No description available.

Submitted by Jos? Henrique Henrique (jose.neves@ufvjm.edu.br) on 2017-03-07T17:37:49Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) lorena_tavares_oliveira.pdf: 1039032 bytes, checksum: 99b6c1aac4a55a13ac7523067c7e14af (MD5) / Approved for entry into archive by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2017-03-30T14:58:02Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) lorena_tavares_oliveira.pdf: 1039032 bytes, checksum: 99b6c1aac4a55a13ac7523067c7e14af (MD5) / Made available in DSpace on 2017-03-30T14:58:02Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) lorena_tavares_oliveira.pdf: 1039032 bytes, checksum: 99b6c1aac4a55a13ac7523067c7e14af (MD5) Previous issue date: 2016 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior (CAPES) / Funda??o de Amparo ? Pesquisa do Estado de Minas Gerais (FAPEMIG) / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico (CNPq) / Objetivou-se com este estudo estimar par?metros gen?ticos e fenot?picos para probabilidade de prenhez nas idades 15, 19, 23, 27, 31, 35, 39 e 43 meses (PP_15, PP_19, PP_23, PP_27, PP_31, PP_35, PP_39 e PP_43), em novilhas da ra?a Sindi, via modelo de limiar em regress?o aleat?ria utilizando os polin?mios ortogonais de Legendre de segunda, terceira e quarta ordem, considerando a homogeneidade e heterogeneidade de vari?ncia residual. Os componentes de covari?ncia foram estimados por abordagem Bayesiana, utilizando o programa THRGIBBS3F90. Foram inclu?dos os efeitos fixos de criador, fazenda do criador, ano de nascimento, esta??o de nascimento e como covari?vel (de efeito linear) foi considerado o peso da vaca na idade em que ela concebeu. Al?m desses efeitos para todas as idades estudadas, foram considerados os efeitos aleat?rios gen?ticos aditivos, de ambiente permanente e residual. O melhor modelo para a an?lise RRTM foi o LEG_4441 que obteve as seguintes estimativas de herdabilidade 0,34; 0,41; 0,45; 0,41; 0,37; 0,32; 0,32; 0,33 para PP_15, PP_19, PP_23, PP_27, PP_31, PP_35, PP_39, PP_43, respectivamente. As estimativas das correla??es gen?ticas obtidas entre PP_15 com PP_19, PP_23, PP_27, PP_31, PP_35, PP_39 e PP_43 foram 0,1; -0,39; -0,65; -0,83; -0,93; -0,81; -0,71, respectivamente. As estimativas das correla??es fenot?picas para PP_15 com PP_19, PP_23, PP_27, PP_31, PP_35, PP_39 e PP_43 foram respectivamente 0,12; -0,09; -0,17; -0,22; -0,26; -0,25; 0,40. A an?lise que utilizou modelo LEG_4441 foi a mais indicada para estimar os par?metros gen?ticos para a probabilidade de prenhez em diferentes idades em novilhas da ra?a Sindi, indicando que a prenhez precoce possui variabilidade gen?tica para ser inclu?da como caracter?stica alvo de sele??o em programas de melhoramento, com potencial para se obter ganhos gen?ticos satisfat?rios. / Disserta??o (Mestrado) ? Programa de P?s-Gradua??o em Zootecnia, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2016. / Our aim with this study was estimating genetic and phenotypic parameters for pregnancy probability at 15, 19, 23, 27, 31, 35, 39 and 43 month old (PP_15, PP_19, PP_23, PP_27, PP_31, PP_35, PP_39 and PP_43) in Sindhi heifers, by using threshold model in a random regression framework, adopting Legendre orthogonal polynomials of second, third and fourth order, considering homogeneity and heterogeneity of residual variance. Covariance components were estimated by Bayesian approach using THRGIBBS3F90 program. The model included the fixed effects of herd, herd of the farm, year of birth, birth season and as a covariate (with linear effect) was considered the weight of the cow at the age when she calved. In addition to these effects for all ages studied, additive genetic, permanent environmental and residual random effects were considered. The best model for the analysis was the RRTM LEG_4441 which obtained the following heritability estimates: 0.34; 0.41; 0.45; 0.41; 0.37; 0.32; 0.32; 0.33 to PP_15, PP_19, PP_23, PP_27, PP_31, PP_35, PP_39 and PP_43, respectively. Genetic correlation estimates between PP_15 with PP_19, PP_23, PP_27, PP_31, PP_35, PP_39 and PP_43 were 0.1; -0.39; -0.65; -0.83; -0.93; -0.81; -0.71, respectively. Phenotypic correlation estimates for PP_15 with PP_19, PP_23, PP_27, PP_31, PP_35, PP_39 and PP_43 were respectively 0.12; -0.09; -0.17; -0.22; -0.26; -0.25; 0.40. The analysis by using LEG_4441 model was the most appropriate to estimate genetic parameters for pregnancy probability at different ages in Sindhi heifers, indicating that early pregnancy has genetic variability to be included as a goal trait selection in breeding programs, with the potential to achieve satisfactory genetic gains.

Spontanabort i tidig graviditet hos kvinnor är den vanligaste typen av spontanabort och drabbar 10-35 % av alla gravida kvinnor. Syftet var att beskriva kvinnors upplevelser av omvårdnad i samband med spontanabort i tidig graviditet. Metoden som användes var systematisk litteraturstudie som totalt inkluderade nio studier. Datainsamlingen genomfördes i databaserna Cinahl, PubMed och PsycINFO. Studierna kvalitetsgranskades, och resultatet analyserades utifrån syftet. Materialet färgkodades utifrån funna mönster och tre kategorier växte fram. Kategorierna blev slutligen: kvinnors upplevelser av emotionellt stöd, kvinnors upplevelser av information och förklaring samt kvinnors upplevelser och behov av eftervård. Litteraturstudiens övervägande resultat innefattade upplevelser av otillfredsställelse med omvårdnaden bland de drabbade kvinnorna. Många kvinnor upplevde ett osympatiskt bemötande, bristande medicinsk förklaring av orsaken till spontanaborten samt en avsaknad av eftervård. Slutsatsen var att majoriteten av kvinnorna inte upplevde tillfredsställelse med det emotionella stödet, den medicinska förklaringen samt att de saknade eftervård i samband med spontanaborten i tidig graviditet. Ny forskning föreslås ur patientperspektivet med fokus på kvinnornas unika känslor och behov och ur personalperspektivet om bemötande och eftervård av kvinnor som nyligen varit med om spontanabort i tidig graviditet. / Early pregnancy loss occurs to 10-35% of all pregnant women and it is the most common type of pregnancy loss. The aim was to describe women’s experiences of nursing care in relation to early pregnancy loss. The used method was systematic literature review and resulted in totally used nine articles. The data collection was accomplished in the databases Cinahl, PubMed and PsycINFO. The articles quality was checked and the result was analyzed with regard to the aim. The material was coded in to colours from the found patterns and three categories took place. The categories were finally women’s experiences of emotional support, women’s experiences of information and explanation and women’s experiences and needs of aftercare. The greater part of the result included experiences of dissatisfaction with the nursing care among the women. Many women experienced an unsympathetic attitude, lack of medical explanation to the course and lack of aftercare. The conclusion was that the majority of the women didn’t experience satisfaction with the emotional support, the medical explanation and the aftercare, in relation to early pregnancy loss. Suggestion for new research is made, with focus on women’s unique feelings and needs, and also with focus on the nurses’ attitude and aftercare of these women.

<p>Spontanabort i tidig graviditet hos kvinnor är den vanligaste typen av spontanabort och drabbar 10-35 % av alla gravida kvinnor. Syftet var att beskriva kvinnors upplevelser av omvårdnad i samband med spontanabort i tidig graviditet. Metoden som användes var systematisk litteraturstudie som totalt inkluderade nio studier. Datainsamlingen genomfördes i databaserna Cinahl, PubMed och PsycINFO. Studierna kvalitetsgranskades, och resultatet analyserades utifrån syftet. Materialet färgkodades utifrån funna mönster och tre kategorier växte fram. Kategorierna blev slutligen: kvinnors upplevelser av emotionellt stöd, kvinnors upplevelser av information och förklaring samt kvinnors upplevelser och behov av eftervård. Litteraturstudiens övervägande resultat innefattade upplevelser av otillfredsställelse med omvårdnaden bland de drabbade kvinnorna. Många kvinnor upplevde ett osympatiskt bemötande, bristande medicinsk förklaring av orsaken till spontanaborten samt en avsaknad av eftervård. Slutsatsen var att majoriteten av kvinnorna inte upplevde tillfredsställelse med det emotionella stödet, den medicinska förklaringen samt att de saknade eftervård i samband med spontanaborten i tidig graviditet. Ny forskning föreslås ur patientperspektivet med fokus på kvinnornas unika känslor och behov och ur personalperspektivet om bemötande och eftervård av kvinnor som nyligen varit med om spontanabort i tidig graviditet.</p> / <p>Early pregnancy loss occurs to 10-35% of all pregnant women and it is the most common type of pregnancy loss. The aim was to describe women’s experiences of nursing care in relation to early pregnancy loss. The used method was systematic literature review and resulted in totally used nine articles. The data collection was accomplished in the databases Cinahl, PubMed and PsycINFO. The articles quality was checked and the result was analyzed with regard to the aim. The material was coded in to colours from the found patterns and three categories took place. The categories were finally women’s experiences of emotional support, women’s experiences of information and explanation and women’s experiences and needs of aftercare. The greater part of the result included experiences of dissatisfaction with the nursing care among the women. Many women experienced an unsympathetic attitude, lack of medical explanation to the course and lack of aftercare. The conclusion was that the majority of the women didn’t experience satisfaction with the emotional support, the medical explanation and the aftercare, in relation to early pregnancy loss. Suggestion for new research is made, with focus on women’s unique feelings and needs, and also with focus on the nurses’ attitude and aftercare of these women.</p>

Abstract The main goal of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatment is a healthy mother and a healthy child. The most important complication following IVF/ICSI arises from the increased risk of multiple pregnancies. An elective single embryo transfer (eSET) with the freezing of spare embryos and subsequent treatment with frozen embryo transfer (FET) is the only way to avoid this complication. For this reason, the number of children born after FET is steadily rising. The aim of this study was to provide more detailed evidence on the safety of FET, particularly focusing on serum hormone profiles during the first trimester weeks of singleton pregnancies after IVF/ICSI fresh embryo transfer (ET), after FET during a natural menstrual cycle, and after spontaneous conception. Another part of this study compared the perinatal outcomes, congenital anomalies (CAs), and morbidity of singletons born after FET and IVF/ICSI fresh ET. The reference group was those born after spontaneously conceived (SC) pregnancies. In the clinical prospective study, the maternal serum estradiol and progesterone levels in pregnancies after fresh ET (n=39) were higher during early pregnancy weeks than in FET (n=30) and SC pregnancies (n=41), while the hormonal profiles after FET did not differ from SC pregnancies. In the large register study, FET children (n=1830) were found to have a reduced risk for adverse perinatal outcomes, such as preterm birth, a low birthweight, and being small for their gestational age compared with children born after fresh ET (n=2942). However, FET children have an increased risk for being large for their gestational age. The major CAs and morbidity until three years of age did not differ between groups. When compared with SC children (n =31 243), the perinatal outcome was worse and the rates of CAs and morbidity were higher in FET children. The FET cycle seemed to provide a better physiological environment for early fetal development than fresh ET. Further, FET protects against some of the adverse perinatal outcomes of children when compared with fresh ET, but not when it comes to the major CAs and early somatic health. This study provides further evidence of the safety of FET in comparison with fresh ET. This information should further encourage clinicians to implement eSET combined with cryopreservation in their IVF/ICSI program. / Tiivistelmä Koeputkihedelmöityshoidon (in vitro fertilization, IVF ja intracytoplasmic sperm injection, ICSI) tavoitteena on terve äiti ja terve lapsi. Monisikiöraskaus on hoidon komplikaatio, koska siihen liittyy selkeästi kohonnut riski äidille ja lapselle. Yhden alkion siirto, jäljelle jääneiden alkioiden pakastus ja myöhemmin tehtävä pakastetun alkion siirto (PAS) ovat lisänneet IVF/ICSI-hoitojen turvallisuutta ja tehokkuutta. Täten PAS:sta syntyneiden lasten määrä kasvaa. Tutkimuksen tavoitteena on lisätä PAS-hoitojen turvallisuutta tarkastelemalla veren steroidihormonien muutoksia alkuraskaudessa naisilta, jotka olivat tulleet raskaiksi IVF/ICSI-tuorealkion siirroista, luonnollisen kuukautiskierron aikana tehdystä PAS:sta ja luonnollisesti. Lisäksi tutkimuksessa verrattiin PAS- ja IVF/ICSI-tuorealkion siirrosta alkunsa saaneiden lasten terveyttä kolmeen ikävuoteen asti. Viiteryhmän muodostivat luonnollisesti alkunsa saaneet lapset. Kliinisessä prospektiivisessa tutkimuksessa havaittiin naisilla, joilla oli tuorealkion siirrosta alkanut raskaus (n=39), merkittävästi koholla olevat seerumin estradioli- ja progesteronipitoisuudet 7-8 raskausviikolle asti verrattuna naisiin, joilla raskaudet olivat alkaneet PAS:sta (n=30) tai luonnollisesti (n=41). Vastaavasti PAS-raskauksissa hormonipitoisuudet eivät eronneet merkittävästi luonnolliseen raskauteen verrattuna. Laajassa rekisteritutkimuksessa havaittiin PAS-lapsilla (n=1830) olevan pienempi riski ennenaikaisuuteen ja pienipainoisuuteen kuin tuorealkiolapsilla (n=2942). Kuitenkin PAS-lapsilla oli lisääntynyt riski syntyä isokokoisina raskausviikkoihin nähden. Synnynnäisten epämuodostumien ja eri sairauksien esiintyvyyksissä ei ollut eroja. Luonnollisesti alkunsa saaneisiin lapsiin (n= 31 243) verrattaessa, PAS-lapsilla oli vastasyntyneisyyskaudelta lähtien enemmän terveyteen liittyviä ongelmia. Tutkimus osoitti PAS-raskaudessa sikiön kehittyvän alkuviikkoina luonnollisemmassa ympäristössä kuin tuorealkion siirtoraskaudessa. Vaikka suurin osa PAS- ja tuorealkiolapsista oli terveitä, tuorealkiolapsilla oli vastasyntyneisyyskaudella enemmän ongelmia kuin PAS-lapsilla. Muita terveyseroja lasten välillä ei todettu. Tutkimus antaa lisänäyttöä PAS hoidon turvallisuudesta. Alkion pakastamisella voidaan välttää koeputkihedelmöityshoidon riskejä pyrkimällä mahdollisimman usein yhden alkion siirtoon.

Devenir mère à l’adolescence peut représenter une situation d’adversité et est associée à des impacts délétères possibles sur la vie de la jeune mère et de ses enfants. Être victime de violence de la part de son partenaire peut aussi représenter une adversité importante, notamment en regard de ses conséquences préjudiciables sur la santé. Cumulées, ces deux adversités peuvent sérieusement compromettre le parcours de vie d’une jeune femme. Cependant, des jeunes mères surmontent ces adversités. S’appuyant sur un cadre de référence composé par l’approche intersectionnelle et la perspective des parcours de vie, cette thèse permet une meilleure compréhension des différentes composantes d’une trajectoire de résilience en contexte de double adversité. Une part importante de cette thèse permet aussi de mieux documenter le contexte de la maternité précoce vécue dans un contexte de violence conjugale, une situation peu étudiée au Québec. Des jeunes mères ayant donné naissance précocement dans un contexte relationnel adverse qui estiment avoir surmonté ces obstacles et qui sont reconnues comme étant résilientes par les intervenants avec qui elles sont en contact participent à cette étude exploratoire. Ces 19 femmes ont partagé leur histoire par le biais d’entretiens individuels ou d’entretiens de groupe. Des observations participantes échelonnées sur neuf mois complètent cette collecte de données, permettant une meilleure compréhension et contextualisation de la maternité précoce et des défis qui lui sont associés. Leurs propos, retranscris puis analysés de façon séquentielle selon une démarche inspirée des stratégies d’analyse de théorisation ancrée, sont au cœur de l’analyse. Le modèle théorique de la résilience présenté dans cette thèse est constitué de cinq composantes : l’adversité, le point tournant, les processus, les facteurs promoteurs et les facteurs de vulnérabilités. Des indicateurs pouvant témoigner de la présence d’une trajectoire de résilience sont aussi proposés. Parmi les résultats importants de cette étude, notons l’importance de la maternité comme point tournant dans la vie de ces jeunes femmes. En effet, la maternité module la trajectoire de résilience notamment en leur permettant de créer un lien significatif avec leur bébé et de développer un sentiment de responsabilité face à celui-ci. Cette étude permet aussi de mieux cerner les processus permettant le déploiement d’une trajectoire de résilience : 1) Créer un milieu de vie sain pour l’enfant, 2) S’activer face au contexte relationnel adverse, 3) Mobiliser et utiliser les ressources disponibles et 4) Se servir du passé pour aller vers l’avant : (ré)investir les habiletés et ressources développées lors d’adversités antérieures. Les facteurs promoteurs, tout comme les facteurs de vulnérabilité, s’inscrivent dans une lecture systémique et relèvent de différents niveaux écologiques. Alors que les premiers constituent des points d’ancrage sur lesquels peuvent s’appuyer le déploiement et le maintien d’une trajectoire résiliente, les seconds fragilisent cette trajectoire. Les retombées possibles de cette étude pour l’intervention et la recherche dans le domaine de la promotion de la santé sont aussi abordées, notamment sous forme de pistes de réflexion et d’action. / Giving birth at a young age may represent a situation of adversity affecting the life of young women and their children. Being a victim of violence at the hands of an intimate partner also represents an important source of adversity, notably because this may lead to numerous consequences on health. Jointly, those two sources of adversity can seriously affect a life course trajectory. However, young mothers may overcome those obstacles. Based on a joint intersectional approach and a life course perspective, this study allows for a better understanding of the different components of a resilience trajectory in a context of dual adversity. As very few studies done in Quebec exist on this subject, an important part of this thesis is also devoted to expanding the literature on early pregnancy in a context of intimate violence. Young mothers who gave birth in a context of adversity (victims of relational violence), who identified themselves as resilient and who were recognised as such by the counsellors with whom they are in contact, participated in this exploratory study. These 19 women shared their stories through in-depth and group interviews. Additionally, field observations allowed for a better understanding and contextualization of early pregnancy and its associated challenges. Their words and stories, transcribed and then analyzed sequentially in a manner inspired by grounded theory analysis strategies, are at the center of the analysis. The theoretical model of a resilience trajectory presented in this thesis has five components: the source(s) of adversity, the turning point, the processes, the promoting factors, and the vulnerability factors. Indicators that can help identify a resilience trajectory are also proposed. One of the notable aspects that emerges from this study is the importance of maternity as a turning point. Indeed, motherhood accentuates the resilience of these women’s life course trajectory, mainly by allowing them to create a bond with their baby, who depends on them for his or her survival and needs. This study also provides a better understanding of the processes that helped these mothers overcome difficulties: 1) building a life setting better suited for their child ; 2) activating themselves in regards to their toxic relationships; 3) mobilizing and using existing resources and 4) using the past to move forward: (re)investing in skills and knowledge gained through previous adversities. The promoting factors, as well as the vulnerability factors, are rooted in a systemic lecture and can be associated to various ecological levels. While the formers represent elements upon which a resilience trajectory may originate and expand, the latters may weaken that trajectory. Possible outcomes of this study for health promotion research and intervention are discussed, notably in terms of future action and reflection.

Devenir mère à l’adolescence peut représenter une situation d’adversité et est associée à des impacts délétères possibles sur la vie de la jeune mère et de ses enfants. Être victime de violence de la part de son partenaire peut aussi représenter une adversité importante, notamment en regard de ses conséquences préjudiciables sur la santé. Cumulées, ces deux adversités peuvent sérieusement compromettre le parcours de vie d’une jeune femme. Cependant, des jeunes mères surmontent ces adversités. S’appuyant sur un cadre de référence composé par l’approche intersectionnelle et la perspective des parcours de vie, cette thèse permet une meilleure compréhension des différentes composantes d’une trajectoire de résilience en contexte de double adversité. Une part importante de cette thèse permet aussi de mieux documenter le contexte de la maternité précoce vécue dans un contexte de violence conjugale, une situation peu étudiée au Québec. Des jeunes mères ayant donné naissance précocement dans un contexte relationnel adverse qui estiment avoir surmonté ces obstacles et qui sont reconnues comme étant résilientes par les intervenants avec qui elles sont en contact participent à cette étude exploratoire. Ces 19 femmes ont partagé leur histoire par le biais d’entretiens individuels ou d’entretiens de groupe. Des observations participantes échelonnées sur neuf mois complètent cette collecte de données, permettant une meilleure compréhension et contextualisation de la maternité précoce et des défis qui lui sont associés. Leurs propos, retranscris puis analysés de façon séquentielle selon une démarche inspirée des stratégies d’analyse de théorisation ancrée, sont au cœur de l’analyse. Le modèle théorique de la résilience présenté dans cette thèse est constitué de cinq composantes : l’adversité, le point tournant, les processus, les facteurs promoteurs et les facteurs de vulnérabilités. Des indicateurs pouvant témoigner de la présence d’une trajectoire de résilience sont aussi proposés. Parmi les résultats importants de cette étude, notons l’importance de la maternité comme point tournant dans la vie de ces jeunes femmes. En effet, la maternité module la trajectoire de résilience notamment en leur permettant de créer un lien significatif avec leur bébé et de développer un sentiment de responsabilité face à celui-ci. Cette étude permet aussi de mieux cerner les processus permettant le déploiement d’une trajectoire de résilience : 1) Créer un milieu de vie sain pour l’enfant, 2) S’activer face au contexte relationnel adverse, 3) Mobiliser et utiliser les ressources disponibles et 4) Se servir du passé pour aller vers l’avant : (ré)investir les habiletés et ressources développées lors d’adversités antérieures. Les facteurs promoteurs, tout comme les facteurs de vulnérabilité, s’inscrivent dans une lecture systémique et relèvent de différents niveaux écologiques. Alors que les premiers constituent des points d’ancrage sur lesquels peuvent s’appuyer le déploiement et le maintien d’une trajectoire résiliente, les seconds fragilisent cette trajectoire. Les retombées possibles de cette étude pour l’intervention et la recherche dans le domaine de la promotion de la santé sont aussi abordées, notamment sous forme de pistes de réflexion et d’action. / Giving birth at a young age may represent a situation of adversity affecting the life of young women and their children. Being a victim of violence at the hands of an intimate partner also represents an important source of adversity, notably because this may lead to numerous consequences on health. Jointly, those two sources of adversity can seriously affect a life course trajectory. However, young mothers may overcome those obstacles. Based on a joint intersectional approach and a life course perspective, this study allows for a better understanding of the different components of a resilience trajectory in a context of dual adversity. As very few studies done in Quebec exist on this subject, an important part of this thesis is also devoted to expanding the literature on early pregnancy in a context of intimate violence. Young mothers who gave birth in a context of adversity (victims of relational violence), who identified themselves as resilient and who were recognised as such by the counsellors with whom they are in contact, participated in this exploratory study. These 19 women shared their stories through in-depth and group interviews. Additionally, field observations allowed for a better understanding and contextualization of early pregnancy and its associated challenges. Their words and stories, transcribed and then analyzed sequentially in a manner inspired by grounded theory analysis strategies, are at the center of the analysis. The theoretical model of a resilience trajectory presented in this thesis has five components: the source(s) of adversity, the turning point, the processes, the promoting factors, and the vulnerability factors. Indicators that can help identify a resilience trajectory are also proposed. One of the notable aspects that emerges from this study is the importance of maternity as a turning point. Indeed, motherhood accentuates the resilience of these women’s life course trajectory, mainly by allowing them to create a bond with their baby, who depends on them for his or her survival and needs. This study also provides a better understanding of the processes that helped these mothers overcome difficulties: 1) building a life setting better suited for their child ; 2) activating themselves in regards to their toxic relationships; 3) mobilizing and using existing resources and 4) using the past to move forward: (re)investing in skills and knowledge gained through previous adversities. The promoting factors, as well as the vulnerability factors, are rooted in a systemic lecture and can be associated to various ecological levels. While the formers represent elements upon which a resilience trajectory may originate and expand, the latters may weaken that trajectory. Possible outcomes of this study for health promotion research and intervention are discussed, notably in terms of future action and reflection.

Antecedentes: El aborto espontáneo es la pérdida fetal espontánea antes de la 20va semana gestacional. 1 de 4 embarazos identificados terminan en aborto, resultando en una complicación frecuente del primer trimestre. El índice neutrófilo-linfocito (INL) surge como posible marcador pronóstico por su utilidad en otras enfermedades inflamatorias. Nuevas evidencias comprueban su asociación en pacientes con y sin amenaza de aborto, sin embargo aún hay estudios que no terminan de establecer una asociación. Objetivos: Evaluar si existe asociación entre un mayor valor de INL con una mayor probabilidad de aborto espontáneo en gestantes con y sin amenaza de aborto. Materiales y métodos: Se realizó una búsqueda sistemática de casos y controles y cohortes en PubMed, Scopus, Medline, Embase, Google Scholar, y Web of Science hasta agosto de 2020. Se evaluaron las medias del INL en todos los casos. El análisis por subgrupos permitió evaluar causas de heterogeneidad. Se aplicó la escala Newcastle Ottawa y el test de Egger para evaluación de sesgos. Se usó Revman 5.2 y Stata 14 para el análisis. Resultados: Se obtuvieron 10 estudios para el meta-análisis. El Odds Ratio (OR) favorecía al aborto, pero no fue significativo (OR = 0.83; IC 95% = 0.55, 1.26). Se halló una heterogeneidad alta (I2 = 88%) y el test de Egger descartó el efecto de pequeños estudios (p = 0.812). Conclusiones: No hay asociación entre el valor de INL y una mayor probabilidad de desenlace en aborto espontáneo en las gestantes que presenten o no amenaza de aborto. / Background: Spontaneous abortion is the spontaneous loss of the fetus before the 20th week of gestation. One out of four of identified pregnancies end in abortion, resulting in a frequent first trimester complication. The neutrophil-lymphocyte ratio (NLR) emerges as a possible prognostic marker in view of its usefulness in other inflammatory diseases. Recent studies have confirmed its association in patients with and without threatened abortion, however there are still studies that do not establish an association. Objective: To assess whether there is an association between a higher NLR value and a higher probability of spontaneous abortion in pregnant women with and without threatened abortion. Material and methods: A systematic search for cases and controls and cohorts was carried out in PubMed, Scopus, Medline, Embase, Google Scholar, and Web of Science until August 2020. NLR means were evaluated in all cases. Subgroup analysis was used to assess causes of heterogeneity. The Newcastle Ottawa scale and Egger's test were applied to assess biases. Revman 5.2 and Stata 14 were used for the analysis. Results: Ten studies were obtained for the meta-analysis. The Odds Ratio (OR) was not significant despite favoring the occurrence of abortion (OR = 0.83; IC 95% = 0.55, 1.26). High heterogeneity was found (I2 = 88%) and the Egger test ruled out the effect of small studies (p = 0.812). Conclusions: There is no association between the NLR value and a higher probability of a spontaneous abortion outcome in pregnant women with or without threat of abortion. / Tesis