepregnancy weight and total weight gain were calculated. Associations between body mass index categories and labor complications were adjusted through logistic regression analysis. RESULTS: Obesity was present in 308 (6.9%) patients. Cesarean delivery was performed in 164 (53.2%) obese, 407 (43.1%) pre-obese, 1,045 (35.1%) normal weight and 64 (24.5%) underweight women. The relative risk for cesarean delivery in obese women was 1.8 (95% CI: 1.5-2.0) compared to normal weight women. Greater weight gain was particularly associated with cesarean among the obese (RR 4th vs 2nd weight gain quartile 2.2; 95% CI: 1.4-3.2). Increased weight at the beginning of pregnancy was associated with a significantly higher adjusted risk of meconium with vaginal delivery and perinatal death and infection in women submitted to cesarean section. Similarly, greater weight gain during pregnancy increased the risk for meconium and hemorrhage in women submitted to vaginal delivery and for prematurity with cesarean. CONCLUSIONS: Pre-gestational obesity and greater weight gain independently increase the risk of cesarean delivery, as well as of several adverse outcomes with vaginal delivery. These findings provide further evidence of the negative effects of prepregnancy obesity and greater gestational weight gain on pregnancy outcomes.

Concepção e instalação de tabelas multifunções para recintos desportivos cobertos

Mestrado em Engenharia Electrotécnica – Sistemas Eléctricos de Energia

Social contextual factors contributing to child and adolescent labor: an ecological analysis

OBJECTIVE: To examine the relationship between social contextual factors and child and adolescent labor. METHODS: Population-based cohort study carried out with 2,512 families living in 23 subareas of a large urban city in Brazil from 2000 to 2002. A random one-stage cluster sampling was used to select families. Data were obtained through individual household interviews using questionnaires. The annual cumulative incidence of child and adolescent labor was estimated for each district. New child and adolescent labor cases were those who had their first job over the two-year follow-up. The annual cumulative incidence of child and adolescent labor was the response variable and predictors were contextual factors such as lack of social support, social deprivation, unstructured family, perceived violence, poor school quality, poor environment conditions, and poor public services. Pearson's correlation and multiple linear regression were used to assess the associations. RESULTS: There were selected 943 families corresponding to 1,326 non-working children and adolescents aged 8 to 17 years. Lack of social support, social deprivation, perceived violence were all positively and individually associated with the annual cumulative incidence of child and adolescent labor. In the multiple linear regression model, however, only lack of social support and perceived violence in the neighborhood were positively associated to child and adolescent labor. No effect was found for poor school quality, poor environment conditions, poor public services or unstructured family. CONCLUSIONS: Poverty reduction programs can reduce the contextual factors associated with child and adolescent labor. Violence reduction programs and strengthening social support at the community level may contribute to reduce CAL.