Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 13 de 13
Filtrar
1.
Health Place ; 76: 102851, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35779324

RESUMO

PURPOSE: According to the social determinants of health framework, income inequality is a potential risk factor for adverse mental health. However, few studies have explored the mechanisms suspected to mediate this relationship. The current study addresses this gap through a mediation analysis to determine if social support and community engagement act as mediators linking neighbourhood income inequality to maternal anxiety and depressive symptoms within a cohort of new mothers living in the City of Calgary, Canada. METHODS: Data collected at three years postpartum from mothers belonging to the All Our Families (AOF) cohort were used in the current study. Maternal data were collected between 2012 and 2015 and linked to neighbourhood socioeconomic data from the 2006 Canadian Census. Income inequality was measured using Gini coefficients derived from 2006 after-tax census data. Generalized structural equation models were used to quantify the associations between income inequality and mental health symptoms, and to assess the potential direct and indirect mediating effects of maternal social support and community engagement. RESULTS: Income inequality was not significantly associated with higher depressive symptoms (ß = 0.32, 95%CI = -0.067, 0.70), anxiety symptoms (ß = 0.11, 95%CI = -0.39, 0.60), or lower social support. Income inequality was not associated with community engagement. For the depression models, higher social support was significantly associated with lower depressive symptoms (ß = -0.13, 95%CI = -0.15, -0.097), while community engagement was not significantly associated with depressive symptoms (ß = 0.059, 95%CI = -0.15, 0.27). Similarly, for the anxiety models, lower anxiety symptoms were significantly associated with higher levels of social support (ß = -0.17, 95%CI = -0.20, -0.13) but not with higher levels of community engagement (ß = 0.14, 95%CI = -0.14, 0.41). CONCLUSION: The current study did not find clear evidence for social support or community engagement mediating the relationship between neighbourhood income inequality and maternal mental health. Future investigations should employ a broader longitudinal approach to capture changes in income inequality, potential mediators, and mental health symptomatology over time.


Assuntos
Análise de Mediação , Saúde Mental , Canadá/epidemiologia , Feminino , Humanos , Renda , Apoio Social , Fatores Socioeconômicos
2.
Diabet Med ; 33(12): 1659-1667, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-26802478

RESUMO

AIMS: In women with a twin pregnancy, to determine the incidence of, risk factors for and outcomes of women with gestational diabetes mellitus, and assess how these have changed with a change in gestational diabetes screening. METHODS: Retrospective cohort study of women with a twin pregnancy attending an Australian tertiary hospital, 2002-2013. Information on gestational diabetes status, gestational diabetes risk factors and pregnancy outcomes was ascertained. Pregnancy outcomes included hypertensive disorders, twin birthweight centile and a composite adverse pregnancy outcome. Analysis was stratified pre/post screening protocol change (epoch 1: 2002-2009, epoch 2: 2010-2013) and by gestational diabetes status. RESULTS: Gestational diabetes was diagnosed in 86/982 (8.8%) women, increasing from 4.4% to 14.7% between epochs (P = 0.0001). The proportion of women with hypertensive disorders increased (11.7% vs. 13.4%, P = 0.009), but the proportion of infant's birthweight > 90th centile decreased (11.0% vs. 7.6%, P = 0.02) between epochs. Overall, 33.6% of women had ≥ 1 risk factors for gestational diabetes. Three-quarters (73.7%) of women overall had an adverse pregnancy outcome, with a slightly higher proportion in women with gestational diabetes compared with those with no gestational diabetes (79.7% vs. 73.1%, P = 0.06). The rate of the adverse pregnancy outcome did not change by epoch, after adjusting for maternal and pregnancy risk factors (adjusted odds ratio = 0.96, 95% confidence interval 0.73-1.26). CONCLUSIONS: Almost 1 in 10 women with a twin pregnancy were diagnosed with gestational diabetes, with the incidence of gestational diabetes increasing threefold with a new screening protocol. The pregnancy outcomes of women with a twin pregnancy did not change with increased detection and treatment for gestational diabetes.


Assuntos
Diabetes Gestacional/epidemiologia , Gravidez de Gêmeos , Adolescente , Adulto , Diabetes Gestacional/diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , New South Wales/epidemiologia , Paridade , Gravidez , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Trimestres da Gravidez , Diagnóstico Pré-Natal , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
3.
Lupus ; 24(10): 1107-10, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25748061

RESUMO

We present two women with severe obstetric complications from antiphospholipid (aPL) syndrome associated with a rare dermatological manifestation, cutaneous pseudovasculitis. Both of these women developed a rash on the palmar aspect of the hands during the post partum period, with histology consistent with microthrombotic disease, despite anticoagulation. Cutaneous pseudovasculitis appears to be a maternal manifestation of aPL coagulopathy, possibly reflecting the severity of the underlying pregnancy pathology.


Assuntos
Síndrome Antifosfolipídica/imunologia , Complicações na Gravidez/imunologia , Dermatopatias/imunologia , Vasculite/imunologia , Adulto , Anticorpos Anticardiolipina/imunologia , Anticorpos Antifosfolipídeos/imunologia , Síndrome Antifosfolipídica/patologia , Exantema/diagnóstico , Exantema/etiologia , Feminino , Humanos , Inibidor de Coagulação do Lúpus/imunologia , Gravidez
4.
J Environ Manage ; 105: 90-5, 2012 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-22537709

RESUMO

A study was conducted on the effectiveness of using vertical baffles to improve the thermal performance of power plant cooling ponds. A small scale physical model of a rectangular cooling pond was used. A base case was established using traditional horizontal baffles to create a serpentine flow pattern through the pond. The horizontal baffles were then replaced by a series of underflow weirs that spanned the pond. An improvement in cooling of over 30% was realized.


Assuntos
Conservação de Recursos Energéticos/métodos , Temperatura Alta , Centrais Elétricas/normas , Engenharia , Arquitetura de Instituições de Saúde
5.
Med J Aust ; 175(5): 258-63, 2001 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-11587258

RESUMO

For the management of acute thrombotic events in pregnancy therapeutic doses of low molecular weight heparins (LMWH) may be used, unless the shorter half-life of intravenous unfractionated heparin (UH) and predictable reversibility by protamine are important. Treatment should be continued up until delivery and into the puerperium. Pregnant women who have had an acute thrombotic event should be delivered by a specialist team. In the case of recent thrombosis, delivery should be planned and the time during which anticoagulation therapy is ceased around the time of delivery should be minimised. Therapeutic doses of LMWH contraindicate the use of regional anaesthesia, and a switch to intravenous UH before delivery may allow greater flexibility in this regard. Prophylactic doses of LMWH can be used to reduce the risk of recurrent thromboembolic events in pregnancy. The regimen used will depend on the previous history, the family history and the presence of risk factors, including the genetic and acquired causes of thrombophilia. Women with mechanical heart valves are at high risk during pregnancy and require therapeutic anticoagulation throughout pregnancy under the direction of experienced specialists. Low-dose aspirin can reduce the risk of recurrent pre-eclampsia by about 15%, but the role of UH and LMWH in the prevention of recurrent miscarriage or obstetric complications associated with uteroplacental insufficiency is still uncertain.


Assuntos
Anticoagulantes/uso terapêutico , Heparina de Baixo Peso Molecular/uso terapêutico , Complicações Hematológicas na Gravidez/tratamento farmacológico , Trombose Venosa/tratamento farmacológico , Anestesia Obstétrica , Anticoagulantes/administração & dosagem , Feminino , Heparina de Baixo Peso Molecular/administração & dosagem , Humanos , Período Pós-Parto , Guias de Prática Clínica como Assunto , Gravidez , Complicações Hematológicas na Gravidez/prevenção & controle , Cuidado Pré-Natal , Fatores de Risco , Trombose Venosa/prevenção & controle
6.
Best Pract Res Clin Obstet Gynaecol ; 15(6): 863-76, 2001 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-11800529

RESUMO

The use of anticonvulsant drugs in pregnancy presents unique challenges to clinicians and their patients. The need for control of maternal epilepsy must be balanced with the fetal and neonatal risks associated with anticonvulsant drugs. Anticonvulsant drugs may have potential effects on embryogenesis, neurological development, growth and subsequent paediatric progress. Drug selection and dose adjustment must be appropriate and based on a combination of known maternal and fetal risks as well as the clinical status of the patient. Overall, no one drug can be specifically recommended but monotherapy with most of the recognized first-line drugs will result in a satisfactory outcome. Polytherapy is associated with an increase in congenital malformations and should be avoided if possible. It is possible that newer second-line agents, for example, gabapentin, may be safer as add-on therapy. Neurological disorders such as migraine, and the less common conditions of myasthenia gravis and multiple sclerosis, may require the use of drugs which have not been well studied in pregnancy. Information is provided about the use of drugs to control symptoms and prevent disease progression in these disorders during pregnancy.


Assuntos
Anticonvulsivantes/efeitos adversos , Doenças do Sistema Nervoso/tratamento farmacológico , Complicações na Gravidez/tratamento farmacológico , Anormalidades Induzidas por Medicamentos/etiologia , Anticonvulsivantes/uso terapêutico , Fármacos do Sistema Nervoso Central/uso terapêutico , Epilepsia/tratamento farmacológico , Feminino , Humanos , Recém-Nascido , Troca Materno-Fetal , Gravidez , Efeitos Tardios da Exposição Pré-Natal
7.
Clin Exp Pharmacol Physiol ; 19(9): 607-12, 1992 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-1395105

RESUMO

1. The control of extracellular fluid volume (ECFV) in normal pregnancy may be related to changes in atrial natriuretic peptide. Previous studies in non-pregnant subjects have suggested that plasma atrial natriuretic peptide (ANP) increases in response to dietary sodium supplementation because of an increase in plasma volume, although this has not been measured directly. 2. Nine women who were pregnant in the third trimester undertook oral sodium supplementation (136 mmol) for 5 days in addition to their usual diet. Twenty-four hour urinary sodium excretion increased by 125 +/- 54 mmol/day (mean +/- s.d.; P less than 0.01). Plasma volume was unchanged, although total ECFV tended to increase (P less than 0.09 and bodyweight increased (1.3 +/- 1.4 kg; P less than 0.01) at the end of these diets. 3. Plasma ANP increased by 30.7 [8.6, 34.5] pmol/L (median [25th, 75th percentile]; P less than 0.05), while plasma renin concentration decreased significantly from 7.3 [6.2, 11.2] to 2.6 [1.7, 3.9] pmol angiotensin I/mL (P less than 0.01), as did plasma aldosterone concentration (1435 [1162, 1722] to 753 [595, 1110] fmol/mL; P less than 0.01). Plasma vasoactive intestinal peptide was unchanged. 4. Pregnant women respond to increased dietary sodium with an increase in plasma ANP in the absence of a significant increase in plasma volume. The acute regulation of plasma ANP in response to increases in dietary sodium in pregnant women does not appear to be mediated by changes in intravascular fluid volume.


Assuntos
Fator Natriurético Atrial/sangue , Gravidez/sangue , Sódio na Dieta/farmacologia , Adulto , Aldosterona/sangue , Volume Sanguíneo , Espaço Extracelular , Feminino , Humanos , Gravidez/efeitos dos fármacos , Radioimunoensaio , Renina/sangue , Sódio/urina , Sódio na Dieta/administração & dosagem , Peptídeo Intestinal Vasoativo/sangue
8.
J Hypertens ; 10(8): 821-9, 1992 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-1325515

RESUMO

OBJECTIVE: To determine whether the increase in extracellular fluid volume (ECFV) that occurs during pregnancy alters: (1) the baseline regulation of atrial natriuretic peptide (ANP); or (2) the ANP response to intravascular volume expansion with either haemaccel or hypertonic saline. DESIGN: A group of normal pregnant subjects was studied longitudinally on three occasions, commencing before 16 weeks of gestation. They were compared with a group of age-matched non-pregnant women. Dietary sodium intake and posture were carefully controlled. METHODS: Plasma volume and total ECFV were determined by tracer dilution methods, using Evans Blue and 20% mannitol, respectively. Plasma ANP and aldosterone concentrations were measured by radioimmunoassay. RESULTS: Plasma ANP did not increase during pregnancy despite increases in both plasma and total ECFV. The plasma ANP response to acute intravenous volume expansion in later pregnancy appears to be more sensitive than either in early pregnancy or in non-pregnant subjects. The initial ANP response to infusions of haemaccel during pregnancy was greater than the ANP response to saline. CONCLUSIONS: During a normal pregnancy, plasma ANP is maintained in the normal non-pregnant range, despite an increase in plasma volume when the effects of dietary sodium intake and posture are carefully accounted for. The ANP response to intravenous volume expansion is enhanced in late pregnancy. The greater ANP response to haemaccel infusions during pregnancy suggests that an increase in atrial stretch mediates the secretion of ANP following intravenous volume expansion.


Assuntos
Fator Natriurético Atrial/sangue , Gravidez/fisiologia , Adulto , Aldosterona/sangue , Fator Natriurético Atrial/metabolismo , Espaço Extracelular/fisiologia , Feminino , Hidratação , Humanos , Estudos Longitudinais , Volume Plasmático/fisiologia , Poligelina , Postura/fisiologia , Gravidez/sangue , Solução Salina Hipertônica , Sódio na Dieta/administração & dosagem
9.
J Hypertens ; 10(3): 201-7, 1992 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-1315815

RESUMO

PURPOSE: The management of pregnancy-induced hypertension (PIH) and preeclampsia using antihypertensive drug therapy remains contentious. Conflicts arise due to differences in diagnostic criteria and varying attitudes regarding the value of treating hypertension, which is only one aspect of this systemic disorder. The following review assesses the role of individual agents and their effects upon both maternal and foetal/neonatal wellbeing. STUDY SELECTION: Human clinical trials of each of the main antihypertensive drugs used in the management of PIH/preeclampsia are reviewed. The value of randomized, placebo-controlled trials and long-term paediatric follow up is stressed. RESULTS OF DATA ANALYSIS: A number of agents have a favourable benefit-risk profile for use in women with PIH/preeclampsia; these include alpha-methyldopa, beta-blockers, hydralazine, prazosin, calcium channel antagonists and ketanserin. Diazoxide and sodium nitroprusside may also be used for acute severe hypertension. Angiotensin converting enzyme inhibitors are contra-indicated. Low-dose aspirin is presently being investigated in multicentre trials and may play a major role in the prevention of preeclampsia. CONCLUSION: Decisions regarding the need for antihypertensive treatment during pregnancy and the selection of a specific antihypertensive agent should be based upon an assessment of the relative benefits and risks for the individual patient. In future studies, the effects of antihypertensive agents upon the underlying pathophysiological processes involved in PIH/preeclampsia may guide therapeutic decision making.


Assuntos
Anti-Hipertensivos/uso terapêutico , Hipertensão/tratamento farmacológico , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Feminino , Humanos , Gravidez
10.
Am J Hypertens ; 4(11): 897-903, 1991 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-1838691

RESUMO

Pregnancy-induced hypertension (PIH) is characterized by a relative decrease in plasma volume and renin and aldosterone concentrations as well as increased capillary permeability compared with normal pregnancy. As many of these features could be explained by the actions of atrial natriuretic peptide (ANP), we examined the relationship between plasma volume and plasma ANP in women with PIH and in normal third trimester pregnant women, and whether ANP responses to alterations in posture were intact in women with PIH. Basal plasma ANP measured after 20 min lateral recumbency in women with PIH was 24.0 (13.9, 33.1) pmol/L (median [25th, 75th percentile]), which was significantly greater than in normal pregnant women (9.9 [6.3, 16.0]), (P less than .05). Plasma ANP did not differ between those with and without proteinuria in the PIH group. Plasma volume was decreased in women with PIH (20.1 [19.0, 23.2] mL/cm) v 23.5 [21.4, 25.3], P less than .05). Plasma renin concentration but not plasma aldosterone concentration was also decreased significantly in women with PIH compared with normal pregnant women (P less than .001) and both were correlated negatively with plasma ANP. Following prolonged lateral recumbency, plasma ANP rose to 26.9 [19.1, 44.1] pmol/L in women with PIH (P less than .05), which was still significantly greater than in normal pregnant women (15.5 [6.7, 21.9] pmol/L) (P less than .05). In a subgroup of these subjects, 30 min head-up tilt decreased plasma ANP by 5.2 [0.9, 22.3] pmol/L in women with PIH and by 6.1 [2.2, 10.3] pmol/L in normal pregnant women, a nonsignificant difference.(ABSTRACT TRUNCATED AT 250 WORDS)


Assuntos
Fator Natriurético Atrial/sangue , Volume Sanguíneo/fisiologia , Hipertensão/etiologia , Hipertensão/fisiopatologia , Complicações na Gravidez/fisiopatologia , Adulto , Aldosterona/sangue , Permeabilidade Capilar/fisiologia , Feminino , Humanos , Gravidez , Complicações na Gravidez/sangue , Renina/sangue
11.
Am J Obstet Gynecol ; 165(3): 591-5, 1991 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-1832521

RESUMO

The response of plasma atrial natriuretic peptide to three changes in posture that alter atrial stretch was examined in the late phase of pregnancy: (1) after 20 minutes in lateral recumbency, remaining upright for 2 hours decreased median plasma atrial natriuretic peptide values from 37.8 (25th percentile, 22.9 and 75th percentile; 64.2) to 21.8 (10.1 and 28.4) pg/ml in pregnant women (p less than 0.05) and from 39.2 (27.8 and 51.2) to 24.0 (18.9 and 35.4) pg/ml (p less than 0.001) in age-matched nonpregnant women; (2) prolongation of lateral recumbency from 20 to 80 minutes increased median plasma atrial natriuretic peptide levels from 31.9 (25.6 and 37.3) to 47.8 (33.0 and 74.6) pg/ml in pregnant women (p less than 0.001) and from 36.5 (22 and 58.6) to 54.0 (36.3 and 111.7) pg/ml in nonpregnant women (p less than 0.01); (3) adoption of supine posture during the late phase of normal pregnancy did not alter median plasma atrial natriuretic peptide values significantly [30.4 (26.7 and 42.5) pg/ml during lateral recumbency compared with 34.2 (25.4 and 43.5) pg/ml while supine]. Plasma atrial natriuretic peptide values fell after supine posture in only half the women and supine hypotension occurred in one subject. These studies demonstrate that upright and prolonged lateral recumbent postures significantly influence plasma atrial natriuretic peptide values during pregnancy, as they do in the nonpregnant state, but that supine posture does not alter plasma atrial natriuretic peptide values significantly. Posture must be carefully accounted for in any study of plasma atrial natriuretic peptide in pregnancy.


Assuntos
Fator Natriurético Atrial/metabolismo , Postura , Gravidez/metabolismo , Adulto , Feminino , Humanos
12.
Clin Sci (Lond) ; 77(6): 599-604, 1989 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-2691173

RESUMO

1. Capillary permeability was determined by the disappearance rate of Evans Blue dye from plasma in healthy non-pregnant women, normal third-trimester primigravidae and primigravidae with pregnancy-induced hypertension. 2. Extracellular fluid volume was determined from the disappearance curves of injected mannitol in the same subjects and the plasma volume was measured by the Evans Blue dye dilution technique. 3. In normal pregnancy capillary permeability was not altered from that of non-pregnant subjects. Although extracellular fluid volume and plasma volume were increased in normal pregnant compared with non-pregnant women, the distribution of fluid between plasma volume and interstitial fluid volume was unaltered. 4. Women with established pregnancy-induced hypertension had a more rapid Evans Blue disappearance rate and a lower plasma volume than normal pregnant women, independent of the presence of proteinuria. Maternal plasma volume correlated positively and significantly with fetal birth weight in women with pregnancy-induced hypertension, emphasizing the important relationship between maternal plasma volume and fetal outcome. 5. The increased capillary permeability in women with pregnancy-induced hypertension was associated with a reduction in the plasma volume/interstitial fluid volume ratio but a normal extracellular fluid volume, suggesting that the reduced plasma volume did not result from sodium loss but rather from a redistribution of the total extracellular fluid volume. These changes did not differ significantly in subgroups with and without oedema.


Assuntos
Permeabilidade Capilar/fisiologia , Espaço Extracelular/fisiologia , Pré-Eclâmpsia/fisiopatologia , Adulto , Peso ao Nascer , Volume Sanguíneo , Técnica de Diluição de Corante , Feminino , Humanos , Recém-Nascido , Gravidez
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...