association between obesity and type II diabetes mellitus is well known. In most of reports, 90% of patients with type II diabetes mellitus are obese. Heart diseases due to obesity are hypertension, hypervolumia and dyslipidemia which cause impaired left ventricular function, heart failure and myocardial infarction. 12 Weight gain is associated with increased premature mortality, mainly due to cardiovascular disease, diabetes and cancer that related to an increased BMI. Obesity is one of the risk factors for preeclampsia. For each 5-7 kg/m 2 increased in BMI before pregnancy, risk of preeclamcia increase two times. 13 Obesity in pregnancy is also associated with risks for mother and fetus. 14 Major complications are preeclampsia, gestational diabetes, thrombosis, infection, cesarean, increased hospital staying and inability to breast–feeding. 15 Increase incidences of fetal congenital anomalies such as neural tube defects, cardiovascular, gastrointestinal and central nervous system abnormalities have been reported in newborns in obese mothers. 16,17 In a review has been shown that rate of emergency and elective cesarean both can be increase substantially. 18 Cesarean section and gestational diabetes are higher in obese adolescents pregnant. Failed induction, labor and normal vaginal delivery and cesarean section, both are increased in obese women. 19
An intervention to improve maternal and child health was conducted in a remote Bolivian province with limited access to modern medical facilities. The intervention focused on initiat- ing and strengthening women’s organizations, developing women’s skills in problem identifi- cation and prioritization, and training community members in safe birthing techniques. Its impact was evaluated by comparing perinatal mortality rates and obstetric behavior among 409 women before and after the intervention. Perinatal mortality decreased from 117 deaths per 1 000 births before the intervention to 43.8 deaths per 1 000 births after. There was a sig- nificant increase in the number of women participating in women’s organizations following the intervention, as well as in the number of organizations. The proportion of women receiv- ing prenatal care and initiating breast-feeding on the first day after birth was also significantly larger. The number of infants attended to immediately after delivery likewise increased, but the change was not statistically significant. This study demonstrates that community organiza- tion can improve maternal and child health in remote areas.
In 2000, United Nations member states signed up to the Millennium Development Goals (MDGs), a set of eight interna- tional development targets intended to catalyse development and reduce global poverty. To date progress towards these goals has been uneven. Of particular concern is Millennium Development Goal 5 (MDG 5), which aims to improve maternal and reproductive health by reducing the maternal mortality ratio (MMR) by 75% and creating universal access to reproductive healthcare by 2015. Current estimates suggest that this initiative is behind schedule. Only 23 countries out of a surveyed 181 are likely to meet the MMR target on time despite increasing volumes of official development aid being provided by donors [1,2]. There is concern, therefore, that not all the aid targeting MDG 5 is reaching the countries in the greatest need or being delivered in an effective manner [2,3].
Results: Study 1: Maternal overweight and obesity were demonstrated to be associated with stillbirth, fetal death and infant death. Being overweight or slightly obese seem to not modify the overall risk for preterm birth, the risk of induced preterm birth was increased in overweight and obese women. Congenital defects such as neural tube defect, spina bifida, cardiovascular anomalies, septal anomalies, cleft palate, cleft lip and palate, anorectal atresia, hydrocephaly, and limb reduction anomalies. The risk of gastroschisis among obese mothers was reduced. There was limited data on neurodevelopmental outcomes, anorectal malformations in offspring, and risk of testicular cancer. Maternal overweight and obesity are associated with risk of asthma and wheezing in children, and has a negative impacton the immediate postpartum care for both mother and baby. Study 2: We found that mothers with overweight and obesity have more often overweight and obese children than normal weight mothers. The same relationship was observed for fathers. Furthermore, it was found that mothers who develop hypertension during pregnancy have more often children with overweight and obesity. However, the association was not observed when other factors such as pre-gestational diabetes, gestational diabetes and pre-gestational hypertension were evaluated.
MS paradigm covers a range of methods in which litters are separated from their dam in the postnatal period, until weaning. This manipulation of dam-pup interaction has been done in several different ways by varying the frequency, the duration and the age at which the separation occurs and the level of social deprivation (pups could be separated either from their dams or from littermates); and the post deprivation environment (e.g. by rearing rats in isolation from others after protocol's deprivation period) (Ellenbroek & Cools, 2002). Taking into account the variety of manipulations described above, there is an attempt in the literature to discriminate three types of separation protocols: the maternal deprivation (MD) where there is a single 24h period of separation; the handling procedure, when rat pups are submitted to short periods ofmaternal separation while being stimulated by the experimenter (< 30 min/day); and maternal separation (MS), consisting on longer periods of separation between rats and their dams (3-12 h/day) for consecutive days (for review Gutman & Nemeroff, 2002). These simple manipulations appear to be critical in the behavioral and neurobiological outcomesof the pups in adult age. In fact, shorts periods of separation (handling), not necessarily with stroking, were found to have long-term effects on corticosteroid response, decreased emotional reactivity and better performances in attention and learning tasks (Levine, 2002). However, long periods of separation were proved to have opposite reactions in rat performances and neurobiological responses, found to increase behavioral and stress reactivity (e.g., Biagini, Pich, Carani, Marrama, & Agnati, 1998; Macrí, Mason, & Würbel, 2004; Mesquita et al., 2007), as we will discuss below.
Brazil is a member of the BRICS nations group, which also includes Russia, India, China and South Africa. The current economic up growth, combined with a significant influence on regional and global matters, bond these emerging nations. It is well known that social and educational improvements do not always progress hand-in-hand with the economic boom, and this is still a challenge not only for Brazil but for the whole BRICS community. In conclusion, improvements in social and educational struc- tures alone will probably not lead to the needed changes on time for the Millennium Development Goal number 5 to be achieved by 2015. Our findings point out clearly that lower income regions in Brazil have a worse performance in all obstetric health care indicators among women with eclampsia. The strengthening of health systems might be a possible strategy to reduce morbidity and deaths in women of reproductive age and their offspring [28,34]. It is known that social and economic determinants are associated with higher maternal and perinatal mortality [3,32]. Waiting for changes in those patterns in order to get better obstetric and perinatal outcomes might not be the faster route to reduce SMO due to eclampsia. Instead, qualifying emergency obstetric health care by promoting continued staff training and increasing the number of well-equipped health care facilities (especially obstetric ICU beds) are a more plausible and expedient pathway not only for Brazil, but also for all other LMIC and emerging nations who endeavor to relieve the burden of eclampsia.
and ten still births; Apgar scores, pre term births and small-for-gestational-age births were studied only in sin- gleton live births leaving 912 mother/child dyads for these analyses. Low birth weight was restricted to single- ton live births with 37 weeks of gestational age or above leaving 795 mother/child dyads for these analyses. A third of the mothers were 16 or younger (Table 1). Two- thirds had completed fewer than eight years of schooling and almost half had a family income less than 400 Reais (US$120). Most cohabited with a partner. The majority had not planned their pregnancy, and were having their first baby (Table 2). One in five mothers had complica- tions during pregnancy. Drinking and smoking were rela- tively uncommon. Only 4.5% (n = 42) of the participants did not present antenatally, but 30% had had fewer than the recommended six antenatal consultations. One hun- dred and thirty one adolescents (14.2%) had pre-term babies. 40.1 percent (n = 370) had a normal vaginal deliv- ery while 32.2% (n = 297) had a forceps delivery and 27.7% (n = 256) had a caesarean section.
The use of a sib pair design in this study is powerful technique, as it controls for unmeasured potential confounders that are common between siblings, including genetic risk factors and many environmental exposures. The lack of effect ofmaternalobesityon childhood asthma seen in our sib pair analysis may indicate that the effect ofmaternal BMI is not due to a direct effect ofmaternal pregnancy obesity, such as fetal programing of the infants immune or metabolic system, as has been suggested by some authors [7,8]. However, despite using data from the whole Swedish population for a 16 year period, relatively few children could be included, as the analysis requires a) a mother to contribute two or more Table 1. Prevalence of ICS use in first borns by selected socio-demographic factors, delivery details, and markers of parental asthma.
In obese women with GDM, a reduced GWG (<5 kg) is associated with better obstetric and neonatal outcomes than an excessive or even an adequate GWG (the ideal GWG for these women is less than the ideal for non- diabetic obese women). Thus, specific recommendations for obese women with GDM should be created because GWG could be a modifiable risk factor for adverse ob- stetric outcomes. Instructing women about appropriate GWG and implementing effective strategies (like diet adjustment and increased physical activity) to obtain the minimum GWG could help optimize maternal and peri- natal outcomes.
plays a critical role in the determination of gestational outcome, as maternal overweight and underweight are both strong predictors of birth weight[11,12]. A meta-analysis of 78 studies involving more than one million women in developed and developing countries revealed that maternal undernutrition was strongly associated with a greater risk of LBW. On the other hand, a meta-analysis of 84 studies consisting of a similar number of women indicated that maternal overweight or obesity might reduce the risk of LBW and that the protective influence appeared to be stronger in developing countries, although the authors identified this association as spurious and due to bias in the analysis. Based on the above research, it is evident that maternal stature and BMI both contribute significantly to the birth weight of children, but no information is available regarding the impactof the combination of short stature and BMI on the risk of LBW.
Most studies of pregnancy outcomes among women in their forties and fifties have focused on neonatal outcomes or relatively common maternal medical conditions such as diabetes and hypertension. Among those studies reporting maternal medical and obstetric complications, most have been small, single-center case series, where maternal death and severe maternal medical morbidity had not been able to be studied, and thus these studies have suggested favorable outcomes in this age group.[26,27] Paulson et al reported in 2002 on the outcomesof 45 live births to healthy post-menopausal women age 50 and older who became pregnant as a result of in-vitro fertilization with donor oocytes. The only medical events that they reported were preeclampsia and gestational diabetes. They concluded that there ‘‘does not appear to be any definitive medical reason for excluding these women from attempting pregnancy on the basis of age alone.’’ Because of their small study size, they were unable to detect serious adverse outcomes that were observed in our study.
Even so, among the deaths studied, in which there was analysis of the uterus and annexes, many medical examiners and “body removal” guides were not suffi - cient to identify the presence or absence of pregnancy. Many families of the deceased women were not aware of the pregnancy and were only made aware of it through the IML autopsy reports during the household interviews. As the results show, the majority of death occurred early in the pregnancy, before the women or their families were aware of it. In other situations, household interviews were strategies critical to conclu- ding the case. The death certifi cates contains data on the cause of death, with no references to the circumstances in which it occurred and/or other factors important in defi ning it.
Nine-week-old male and female SHR rats, weighing approximately 180g and 220g were kept in collective cages in controlled conditions of temperature of (22 ± 3ºC), light (12h light/dark cycle) and relative humidity (60 ± 5%). The animals were fed with laboratory chow and tap water ad libitum. All female rats were mated overnight with SHR male rats. The day when sperm was found in the vaginal smear was designated gestational day 0. The mating procedure consisted of 15 consecutive days, a period comprising approximately three estral cycles, until a replicate number of groups were obtained. However, during this period, unmated female rats were considered to be infertile and were discarded from the study 20 . Thirty three pregnant SHR
The allele and haplotype frequencies were estimated by direct gene counting. The software package Arlequin, version 3.5 (http://cmpg.unibe.ch/software/arlequin35/) , was used to calculate allele frequencies, Hardy-Weinberg equilibrium proba- bility values and D’ and r 2 values for linkage disequilibrium (LD). Haplotype phase was determined by statistical inference via the ELB algorithm implemented in Arlequin, version 3.5. The quantitative variables were expressed as means and standard deviation, and qualitative variables were presented as absolute numbers and frequencies. The one-way analyses of variance (ANOVA), followed by post hoc Bonferroni test, was used to examine anthropometric traits for differences between genotype groups. For the analyses of covariance (age and gender) General Linear Models were used. Logistic regression models, adjusted for age and gender, were used to calculate p values, odds ratio (OR), and 95% confidence intervals (CI), for each SNP and haplotypes. All association analyses were performed using the Statistical Package for the Social Sciences (SPSS, for windows version 18.0). Statistical significance was taken at p-values #0.05 for all comparisons.
Hyland, 33 refers that HRQOL used to be pre- sented in two different approaches: One which he calls ‘‘the multifaceted approach’’ consists of an aggregation of several, conventionally agreed, health indices. Another approach, ‘‘the causal process approach’’ describes HRQOL as a causal sequence resulting from an interaction between morbidity and psychological factors. Hyland states that the conventional approach in medicine is the multifaceted approach. QOL is commonly consid- ered as an outcome measure that is independent of mortality and morbidity data, 33 i.e. QOL and morbidity are analysed as unrelated dependent variables. In opposition to that traditional position, Hyland proposes the causal sequence approach which assumes that QOL must be affected by morbidity, and therefore correlated with it. Since QOL is also affected by psychological factors, QOL measures must represent some kind of causal interaction between morbidity and psychological aspects.
evaluated 10,021 pregnant women with normal TSH and T4 and 232 with hypothyroxinemia (17). In the first trimester, hypothyroxinemia was associated with preterm labor (adjusted odds ratio [aOR] 1.62; 95% confidence interval [CI] 1.00-2.62) and macrosomia (aOR 1.97; 95% CI 1.37-2.83) (17). In the second trimester, it was associated with gestational diabetes (aOR 1.7; 95% CI 1.02-2.84) (17). Finally, a third study involving more than 5,000 women revealed an association of hypothyroxinemia with preterm labor (18), but not with hypertensive disease in pregnancy (19). A meta-analysis that included these and other smaller studies found only a statistically significant increased risk of placental abruption (OR 2.3; 95% CI: 1.1–4.8) compared to euthyroid controls (20). Taken together, these findings show that the association of hypothyroxinemia with obstetric and neonatal outcomes is still inconsistent (4). In fact, there is no reproducibility of the results in the different studies and no cause-effect relationship could be established.
Enhanced recovery is so important in the petroleum industry that the location of the producer well is chosen with the secondary well (injection well) in mind. As mentioned before, efforts to enhance recovery are costly and are dependent upon the state of the economy and the potential oil recovery volume. Consequently, repeated monitoring of a reservoir is essential to choose the best locations for the injection wells. The idea is to design an optimal distribution of injection wells so as to optimize long-term production. There are several types of wells: wildcat well, rank wildcat well, step-out well, pro- ducer well, injection well, etc. Since there are different steps in the process of obtaining oil, wells are classified broadly as exploratory wells and development wells. Examples of exploratory wells are wildcat wells (drilled a mile or more from an area of existing oil production) and rank wildcat wells (drilled in an area where there is no existing produc- tion). If the exploratory drilling proves successful, the company starts to drill step-out wells (also included in the exploratory well category). After the oil field has been delin- eated, the company starts to drill production wells within the known extent of the field. Every well drilled inside the known extent of the field is called a development well (Hyne (2001)). The development well category includes producer wells and injection wells (re- call that injection wells are drilled to enhance oil recovery). Different categories of wells have different probabilities of finding oil. On average, rank wildcat exploratory wells have lower success ratio than step-out wells. An oil company can rank wells in terms of probability, even in the face of uncertainty. The American Petroleum Institute reported that in 2000 the success rate for wildcat wells was 39% (Hyne (2001)). Note that an unsuccessful drilling is classified as a dry hole in both exploratory and development well categories.
The chi-square test was used to verify homogeneity of the sample in terms of distribution of socioeconomic and demographic variables across the intervention and control groups after randomization. The chi-square test was also used to evaluate the differences in the prevalence rates of the primary study outcomes: anemia, ID and IDA. Relative risks and their respective 95%CI were calculated in order to quantify the effect of the intervention on breastfeeding and feeding habits. The sample size changed for different analyses, depending on the availability of data. Student’s t test and the Mann-Whitney nonparametric test were used for intake variables, Hb and SF and the Kolmogorov- Smirnov test was used to check they were applicable. The cutoff for rejection of the null hypothesis was set at 5% for all tests.
individuals who underwent pancreatic resections for ductal adenocarcinoma divided into two groups: one under 45 years old (n=75) and the other abobe this age (n=870), analyzing the type of resection, the tumor staging, and the co-morbidities (CACI) between the groups. As a result, it was observed a lower rate of complications (pancreatic leak and gastric empyting delay) and higher survival among the younger individuals. This finding demonstrated a correlation between a more favorable evolution and the preoperative clinical conditions of the individuals with more physiological reserve. The significant finding of null mortality among the individuals who underwent surgery due to less aggressive tumors is likely to have been observed not only due to the etiology itself, but mainly due to the better clinical status of the patients, since they were younger than the ones with the other etiologies. Another important factor is that there is no necessity for a higher surgical radicality within this group, since these tumors usually do not feature such a locally invasive presentation.
Of the 1,697 individuals identified, 1,519 answered the questionnaire. Of them, 29 individuals were excluded because they were unable to remain standing still, 16 because they were pregnant or had a child younger than six months, and 10 because of a prosthesis or plaster or amputated limbs. This resulted in 1,464 individuals eligible for anthropometry; of them, 31 could not be measured for weight or height and 35 for waist circumference. Thus, the results presented refer to 1,433 individuals with measures of weight and height and 1,429 individuals with measures of waist circumference, corresponding to 84.4% and 84.2% of the initial sample of the survey, respectively. The sample included in the study was mostly female (51.2%), white (85.8%), with up to eight years of education (75.7%), and living with a partner (71.9%). Most (66.9%) lived in the rural area since birth and 34% performed some type of rural activity (Table 1). The mean age of the individuals included in the study was 47 (SD = 0.7) years.