Design evaluation of a prototype user interface to support a guideline-based decision support system in gestational diabetes

Gestational Diabetes (GD) has increased over the last 20 years, affecting up to 15% of pregnant women worldwide. The complications associated can be reduced with the appropriate glycemic control during the pregnancy.

Influencia del ejercicio físico desarrollado durante el embarazo en la respuesta cardiaca fetal = Influence of a physical activity program performed during pregnancy on fetal heart response

INTRODUCCIÓN: El riesgo de padecer enfermedades cardiovasculares y los índices de obesidad infantil han ido en aumento durante los últimos años empobreciendo la salud de la población. La Teoría de Barker relaciona el estado de salud de la madre con el desarrollo fetal, asociando a un deficiente estado físico y hábitos de vida negativos de la mujer embarazada con el aumento del riesgo de padecer cardiopatías en la infancia y adolescencia, así como predisponer al recién nacido a padecer sobrepeso y/u obesidad en su vida posterior. Por otro lado los estudios efectuados sobre ejercicio físico durante el embarazo reportan beneficios para salud materna y fetal. Uno de los parámetros más utilizados para comprobar la salud fetal es su frecuencia cardiaca, mediante la que se comprueba el buen desarrollo del sistema nervioso autónomo. Si se observa este parámetro en presencia de ejercicio materno podría encontrarse una respuesta crónica del corazón fetal al ejercicio materno como consecuencia de una adaptación y mejora en el funcionamiento del sistema nervioso autónomo del feto. De esta forma podría mejorar su salud cardiovascular intrauterina, lo que podría mantenerse en su vida posterior descendiendo el riesgo de padecer enfermedades cardiovasculares en la edad adulta. OBJETIVOS: Conocer la influencia de un programa de ejercicio físico supervisado en la frecuencia cardiaca fetal (FCF) en reposo y después del ejercicio materno en relación con gestantes sedentarias mediante la realización de un protocolo específico. Conocer la influencia de un programa de ejercicio físico en el desarrollo del sistema nervioso autónomo fetal, relacionado con el tiempo de recuperación de la FCF. MATERIAL Y MÉTODO: Se diseñó un ensayo clínico aleatorizado multicéntrico en el que participaron 81 gestantes (GC=38, GE=43). El estudio fue aprobado por el comité ético de los hospitales que participaron en el estudio. Todas las gestantes fueron informadas y firmaron un consentimiento para su participación en el estudio. Las participantes del GE recibieron una intervención basada en un programa de ejercicio físico desarrollado durante la gestación (12-36 semanas de gestación) con una frecuencia de tres veces por semana. Todas las gestantes realizaron un protocolo de medida de la FCF entre las semanas 34-36 de gestación. Dicho protocolo consistía en dos test llevados a cabo caminando a diferentes intensidades (40% y 60% de la frecuencia cardiaca de reserva). De este protocolo se obtuvieron las principales variables de estudio: FCF en reposo, FCF posejercicio al 40 y al 60% de intensidad, tiempo de recuperación de la frecuencia cardiaca fetal en ambos esfuerzos. El material utilizado para la realización del protocolo fue un monitor de frecuencia cardiaca para controlar la frecuencia cardiaca de la gestante y un monitor fetal inalámbrico (telemetría fetal) para registrar el latido fetal durante todo el protocolo. RESULTADOS: No se encontraron diferencias estadísticamente significativas en la FCF en reposo entre grupos (GE=140,88 lat/min vs GC= 141,95 lat/min; p>,05). Se encontraron diferencias estadísticamente significativas en el tiempo de recuperación de la FCF entre los fetos de ambos grupos (GE=135,65 s vs GC=426,11 s esfuerzo al 40%; p<,001); (GE=180,26 s vs GC=565,61 s esfuerzo al 60%; p<,001). Se encontraron diferencias estadísticamente significativas en la FCF posejercicio al 40% (GE=139,93 lat/min vs GC=147,87 lat/min; p<,01). No se encontraron diferencias estadísticamente significativas en la FCF posejercicio al 60% (GE=143,74 lat/min vs GC=148,08 lat/min; p>,05). CONLUSIÓN: El programa de ejercicio físico desarrollado durante la gestación influyó sobre el corazón fetal de los fetos de las gestantes del GE en relación con el tiempo de recuperación de la FCF. Los resultados muestran un posible mejor funcionamiento del sistema nervioso autónomo en fetos de gestantes activas durante el embarazo. ABSTRACT INTRODUCTION: The risk to suffer cardiovascular diseases and childhood obesity index has grown in the last years worsening the health around the population. Barker´s Theory related maternal health with fetal development establishing an association between a poorly physical state and an unhealthy lifestyle in the pregnant woman with the risk to suffer heart disease during childhood and adolescence, childhood overweight and/or obese is related to maternal lifestyle. By the other way researches carried out about physical exercise and pregnancy show benefits in maternal and fetal health. One of the most studied parameters to check fetal health is its heart rate, correct fetal autonomic nervous system development and work is also corroborated by fetal heart rate. Looking at this parameter during maternal exercise a chronic response of fetal heart could be found due to an adaptation and improvement in the working of the autonomic nervous system. Therefore its cardiovascular health could be enhanced during its intrauterine life and maybe it could be maintained in its posterior life descending the risk to suffer cardiovascular diseases in adult life. OBJECTIVES: To know the influence of a supervised physical activity program in the fetal heart rate (FHR) at rest, FHR after maternal exercise related to sedentary pregnant women by a FHR assessment protocol. To know the influence of a physical activity program in the development of the autonomic nervous system related to FHR recovery time. MATERIAL AND METHOD: A multicentric randomized clinical trial was design in which 81 pregnant women participated (CG=38, EG=43). The study was approved by the ethics committee of all of the hospitals participating in the study. All of the participants signed an informed consent for their participation in the study. EG participants received an intervention based on a physical activity program carried out during gestation (12-36 gestation weeks) with a three days a week frequency. All of the participants were tested between 34-36 weeks of gestation by a specific FHR assessment protocol. The mentioned protocol consisted in two test performed walking and at a two different intensities (40% and 60% of the reserve heart rate). From this protocol we obtained the main research variables: FHR at rest, FHR post-exercise at 40% and 60% intensity, and FHR recovery time at both walking test. The material used to perform the protocol were a FH monitor to check maternal HR and a wireless fetal monitor (Telemetry) to register fetal beats during the whole protocol. RESULTS: There were no statistical differences in FHR at rest between groups (EG=140,88 beats/min vs CG= 141,95 beats/min; p>,05). There were statistical differences in FHR recovery time in both walking tests between groups (EG=135,65 s vs CG=426,11 s test at 40% intensity; p<,001); (EG=180,26 s vs CG=565,61 s test at 60% intensity; p<,001). Statistical differences were found in FHR post-exercise at 40% intensity between groups (EG=139,93 beats/min vs CG=147,87 beats/min; p<,01). No statistical differences were found in FHR at rest post-exercise at 60% intensity between groups (EG=143,74 beats/min vs CG=148,08 beats/min; p>,05). CONCLUSIONS: The physical activity program performed during gestation had an influence in fetal heart of the fetus from mother in the EG related to FHR recovery time. These results show a possible enhancement on autonomic nervous system working in fetus from active mothers during gestation.

Influence of body composition on gait Kknetics throughout pregnancy and postpartum period

Pregnancy leads to several changes in body composition and morphology of women. It is not clear whether the biomechanical changes occurring in this period are due exclusively to body composition and size or to other physiological factors. The purpose was to quantify the morphology and body composition of women throughout pregnancy and in the postpartum period and identify the contribution of these parameters on the lower limb joints kinetic during gait. Eleven women were assessed longitudinally, regarding anthropometric, body composition, and kinetic parameters of gait. Body composition and body dimensions showed a significant increase during pregnancy and a decrease in the postpartum period. In the postpartum period, body composition was similar to the 1st trimester, except for triceps skinfold, total calf area, and body mass index, with higher results than at the beginning of pregnancy. Regression models were developed to predict women’s internal loading through anthropometric variables. Four models include variables associated with the amount of fat; four models include variables related to overall body weight; three models include fat-free mass; one model includes the shape of the trunk as a predictor variable. Changes in maternal body composition and morphology largely determine kinetic dynamics of the joints in pregnant women.

Plasmodium falciparum domain mediating adhesion to chondroitin sulfate A: A receptor for human placental infection

Malaria during the first pregnancy causes a high rate of fetal and neonatal death. The decreasing susceptibility during subsequent pregnancies correlates with acquisition of antibodies that block binding of infected red cells to chondroitin sulfate A (CSA), a receptor for parasites in the placenta. Here we identify a domain within a particular Plasmodium falciparum erythrocyte membrane protein 1 that binds CSA. We cloned a var gene expressed in CSA-binding parasitized red blood cells (PRBCs). The gene had eight receptor-like domains, each of which was expressed on the surface of Chinese hamster ovary cells and was tested for CSA binding. CSA linked to biotin used as a probe demonstrated that two Duffy-binding-like (DBL) domains (DBL3 and DBL7) bound CSA. DBL7, but not DBL3, also bound chondroitin sulfate C (CSC) linked to biotin, a negatively charged sugar that does not support PRBC adhesion. Furthermore, CSA, but not CSC, blocked the interaction with DBL3; both CSA and CSC blocked binding to DBL7. Thus, only the DBL3 domain displays the same binding specificity as PRBCs. Because protective antibodies present after pregnancy block binding to CSA of parasites from different parts of the world, DBL-3, although variant, may induce cross-reactive immunity that will protect pregnant women and their fetuses.

Male fetal progenitor cells persist in maternal blood for as long as 27 years postpartum.

Rare nucleated fetal cells circulate within maternal blood. Noninvasive prenatal diagnosis by isolation and genetic analysis of these cells is currently being undertaken. We sought to determine if genetic evidence existed for persistent circulation of fetal cells from prior pregnancies. Venous blood samples were obtained from 32 pregnant women and 8 nonpregnant women who had given birth to males 6 months to 27 years earlier. Mononuclear cells were sorted by flow cytometry using antibodies to CD antigens 3, 4, 5, 19, 23, 34, and 38. DNA within sorted cells, amplified by PCR for Y chromosome sequences, was considered predictive of a male fetus or evidence of persistent male fetal cells. In the 32 pregnancies, male DNA was detected in 13 of 19 women carrying a male fetus. In 4 of 13 pregnancies with female fetuses, male DNA was also detected. All of the 4 women had prior pregnancies; 2 of the 4 had prior males and the other 2 had terminations of pregnancy. In 6 of the 8 nonpregnant women, male DNA was detected in CD34+CD38+ cells, even in a woman who had her last son 27 years prior to blood sampling. Our data demonstrate the continued maternal circulation of fetal CD34+ or CD34+CD38+ cells from a prior pregnancy. The prolonged persistence of fetal progenitor cells may represent a human analogue of the microchimerism described in the mouse and may have significance in development of tolerance of the fetus. Pregnancy may thus establish a long-term, low-grade chimeric state in the human female.

Maternal plasma human immunodeficiency virus type 1 RNA level: a determinant and projected threshold for mother-to-child transmission.

To prevent mother-to-child human immunodeficiency virus type 1 (HIV-1) transmission, it is important to identify its determinants. Because HIV-1 RNA levels can be reduced by antiviral therapy, we examined the role of maternal plasma HIV-1 RNA level in mother-to-child transmission. We used quantitative competitive PCR to measure HIV-RNA in 30 infected pregnant women and then followed their infants prospectively; 27% of the women transmitted HIV-1 to their infants and maternal plasma HIV-1 RNA level correlated strikingly with transmission. Eight of the 10 women with the highest HIV-1 RNA levels at delivery (190,400-1,664,100 copies per ml of plasma) transmitted, while none of the 20 women with lower levels (500-155,800 copies per ml) did (P = 0.0002). Statistical analysis of the distribution of HIV-1 RNA loads in these 30 women projected a threshold for mother-to-child transmission in a larger population; the probability of a woman with a viral RNA level of < or = 100,000 copies per ml not transmitting is predicted to be 97%. Examination of serial HIV-1 RNA levels during pregnancy showed that viral load was stable in women who did not initiate or change antiviral therapy. These data identify maternal plasma HIV-1-RNA level as a major determinant of mother-to-child transmission and suggest that quantitation of HIV-1 RNA may predict the risk of transmission.

Intermediate hosts of Toxoplasma gondii and food safety:epidemiology, genetics and parasite survival in meat-producing animals in Italy

Toxoplasma gondii is a coccidian parasite with a global distribution. The definitive host is the cat (and other felids). All warm-blooded animals can act as intermediate hosts, including humans. Sexual reproduction (gametogony) takes place in the final host and oocysts are released in the environment, where they then sporulate to become infective. In intermediate hosts the cycle is extra-intestinal and results in the formation of tachyzoites and bradyzoites. Tachyzoites represent the invasive and proliferative stage and on entering a cell it multiplies asexually by endodyogeny. Bradyzoites within tissue cysts are the latent form. T. gondii is a food-borne parasite causing toxoplasmosis, which can occur in both animals and humans. Infection in humans is asymptomatic in more than 80% of cases in Europe and North-America. In the remaining cases patients present fever, cervical lymphadenopathy and other non-specific clinical signs. Nevertheless, toxoplasmosis is life threatening if it occurs in immunocompromised subjects. The main organs involved are brain (toxoplasmic encephalitis), heart (myocarditis), lungs (pulmonary toxoplasmosis), eyes, pancreas and parasite can be isolated from these tissues. Another aspect is congenital toxoplasmosis that may occur in pregnant women and the severity of the consequences depends on the stage of pregnancy when maternal infection occurs. Acute toxoplasmosis in developing foetuses may result in blindness, deformation, mental retardation or even death. The European Food Safety Authority (EFSA), in recent reports on zoonoses, highlighted that an increasing numbers of animals resulted infected with T. gondii in EU (reported by the European Member States for pigs, sheep, goats, hunted wild boar and hunted deer, in 2011 and 2012). In addition, high prevalence values have been detected in cats, cattle and dogs, as well as several other animal species, indicating the wide distribution of the parasite among different animal and wildlife species. The main route of transmission is consumption of food and water contaminated with sporulated oocysts. However, infection through the ingestion of meat contaminated with tissue cysts is frequent. Finally, although less frequent, other food products contaminated with tachyzoites such as milk, may also pose a risk. The importance of this parasite as a risk for human health was recently highlighted by EFSA’s opinion on modernization of meat inspection, where Toxoplasma gondii was identified as a relevant hazard to be addressed in revised meat inspection systems for pigs, sheep, goats, farmed wild boar and farmed deer (Call for proposals -GP/EFSA/BIOHAZ/2013/01). The risk of infection is more highly associated to animals reared outside, also in free-range or organic farms, where biohazard measure are less strict than in large scale, industrial farms. Here, animals are kept under strict biosecurity measures, including barriers, which inhibit access by cats, thus making soil contamination by oocysts nearly impossible. A growing demand by the consumer for organic products, coming from free-range livestock, in respect of animal-welfare, and the desire for the best quality of derived products, have all led to an increase in the farming of free-range animals. The risk of Toxoplasma gondii infection increases when animals have access to environment and the absence of data in Italy, together with need for in depth study of both the prevalence and genotypes of Toxoplasma gondii present in our country were the main reasons for the development of this thesis project. A total of 152 animals have been analyzed, including 21 free-range pigs (Suino Nero race), 24 transhumant Cornigliese sheep, 77 free-range chickens and 21 wild animals. Serology (on meat juice) and identification of T. gondii DNA through PCR was performed on all samples, except for wild animals (no serology). An in-vitro test was also applied with the aim to find an alternative and valid method to bioassay, actually the gold standard. Meat samples were digested and seeded onto Vero cells, checked every day and a RT-PCR protocol was used to determine an eventual increase in the amount of DNA, demonstrating the viability of the parasite. Several samples were alos genetically characterized using a PCR-RFLP protocol to define the major genotypes diffused in the geographical area studied. Within the context of a project promoted by Istituto Zooprofilattico of Pavia and Brescia (Italy), experimentally infected pigs were also analyzed. One of the aims was to verify if the production process of cured “Prosciutto di Parma” is able to kill the parasite. Our contribution included the digestion and seeding of homogenates on Vero cells and applying the Elisa test on meat juice. This thesis project has highlighted widespread diffusion of T. gondii in the geographical area taken into account. Pigs, sheep, chickens and wild animals showed high prevalence of infection. The data obtained with serology were 95.2%, 70.8%, 36.4%, respectively, indicating the spread of the parasite among numerous animal species. For wild animals, the average value of parasite infection determined through PCR was 44.8%. Meat juice serology appears to be a very useful, rapid and sensitive method for screening carcasses at slaughterhouse and for marketing “Toxo-free” meat. The results obtained on fresh pork meat (derived from experimentally infected pigs) before (on serum) and after (on meat juice) slaughter showed a good concordance. The free-range farming put in evidence a marked risk for meat-producing animals and as a consequence also for the consumer. Genotyping revealed the diffusion of Type-II and in a lower percentage of Type-III. In pigs is predominant the Type-II profile, while in wildlife is more diffused a Type-III and mixed profiles (mainly Type-II/III). The mixed genotypes (Type-II/III) could be explained by the presence of mixed infections. Free-range farming and the contact with wildlife could facilitate the spread of the parasite and the generation of new and atypical strains, with unknown consequences on human health. The curing process employed in this study appears to produce hams that do not pose a serious concern to human health and therefore could be marketed and consumed without significant health risk. Little is known about the diffusion and genotypes of T. gondii in wild animals; further studies on the way in which new and mixed genotypes may be introduced into the domestic cycle should be very interesting, also with the use of NGS techniques, more rapid and sensitive than PCR-RFLP. Furthermore wildlife can become a valuable indicator of environmental contamination with T. gondii oocysts. Other future perspectives regarding pigs include the expansion of the number of free-range animals and farms and for Cornigliese sheep the evaluation of other food products as raw milk and cheeses. It should be interesting to proceed with the validation of an ELISA test for infection in chickens, using both serum and meat juice on a larger number of animals and the same should be done also for wildlife (at the moment no ELISA tests are available and MAT is the reference method for them). Results related to Parma ham do not suggest a concerning risk for consumers. However, further studies are needed to complete the risk assessment and the analysis of other products cured using technological processes other than those investigated in the present study. For example, it could be interesting to analyze products such as salami, produced with pig meat all over the Italian country, with very different recipes, also in domestic and rural contexts, characterized by a very short period of curing (1 to 6 months). Toxoplasma gondii is one of the most diffuse food-borne parasites globally. Public health safety, improved animal production and protection of endangered livestock species are all important goals of research into reliable diagnostic tools for this infection. Future studies into the epidemiology, parasite survival and genotypes of T. gondii in meat producing animals should continue to be a research priority.

Colaboração interprofissional na Estratégia Saúde da Família e a produção do cuidado em saúde durante o pré-natal

Introdução: Uma das mudanças mais importantes na produção do cuidado à saúde é a reorganização do processo de trabalho para a atuação de equipes multiprofissionais com abordagens interdisciplinares. A colaboração interprofissional tem sido apontada como um recurso que pode ser mobilizado para elevar a efetividade dos sistemas de saúde, e como estratégia inovadora, ela pode desempenhar um importante papel para enfrentar problemas do modelo de atenção e da força de trabalho em saúde. Objetivo: Descrever as percepções e atitudes de profissionais de saúde da Estratégia de Saúde da Família sobre as relações interprofissionais na atenção ao pré-natal, construir coletivamente e testar um protocolo de atenção à gestante para impulsionar as competências no trabalho colaborativo com vistas ao incremento da qualidade do cuidado. Métodos: Para isso, realizou-se previamente um estudo observacional descritivo para seleção de duas unidades de saúde. Na sequência foi realizado um estudo de intervenção do tipo antes e depois, com um grupo de controle pós-teste, incluindo métodos mistos. A população do estudo compreendeu oito profissionais de saúde (médicos, dentistas, enfermeiros e técnicos em saúde bucal) e 60 gestantes cadastradas em duas unidades de saúde da família do município de Uberlândia, sendo 36 incluídas no grupo intervenção e 24 no grupo controle. Dados numéricos, narrativas provenientes de entrevistas e registros de diário de campo foram usados para identificar mudanças na autoavaliação da saúde bucal, na qualidade de vida relacionada à saúde bucal medida pelo OHIP-14, na percepção das gestantes sobre o trabalho em equipe e nas práticas profissionais. Testes estatísticos para detectar diferenças de significância e análise temática de conteúdo foram empregados para interpretar os desfechos. Resultados: Em geral, observou-se percepção/atitude favorável dos profissionais em relação à colaboração interprofissional. Diferenças entre as categorias profissionais podem representar uma barreira subjetiva à implementação de protocolos que demandariam maior grau de trabalho colaborativo. Diferenças entre as unidades de atenção primária mostraram que a interação entre membros das equipes multiprofissionais pode sobrepujar dificuldades decorrentes do modo isolado e distinto no qual cada categoria profissional é formada. Foi produzido um Protocolo de Atenção à Gestante abrangendo o fluxo e a dinâmica dos processos de trabalho dentro de uma perspectiva de colaboração interprofissional. Segundo os profissionais, a intervenção apesar do seu caráter desafiador, estimulou o comprometimento da equipe para reorientar o processo de trabalho resultando em maior interação profissional colaborativa. Em relação às gestantes, a maioria era jovem (menos de 26 anos de idade) e tinha ensino médio incompleto ou completo sem diferenças significativas entre os grupos teste e controle. Gestantes do grupo intervenção perceberam que os profissionais trabalhavam mais em equipe do que as gestantes do grupo controle. De modo geral, as gestantes avaliaram que a saúde bucal e a qualidade de vida decorrente da saúde bucal melhoraram após a intervenção. Conclusões: Concluiu-se que apesar da percepção geral dos profissionais favorável à colaboração interprofissional, recursos formais e organizacionais não estavam sendo empregados. O método ZOPP se mostrou flexível e adequado para o desenvolvimento de competências para o trabalho colaborativo e para a construção de um protocolo de organização de serviços na atenção primária à saúde. O Protocolo de Atenção à Gestante testado provocou tensões e produziu efeitos positivos na colaboração interprofissional e na qualidade de vida relacionada à saúde bucal contribuindo para qualificar a atenção ao pré-natal oferecido.

Avaliação do volume e índices vasculares placentários pela ultrassonografia tridimensional em gestações com restrição grave de crescimento fetal

INTRODUÇÃO: A restrição de crescimento fetal (RCF) representa uma das principais complicações da gravidez e está associada a elevadas taxas de morbimortalidade perinatal. A frequência de desfechos desfavoráveis neonatais está diretamente relacionada à gravidade da RCF, sendo que os casos de pior evolução estão relacionados com peso abaixo do percentil 3. O mecanismo do crescimento fetal não está totalmente esclarecido, mas resulta da interação entre potencial genético de crescimento e fatores placentários, maternos e ambientais. Dentre os fatores etiológicos, o desenvolvimento anormal da placenta e a diminuição da perfusão uteroplacentária são as principais causas de RCF. Este estudo teve por objetivo avaliar volume e índices de vascularização placentários, por meio da ultrassonografia tridimensional (US3D), em gestações com RCF grave, e as correlações dos parâmetros placentários com valores de normalidade e dopplervelocimetria materno-fetal. MÉTODOS: Foram avaliadas 27 gestantes cujos fetos apresentavam peso estimado abaixo do percentil 3 para a idade gestacional. Por meio da US3D, utilizando-se a técnica VOCAL, foram mensurados o volume placentário (VP) e os índices vasculares: índice de vascularização (IV), índice de fluxo (IF) e índice de vascularização e fluxo (IVF). Os dados foram comparados com a curva de normalidade para a idade gestacional e peso fetal descrita por De Paula e cols. (2008, 2009). Desde que os volumes placentários variam durante a gravidez, os valores observados foram comparados com os valores esperados para a idade gestacional e peso fetal. Foram criados os índices volume observado/ esperado para a idade gestacional (Vo/e IG) e volume placentário observado/ esperado para o peso fetal (Vo/e PF). Os parâmetros placentários foram correlacionados com índice de pulsatilidade (IP) médio de (AUt) e IP de artéria umbilical (AU), e avaliados segundo a presença de incisura protodiastólica bilateral em AUt. RESULTADOS: Quando comparadas à curva de normalidade, as placentas de gestação com RCF grave apresentaram VP, IV, IF e IVF significativamente menores (p < 0,0001 para todos os parâmetros). Houve correlação inversa estatisticamente significante da média do PI de AUt com o Vo/e IG (r= -0,461, p= 0,018), IV (r= -0,401, p= 0,042) e IVF (r= -0,421, p= 0,048). No grupo de gestantes que apresentavam incisura protodiastólica bilateral de artérias uterinas, Vo/e IG (p= 0,014), Vo/e PF (p= 0,02) e IV (p= 0,044) foram significativamente mais baixos. Nenhum dos parâmetros placentários apresentou correlação significativa com IP de AU. CONCLUSÕES: Observou-se que o volume e os índices de vascularização placentários apresentam-se diminuídos nos fetos com RCF grave. IP médio de AUT apresenta correlação negativa com Vo/e IG, IV e IVF, e Vo/e IG, Vo/e PF e IV apresentaram-se reduzidos nos casos de incisura bilateral. Não houve correlação significativa dos parâmetros placentários com IP de AU

Nutrição da gestante portadora de anemia falciforme, complicações maternas e resultados perinatais

O prognóstico da gestação é influenciado pelo estado nutricional materno. Sabe-se que, desde a infância, as pessoas portadoras da doença falciforme apresentam crescimento deficiente. Pouco se conhece sobre a evolução do estado nutricional materno na anemia falciforme. O objetivo foi analisar o estado nutricional de gestantes portadoras de anemia falciforme, avaliando o ganho de peso, o consumo dietético materno e os resultados adversos maternos e perinatais. Métodos: Foram avaliadas 26 gestantes portadoras de anemia falciforme SS e 23 SC, a partir do início do pré-natal especializado até o puerpério. Como grupo controle foram utilizadas 63 gestantes, sem comorbidades. O estado nutricional das gestantes foi avaliado de acordo com índice de massa corporal, pré-gestacional e ao final da gravidez, bem como analisado o ganho de peso materno. O consumo dietético foi analisado utilizando-se questionário de frequência alimentar, em cada trimestre, caracterizando-se o valor energético total e a ingestão de macronutrientes e micronutrientes. As complicações maternas e perinatais foram investigadas. O nível de significância foi 0,05 (alfa=5%). Resultados: O IMC pré-gestacional foi significativamente menor no grupo SS (mediana 20,3 kg/m2) quando comparado com os grupos SC (22,7 kg/m2, p < 0,05) e controle (23,2 kg/m2, p < 0,05). O baixo peso pré-gestacional (IMC < 18,5 kg/m2) foi significativamente mais frequente no grupo SS (15,4%) quando comparado aos grupos SC (4,4%) e controle (1,6%, p=0,009). Ao final da gestação, o grupo SS apresentou menor IMC (mediana 23,1 kg/m2) quando comparado com o grupo SC (26,1 kg/m2, p < 0,05) e controle (28,5 kg/m2, p < 0,05). O ganho ponderal na gestação foi menor no grupo SS (mediana 8,0 kg) quando comparado com o grupo SC (11,9 kg, p < 0,05) e Controle (13,7 kg, p < 0,05). Na análise do consumo dietético no 2º trimestre, constatou-se que os grupos SS e SC apresentaram menor consumo de proteínas (medianas, 73 g/d e 69 g/d) quando comparados aos controles (96 g/d, p < 0,05); e o consumo de cálcio foi menor no grupo SS comparado ao controle (mediana, 410 vs. 748 g/d, p<0,05). No 3º trimestre, houve menor consumo de proteínas pelo grupo SS quando comparado com os controles (mediana, 68 g/d vs. 93 g/d, p < 0,05); o consumo de vitamina A foi menor no grupo SS quando comparado aos controles (mediana, 447 vs. 940 mcg/d, p < 0,05); o consumo de vitamina E foi menor no grupo SS (mediana, 6 mg/d) quando comparado aos grupos SC (10 mg/d) e controle (7 mg/d, p < 0,05). As complicações maternas mais frequentes foram: crise álgica, 58% no grupo SS e 44% no SC (p=NS); infecção urinária, 31% no SS e 17% no SC (p=NS); e infecção pulmonar, 35% no SS e 9% no SC (p=NS). Houve diferença significativa no diagnóstico de sofrimento fetal: SS (36%), SC (14%) e controle (13%, p=0,032). Resultados perinatais adversos foram mais frequentes nos grupos SS e SC quando comparados aos controles. Conclusões: O estado nutricional das gestantes portadoras de doença falciforme SS caracterizou-se pela desnutrição materna, com baixo ganho ponderal na gestação. O consumo dietético de macronutrientes demonstrou ingestão inadequada de proteínas nos 2º e 3º trimestres. As complicações maternas e resultados perinatais adversos foram eventos frequentes nas gestantes portadoras de doença falciforme

Fish Consumption and Prenatal Mercury Exposure

Methyl mercury levels in fish tissues have recently become a health issue. Does this toxin adversely affect humans to the point that fish consumption should be severely limited? Health effects of high levels of mercury exposure to human adults are fairly well known, however the effects of lower levels of exposure on human fetal development are less understood. Recent guidelines issued by the United States Food and Drug Agency and the Environmental Protection Agency recommended that pregnant women should refrain from consuming some types of fish, and limit consumption to certain levels, but results of health studies used to develop recommendations were inconclusive when low levels of in-utero methyl mercury exposure were compared. Other studies demonstrated health benefits of fish consumption to developing fetuses. These health benefits may be an over-riding factor, and my interpretation of various studies concludes that restricted consumption of some fish species may be premature at this time due to a need to balance potential health benefits against mercury toxicity hazard.

Prevalence of exposure to occupational risks during preganancy in Spain

Objectives. We describe reported exposures to main categories of occupational agents and conditions in Spanish pregnant workers. Methods. Women were recruited at 12th week of pregnancy from main public gynaecological consults to be included in the INMA Spanish cohorts study (n = 2,058). Through personal interviews with structured questionnaires, information on working situation and working conditions during pregnancy was obtained. Results. Fifty percent of the women reported frequent exposure to physical load (standing, heavy lifting) and 45 % reported exposure to three or more indicators of job strain. Exposure to at least one physical agent (noise, vibrations, etc.) affected 25 % of the women. Exposure to chemicals was reported by 20 % of the women, mostly including solvents and cleaning products. Eight percent of the women worked at night shifts. Job strain was more prevalent in office workers and industrial operators. Industrial workers showed the highest prevalence of exposure to chemical and physical pollutants. Conclusions. Our data suggest that working conditions of pregnant women may need increased control in Spain.

Life satisfaction and health related quality of life during pregnancy and puerperium

Poster submitted to the 22nd International Conference Stress and Anxiety Research Society (STAR), Palma de Mallorca, July, 12-14, 2001.

The Spanish version of the Prenatal Breast-feeding Self-efficacy Scale: Reliability and validity assessment

Background: Only a minority of infants are exclusively breastfed for the recommended 6 months postpartum. Breast-feeding self-efficacy is a mother's confidence in her ability to breastfeed and is predictive of breastfeeding behaviors. The Prenatal Breast-feeding Self-efficacy Scale (PBSES) was developed among English-speaking mothers to measure breastfeeding self-efficacy before delivery. Objectives: To translate the PBSES into Spanish and assess its psychometric properties. Design: Reliability and validity assessment. Setting: A public hospital in Yecla, Spain. Participants: A convenience sample of 234 pregnant women in their third trimester of pregnancy. Methods: The PBSES was translated into Spanish using forward and back translation. A battery of self-administered questionnaires was completed by participants, including a questionnaire on sociodemographic variables, breastfeeding experience and intention, as well as the Spanish version of the PBSES. Also, data on exclusive breastfeeding at discharge were collected from hospital database. Dimensional structure, internal consistency and construct validity of the Spanish version of PBSES were assessed. Results: Confirmatory factor analysis suggested the presence of one construct, self-efficacy, with four dimensions or latent variables. Cronbach's alpha coefficient for internal consistency was 0.91. Response patterns based on decision to breastfeed during pregnancy provided evidence of construct validity. In addition, the scores of the Spanish version of the PBSES significantly predicted exclusive breastfeeding at discharge. Conclusions: The Spanish version of PBSES shows evidences of reliability, and contrasting group and predictive validity. Confirmatory factor analysis indicated marginal fit and further studies are needed to provide new evidence on the structure of the scale. The Spanish version of the PBSES can be considered a reliable measure and shows validity evidences.

A public-professional web-bridge for vaccines and vaccination: User concerns about vaccine safety

Vacunas.org (http://www.vacunas.org), a website founded by the Spanish Association of Vaccinology offers a personalized service called Ask the Expert, which answers any questions posed by the public or health professionals about vaccines and vaccination. The aim of this study was to analyze the factors associated with questions on vaccination safety and determine the characteristics of questioners and the type of question asked during the period 2008–2010. A total of 1341 questions were finally included in the analysis. Of those, 30% were related to vaccine safety. Questions about pregnant women had 5.01 higher odds of asking about safety (95% CI 2.82–8.93) than people not belonging to any risk group. Older questioners (>50 years) were less likely to ask about vaccine safety compared to younger questioners (OR: 0.44, 95% CI 0.25–0.76). Questions made after vaccination or related to influenza (including H1N1) or travel vaccines were also associated with a higher likelihood of asking about vaccine safety. These results identify risk groups (pregnant women), population groups (older people) and some vaccines (travel and influenza vaccines, including H1N1) where greater efforts to provide improved, more-tailored vaccine information in general and on the Internet are required.