This thesis aimed to explore whether self-management techniques, effective in essential hypertension, could be applied to women with hypertensive disorders of pregnancy postpartum (HDP). HDP affect one in ten pregnancies, remain a leading cause of maternal death worldwide and are associated with elevated long-term maternal cardiovascular risk. Hypertension often persists postpartum and complications can occur. During the puerperium, multiple stresses on new mothers and their healthcare professionals can distract from good quality blood pressure (BP) management. Transfer of responsibility, from secondary to primary care, increases scope for uncertainty. The primary objective was to develop and test the feasibility of a novel self-management intervention for postnatal antihypertensive treatment. A systematic literature review (39 studies), local audit (n=20) and regional survey (n=101) were conducted to evaluate existing evidence and clinical practice. A pilot randomised controlled trial compared self-management of postnatal antihypertensive medication with usual care (n=91). Taking patients' views of self-management into account is essential to successful implementation and these were captured through qualitative interviews (n=68). A sub-study to assess markers of vascular risk (n=16) was conducted to further evaluate the relationship between postnatal BP and elevated long-term cardiovascular risk. There is a lack of good quality evidence underpinning hypertension management postpartum and widespread inconsistencies in approaches to care. The pilot trial suggested that expanding the study would be feasible, and that self-management may be more effective than usual care in terms of BP control. Strikingly, the 4-5mmHg reduction in diastolic BP observed with self-management persisted to six months, despite the majority of women being off treatment by this stage, reinforcing the idea that BP control during the puerperium may influence cardiovascular remodelling. However, no differences were demonstrated in markers of cardiovascular risk between sub-study groups. Participants commonly preferred self-management to usual care, and reported feeling more in control through this approach.

Fetal exposure to an intrauterine environment affected by maternal obesity and excessive gestational weight gain (GWG) pose several adverse short- and long-term health risks to infants. Excessive GWG and maternal obesity are of high priority to public health across many nations. Improving maternal and child health can be achieved by encouraging women to meet Institute of Medicine (IOM) weight gain recommendations, sound clinical guidance, and other forms of support. Another means of helping women adhere to weight gain guidelines is by making use of the near ubiquitous nature of mobile technology and promoting healthy pregnancies through reliable mobile health (mHealth) applications (apps). The objective of the first study of this thesis was to examine the associations between psychosocial factors and achieving IOM-recommended weight gain during pregnancy. Cross-sectional data were collected from pregnant and postpartum women who responded to a validated questionnaire, the Electronic Maternal health survey. Multiple linear logistic regression analyses were used to determine correlates associated with meeting IOM guidelines. The objective of the second study was to conduct a preliminary exploration of women’s attitudes towards an evidence-based, mHealth app, SmartMoms Canada, as a valid source of pregnancy-related information and its ability to offer physical activity, nutrition, and lifestyle support. Focus groups were organized to assess women’s attitudes towards the app and inductive thematic content analysis was utilized to interpret focus group data. It was found that self-efficacy and perceived controllability of behaviours are important factors contributing to whether women meet IOM weight gain recommendations. Further, pregnant women are quite receptive to mHealth technology and positively viewed the future prospective of SmartMoms Canada as a means of promoting overall maternal health. Combined, these findings will contribute to our understanding of how to best improve maternal-fetal health outcomes in the near future.

Made available in DSpace on 2014-06-11T19:25:19Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-02-12Bitstream added on 2014-06-13T20:32:44Z : No. of bitstreams: 1 soares_pdpb_me_botfm.pdf: 324440 bytes, checksum: f230b3dd4a45d393366209805ed781ec (MD5) / Financiadora de Estudos e Projetos (FINEP) / Traçar um padrão de distribuição geográfica da doença trofoblástica gestacional (DTG) em centro de referência do estado da Bahia, no Nordeste do Brasil e determinar as características demográficas na apresentação da doença. Estudo observacional descritivo com dados obtidos de prontuários de 140 pacientes com DTG encaminhadas ao Centro de Doença Trofoblástica Gestacional da Maternidade Climério de Oliveira, no estado da Bahia, Brasil, de 2002 a 2007. Foi feita uma distribuição geográfica das pacientes com DTG, nas macrorregiões de saúde e foram avaliadas variáveis demográficas, fonte de referência, e tipo de gestação antecedente. Para análise estatística foi usado teste qui-quadrado (p<0,05%). A principal procedência das pacientes foi da macrorregião de saúde Leste (77,9%). A incidência da DTG no centro de referência foi de 8,5/1.000 partos. A faixa etária foi predominante de 20 a 34 anos (65%). Uma pequena proporção de pacientes estava trabalhando (42,9%). O nível educacional foi baixo: 67,9% das pacientes cursaram apenas o ensino fundamental. Hospitais secundários foram a principal fonte de referência de pacientes (84,3%). A maioria das pacientes teve gestação de termo prévia à DTG (42,1%). Neste estudo, a DTG predominou na melhor faixa etária para fecundidade e em pacientes com aspectos sócio-demográficos desfavoráveis. A tendência de referência dessas pacientes foi principalmente da macrorregião de saúde Leste. / To outline the geographical distribution pattern of gestational trophoblastic disease (GTD) in a referral center located in the state of Bahia, northeastern Brazil, and to determine the demographic characteristics in the presentation of the disease. Observational, descriptive study of the data retrieved from the medical records of 140 GTD patients referred to the Gestational Trophoblastic Disease Center of Climério de Oliveira Maternity, Bahia, Brazil between 2002 and 2007. The geographical distribution of GTD patients across healthcare macroregions was determined and demographic variables, referral sources and type of previous gestation were assessed. Statistical analysis was performed using the chi-square test (p<0.05%). Results: The majority of the patients originated from the East Healthcare Macroregion (77.9%). DTG incidence at the referral Center was 8.5/1.000 deliveries. The 20-34-year age group predominated (65%). A small percentage of the patients was employed (42.9%). Education level was low: 67.9% of the patients attended only elementary school. Secondary hospitals were the principal sources of patient referral (84.3%). In most cases (42.1%), GTD was preceded by term gestation. DTG predominated in the peak fertility age group and among patients of unfavorable socio-demographic status. Most referred patients tended to come from the East Healthcare Macroregion.

Made available in DSpace on 2014-06-11T19:32:59Z (GMT). No. of bitstreams: 0 Previous issue date: 2006-10-20Bitstream added on 2014-06-13T18:44:46Z : No. of bitstreams: 1 negrato_ca_dr_botfm_prot.pdf: 898163 bytes, checksum: a56403a143501d6e1f412e9ff5d74684 (MD5) / Fundação para o Desenvolvimento Médico e Hospitalar (Famesp) / Em 1988, Reaven descreveu a síndrome X, uma junção de diversos fatores de risco para as doenças cardiovasculares, sendo a resistência à insulina o ponto de partida para o estabelecimento de tais fatores. Várias denominações foram dadas a este grupo de comorbidades e hoje ela é conhecida como Síndrome Metabólica. Seu estudo tem sido dificultado pela ausência de consenso na sua definição. Sua prevalência varia de acordo com o critério diagnóstico utilizado e com as características da população estudada, sendo mais encontrada em portadores de obesidade central. A prevalência em mulheres varia de 10,7% a 40,5%, e é um preditor para o desenvolvimento de complicações cardiovasculares, estando associada a duas importantes entidades nosológicas bastante estudadas em ginecologia e obstetrícia: a síndrome dos ovários policísticos e o diabetes gestacional. Embora não façam parte dos critérios diagnósticos, várias condições clínicas e fisiopatológicas estão freqüentemente a ela associadas, tais como: acantose nigricans, doença hepática gordurosa não-alcoólica, microalbuminúria, estados pró trombóticos (elevação dos níveis de PAI-1 e fibrinogênio), estados pró- inflamatórios (elevação dos níveis de IL-6, TNF-a, resistina e PC-R), disfunção endotelial e hiperuncemia. Os autores fazem uma revisão sobre o diagnóstico laboratorial e os fatores ligados a SM evidenciando que a Critósos diagnósticos atuais da síndrome metabólica gravidez é um modelo da SM compensada e sugerem que o diabetes gestacional e a hipergilcemia materna diária devam ser acrescentados aos critérios diagnósticos. / In 1988, Reaven described the Syndrome X, a junction of several risk factors for cardiovascular diseases, being the insulin resistance the set point for the establishment of such factors. Many denominations were given to this group of co-morbidities and today it is known as metabolic syndrome. lts study has been difficult by the absence of a consensus for its definition. lts prevalence vanes according to the diagnostic criterion used and with the characteristics of the studíed population, being found mainly in people with central obesity. The prevalence in women varies from 10.7% to 40.5%, and it is a predictor of cardiovascular complications associated with two important nosologic entities concerned with gynecology and obstetrics: the polycystic ovaries syndrome and gestational diabetes. A variety of clinical and physiopathoiogical conditions are frequently associated to it. These are: acanthosis nigricans, non alcoholic fatty tiver disease, microalbuminuria, prothrombotic states (elevation of PAI-1 and fibrinogen leveIs), proinflammatory states (elevation of IL-6, TNF-a, resistin and C-RP leveis), endothelial dysfunction and hyperuricemia. The authors make a revision on the laboratorial diagnosis and the factors Iinked to the metabolic syndrome and attest that pregnancy is a counterbalanced model of the syndrome Critérios diagnósticos atuaiS da 5ifldrOme metabólica and suggest that gestational diabetes and diurnal maternal hyperglycemia should be added to the diagnostic criteria.

Made available in DSpace on 2014-06-11T19:32:59Z (GMT). No. of bitstreams: 0 Previous issue date: 2003Bitstream added on 2014-06-13T19:03:49Z : No. of bitstreams: 1 guilhen_jc_dr_botfm.pdf: 664786 bytes, checksum: 3ffe505338f83491a511e51efed2c3bd (MD5) / A proteinúria tem sido considerada um sinal importante para identificar o tipo de hipertensão que ocorre na gestação e está relacionada com o resultado materno e perinatal. Objetivo: o objetivo deste estudo foi avaliar, em gestantes hipertensas, por meio da eletroforese, o padrão das proteínas urinárias e seus pesos moleculares. Sujeitos e métodos: eletroforese em gel de poliacrilamida foi realizada em urina de 143 gestantes hipertensas, divididas em quatro grupos: hipertensão arterial crônica (HAC), pré-eclâmpsia/eclâmpsia (PE), hipertensão arterial crônica superposta por pré-eclâmpsia (HAC+PE) e hipertensão gestacional (HG). A presença e o número de bandas das proteínas tubular e glomerular e, seus pesos moleculares foram correlacionados com o tipo de hipertensão arterial, a presença (≥ 300 mg/24horas) ou não de proteinúria, o grau de proteinúria (leve: < 2g/24horas e grave: ≥ 2 g/24horas) e o valor do ácido úrico (< 6 mg% e ≥ 6 mg%). Para comparação das variáveis qualitativas foi usado o teste do qui-quadrado e para comparação das variáveis quantitativas foi usado o teste t de Student. Foi considerado significância quando valor de p < 0,05. Resultados: em todas as gestantes avaliadas foram encontradas proteínas tubular e glomerular e o número de bandas de proteínas não diferenciou os tipos de hipertensão arterial. A presença de pelo menos quatro bandas glomerulares foi significativamente maior nas gestantes com PE e HAC+PE, com proteinúria significativa, com proteinúria grave e com valor de ácido úrico ≥ 6 mg%. Quando comparada com proteínas de peso molecular ≤ 90 kDa a porcentagem de proteínas com peso molecular ≥ 160 kDa foi significativamente maior nas gestantes com PE, HAC+PE e HG, nas gestantes com proteinúria significativa e com ácido úrico ≥ 6 mg%... / Proteinuria has been considered an important sign to identify the hypertensive disorders encountered during pregnancy and it is related to the maternal and perinatal outcomes. Objective: the aim of this study was to evaluate the urinary protein patterns and their molecular weight in hypertensive pregnant women, through urinary electrophoresis. Subjects and methods: Sodium dodecyl sulphatepolyacrylamide gel electrophoresis (SDS-PAGE) was performed on the urine of143 hypertensive pregnant women that were divided into the following groups: chronic hypertension (CH), pre-eclampsia/eclampsia (PE), pre-eclampsia superimposed upon chronic hypertension (CH+PE), and gestational hypertension (GH). Presence and the number of tubular and glomerular protein bands, and their molecular weight were correlated with the type of hypertension, the proteinuria level (present: ≥ 300 mg/24h or absent: < 300 mg/24h; mild: < 2 mg/24h or severe: ≥ 2 mg/24h) and the uric acid level (< 6.0 mg/dL or ≥ 6.0 mg/dL). The chi-square test was used for comparing the qualitative date and the Student t test was used to compare the quantitative date. A p value of 0.05 was regarded as statistically significant. Results: glomerular and tubular proteins were found on all the hypertensive pregnant women and there were no significant differences in the number of protein bands. The glomerular protein band number was significantly higher in PE and CH+PE groups, in pregnant women with proteinuria, in pregnant women with severe proteinuria, and in pregnant women with uric acid level ≥ 6 mg/dL. When compared with the protein of molecular mass ≤90 kDa... (Complete abstract click electronic access below)

Resumo: Objetivo. Avaliar a influência da quimioterapia no resultado da primeira gravidez após a neoplasia trofoblástica gestacional (NTG). Pacientes e Métodos. Trata-se do estudo observacional restropsectivo e comparativo, realizado em 3590 pacientes acompanhadas com doença trofoblástica gestacional (DTG) no centro de NTG da Santa Casa Misericórdia do Rio de Janeiro, entre janeiro de 1960 e dezembro de 2005. Destas 867 reternaram grávidas e tiveram seus resultados obstétricos e perinatais confrontados entre grupos que cursaram com remissão espontânea (RE) e NTG, subgrupos de pacientes com NTG que engravidaram com menos de 6 meses, entre os 6 e 12 meses e com mais de 12 meses da última sessão de quimioterapia, e que receberam quioterapia por agente único (NTG-M) ou multiplos agentes (NTG-P)... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Objective. To evaluate the influence to chemoterapy on the results of the first pregnancy after gestational trophoblastic neoplasia (GTN). Patients and methods. It is an obsrvational, retrospective and comparative study comprising 3590 patients followed for gestational trophoblastic disease (GTD) at Santa Casa de Misericórdia do Rio de Janeiro GTN Center between January 1960 and December 2005... (Complete abstract click electronic access below) / Orientador: Izildinha Maestá / Coorientador: Odair Carlito Michelin / Banca: Luiz Camano / Banca: Paulo Belfort / Mestre

Made available in DSpace on 2014-06-11T19:27:44Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-02-28Bitstream added on 2014-06-13T19:35:50Z : No. of bitstreams: 1 braganeto_ar_me_botfm_prot.pdf: 602090 bytes, checksum: f38c1cdc313cf9ea229f0e479bcde7c3 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação para o Desenvolvimento Médico e Hospitalar (Famesp) / Objetivo. Avaliar a influência da quimioterapia no resultado da primeira gravidez após a neoplasia trofoblástica gestacional (NTG). Pacientes e Métodos. Trata-se do estudo observacional restropsectivo e comparativo, realizado em 3590 pacientes acompanhadas com doença trofoblástica gestacional (DTG) no centro de NTG da Santa Casa Misericórdia do Rio de Janeiro, entre janeiro de 1960 e dezembro de 2005. Destas 867 reternaram grávidas e tiveram seus resultados obstétricos e perinatais confrontados entre grupos que cursaram com remissão espontânea (RE) e NTG, subgrupos de pacientes com NTG que engravidaram com menos de 6 meses, entre os 6 e 12 meses e com mais de 12 meses da última sessão de quimioterapia, e que receberam quioterapia por agente único (NTG-M) ou multiplos agentes (NTG-P)... / Objective. To evaluate the influence to chemoterapy on the results of the first pregnancy after gestational trophoblastic neoplasia (GTN). Patients and methods. It is an obsrvational, retrospective and comparative study comprising 3590 patients followed for gestational trophoblastic disease (GTD) at Santa Casa de Misericórdia do Rio de Janeiro GTN Center between January 1960 and December 2005... (Complete abstract click electronic access below)

Made available in DSpace on 2016-07-01T13:10:28Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-08-25. Added 1 bitstream(s) on 2016-07-01T13:13:45Z : No. of bitstreams: 1 000866746.pdf: 1167888 bytes, checksum: 2ccca8898155c05e91242086adfebf49 (MD5) / Doppler ultrasonography can be used to assess neoangiogenesis, a characteristic feature of postmolar gestational trophoblastic neoplasia (GTN). However, there is limited information on whether uterine artery Doppler flow velocimetry (DFV) can predict GTN following complete hydatidiform mole (CHM). The purpose of this study was: 1) to compare uterine blood flow before and after CHM evacuation between women who developed post-molar GTN and those who achieved spontaneous remission; 2) to assess the usefulness of uterine DFV parameters as predictors of post-CHM GTN, and to determine the best parameters and cutoff values for predicting post-CHM GTN. Methods. This prospective cohort study included246 CHM patients attending three trophoblastic diseases centers (Botucatu -Sao Paulo State University, Rio de Janeiro Federal University and Fluminense Federal University) between 2013 and 2014. Pulsatility index (PI), resistivity index (RI), and sistolic/dyastolic ratio (S/D) were measured by DVF before and 4-6 weeks post CHM evacuation. Statistical analysis was performed using Wilcoxon's test, logistic regression and ROC analysis. Results. No differences in pre- and postevacuation DVF measurements were observed in patients who developed post-CHM GTN. In those that achieved spontaneous remission, PI and SD were increased after evacuation. Pre- and post-evacuation PI was significantly lower in patients who developed GTN with estimates of odds ratio of 13.9-30.5. Pre-evacuation PI ≤1.38 (77% sensitivity, 82% specificity), and post-evacuation PI≤1.77 (79% sensitivity, 86% specificity) were significantly predictive of GTN. Conclusions. Uterine DFV measurements, particularly pre- and post-molar evacuation PI, can be useful for predicting post-CHM GTN

Resumo: Clicar acesso eletrônico abaixo. / Abstract: Objective: to assess quality of life and psychological aspects in patients with gestational trophoblastic disease (GTD). Methods: This cross-sectional self-report study was carried out among 54 women treated at Botucatu Trophoblastic Diseases Center, São Paulo, Brazil. Validated questionnaires were used to assess quality of life (QoL) (WHOQOL-bref), symptoms of depression (Beck Depression Inventory-BDI) and anxiety (State-Trait Anxiety Inventory -STAI). Results: Most patients rated overall QoL as good (44.44%), and were satisfied with their health status (42.59%). However, these findings did not reach statistical significance. Mean QoL domain score was the highest for psychological health (53.86 ± 21.46), and the lowest for social relationships (65.74 ± 22.41). BDI mean was 15.81 ± 11.15, indicating dysphoria. STAI means were 46 ± 6.46 for trait-anxiety, and 43.72 ± 4.23 for state-anxiety, both evidencing medium-high anxiety. Among patients who were employed, the environment domain mean was the highest (p=0.024). The presence of children prior to disease onset resulted in the lowest means for physical health (p=0,041) and environment (p=0.045). The patients desiring to have children showed significantly higher means for physical health (p=0.004), psychological health (p=0.021) and environment (p=0.003). The need for chemotherapy to achieve complete response had no significant influence on QoL. Conclusion: This study evidenced the psychological impact on GTD patients. This information suggests that specialized care centers should provide psychological interventions during the treatment and follow-up of GTD patients... (Complete abstract click electronic access below) / Orientador: Marilza Vieira Cunha Rudge / Coorientador: Izildinha Maestá / Banca: Rafael Cortes-Chary / Banca: Olivia Lucia Costa / Mestre

Orientador: Marilza Vieira Cunha Rudge / Banca: Marilza Vieira Cunha Rudge / Banca: Domingos Augusto Malerbi / Banca: Marcos Antonio Tambacia / Banca: Angela de Azevedo Jacób Reichelt / Resumo: Em 1988, Reaven descreveu a síndrome X, uma junção de diversos fatores de risco para as doenças cardiovasculares, sendo a resistência à insulina o ponto de partida para o estabelecimento de tais fatores. Várias denominações foram dadas a este grupo de comorbidades e hoje ela é conhecida como Síndrome Metabólica. Seu estudo tem sido dificultado pela ausência de consenso na sua definição. Sua prevalência varia de acordo com o critério diagnóstico utilizado e com as características da população estudada, sendo mais encontrada em portadores de obesidade central. A prevalência em mulheres varia de 10,7% a 40,5%, e é um preditor para o desenvolvimento de complicações cardiovasculares, estando associada a duas importantes entidades nosológicas bastante estudadas em ginecologia e obstetrícia: a síndrome dos ovários policísticos e o diabetes gestacional. Embora não façam parte dos critérios diagnósticos, várias condições clínicas e fisiopatológicas estão freqüentemente a ela associadas, tais como: acantose nigricans, doença hepática gordurosa não-alcoólica, microalbuminúria, estados pró trombóticos (elevação dos níveis de PAI-1 e fibrinogênio), estados pró- inflamatórios (elevação dos níveis de IL-6, TNF-a, resistina e PC-R), disfunção endotelial e hiperuncemia. Os autores fazem uma revisão sobre o diagnóstico laboratorial e os fatores ligados a SM evidenciando que a Critósos diagnósticos atuais da síndrome metabólica gravidez é um modelo da SM compensada e sugerem que o diabetes gestacional e a hipergilcemia materna diária devam ser acrescentados aos critérios diagnósticos. / Abstract: In 1988, Reaven described the Syndrome X, a junction of several risk factors for cardiovascular diseases, being the insulin resistance the set point for the establishment of such factors. Many denominations were given to this group of co-morbidities and today it is known as metabolic syndrome. lts study has been difficult by the absence of a consensus for its definition. lts prevalence vanes according to the diagnostic criterion used and with the characteristics of the studíed population, being found mainly in people with central obesity. The prevalence in women varies from 10.7% to 40.5%, and it is a predictor of cardiovascular complications associated with two important nosologic entities concerned with gynecology and obstetrics: the polycystic ovaries syndrome and gestational diabetes. A variety of clinical and physiopathoiogical conditions are frequently associated to it. These are: acanthosis nigricans, non alcoholic fatty tiver disease, microalbuminuria, prothrombotic states (elevation of PAI-1 and fibrinogen leveIs), proinflammatory states (elevation of IL-6, TNF-a, resistin and C-RP leveis), endothelial dysfunction and hyperuricemia. The authors make a revision on the laboratorial diagnosis and the factors Iinked to the metabolic syndrome and attest that pregnancy is a counterbalanced model of the syndrome Critérios diagnósticos atuaiS da 5ifldrOme metabólica and suggest that gestational diabetes and diurnal maternal hyperglycemia should be added to the diagnostic criteria. / Doutor