Les centres d’information sur les tératogènes (CIT) fournissent aux professionnels de la santé ainsi qu’au public de l’information sur les risques et bienfaits associés à l’utilisation des médicaments durant la grossesse et l’allaitement. Le Centre IMAGe (Info-Médicaments en Allaitement et Grossesse) du CHU Sainte-Justine (Centre Hospitalier Universitaire Sainte-Justine) au Québec, est un CIT qui offre depuis 1997 un service téléphonique d’information gratuit aux professionnels de la santé. Deux études ont été réalisées à partir des appels reçus au Centre IMAGe. La première étude a été réalisée sur l’ensemble des appels reçus entre janvier 2004 et avril 2007 au sujet de femmes qui prenaient ou envisageaient prendre un médicament durant la grossesse ou l’allaitement. Les objectifs de cette étude visaient à déterminer les classes de médicaments les plus fréquentes ainsi que les indications d’utilisation et les déterminants d’un appel à leur sujet (caractéristiques maternelles associées). Les antidépresseurs, les anti-inflammatoires, les antibiotiques, les benzodiazépines et les antipsychotiques sont les classes de médicaments qui correspondaient aux plus grands nombres d’appels. Cela porte à croire que pour ces classes de médicaments, il existe chez les professionnels de la santé un besoin d’information en ce qui concerne les risques et bienfaits de leur utilisation durant la grossesse et l’allaitement. La dépression représentait une des trois indications les plus prévalentes chez les femmes qui prenaient ou désiraient prendre des antidépresseurs, des benzodiazépines ou des anti-psychotiques durant la grossesse ou l’allaitement. Le tabagisme était associé à l’utilisation des antidépresseurs et des anti-psychotiques durant la grossesse, ainsi qu’à un appel au sujet des anti-inflammatoires durant l’allaitement. La deuxième étude a été réalisée sur l’ensemble des appels reçus entre janvier 2003 et mars 2008. Cette étude visait à déterminer l’impact des avis émis par Santé Canada concernant les risques de l’exposition aux antidépresseurs durant la grossesse et celui concernant le retrait du rofécoxib, sur le nombre d’appels reçus à IMAGe. L’analyse des séries temporelles du nombre hebdomadaire d’appels reçus a révélé que l’avis de Santé Canada sur les risques de malformations cardiaques associés à l’utilisation de la paroxétine lors du premier trimestre de la grossesse a généré une augmentation statistiquement significative, soudaine et permanente du nombre d’appels reçus à IMAGe au sujet des antidépresseurs. Ces études permettent de mieux comprendre le besoin d’information des professionnels de la santé sur les risques et bienfaits de l’utilisation des médicaments durant la grossesse et l’allaitement. / Teratogen Information Services (TIS) are giving information on the risks and benefits associated with medication use during pregnancy and lactation, to the health care providers and the public. IMAGe Center at the CHU Sainte-Justine in Quebec is a TIS which providing since 1997 a free telephone information service to the health care providers. Two studies were conducted using the calls received at IMAGe Center. The first study included all the calls received between January 2004, and April 2007, concerning women who used or expected to use medication during pregnancy or lactation. The objectives of this study aimed to identify the most frequent medication classes, the indications of use, and the predictors of a call concerning them (associated maternal characteristics). Antidepressants, anti-inflammatory drugs, antibiotics, benzodiazepines, and anti-psychotics represented the medication classes with the greater amount of calls. These results rise to the possibility that more information about the risks and benefits associated with the use of these medication classes during pregnancy and lactation is needed by the health care providers. Depression was in the top three of the most prevalent indications of use for the antidepressants, benzodiazepines, and anti-psychotics. Smoking was associated with the use of antidepressants and anti-psychotics during pregnancy, and with a call concerning the anti-inflammatory drugs during lactation. The second study included all the calls received between January 2003, and March 2008. This study aimed to identify the impact of the Health Canada (HC) warnings, concerning the risks of antidepressant use during pregnancy, and related to the rofecoxib market withdrawal, on the number of calls received to IMAGe. Time series of the weekly number of calls received demonstrated that the Health Canada warning on the risk of cardiac malformations associated with paroxetine use during the first trimester of pregnancy generated a statistically significant abrupt and permanent increase of the calls received at IMAGe about the antidepressants. These studies ensure to better understand the information need of the health care providers concerning the risks and benefits of medication use during pregnancy and lactation.

Submitted by PPG Pediatria e Sa?de da Crian?a (pediatria-pg@pucrs.br) on 2018-05-25T14:26:20Z No. of bitstreams: 1 Mestrado Vers?o Final Homologa??o Fernanda Salcher.pdf: 1235390 bytes, checksum: afff1b0b8bb828f139197eb845e2dfef (MD5) / Approved for entry into archive by Caroline Xavier (caroline.xavier@pucrs.br) on 2018-06-11T17:52:43Z (GMT) No. of bitstreams: 1 Mestrado Vers?o Final Homologa??o Fernanda Salcher.pdf: 1235390 bytes, checksum: afff1b0b8bb828f139197eb845e2dfef (MD5) / Made available in DSpace on 2018-06-11T17:55:08Z (GMT). No. of bitstreams: 1 Mestrado Vers?o Final Homologa??o Fernanda Salcher.pdf: 1235390 bytes, checksum: afff1b0b8bb828f139197eb845e2dfef (MD5) Previous issue date: 2018-03-14 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / INTRODUCTION: Colostrum therapy, also called oral immunological therapy, is the administration of colostrum via the oropharyngeal route to preterm infants and can be started within the first six hours of life. Small doses of colostrum are administered to the oral mucosa and upper respiratory tract of the infant, which may exert a protective effect on the mucosal membrane. In addition, immunoglobulin A, colostrum cytokines, antioxidant agents and all anti-infective agents may interact with lymphoid cells within the oropharynx, stimulating the infant's immune function. Recently, studies have reported the importance of colostrum administered by the oropharyngeal route, especially for extremely low birth weight preterm infants, with nutritional and immune defense effects already demonstrated. The more premature the baby, the more it will benefit from early exposure to colostrum. OBJECTIVE: To estimate the success rate after implantation of a colostrum administration protocol in low birth weight preterm infants at the Hospital Sa?de, in Caxias do Sul, RS. METHODOLOGY: The study took place between March and July 2017, after the ethical approval of the project. The participants were 41 mother / baby pairs whose mothers, after signing the free and informed consent, made attempts to exhaust the breast to provide colostrum to their children. Preterm infants between 24 and 32 weeks of age who had an indication of colostrum therapy prescribed by the physician were included, and attempts were made to exhaust the breast before six hours of the newborn's life. Two data collection instruments created by the researcher were used, one with information about mothers and newborns and the other for the Neonatal Intensive Care Unit nursing team to respond. After the observation of the attempt to obtain the colostrum, the questions of the collection instrument were considered, as if the puerpera managed to exhaust 0.2 mL of colostrum or not, or if the breast was exhausted before six hours. Through the charts of each baby, the data on administration were collected. It was observed if there was a decrease in oxygen saturation and / or an increase in respiratory and cardiac frequencies at the time of administration of colostrum. The success of colostrum therapy was considered to be the administration of at least one dose of colostrum within the first 72 hours of life, and the success rate was reported as a percentage of the cases that were successful among all included. RESULTS: Among the 41 premature infants included in the protocol, 19 (46.3%) received at least one dose of colostrum within the first 72 hours of life and 22 (53.7%) did not receive colostrum. There was an association between being able to deplete the breast earlier and the baby to be able to receive colostrum, regardless of when it was received. All 22 cases of colostrum failure were due to failure to obtain colostrum within 72 hours postpartum. There was no association between whether or not colostrum could be collected and maternal age or gestational age. There were no adverse events, such as alterations in the respiratory and cardiac frequencies or decrease in oxygen saturation, in the 19 infants who received oropharyngeal colostrum. Regarding the perception of the professional care team about colostrum therapy, more than half reported being partially knowledgeable about the practice and only one felt totally knowledgeable. However, most of the care team (83.4%) reported being satisfied, very satisfied or totally satisfied with the implementation of the colostrum protocol. CONCLUSIONS: In general, this study demonstrated difficulties in the implantation of the protocol of colostrum therapy to premature infants at Hospital Sa?de in Caxias do Sul. The obstacles to the success of a protocol of colostrum therapy were revealed, which mainly resided in the fact that the puerperae had difficulty in exhausting the breast in the first few days after preterm birth, and as a consequence, most newborns were unable to receive maternal colostrum within the first three days of life. In successful cases, the mother's satisfaction with the fact that the child received her colostrum was rewarding. There was a insufficient deepening in the training of the professional care team. These results brought important data that can be used in the execution of a new protocol, in the same unit as well as in other units with the same characteristics. Additional studies should be performed to reveal ways to achieve better success in the application of colostrum therapy protocol, supplanting the difficulties of early breast exhaustion, and can thus benefit from the administration of oropharyngeal colostrum to premature infants. / INTRODU??O: A colostroterapia, tamb?m chamada de terapia imunol?gica oral, ? a administra??o do colostro por via orofar?ngea para rec?m-nascidos prematuros e pode ser iniciada nas primeiras seis horas de vida. S?o administradas pequenas doses de colostro na mucosa oral e trato respirat?rio superior do rec?m-nascido, o que poder? exercer efeito protetor sobre a membrana da mucosa. Al?m disso a imunoglobulina A, as citocinas colostrais, os agentes antioxidantes e todos os agentes anti-infecciosos podem interagir com c?lulas linfoides dentro da orofaringe, estimulando a fun??o imunol?gica do beb?. Recentemente estudos relatam a import?ncia do colostro administrado pela via orofar?ngea, principalmente para o prematuro de extremo baixo peso, com efeitos nutricionais e de defesa imunol?gica j? demonstrados. Quanto mais prematuro o beb?, mais ele se beneficiar? da exposi??o precoce ao colostro. OBJETIVO: Estimar o ?ndice de sucesso ap?s a implanta??o de um protocolo de administra??o de colostro em rec?m-nascidos prematuros de baixo peso, no Hospital Sa?de, em Caxias do Sul/RS. METODOLOGIA: O estudo ocorreu entre mar?o e julho de 2017, ap?s a aprova??o ?tica do projeto. Os participantes foram 41 pares m?e/beb? cujas m?es, ap?s assinatura do consentimento livre e esclarecido, fizeram tentativas de esgotar a mama para prover colostro aos seus filhos. Foram inclu?dos prematuros entre 24 e 32 semanas que tinham indica??o de colostroterapia, prescrita pelo m?dico, sendo iniciadas as tentativas de esgota da mama antes das seis horas de vida do rec?m-nascido. Utilizaram-se dois instrumentos de coleta de dados criados pela pesquisadora, um com informa??es sobre as m?es e sobre os rec?m-nascidos e o outro para a equipe de enfermagem da Unidade de Terapia Intensiva Neonatal responder. Ap?s a observa??o da tentativa de se esgotar ou n?o o colostro, foram contempladas as quest?es do instrumento de coleta, como se a pu?rpera conseguiu esgotar 0,2 mL de leite ou n?o, ou se conseguiu esgotar a mama antes das seis horas. Atrav?s do prontu?rio de cada beb?, foram coletados os dados sobre a administra??o. Observou-se se houve queda de satura??o de oxig?nio e/ou aumento das frequ?ncias respirat?ria e card?aca na hora da administra??o da colostroterapia. Considerou-se como sucesso da colostroterapia a administra??o de pelo menos uma dose de colostro dentro das primeiras 72 horas de vida, sendo o ?ndice de sucesso referido como porcentagem dos casos que obtiveram sucesso entre todos os inclu?dos. RESULTADOS: Entre os 41 prematuros inclu?dos no protocolo, 19 (46,3%) receberam pelo menos uma dose de colostro dentro das primeiras 72 horas de vida e 22 (53,7%) n?o receberam a colostroterapia. Houve associa??o entre conseguir esgotar a mama mais precocemente e o beb? conseguir receber a colostroterapia, independentemente do momento em que a recebeu. Todos os 22 casos de insucesso da colostroterapia se deveram ? n?o obten??o de colostro dentro das 72 horas p?s-parto. N?o houve associa??o entre o fato de conseguir ou n?o coletar o colostro e a idade materna, ou a idade gestacional. N?o houve nenhum evento adverso, como altera??o nas frequ?ncias respirat?ria e card?aca ou diminui??o da satura??o de oxig?nio, nos 19 RN que receberam colostro por via orofar?ngea. Em rela??o ? percep??o da equipe assistencial quanto ? colostroterapia, mais da metade referiu ser conhecedor parcial da pr?tica e apenas um sentia-se totalmente conhecedor. Entretanto, a maior parte da equipe assistencial (83,4%) referiu estar satisfeita, muito satisfeita ou totalmente satisfeita com a implanta??o do protocolo da colostroterapia. CONCLUS?ES: Em geral, este estudo demonstrou dificuldades na implanta??o do protocolo de colostroterapia a prematuros no Hospital Sa?de de Caxias do Sul. Foram revelados os empecilhos para o sucesso de um protocolo de colostroterapia, os quais residiram principalmente no fato de que as pu?rperas tiveram dificuldade em esgotar a mama nos primeiros dias ap?s o parto prematuro e, como consequ?ncia, a maioria dos rec?m-nascidos n?o conseguiu receber o colostro materno dentro dos primeiros tr?s dias de vida. Nos casos de sucesso, a satisfa??o da m?e pelo fato do filho receber o seu colostro foi compensadora. Faltou maior aprofundamento no treinamento da equipe assistencial. Os resultados trouxeram dados importantes que podem ser aproveitados na execu??o de um novo protocolo, na mesma unidade, assim como em outras unidades com as mesmas caracter?sticas. Estudos adicionais devem ser realizados para revelar formas de obter melhor sucesso na aplica??o do protocolo de colostroterapia, suplantando as dificuldades da esgota precoce da mama, podendo assim auferir os benef?cios da administra??o de colostro por via orofar?ngea aos prematuros.

Submitted by Ana Lúcia Torres (bfmhuap@gmail.com) on 2017-09-28T12:43:48Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) DISSERTAÇÃO MONIQUE BABINSKI_Pós Defesa 2016 SEM APENDICES (1).pdf: 1899605 bytes, checksum: 5667910f275aadea7cc77dcc4a1ea0c1 (MD5) / Approved for entry into archive by Ana Lúcia Torres (bfmhuap@gmail.com) on 2017-09-28T12:44:09Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) DISSERTAÇÃO MONIQUE BABINSKI_Pós Defesa 2016 SEM APENDICES (1).pdf: 1899605 bytes, checksum: 5667910f275aadea7cc77dcc4a1ea0c1 (MD5) / Made available in DSpace on 2017-09-28T12:44:09Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) DISSERTAÇÃO MONIQUE BABINSKI_Pós Defesa 2016 SEM APENDICES (1).pdf: 1899605 bytes, checksum: 5667910f275aadea7cc77dcc4a1ea0c1 (MD5) Previous issue date: 2016 / Complexo Hospitalar de Niterói / O objetivo deste estudo foi avaliar os efeitos da restrição proteica e calórica materna durante a lactação, analisando se haveria recuperação, o conhecido “catch-up” das dimensões morfológicas femorais após a restauração da dieta nutricional. Ao nascimento da ninhada, as progenitoras foram divididas nos seguintes grupos: Controle (C) com dieta a 23% de proteína ad libitum; Restrição Proteico-Calórica (RPC) com dieta a 8% de proteína e Restrição Calórica (RC) com dieta a 23% de proteína, em quantidades restritas de acordo com a ingestão do grupo RPC. Após o desmame, todos os filhotes foram separados das mães e receberam livre acesso a uma dieta padrão de laboratório contendo 23% de proteína, até 180 dias, quando os ratos foram eutanasiados. O fêmur foi excisado e as dimensões femorais macroscópicas foram medidas usando pontos anatômicos pré-estabelecidos. Após a morfometria macroscópica, os fêmures foram fixados em formol 10% (24h) e descalcificados por EDTA. Foram realizadas secções transversais de 10μm de espessura no terço médio diafisário dos espécimes, corados com HE e levados ao microscópio para análise qualitativa e histomorfometria da cortical óssea. Os resultados morfométricos macroscópicos mostraram que a maioria das medidas nos grupos de RC e RPC foram significativamente menores do que no grupo controle. As maiores reduções ocorrendo no grupo de RPC e com várias anormalidades histoarquiteturais, eg., diminuição da área cortical e aumento da área medular. Cortical com lacunas aumentadas significativamente nos grupos RC e RPC. Nossos resultados mostram que a restrição proteico-calórica durante a lactação leva a uma recuperação incompleta na idade adulta. O fêmur mostrou redução significativa na maior parte dos parâmetros macro e microscópicos nos dois grupos tratados, em particular o grupo RPC, quando comparado com o grupo C / The aim of this study was to evaluate the effects of maternal protein and energy restriction during lactation, analyzing on morphological dimensions whether there was catch-up growth through normative nutrition restored, as well as on mechanical axis of femur of the offspring at adulthood. At parturition, Wistar rat dams were randomly assigned to the following groups: 1) control group (C) - free access to a standard laboratory diet containing 23 % protein, 2) protein-energy restricted group (PER) - free access to an isoenergetic, protein-restricted diet containing 8 % protein, and 3) energy-restricted group (ER) – fed with restricted amounts of a standard laboratory diet. At weaning, all pups were separated of dams and received free access to a standard laboratory diet containing 23% protein until 180 days, when the rats were anesthetized and sacrificed. The dimensions of excised pup femur were measured directly using pre-established anatomical points. After macroscopic morphometry, the femurs were fixed in 10% formalin (24h) and decalcified by EDTA. Cross sections of 10μm thickness were made in the middle third (diaphyseal) of the specimens stained with HE and taken to the microscope for qualitative analysis and histomorphometry of cortical bone. Morphometric analysis of the femur (macroscopic) showed that most of the measurements in the ER and PER groups were significantly lower than in the control group, with the greatest reductions occurring in the PER group and several histoarchitectural abnormalities, e.g., decrease in cortical area and increased medullary area. Cortical bone with gaps increased significantly in ER and PER groups. Our results show that protein and energy restriction during lactation leads to an incomplete catch-up growth in adulthood. The femur showed significant reduction in most of the parameters in the two treated groups, particularly the PER group, when compared to the control group

In der vorliegenden Arbeit wurde die Bedeutung des Einflusses von Laktationsnummer, Laktationsstadium, Körperkondition und Absetzverfahren auf Merkmale der Milchleistung und Eutergesundheit einer Herde Ostfriesischer Milchschafe untersucht. Die Tiere wurden nach dem Ablammen zufällig einer Früh- bzw. Spätabsetzergruppe zugeordnet (Absetzen der Lämmer 3 bzw. 42 Tage post partum). An insgesamt 40 Terminen wurden über eine vollständige Laktation Vorgemelks-, Hälftenanfangsgemelks- und Einzeltiergemelksproben gewonnen. Das Spektrum der untersuchten Merkmale umfasste die Milchmenge, die Milchinhaltsstoffe (Fett, Eiweiß, Laktose), die klinische Untersuchung des Euters, die somatische Zellzahl, die elektrische Leitfähigkeit und bakteriologische Untersuchungen. Zusätzlich wurden das Körpergewicht und die Körperkondition der Mutterschafe erfasst. Das durchschnittliche Leistungsniveau der Herde betrug 301±101,3 kg Milch, bei mittleren Milchfett-, Milcheiweiß-, und Laktosegehalten von 5,00, 5,14 bzw. 5,00 % (150-Tageleistung). Die Laktationsnummer hatte keinen signifikanten Effekt auf die Milchleistung. Schafe der Spätabsetzer-Gruppe produzierten im Anschluss an die Säugephase eine um 300 g signifikant höhere Testtagsmilchmenge als Tiere der Frühabsetzer-Gruppe. Das Absetzverfahren hatte keinen nachweisbaren Effekt auf die Milchinhaltsstoffe. Die Herde wies eine gute Eutergesundheit auf. Der Anteil bakteriologisch positiver Schafmilchproben betrug 28,5 %. Als dominante Erreger wurden in 96,6 % der bakteriologisch positiven Schafmilchproben Koagulasenegative Staphylokokken nachgewiesen. Der Anteil bakteriologisch positiver Euterhälftenbefunde stieg signifikant mit dem Fortschreiten der Laktation und zunehmender Laktationsnummer. Eine Euterinfektion mit Koagulasenegativen Staphylokokken sowie das Verfahren des Spätabsetzens beeinflussten alle drei untersuchten Eutergesundheitsparameter (logarithmierte Zellzahl, elektrische Leitfähigkeit und Laktosegehalt) negativ (p < 0,001).

Les centres d’information sur les tératogènes (CIT) fournissent aux professionnels de la santé ainsi qu’au public de l’information sur les risques et bienfaits associés à l’utilisation des médicaments durant la grossesse et l’allaitement. Le Centre IMAGe (Info-Médicaments en Allaitement et Grossesse) du CHU Sainte-Justine (Centre Hospitalier Universitaire Sainte-Justine) au Québec, est un CIT qui offre depuis 1997 un service téléphonique d’information gratuit aux professionnels de la santé. Deux études ont été réalisées à partir des appels reçus au Centre IMAGe. La première étude a été réalisée sur l’ensemble des appels reçus entre janvier 2004 et avril 2007 au sujet de femmes qui prenaient ou envisageaient prendre un médicament durant la grossesse ou l’allaitement. Les objectifs de cette étude visaient à déterminer les classes de médicaments les plus fréquentes ainsi que les indications d’utilisation et les déterminants d’un appel à leur sujet (caractéristiques maternelles associées). Les antidépresseurs, les anti-inflammatoires, les antibiotiques, les benzodiazépines et les antipsychotiques sont les classes de médicaments qui correspondaient aux plus grands nombres d’appels. Cela porte à croire que pour ces classes de médicaments, il existe chez les professionnels de la santé un besoin d’information en ce qui concerne les risques et bienfaits de leur utilisation durant la grossesse et l’allaitement. La dépression représentait une des trois indications les plus prévalentes chez les femmes qui prenaient ou désiraient prendre des antidépresseurs, des benzodiazépines ou des anti-psychotiques durant la grossesse ou l’allaitement. Le tabagisme était associé à l’utilisation des antidépresseurs et des anti-psychotiques durant la grossesse, ainsi qu’à un appel au sujet des anti-inflammatoires durant l’allaitement. La deuxième étude a été réalisée sur l’ensemble des appels reçus entre janvier 2003 et mars 2008. Cette étude visait à déterminer l’impact des avis émis par Santé Canada concernant les risques de l’exposition aux antidépresseurs durant la grossesse et celui concernant le retrait du rofécoxib, sur le nombre d’appels reçus à IMAGe. L’analyse des séries temporelles du nombre hebdomadaire d’appels reçus a révélé que l’avis de Santé Canada sur les risques de malformations cardiaques associés à l’utilisation de la paroxétine lors du premier trimestre de la grossesse a généré une augmentation statistiquement significative, soudaine et permanente du nombre d’appels reçus à IMAGe au sujet des antidépresseurs. Ces études permettent de mieux comprendre le besoin d’information des professionnels de la santé sur les risques et bienfaits de l’utilisation des médicaments durant la grossesse et l’allaitement. / Teratogen Information Services (TIS) are giving information on the risks and benefits associated with medication use during pregnancy and lactation, to the health care providers and the public. IMAGe Center at the CHU Sainte-Justine in Quebec is a TIS which providing since 1997 a free telephone information service to the health care providers. Two studies were conducted using the calls received at IMAGe Center. The first study included all the calls received between January 2004, and April 2007, concerning women who used or expected to use medication during pregnancy or lactation. The objectives of this study aimed to identify the most frequent medication classes, the indications of use, and the predictors of a call concerning them (associated maternal characteristics). Antidepressants, anti-inflammatory drugs, antibiotics, benzodiazepines, and anti-psychotics represented the medication classes with the greater amount of calls. These results rise to the possibility that more information about the risks and benefits associated with the use of these medication classes during pregnancy and lactation is needed by the health care providers. Depression was in the top three of the most prevalent indications of use for the antidepressants, benzodiazepines, and anti-psychotics. Smoking was associated with the use of antidepressants and anti-psychotics during pregnancy, and with a call concerning the anti-inflammatory drugs during lactation. The second study included all the calls received between January 2003, and March 2008. This study aimed to identify the impact of the Health Canada (HC) warnings, concerning the risks of antidepressant use during pregnancy, and related to the rofecoxib market withdrawal, on the number of calls received to IMAGe. Time series of the weekly number of calls received demonstrated that the Health Canada warning on the risk of cardiac malformations associated with paroxetine use during the first trimester of pregnancy generated a statistically significant abrupt and permanent increase of the calls received at IMAGe about the antidepressants. These studies ensure to better understand the information need of the health care providers concerning the risks and benefits of medication use during pregnancy and lactation.

Lietuvoje išimtinai kūdikius iki 6 mėn. žindo tik 25, 7 proc. motinų, o 14 proc. jau nuo 1 gyvenimo mėnesio davė arbatos. Tyrimais yra nustatyta, kad žindymo ir laktacijos valdymo mokymas nėštumo metu, gali prailginti išimtinio žindymo trukmę.Tikslas – nustatyti nėščiųjų mokymo apie žindymo ir laktacijos valdymą įtaką išimtinio žindymo(IŽ) paplitimui, papildomo maitinimo(PM) įvedimo pradžiai bei įvertinti motinų žinias ir pastangas, siekiant spręsti su žindymu susijusias problemas.Uždaviniai: 1. Įvertinti nėščiųjų mokymo apie žindymą įtaką IŽ paplitimui ir trukmei; 2.Įvertinti nėščiųjų mokymo apie žindymą įtaką PM įvedimo pradžiai; 3.Įvertinti išklausiusių ir neišklausiusių mokymo apie žindymą motinų žinias ir pastangas siekiant spręsti su žindymu susijusias problemas; 4. Išsiaiškinti motinų nuostatas apie žindymo trukmę ir veiksnius, galinčius ją įtakoti; 5. Nustatyti motinų požiūrį į personalo pagalbą pradedant žindyti.Tyrimo metodas. Tyrimas buvo atliktas VU Sporto medicinos, reabilitacijos ir slaugos instituto ir RMC bazėje 2006-2008 metais. Naudojant anoniminę anketą-klausimyną buvo apklaustos 50 moterų, auginančios 6-18 mėn. amžiaus vaikus ir išklausiusios prenatalinį žindymo ir laktacijos valdymo pagrindų kursą (poveikio grupė(PG)), ir 50 moterų (kontrolinė grupė(KG)), auginančių tokio paties amžiaus vaikus ir neišklausiusios tokio kurso. Klausimyno pirmoje dalyje buvo siekiama išsiaiškinti moterų žindymo ir papildomo maisto įvedimo praktiką, nuostatas apie sėkmingo... [toliau žr. visą tekstą] / In Lithuania only 25.7% of babies are exclusively breastfed (BF) up to 6 months. Evidence has proved that prenatal teaching on BF and lactation management(LM) can prolong exclusive BF. Objective: to determine the influence of prenatal BF training over the rates of exclusive BF and the initiation of complementary feeding(CF) and to assess the mothers‘ knowledge and efforts in solving BF-related problems. Tasks: 1.Assess the influence of prenatal BF training over the rates and length of exclusive BF. 2. Assess the influence of prenatal BF training over the initiation of CF. 3. Assess the knowledge and efforts in solving BF-related problems by mothers who have undergone and who haven‘t undergone prenatal BF training. 4. Determine mothers‘ attitudes toward the length of BF and the factors influencing this length. 5. Determine mothers’ attitudes toward the personnel’s assistance at the initiation of BF. Methods: The investigation was carried out at the IRSMN at the MF of VU and the NNC in 2006 – 2008. The survey included 50 women raising children aged 6–18 months, having completed a prenatal BF and LM course (“intervention group” IG) and 50 - raising children of the same age but having not completed such course (“control group” CG). The first part of the anonymous questionnaire was aimed at determining the practices of BF and initiating CF, the successful BF factors, the assessment of assistance in BF and trust in nurses in solving BF-related problems; the second - a test aimed at... [to full text]

Die Belastung des Energiestoffwechsels der Hochleistungskuh ist in der peripartalen Phase am größten. Die Regulation der Futteraufnahme und des Energiestoffwechsels durch den Nucleus arcuatus (ARC) des Hypothalamus spielt eine entscheidende Rolle während dieser Phase. Zahlreiche Metabolite und Hormone, wie z.B. das Peptidhormon Ghrelin, beeinflussen die Expression des orexigenen (futteraufnahmesteigernden) Neuropeptids Agouti-related Protein (AgRP) im ARC des Hypothalamus. Das Ziel dieser Arbeit war es, den Zusammenhang zwischen Körperfettmobilisierung und orexigenen Signalen im peripartalen Zeitraum der Hochleistungskuh näher zu untersuchen. Hierfür wurden 20 multipare Hochleistungskühe der Rasse Deutsch-Holstein (2.-4. Laktation) 7 Wochen ante partum (ap) bis 6 Wochen post partum (pp) untersucht. Die Tiere wurden in Anbindehaltung aufgestallt und entsprechend der jeweiligen Produktionsperiode bedarfsgerecht energetisch versorgt. Die ad libitum Futteraufnahme und Milchleistung wurden täglich gemessen und die Milchzusammensetzung wöchentlich analysiert. Das Körpergewicht und die Rückenfettdicke (RFD) wurden ebenfalls wöchentlich bestimmt. Einmal wöchentlich wurden Blutproben genommen, um die Konzentration von nicht-veresterten Fettsäuren (NEFA), Triglyceriden (TG) und Aminosäuren zu bestimmen. Eine Leberbiopsie wurde am 34. Tag ap und am 3., 18. und 30. Tag pp entnommen. In der 5. Woche ap und in der 2. Woche pp wurden die Tiere in eine Respirationskammer eingestallt und darin jeweils am 1. Tag ad libitum versorgt, während ihnen am 2. Tag das Futter für 10 h entzogen wurde. Die Futteraufnahme bzw. die kompensatorische Futteraufnahme nach Futterentzug wurden ebenfalls gemessen. Mit Hilfe der indirekten Kalorimetrie wurden der Sauerstoffverbrauch, die Bildung von Kohlenstoffdioxid und Methan gemessen, und der Respiratorische Quotient (RQ), die Fettoxidation (FOX) und die Kohlenhydratoxidation (KOX) berechnet. An beiden Tagen des Aufenthaltes in der Respirationskammer wurden stündlich Blutproben entnommen und die Konzentration von Acyl- und Gesamtghrelin, NEFA und TG bestimmt. Am 40. Tag pp wurden die Tiere geschlachtet und der ARC entnommen. In Studie 1 wurden 16 Tiere, basierend auf ihren Leberfettgehalt (LFC) am 18. Tag pp in eine Gruppe mit hohem LFC (H, n=8) und eine mit niedrigem LFC (L, n=8) eingeteilt. Für die Studie 2 wurden 18 Kühe entsprechend ihrer NEFA-Blutplasmakonzentration am Schlachttag in eine Gruppe mit hoher NEFA- (H, n=9) und eine mit niedriger NEFA-Plasmakonzentration (L, n=9) eingeteilt. In Studie 1 konnte gezeigt werden, dass die Acyl- und Gesamtghrelin- Plasmakonzentrationen nicht mit der pp Futteraufnahmesteigerung von Hochleistungskühen korrelierten. H-Kühe, die im Vergleich zu L-Kühen einen höheren Leber- und Milchfettgehalt, eine größere RFD und einen geringeren RQ aufwiesen, zeigten während des 10-stündigen Futterentzuges den größeren Anstieg der Acylghrelinkonzentration sowie ein größeres Acyl- und Gesamtghrelin-Verhältnis. Signifikante Korrelationen zwischen dem präprandialen Acyl:Gesamtghrelin- Verhältnis und zahlreichen Parametern des Fettstoffwechsels, wie bspw. LFC, Milchfettgehalt, RQ und RFD, lassen einen Zusammenhang zwischen Ghrelin, dem Fettstoffwechsel und der Fettverteilung erkennen. In Studie 2 konnte nachgewiesen werden, dass die in der Frühlaktation auftretende unterschiedliche Aktivierung hypothalamischer AgRP-Neurone von H- und L-Kühen nicht mit deren Futteraufnahme assoziiert ist. Die höhere NEFA-Plasmakonzentration, die höhere RFD, die höhere FOX und der höhere Sauerstoffverbrauch der H-Kühe waren jeweils signifikant mit der geringeren Aktivierung hypothalamischer AgRP-Neurone korreliert. Diese Korrelationen belegen einen Zusammenhang zwischen dem prozentualen Anteil aktivierter AgRP-Neurone und dem Sauerstoffverbrauch sowie der Substratverstoffwechselung während der Frühlaktation. Zusammenfassend lässt sich schlussfolgern, dass die untersuchten Signale des orexigenen Systems im peripartalen Zeitraum der Hochleistungskuh nicht mit der Futteraufnahme, jedoch mit dem Fett- und Energiestoffwechsel assoziiert waren. Ferner lassen die Resultate den Schluss zu, dass die Futteraufnahme bereits vor der Kalbung durch den Körperfettgehalt determiniert ist, und dass die Fettmobilisierung per se kaum einen Einfluss auf die Futteraufnahmesteigerung in der Frühlaktation besitzt.

Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro / O cálcio tem se mostrado útil na regulação do metabolismo energético, favorecendo a perda de peso. Visto que tanto o desmame precoce como a exposição materna à nicotina na lactação são fatores condicionantes para o desenvolvimento de obesidade, hiperleptinemia e resistência à insulina, além de outras alterações endócrinas na idade adulta, decidimos avaliar os possíveis efeitos da suplementação dietética com cálcio sobre as disfunções apresentadas pelos seguintes modelos experimentais: 1) Desmame precoce (DP): ratas lactantes foram envolvidas com atadura para interromper o acesso da prole ao leite nos 3 últimos dias da lactação. As proles das ratas controles tiveram livre acesso ao leite materno durante todo o período da lactação (21 dias). 2) Exposição materna à nicotina (N): Dois dias após o nascimento, ratas lactantes receberam implantes de minibombas osmóticas contendo solução de nicotina (6 mg/kg/dia, 14 dias) ou salina (C), nas mesmas condições. Aos 120 dias de idade, as proles de ambos os modelos de obesidade experimental receberam dieta padrão ou dieta suplementada com cálcio (10g de carbonato de cálcio/kg de ração). O sacrifício ocorreu aos 180 dias de idade. Os dados foram considerados significativos quando p<0,05. Corroborando dados anteriores do nosso grupo, as proles de ambos os modelos de programação (N e DP) apresentaram maior gordura corporal total e visceral, hiperleptinemia, resistência hipotalâmica a leptina e distúrbios na homeostase glicêmica. Além disto, verificamos que as proles N e DP também exibiram aumento dos níveis séricos de 25-hidroxivitamina D3. Todos essas alterações endócrino-metabólicas foram corrigidas pelo tratamento com suplementação com cálcio. Além disso, a prole DP aos 180 dias mostrou hiperfagia e hipertrigliceridemia, que também foram normalizados pela suplementação dietética com cálcio. A prole N apresentou hipotireoidismo, maior conteúdo de catecolaminas e maior expressão de tirosina hidroxilase (TH). A terapia com cálcio reverteu a disfunção adrenal, embora não tenha sido eficaz para normalizar a hipofunção tireoideana. Assim, a suplementação dietética com cálcio normalizou a maioria dos parâmetros da síndrome metabólica observadas nos dois modelos de plasticidade ontogenética. É possível que a redução da adiposidade central induzida pela terapia com cálcio, por si, tenha sido o principal mecanismo que resultou na melhora dos parâmetros estudados. Uma vez que a suplentação de cálcio reverteu as concentrações séricas de 25-hidroxivitamina D3 dos animais obesos, é possível que o efeito anti-obesidade do cálcio também ocorra via ação do calcitriol sobre o adipócito. / Calcium influences energy metabolism regulation and causes body weight loss. Since early weaning and maternal nicotine exposure during lactation programs for obesity, hyperleptinemia, insulin resistance and others endocrine dysfunctions, we studied the possible effect of dietary calcium supplementation on endocrine dysfunctions in these two experimental model of obesity: 1) Early Weaning (EW): lactating rats were involved with a bandage to interrupt the lactation during the last 3 days of standard lactation, and C (control) - dams whose pups had free access to milk during all lactation (21 days). 2) Maternal nicotine exposure (N): Two days after birth, it was implanted on the mothers, osmotic minipumps containing nicotine solution (6 mg/Kg/day, 14 days) or saline (C) in the same condition. At 120 days-old, all offspring received dietary calcium supplementation (10g of calcium carbonate/Kg of rat chow) or standard diet. Rats were killed at 180 days-old. Significant data were p<0.05. As expected, N and DP offspring showed higher visceral and total body fat mass, hyperleptinemia, hypothalamic leptin resistance and insulin resistance. In addition they presented higher serum 25-hydroxyvitamin D3. All these disturbances were corrected after calcium supplementation. Besides, adult EW offspring displayed hyperphagia and hypertriglyceridemia that was normalized with calcium therapy. Also, N offspring presented hypothyroidism, higher tyrosine hydroxylase expression and higher adrenal catecholamine content. Despite calcium treatment have normalized adrenal dysfunction, it did not reverse the hypothyroidism. So, dietary calcium supplementation seems to revert most of the metabolic syndrome parameters observed in our two developmental plasticity models. It is conceivable that the reduction in fat mass per se, induced by calcium therapy, is the main mechanism that improves all parameters. Because serum 25-hydroxyvitamin D3 levels were corrected by calcium supplementation in obese offspring, it is possible that the anti-obesity effect of calcium occurs through calcitriol action on the adipocyte.

A dieta hiperlipídica (high-fat, HF) materna durante a gestação e/ou lactação aumenta a susceptibilidade da prole para o desenvolvimento de doenças crônicas na fase adulta. Verificar a hipótese que a ingestão materna de dieta HF nos períodos críticos de desenvolvimento (gestação e/ou lactação) predispõe à doença não alcoólica do fígado gorduroso e alterações pancreáticas e no tecido adiposo de camundongos machos adultos. Camundongos C57BL/6 fêmeas receberam durante a gestação e/ou lactação dieta padrão (standard chow, SC) ou HF. Filhotes machos foram divididos em cinco grupos: SC provenientes de mães SC; G provenientes de mães HF durante a gestação; L provenientes de mães HF durante a lactação; GL/HF provenientes de mães HF durante a gestação/lactação, mantendo a mesma dieta HF no período pós-natal (do desmame aos 3 meses deidade); GL provenientes de mães HF durante a gestação/lactação trocando a dieta para SC no período pós-natal (do desmame aos 3 meses deidade). Foi analisada ao longo do experimento a massa corporal da prole. No sacrifício (3 meses), o fígado, o pâncreas e a gordura epididimária foram removidos, pesados e processados e o sangue foi coletado para análise bioquímica. Ao nascimento e ao desmame, filhotes GL/HF foram mais pesados (+6% e +44%, p<0,05, respectivamente) que os filhotes SC. Os filhotes G apresentaram resistência à insulina e menor expressão do transportador de glicose no fígado (GLUT-2). A esteatose hepática foi observada nos grupos G, L, GL e principalmente nos filhotes do grupo GL/HF. A expressão hepática da proteína ligante de elementos regulatórios de esteróis (SREBP-1c) estava aumentada nos filhotes G, GL e GL/HF. Os filhotes G, GL e GL/HF apresentaram hipertrofia da ilhota pancreática e dos adipócitos quando comparados com o grupo SC. O consumo de dieta HF durante a gestação mostra-se ser o período mais prejudicial para os filhotes adultos de camundongos. A programação metabólica por dieta HF leva ao remodelamento adverso do fígado, do pâncreas e do tecido adiposo / Maternal high-fat diet (HF) during gestation and/or lactation period increases the susceptibility to development of chronic disease in offspring adult life. This work aimed to verify the hypothesis that maternal intake of high-fat diet in critical periods of pregnancy and/or suckling period predisposes to non alcoholic fatty liver disease, pancreatic and adipose tissue alterations in adulthood mice offspring. C57BL/6 female mice were fed, during gestation and/or lactation phases, with standard chow (SC) or HF diet. Male pups were divided into 5 groups: SC- from SC fed dam; G- from HF fed dam during gestation period; L- from HF fed dam during lactation period; GL- from HF fed dam during gestation and lactation periods and GL/HF- from HF fed dam during gestation and lactation, maintaining HF diet from post-weaning to adulthood. We analyzed body mass in all experiment, and at the euthanasia (3 mo-old), liver, pancreas and adipose tissue were removed, weighted and embedded. Blood was collected to biochemical analyses. At birth and at weaning, GL/HF pups were heavier than SC pups (+6% and +44%, p<0.05, respectively). G offspring showed insulin resistance and lower glucose transporter-2 expression (GLUT-2). Hepatic steatosis was present in G, L, GL and mainly in GL/HF offspring. Sterol regulatory element-binding protein-1c (SREBP-1c) expression was higher in G, GL and GL/HF offspring. It is important to mention that pancreatic islet hypertrophy and adipocyte hypertrophy were affected in G, GL and GL/HF offspring in comparison to SC. HF diet administration during gestation period is worse than lactation period. Furthermore, this type of programming by HF predisposes to adverse remodeling in liver, pancreas and adipose tissue in adult mice offspring

Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro / O cálcio tem se mostrado útil na regulação do metabolismo energético, favorecendo a perda de peso. Visto que tanto o desmame precoce como a exposição materna à nicotina na lactação são fatores condicionantes para o desenvolvimento de obesidade, hiperleptinemia e resistência à insulina, além de outras alterações endócrinas na idade adulta, decidimos avaliar os possíveis efeitos da suplementação dietética com cálcio sobre as disfunções apresentadas pelos seguintes modelos experimentais: 1) Desmame precoce (DP): ratas lactantes foram envolvidas com atadura para interromper o acesso da prole ao leite nos 3 últimos dias da lactação. As proles das ratas controles tiveram livre acesso ao leite materno durante todo o período da lactação (21 dias). 2) Exposição materna à nicotina (N): Dois dias após o nascimento, ratas lactantes receberam implantes de minibombas osmóticas contendo solução de nicotina (6 mg/kg/dia, 14 dias) ou salina (C), nas mesmas condições. Aos 120 dias de idade, as proles de ambos os modelos de obesidade experimental receberam dieta padrão ou dieta suplementada com cálcio (10g de carbonato de cálcio/kg de ração). O sacrifício ocorreu aos 180 dias de idade. Os dados foram considerados significativos quando p<0,05. Corroborando dados anteriores do nosso grupo, as proles de ambos os modelos de programação (N e DP) apresentaram maior gordura corporal total e visceral, hiperleptinemia, resistência hipotalâmica a leptina e distúrbios na homeostase glicêmica. Além disto, verificamos que as proles N e DP também exibiram aumento dos níveis séricos de 25-hidroxivitamina D3. Todos essas alterações endócrino-metabólicas foram corrigidas pelo tratamento com suplementação com cálcio. Além disso, a prole DP aos 180 dias mostrou hiperfagia e hipertrigliceridemia, que também foram normalizados pela suplementação dietética com cálcio. A prole N apresentou hipotireoidismo, maior conteúdo de catecolaminas e maior expressão de tirosina hidroxilase (TH). A terapia com cálcio reverteu a disfunção adrenal, embora não tenha sido eficaz para normalizar a hipofunção tireoideana. Assim, a suplementação dietética com cálcio normalizou a maioria dos parâmetros da síndrome metabólica observadas nos dois modelos de plasticidade ontogenética. É possível que a redução da adiposidade central induzida pela terapia com cálcio, por si, tenha sido o principal mecanismo que resultou na melhora dos parâmetros estudados. Uma vez que a suplentação de cálcio reverteu as concentrações séricas de 25-hidroxivitamina D3 dos animais obesos, é possível que o efeito anti-obesidade do cálcio também ocorra via ação do calcitriol sobre o adipócito. / Calcium influences energy metabolism regulation and causes body weight loss. Since early weaning and maternal nicotine exposure during lactation programs for obesity, hyperleptinemia, insulin resistance and others endocrine dysfunctions, we studied the possible effect of dietary calcium supplementation on endocrine dysfunctions in these two experimental model of obesity: 1) Early Weaning (EW): lactating rats were involved with a bandage to interrupt the lactation during the last 3 days of standard lactation, and C (control) - dams whose pups had free access to milk during all lactation (21 days). 2) Maternal nicotine exposure (N): Two days after birth, it was implanted on the mothers, osmotic minipumps containing nicotine solution (6 mg/Kg/day, 14 days) or saline (C) in the same condition. At 120 days-old, all offspring received dietary calcium supplementation (10g of calcium carbonate/Kg of rat chow) or standard diet. Rats were killed at 180 days-old. Significant data were p<0.05. As expected, N and DP offspring showed higher visceral and total body fat mass, hyperleptinemia, hypothalamic leptin resistance and insulin resistance. In addition they presented higher serum 25-hydroxyvitamin D3. All these disturbances were corrected after calcium supplementation. Besides, adult EW offspring displayed hyperphagia and hypertriglyceridemia that was normalized with calcium therapy. Also, N offspring presented hypothyroidism, higher tyrosine hydroxylase expression and higher adrenal catecholamine content. Despite calcium treatment have normalized adrenal dysfunction, it did not reverse the hypothyroidism. So, dietary calcium supplementation seems to revert most of the metabolic syndrome parameters observed in our two developmental plasticity models. It is conceivable that the reduction in fat mass per se, induced by calcium therapy, is the main mechanism that improves all parameters. Because serum 25-hydroxyvitamin D3 levels were corrected by calcium supplementation in obese offspring, it is possible that the anti-obesity effect of calcium occurs through calcitriol action on the adipocyte.