The molecular mechanisms by which pregnancy malaria affects the outcome of fetal development are unknown. Megalin, which has been well studied in kidney, has high expression in the placenta from early stages to term, and is proposed to be an important factor in extensive maternofetal exchange during development of the fetus. Pregnancy malaria (PM) is characterized by inflammation in placenta and is associated with low birthweight (LBW), stillborn birth, and other pathologies. It is hypothesized that PM disturbs megalin function/expression/distribution in the brush boarder of syncytiotrophoblast which, in turn, may contribute significantly to pathology of LBW. Our studies show that the presence of infected erythrocytes in placenta at the time of delivery negatively affects protein abundance for megalin and Dab2. This is the first report associating the abundance of placental megalin system proteins with the birth weight of newborn babies, and associating PM with changes in megalin system protein abundance. / Includes bibliography. / Thesis (M.S.)--Florida Atlantic University, 2015. / FAU Electronic Theses and Dissertations Collection

Leung, Siu Lun. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 153-190). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts also in Chinese.

Orientador: Cristina Maria Garcia de Lima Parada / Banca: Vera Lúcia P. Tonete / Banca: Maria José Clapis / Acompanha 1 CD-Rom / Resumo: A morte materna é um evento trágico que acomete a mulher durante o processo fisiológico da reprodução. Constitui um indicador da iniquidade existente entre gêneros e está inversamente associada ao grau de desenvolvimento humano. Os objetivos deste estudo foram compreender a experiência relativa à morbidade materna grave, a partir de um grupo de mulheres que vivenciou esse problema, bem como caracterizá-las considerando aspectos sociodemográficos e dados relativos ao pré-natal, admissão, pré-parto, parto e puerpério. Foram sujeitos da investigação 16 mulheres (uma gestante e 15 puérperas), atendidas em serviço terciário. Adotaram os preceitos metodológicos da pesquisa qualitativa, para tanto, elegeram-se as Representações Sociais como Referencial Teórico e como referencial metodológico utilizou-se a construção do Discurso do Sujeito Coletivo (DSC). A coleta de dados deu-se a partir de entrevista semiestruturada e as questões norteadoras relacionaram-se ao desejo e programação da gestação em curso e sobre a experiência e vivência da gestação de alto risco. Os resultados foram sistematizados em quatro temas e suas respectivas ideias centrais: Tema 1. Descrevendo o desejo e a programação para ter um filho (ICs: Não planejei, mas está sendo uma bênção; Já passei por gravidez de alto risco, por isso não planejei; Minha gravidez foi planejada); Tema 2. Percebendo seu problema de saúde, sua influência na gestação e para o concepto (ICs: Senti que estava correndo risco de vida, mas agora estou bem; Encontrei força na minha igreja; Foi horrível, senti que estava matando a minha filha; Me sinto culpada por tudo o que aconteceu); Tema 3. Superando o choque inicial no pós-parto (ICs: Fiquei Resumo Ana Paula Pinho Carvalheira sem saber notícias sobre o meu filho após o nascimento; Foi sofrido ver meu filho na UTI, a gente sonha em pegar no colo... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Maternal death is a tragic event that affects women during the physiological process of reproduction. It constitutes an indicator of the iniquity existing between genders, and it is inversely associated to the level of human development. The objectives of the present study were to understand the experience related to severe maternal morbidity based on a group of women who experienced such problem as well as to characterize such women by taking into account sociodemographic aspects and data related to prenatal follow-up, hospital admission, prepartum period, parturition and puerperium. The subjects of investigation were 16 women (one pregnant woman and 15 puerperae) attended to by a tertiary service. The methodological precepts of qualitative research were adopted, and for that end, Social Representations were elected as a theoretical framework, and the construction of the Collective Subject Discourse (CSD) was used as a methodological framework. Data were collected by semi-structured interviews, and the guiding questions were related to the desire for and planning of the pregnancy in course and to the experience of a high-risk pregnancy. The results were systematized into four themes and their respective core ideas: Theme 1. Describing the desire and plan to have a child (CIs: I didn't plan it, but it's been a blessing; I've had high-risk pregnancies, for this reason I wasn't planning it: My pregnancy was planned); Theme 2. Perceiving one's health problem, its influence on pregnancy and on the conceptus (CIs: I felt that I was at risk of death, but I'm fine; I found strength in my church; It was horrible, I felt like I was killing my daughter; I feel guilty for everything that happened); Theme 3. Summary Ana Paula Pinho Carvalheira Overcoming the initial shock in the post-partum period (CIs: I didn't hear about my child after the birth; It was a lot of suffering... (Complete abstract click electronic access below) / Mestre

Normal birth, defined as birth without induction of labour, anaesthetic, instruments or caesarean section conveys significant maternal and neonatal benefits. Currently one-fifth of women in the United Kingdom are obese. There is increasing evidence of the detrimental effects obesity has on intrapartum outcomes. There is a lack of research on how to minimise the associated risks of obesity through non-medicalised interventions and how to support obese women to maximise their opportunity for normal birth. This thesis aims to provide evidence to address this gap and develop an evidence-based intervention to promote normal birth. Using a methodological approach aligned with pragmatism, this research was conducted in four parts and underpinned by the Medical Research Council framework for the development of complex interventions. Part one was a national survey involving 24 maternity units. Part two was a qualitative study of the experiences of 24 health professionals and part three involved 8 obese women. The final part was a multi-disciplinary workshop that used consensus decision-making to design the intervention. Collectively, the findings suggest that intrapartum care of obese women is medicalised. Health professionals face challenges when caring for obese women but many strive to optimise the potential for normal birth by challenging practice and utilising ‘interventions’ to promote normality. The findings also demonstrate that obese women have an intrinsic fear of pregnancy and birth, have a desire for normal birth and ‘obese pregnancy’ presents a window of opportunity for change. The intervention consists of three component parts; an educational aspect (e-learning package), a clinical aspect (intrapartum care pathway) and a leadership aspect (ward champions). Whilst acknowledging the importance of safety, increasing intervention during labour for obese women may further increase the risk of complications, with detrimental effects. Addressing intrapartum management of obese women through non-medicalised interventions is of paramount importance in order to promote normality, maximise the opportunity for normal birth and reduce the associated morbidities.

Orientador: José Guilherme Cecatti / Tese ( doutorado ) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-11-09T15:32:48Z (GMT). No. of bitstreams: 1 Pacagnella_RodolfodeCarvalho_D.pdf: 10638117 bytes, checksum: 8f100a09c4f1f7363e14fe20dcfe772e (MD5) Previous issue date: 2011 / Resumo: Introdução: Embora a maioria das causas das mortes maternas seja evitável, não podem ser previstas, mesmo nos melhores contextos, mesmo onde haja pré-natal adequado, educação adequada e bom suporte nutricional. Contudo, embora as complicações no parto e puerpério não sejam previsíveis e nem preveníveis, os indicadores de mortalidade materna são extremamente sensíveis à instituição de cuidados obstétricos adequados e o tempo na obtenção de cuidados adequados é o fator mais importante relacionado às mortes maternas. A partir dessa observação um modelo "three delays" que avalia as demoras na assistência obstétrica tem sido amplamente utilizado como referencial teórico para a pesquisa sobre mortalidade materna. Seu uso tem sido intensificado a partir da utilização do conceito de near-miss materno, uma alternativa à mortalidade materna. Objetivos: Avaliar a associação entre demoras na obtenção de cuidados obstétricos adequados e diferentes desfechos maternos segundo o modelo "three delays". Método: foi realizada ampla revisão bibliográfica e elaboração de um ensaio abordando o marco conceitual sobre o tema e um estudo de corte transversal multicêntrico para vigilância prospectiva e coleta de dados para a identificação dos casos com morbidade materna grave (MMG) e condições potencialmente ameaçadoras da vida (CPAV) segundo critérios previamente definidos pela OMS. Dados sobre as demora foram colhidos dos prontuários médicos e por informações com a equipe assistente. Resultados: Os dados da literatura permitiram inferir que o uso da análise de demoras na assistência obstétrica com o modelo "three delays" pode ser extremamente útil na avaliação dos determinantes da mortalidade materna, especialmente se associada à investigação do near-miss materno. Os dados obtidos no estudo transversal permitiram a comparação entre diferentes desfechos maternos e com isso observou-se uma associação crescente entre a identificação de alguma demora no atendimento obstétrico e desfechos maternos adversos extremos (near-miss materno e óbito). Observou-se 54% de demoras em geral, 52% de demoras nas mulheres apenas com condições potencialmente ameaçadoras da vida, 68,4% no grupo de near-miss materno e 84,1% no grupo de com óbito materno. Conclusão: O modelo "Three delays" é um importante referencial teórico para o estudo dos casos de near-miss materno. A freqüência de demoras na assistência obstétrica está diretamente relacionada ao pior desfecho materno / Abstract: Introduction: Although the majority of causes of maternal deaths are preventable they cannot be predicted, even in the best settings, where there is adequate antenatal care, education and good nutritional support. However, maternal mortality indicators are extremely sensitive to the adequate obstetric care and time in getting appropriate care is the most important factor related to maternal deaths. Considering this, the "three delays model", which evaluates the delays in obstetric care, has been widely used as a theoretical framework for research on maternal mortality. Its use has been intensified since the use of the concept of maternal near-miss, a proxy of maternal mortality. Objectives: To evaluate the association between delays in obtaining adequate obstetric care and different maternal outcomes according to the "three delays model". Methods: We performed an extensive literature review and preparation of an essay addressing the conceptual framework on the issue and a multicenter cross-sectional study for prospective surveillance and data collection of cases with maternal near-miss (MNM) and potentially life threatening conditions (PLTC) according to previously defined criteria by WHO. Data on delay were collected from medical records and interviews with the staff. Results: The literature data allowed inferring that the use of the analysis of delays in obstetric care using the "three delays model" can be extremely useful in assessing the determinants of maternal mortality, especially if associated with the investigation of maternal near-miss. The data provided by the crosssectional study allowed comparison between different maternal outcomes and it was observed that there was a growing association between the identification of some delay in obstetric care and extreme maternal adverse outcomes (nearmiss and maternal death). In general, there was a frequency of 54% delays, 52% of delays in women only with potentially life-threatening conditions, 68.4% in the maternal near-miss group and 84.1% in the group with maternal death. Conclusion: The "Three Delays model" is an important theoretical framework for the study of near-miss cases. The frequency of delays in obstetric care is directly related to worse maternal outcome / Doutorado / Saúde Materna e Perinatal / Doutor em Ciências da Saúde

Lee, Man Yuen. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 191-215). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

Objectives: Adherence to National Comprehensive Cancer Network (NCCN) guidelines for ovarian cancer treatment improves patient outcomes. The aim of this study was to assess disparities associated with ovarian cancer treatment in the state of Kentucky and central Appalachia. Methods: Data on patients diagnosed as having ovarian cancer from 2007 through 2011 were extracted from administrative claims-linked Kentucky Cancer Registry data. NCCN compliance was defined by stage, grade, surgical procedure, and chemotherapy. Selection criteria were reviewed carefully to ensure data quality and accuracy. Descriptive analysis, logistic regression, and Cox regression analyses were performed to examine factors associated with guidelines compliance and survival. Results: Most women were age 65 years or older (62.5%), had high grade (65.9%) and advanced stage (61.0%) ovarian cancer. Two-thirds of cases (65.9%) received NCCN-recommended treatment for ovarian cancer. The hazard ratio (HR) of death for women who did not receive NCCN-compliant care was 62% higher compared to the women who did receive NCCN compliant treatment (HR 1.62, 95% CI 1.11-2.35). Results from the logistic regression showed that NCCN-compliant treatment was more likely for: women age 65-74 years compared to age 20-49 (OR=3.32, 95% CI=1.32- 8.32), late stage compared to early stage cancers (OR 0.32, 95% CI 0.20-0.53), receipt of care at tertiary hospitals (OR=1.92, 95% CI=1.10-3.34), and privately insured compared to Medicaid (OR=0.31, 95% CI=0.13-0.77) or Medicare (OR=0.31, 95% CI=0.15-0.66). Conclusions: When the treatment of ovarian cancer did not follow NCCN-recommendations, patients had a significantly higher risk of death. Women were less likely to receive NCCN-compliant care if they were of younger age (20-49 years), had early stage disease, were not privately insured, or had care provided at a non-tertiary hospital.

Abstract not available

Includes bibliographical references (leaves 228-257). Aims to determine the impact of maternal undernutrition during late gestation and during the periconceptional and gestational periods on fetal growth, fetal blood pressure and the fetal hypothalamo-pituitary adrenal axis in the sheep.

Intrauterine Growth Restriction (IUGR) is evident in infants born with a reduced weight or length, and/or increased thinness for gestational age. IUGR is associated with altered postnatal growth and regulation, due to unknown mechanisms. Much clinical IUGR results from the reduced delivery of essential substrates (oxygen and nutrients) to the fetus, due to either maternal or placental limitations. Catch-up growth (accelerated rate of growth in absolute or fractional terms) occurs in the majority of IUGR infants, and returns an infant to their predetermined growth curve. IUGR is associated with increased risks of morbidity and mortality in the perinatal period, and with a reduced final adult stature and increased risk of adult onset diseases, particularly diabetes and cardiovascular disease. Catch-up growth after IUGR predicts improved health in terms of reduced hospital visits in infants and children, and an increased final adult stature but also predicts an increased risk of developing obesity, as well as diabetes and cardiovascular disease. The underlying mechanisms for catch-up growth may contribute to this range of outcomes in later life, but are poorly understood. Studies in IUGR infants have demonstrated increased absolute and/or fractional growth rates following birth, termed catch-up growth, in the presence of reduced or normal plasma concentrations of the thyroid hormones and major anabolic hormones (insulin and/or IGF-I). This suggests that increased sensitivity to, rather than increased production of insulin, IGF-I and thyroid hormone, causes catch-up growth following IUGR. We therefore hypothesised that placental restriction of fetal growth would reduce size at birth and increase postnatal growth and adiposity in association with increased metabolic sensitivity to insulin, IGFs and thyroid hormones. This study has shown that the placentally restricted (PR) lamb has a reduced size at birth in terms of soft and skeletal tissues, has increased rates of growth postnatally, and has increased adiposity by six weeks of age. We have also shown that PR of fetal growth in the sheep did not alter gestational age at delivery, but reduced survival rate. PR lambs demonstrated catch-up growth in most parameters by 30 days of age and increased adiposity at six weeks of age compared to the control lambs. Placental restriction increased insulin and IGF sensitivity of circulating free fatty acids, which in turn, predicts increased adiposity. Neonatal catch-up growth after fetal growth restriction was substantially predicted by both abundance of, and metabolic sensitivity to insulin, suggesting increased insulin action as an underlying cause. Catch-up growth occurs in the neonate despite reduced concentrations of fasting plasma IGFs, along with increased IGF sensitivity of free fatty acid metabolism and adiposity. Plasma TH concentrations predicted growth of soft and skeletal tissue in lambs during early postnatal life, particularly in those undergoing catch-up growth following PR. Therefore neonatal catch-up growth after IUGR is associated with increased sensitivity to both insulin and IGFs, particularly of circulating free fatty acids, and appears to occur to the extent allowed by the prevailing abundance of these hormones and of thyroid hormones. If this altered endocrine state persists, increased adiposity and its subsequent amplification may contribute to the development of obesity, and related adverse metabolic and cardiovascular outcomes in adult life. / Thesis (Ph.D.)--School of Molecular and Biomedical Science, 2004.