Postpartum depression (PPD) is a mood disorder that affects women shortly after the birth of their newborn. Prevalent symptoms include sadness, anxiety, fatigue, and lack of interest in activities that used to be pleasurable. Severe cases may include suicide ideation. While the pathogenesis and treatment methods are similar to major depressive disorder (MDD), it is not until recently that individual research has been performed to further understand PPD and its origins as well as efficacy of treatments on mothers with their wavering biology. Risk factors that are statistically significant in contributing to a higher risk of PPD include biological and genetic predispositions, environmental factors such as demographics, and most importantly, the mother’s previous mental history. Clinicians suggest treatment methods depending on the severity of the case and the mother’s lifestyle. Psychotherapy is the first-line treatment recommended to mothers with mild to moderate PPD; this is also a favorable choice for mothers breastfeeding as all antidepressants can secrete into breast milk. Antidepressants fall under several classifications, with selective serotonin reuptake inhibitors (SSRIs) being the optimal choice as they produce less side effects compared to the others. Mothers with a previous mental history or severe PPD are immediately recommended antidepressants as the therapy of choice. Electroconvulsive therapy (ECT), while controversial, has become a more prominent option for mothers with severe PPD or for patients who simply want results sooner. Meta-analyses performed explore the origin of PPD and compare treatments currently in place. Similar confounding variables arise time and time again in these studies; region, local demographics, and self-report surveys make it difficult to apply data from one city, much less another country, to another. Studies with a large population of people of color or areas where seeking mental health counseling is looked down upon show large numbers of subjects dropping out of studies midway. The accuracy of data from self-report surveys is also questionable. As research continues to find more effective treatments and better comprehend the biological aspect of PPD, an increased understanding of current studies may aid in the management of PPD.

Bakgrund: Postpartumdepression (PPD) drabbar mellan 8-15% av alla kvinnor som föder barn och innebär stora påfrestningar för både modern, partnern och spädbarnet. Utvecklandet av PPD har multifaktoriella orsaker som tidigare psykiatrisk sjukdom, dåligt parförhållande och brist på socialt stöd. Syfte: Studiens syfte var att undersöka kvinnors upplevelser av postpartumdepression. Metod: Studien är en litteraturöversikt där vetenskapliga artiklar motsvarande studiens syfte granskades. Samtliga artiklar hade kvalitativ ansats och söktes i databaserna Cinahl och Pubmed. Resultat: Studiens resultat indelades i tre övergripande teman: moderskap, diagnostisering - samt stöd. Kvinnor som drabbas av PPD uppfattar sig vara misslyckade mödrar samt upplever känslor av hopplöshet och utmattning. Stigmatiseringen kring PPD samt att bli diagnostiserad med psykiatrisk sjukdom, och rädslan av att bli uppfattad som en otillräcklig mor, leder till motvilja att uppsöka vård. Vårdpersonalen uppfattas ofta normalisera kvinnornas depressionssymptom vilket leder till att dessa kvinnor tappar förtroende för vården och inte känner sig sedda eller tagna på allvar. Partnerns och den närmaste omgivningens stöd spelar en betydande roll för att identifiera symptom, söka hjälp och tillfriskna. Slutsats: PPD upplevs av drabbade kvinnor både som ett personligt och socialt stigma, där den egna förmågan till moderskap och lämplighet ifrågasätts. Resultaten indikerar behov av förbättrat bemötande från vården, samt nytänkande inom tillgänglighet och prevention. / Background: Postpartum depression (PPD) affects between 8-15% of all women who give birth to children and poses major new challenges for the mother, partner and baby. The causes behind the development of postpartum depression are multifactorial; a previous psychiatric illness, poor partner relationship and a lack of social support. Aim: The aim of the study was to explore women's experiences of postpartum depression. Method: The study is a literature review in which scientific papers corresponding to the study's aim were reviewed. All reviewed articles had a qualitative approach and was searched in the databases CINAHL and Pubmed. Results: The results of the study were divided into three overarching themes: maternity, diagnosis and support. Women who suffer from PPD perceive themselves to be a failure as mothers and experience feelings of hopelessness and exhaustion. The stigma surrounding PPD and beeing diagnosed with a mental illness, as well as the fear of being perceived as an inadequate mother, are leading to reluctance to seek care. Health care workers are often perceived to normalize women's depressive symptoms which leads to that these women lose trust in the health care system and do not feel they are seen or taken seriously. Support from partner and the immediate surrounding plays a significant role in identifying symptoms, helpseeking and the process of recovery. Conclusion: PPD was experienced by the affected women as both a personal and a social stigma, where their ability to motherhood and suitability was questioned. The results indicate the need for improved treatment of health care, as well as innovation in availability and prevention.

A inexistência de padrões nacionais para a realização e interpretação da prova de tuberculina em ovinos motivou o presente trabalho, pois apesar da tuberculose não estar incluída em Plano Nacional de Controle e Erradicação em pequenos ruminantes, estabelece a legislação vigente que é obrigatório o sacrifício de animais com essa zoonose, sendo o diagnóstico firmado nesses animais principalmente através do alergoteste tuberculínico. Assim, esta pesquisa visou além de avaliar reações clínicas provocadas pela resposta imuno-alérgica intradérmica à tuberculina, estabelecer valores de referência para a interpretação da reação em ovinos experimentalmente inoculados com antígenos de cepas padrões de Mycobacterium bovis e Mycobacterium avium. Utilizou-se 30 ovinos, clinicamente sadios, negativos à prova de tuberculina cervical comparativa (TCC), segundo critérios estabelecidos pelo Ministério da Agricultura, Pecuária e Abastecimento (MAPA) através do Plano Nacional de Controle e Erradicação da Brucelose e Tuberculose (PNCEBT) em bovinos e bubalinos, distribuídos por três grupos de 10 animais cada, a saber: A - sensibilizados com M. avium; B - sensibilizados com M. bovis e C (Controle) - que receberam injeção de solução fisiológica. Os ovinos foram monitorados através de exames físicos e complementares semanais. Após 45 dias da sensibilização, realizou-se a prova de TCC com reação medida pela variação da espessura da pele com cutímetro de mola, nos seguintes momentos: antes da aplicação das tuberculinas (PPDs); 12h, 24h, 48h, 72h e 96h após a aplicação das mesmas. Em relação à reação ao PPD bovino, no teste cervical simples, lido às 72 horas (± 6 horas) pós-tuberculinização (p. t.), considerou-se uma reação como positiva, quando o aumento da espessura da pele foi igual ou maior que 2,49 mm; como inconclusiva, com as medidas de aumento entre 1,00 e 2,48 mm, e como reação negativa, aumentos da espessura da pele inferiores a 1,00 mm, sendo estes valores propostos como padrão para o teste intradérmico simples na região cervical. A análise dos resultados da leitura do teste cervical comparativo, realizada às 72 horas (± 6 horas) p. t., permitiu concluir-se que o animal poderá ser considerado com resposta: positiva, quando a reação ao PPD bovino superar aquela ao aviário em pelo menos 2,00 mm; inconclusiva, quando a reação ao PPD bovino for maior que aquela ao aviário, com diferença entre 1,00 e 1,99 mm, e negativa quando a reação bovina for menor que a aviária ou > em até 0,99 mm. Na avaliação histológica das respostas tuberculínicas homólogas, 96 horas após a injeção do PPD, constatou-se a presença de moderado a intenso infiltrado inflamatória, constituído, preferencialmente, por células mononucleares. / The inexistence of national patterns for the realization and interpretation of tuberculin test in sheep motivated this research. Although tuberculosis is not included in the National Plan for the Control and Eradication in small ruminants, the current legislation has made it mandatory the sacrifice of animals with this zoonosis, where diagnosis is confirmed principally by the usage of the tuberculin skin reaction. Therefore, this study evaluated the clinical manifestations induced by the intradermic immune-allergic response to tuberculin, and established the reference values for the interpretation of this reaction in sheep experimentally inoculated with antigens of recognized strains of Mycobacterium bovis and Mycobacterium avium. Thirty healthy sheep negative to the Comparative Cervical Tuberculin Test (CCT) based on criteria established by the Ministério da Agricultura, Pecuária e Abastecimento (MAPA) in the National Plan for the Control and Eradication of Brucellosis and Tuberculosis in cattle and buffalos were used during this experiment. Animals were separated in three groups: A) sensitized with M. avium, n=10; B) sensitized with M. bovis, n=10; and C) control, n=10, which were injected with saline solution. Sheep were monitored by weekly clinical and complementary exams. After 45 days of inoculation the CCT was evaluated by the variation of dermal thickness determined by a pakimeter realized in the following moments: before the administration of tuberculin (PPD); and 12, 48, 72, and 96 hours after administration of inoculation. Relative to the bovine PPD, the simple cervical test, observed at 72 hours (± 6 hours) post-tuberculinization (p.t.) was considered as: positive, when skin fold thickness was equal or greater than 2.49 mm; inconclusive, skin fold thickness between 1 and 2,48 mm; and negative, when thickness was lower than 1 mm; these values being proposed as reference values for the simple intradermic cervical test. Analyses of the results of the comparative cervical tests realized 72 hr (± 6 hr) p.t. concluded that the animal was considered as: positive, when the bovine PPD reaction was greater than that of the avian by at least 2 mm; and negative, when the bovine reaction was less than the avian or > by 0.99 mm. Histological evaluation of the homologous tuberculin response 96 hr after PPD injection, revealed a moderate to intense inflammatory cellular influx, constituted preferentially, of mononuclear cells.

Esta pesquisa visou determinar a resposta alérgica à aplicação do PPD bovino, em diferentes regiões da superfície corpórea de caprinos (Cabra hircus). Para tanto, foram utilizados caprinos adultos, clinicamente sadios e sensibilizados previamente com micobactéria bovina (M. bovis AN5). Para avaliar o local de melhor reação, foram usados 20 animais sensibilizados, distribuídos ao acaso, dos quais 14 animais para constituir o grupo experimental, que recebeu o PPD bovino, e seis animais para o grupo controle, que recebeu solução fisiológica, respectivamente em diferentes regiões do corpo. Os caprinos foram monitorados através de exame clínico com leituras da reação ao PPD realizadas nos seguintes momentos: 24h antes, 0h, 24h, 48h, 72h e 96h após a tuberculinização. Os resultados analisados estatisticamente mostraram uma significância para os melhores locais de aplicação, a saber: as regiões abdominal e torácica dorsais e cervical caudal tanto em 24, quanto em 48 horas e 72 horas pós-tuberculinização. A prega da cauda apresentou resultados menos evidentes que nos mencionados momentos, tendo as regiões torácica e a abdominal ventrais os resultados com menor magnitude de reação. / This study aimed to determine the allergic response to the application of PPD cattle in different regions of the body surface of goats (Goat hircus). For both, were used adult goats, clinically healthy and aware beforehand with bovine mycobacteria (M. bovis AN5). To assess the place of better reaction, 20 animals were used aware, distributed at random, including 14 animals to be the experimental group, which received the PPD veal, and six animal control to group that received saline, respectively in different regions of the body. The goats were monitored by clinical examination with readings of the reaction to the PPD conducted in the following times: 24 hours before, 0h, 24h, 48h, 72h and 96h after tuberculinization. The results showed a statistically analysed significance to the best sites of application, namely: the abdominal and chest regions dorsal and cervical flow in both 24, as in 48 hours and 72 hours after tuberculinization. The results showed the tail fold less evident in the mentioned moments, and the regions thoracic and abdominal ventral results with smaller magnitude of reaction.

A inexistência de padrões nacionais para a realização e interpretação da prova de tuberculina em ovinos motivou o presente trabalho, pois apesar da tuberculose não estar incluída em Plano Nacional de Controle e Erradicação em pequenos ruminantes, estabelece a legislação vigente que é obrigatório o sacrifício de animais com essa zoonose, sendo o diagnóstico firmado nesses animais principalmente através do alergoteste tuberculínico. Assim, esta pesquisa visou além de avaliar reações clínicas provocadas pela resposta imuno-alérgica intradérmica à tuberculina, estabelecer valores de referência para a interpretação da reação em ovinos experimentalmente inoculados com antígenos de cepas padrões de Mycobacterium bovis e Mycobacterium avium. Utilizou-se 30 ovinos, clinicamente sadios, negativos à prova de tuberculina cervical comparativa (TCC), segundo critérios estabelecidos pelo Ministério da Agricultura, Pecuária e Abastecimento (MAPA) através do Plano Nacional de Controle e Erradicação da Brucelose e Tuberculose (PNCEBT) em bovinos e bubalinos, distribuídos por três grupos de 10 animais cada, a saber: A - sensibilizados com M. avium; B - sensibilizados com M. bovis e C (Controle) - que receberam injeção de solução fisiológica. Os ovinos foram monitorados através de exames físicos e complementares semanais. Após 45 dias da sensibilização, realizou-se a prova de TCC com reação medida pela variação da espessura da pele com cutímetro de mola, nos seguintes momentos: antes da aplicação das tuberculinas (PPDs); 12h, 24h, 48h, 72h e 96h após a aplicação das mesmas. Em relação à reação ao PPD bovino, no teste cervical simples, lido às 72 horas (± 6 horas) pós-tuberculinização (p. t.), considerou-se uma reação como positiva, quando o aumento da espessura da pele foi igual ou maior que 2,49 mm; como inconclusiva, com as medidas de aumento entre 1,00 e 2,48 mm, e como reação negativa, aumentos da espessura da pele inferiores a 1,00 mm, sendo estes valores propostos como padrão para o teste intradérmico simples na região cervical. A análise dos resultados da leitura do teste cervical comparativo, realizada às 72 horas (± 6 horas) p. t., permitiu concluir-se que o animal poderá ser considerado com resposta: positiva, quando a reação ao PPD bovino superar aquela ao aviário em pelo menos 2,00 mm; inconclusiva, quando a reação ao PPD bovino for maior que aquela ao aviário, com diferença entre 1,00 e 1,99 mm, e negativa quando a reação bovina for menor que a aviária ou > em até 0,99 mm. Na avaliação histológica das respostas tuberculínicas homólogas, 96 horas após a injeção do PPD, constatou-se a presença de moderado a intenso infiltrado inflamatória, constituído, preferencialmente, por células mononucleares. / The inexistence of national patterns for the realization and interpretation of tuberculin test in sheep motivated this research. Although tuberculosis is not included in the National Plan for the Control and Eradication in small ruminants, the current legislation has made it mandatory the sacrifice of animals with this zoonosis, where diagnosis is confirmed principally by the usage of the tuberculin skin reaction. Therefore, this study evaluated the clinical manifestations induced by the intradermic immune-allergic response to tuberculin, and established the reference values for the interpretation of this reaction in sheep experimentally inoculated with antigens of recognized strains of Mycobacterium bovis and Mycobacterium avium. Thirty healthy sheep negative to the Comparative Cervical Tuberculin Test (CCT) based on criteria established by the Ministério da Agricultura, Pecuária e Abastecimento (MAPA) in the National Plan for the Control and Eradication of Brucellosis and Tuberculosis in cattle and buffalos were used during this experiment. Animals were separated in three groups: A) sensitized with M. avium, n=10; B) sensitized with M. bovis, n=10; and C) control, n=10, which were injected with saline solution. Sheep were monitored by weekly clinical and complementary exams. After 45 days of inoculation the CCT was evaluated by the variation of dermal thickness determined by a pakimeter realized in the following moments: before the administration of tuberculin (PPD); and 12, 48, 72, and 96 hours after administration of inoculation. Relative to the bovine PPD, the simple cervical test, observed at 72 hours (± 6 hours) post-tuberculinization (p.t.) was considered as: positive, when skin fold thickness was equal or greater than 2.49 mm; inconclusive, skin fold thickness between 1 and 2,48 mm; and negative, when thickness was lower than 1 mm; these values being proposed as reference values for the simple intradermic cervical test. Analyses of the results of the comparative cervical tests realized 72 hr (± 6 hr) p.t. concluded that the animal was considered as: positive, when the bovine PPD reaction was greater than that of the avian by at least 2 mm; and negative, when the bovine reaction was less than the avian or > by 0.99 mm. Histological evaluation of the homologous tuberculin response 96 hr after PPD injection, revealed a moderate to intense inflammatory cellular influx, constituted preferentially, of mononuclear cells.

Esta pesquisa visou determinar a resposta alérgica à aplicação do PPD bovino, em diferentes regiões da superfície corpórea de caprinos (Cabra hircus). Para tanto, foram utilizados caprinos adultos, clinicamente sadios e sensibilizados previamente com micobactéria bovina (M. bovis AN5). Para avaliar o local de melhor reação, foram usados 20 animais sensibilizados, distribuídos ao acaso, dos quais 14 animais para constituir o grupo experimental, que recebeu o PPD bovino, e seis animais para o grupo controle, que recebeu solução fisiológica, respectivamente em diferentes regiões do corpo. Os caprinos foram monitorados através de exame clínico com leituras da reação ao PPD realizadas nos seguintes momentos: 24h antes, 0h, 24h, 48h, 72h e 96h após a tuberculinização. Os resultados analisados estatisticamente mostraram uma significância para os melhores locais de aplicação, a saber: as regiões abdominal e torácica dorsais e cervical caudal tanto em 24, quanto em 48 horas e 72 horas pós-tuberculinização. A prega da cauda apresentou resultados menos evidentes que nos mencionados momentos, tendo as regiões torácica e a abdominal ventrais os resultados com menor magnitude de reação. / This study aimed to determine the allergic response to the application of PPD cattle in different regions of the body surface of goats (Goat hircus). For both, were used adult goats, clinically healthy and aware beforehand with bovine mycobacteria (M. bovis AN5). To assess the place of better reaction, 20 animals were used aware, distributed at random, including 14 animals to be the experimental group, which received the PPD veal, and six animal control to group that received saline, respectively in different regions of the body. The goats were monitored by clinical examination with readings of the reaction to the PPD conducted in the following times: 24 hours before, 0h, 24h, 48h, 72h and 96h after tuberculinization. The results showed a statistically analysed significance to the best sites of application, namely: the abdominal and chest regions dorsal and cervical flow in both 24, as in 48 hours and 72 hours after tuberculinization. The results showed the tail fold less evident in the mentioned moments, and the regions thoracic and abdominal ventral results with smaller magnitude of reaction.

No description available.

Made available in DSpace on 2016-08-29T15:34:50Z (GMT). No. of bitstreams: 1 tese_5884_.pdf: 4378934 bytes, checksum: e55f89d472f97ebc5973011002da350a (MD5) Previous issue date: 2012-08-27 / A (re)ativação do Mycobcaterium tuberculosis (Mtb) e, por conseguinte o desenvolvimento da doença ainda é um mistério. Sabe-se que a resposta contra o Mtb é mediada pelo desenvolvimento de linfócitos T do tipo Th1, que tem como característica principal a produção de IFN-γ. O IFN-γ atua na ativação dos macrófagos que por meio da fagocitose eliminam os bacilos nos locais da infecção. A resistência do bacilo frente às respostas do organismo pode ser realizada de diversas formas, principalmente pela evasão do sistema fagocitário. Sabemos que indivíduos pré-expostos e sensibilizados desenvolvem um tipo de tuberculose latente que pode ser reativada ao longo de sua vida. Neste trabalho, demonstramos que indivíduos reativos ao teste intradérmico com Purified Protein Derivative (PPD) e pacientes com TB apresentavam atividade microbicida menor que indivíduos não reativos ao teste com PPD (PPD-). Esta atividade microbicida foi avaliada tanto em amostras de sangue total, quanto de PBMC. Para isso foram arrolados 13 indivíduos PPD+, 13 indivíduos PPD- e 11 pacientes com TB pulmonar virgens de tratamento. Para a realização da infecção, foram utilizados dois isolados clínicos sensíveis (2220-S1 e 0885-S5) e outros dois, multidroga-resistente (0530-R3 e 0669-R6); e como padrão foi utilizado à cepa H37-Rv. A frequência das células T reguladoras esteve aumentada nos indivíduos PPD+ e pacientes com TB, o que poderia estar envolvido na latência/desenvolvimento da doença no individuo. Comparando o aumento da frequência das células T reguladoras com a atividade microbicida, fica evidente que a presença destas células atua de forma negativa a resposta microbicida tanto nas culturas de sangue total quanto nas culturas de PBMC. Ensaios de fagócitos e de produção de óxido nítrico também foram realizados, porém não foi encontrada nenhuma resposta que se destacasse. A produção de citocinas em culturas de sangue total nos mostrou uma alta atividade microbicida realizada por indivíduos PPD-, caracterizada pela produção de IFN-g enquanto indivíduos com tuberculose latente desenvolveram grande produção de IL-10 e TGF-β. Fato marcante foi à produção de IFN-γ e de IL-23 por pacientes com TB, dados que nos sugerem o desenvolvimento de uma resposta Th17. Frente a estes resultados, foram realizadas culturas com PBMC em que as células T reguladoras haviam sido depletadas. Após a depleção destas células ocorreu o aumento da atividade microbicida nas culturas dos três grupos. Nossos resultados acabam por sugerir que a pré-exposição seguida de sensibilização para o patógeno, pode desencadear uma maior propensão para o desenvolvimento da latência/doença. PALAVRAS CHAVES: Mycobacterium tuberculosis, Tuberculose, Purified Protein Derivative, PPD, células T reguladoras, Citocinas.

Cassava (Manihot esculenta Crantz) is an important tropical crop which provides a large portion of daily calories intake to hundreds of millions of people in Africa, Latin America, and tropical Asia. Cassava is grown for its starchy storage roots as staple food, as animal feed, and as industrial raw material. The utilisation of cassava is hindered by its characteristic physiological response, the post-harvest physiological deterioration (PPD). The inevitable wounding caused during harvesting and handling will trigger a series of physiological responses within 24 to 48 hours, which causes a blue-black discoloration in the storage roots, rendering these roots unmarketable and unpalatable in a few days. During the PPD response large amount of phenylpropanoid compounds, especially scopoletin and its glycoside, accumulate in the roots. Scopoletin may play an important role in PPD development but little work has been done on the possible relationship. Here we aim to examine the effects of altering scopoletin synthesis in cassava roots on the PPD response. In Arabidopsis thaliana, gene F6’H1 (feruloul CoA 6’-hydroxylase 1) is indispensable in the biosynthesis of scopoletin. Cassava F6’H1 candidate gene family involved in scopoletin synthesis were identified by their ability to functionally complement F6’H1 T-DNA insertion mutation in Arabidopsis thaliana that prevented synthesis of scopoletin. RNAi constructs targeting the identified cassava F6’H1 candidate gene family were designed, under the control of either constitutive CaMV 35S or root-specific StPAT promoters. These were used to transform wild-type cassava to down-regulate the expression of these scopoletin synthetic genes in F6’H1 gene family. The inhibition of cassava F6’H1 candidate gene expression and thus the scopoletin synthesis in transgenic cassava roots were confirmed by qRT-PCR and LC-MS, respectively. The RNAi transgenic cassava lines show less scopoletin accumulation and inhibited F6’H1 candidate genes expression during the PPD response. A reduced PPD discoloration development compared to that of the wild-type was also observed in the RNAi transgenic cassava lines.

A growing body of research has emerged about effective treatments for postpartum depression, specifically how the internet could become a pivotal and vital option for women with postpartum symptoms. With that in mind, the purpose of this quantitative study was to investigate whether women suffering from postpartum depression preferred traditional therapy treatment or internet therapy treatment. The nonexperimental survey design was used to assess differences between groups related to stigma, satisfaction with treatment, and perceived quality of treatment received. Data collected from a sample of 78 adult females, who had previously received postpartum depression therapy treatment, indicated there was no difference experienced between the treatment modalities. Results were calculated using an independent sample t-test, noninferiority design, and it was determined that participants perceived no difference in their experience of stigma, treatment satisfaction, and perception of credibility and quality between the two therapy modalities. This study adds to the growing body of literature that suggests internet therapy may be a viable option for some women. The results encourage positive social change in that psychologists may advance clinical practice through incorporating technology into their treatment plans, thereby benefiting women who suffer from this condition and who may not be able to readily access a therapist's office on a weekly basis.