Partindo de hipóteses básicas onde o processo saúde-doença no período perinatal apresenta-se, por um lado, como expressão de condições particulares ás quais famílias estão submetidas, de maneira diferencial, em função de sua adscrição de classe e, por outro, como expressão da articulação de um conjunto de condições biológicas e sociais em permanente relação, o presente trabalho procura, em uma amostra de parturientes e recém-nascidos de hospitais de São Luis do Maranhão, refletir sobre o assunto. Conclui pela pertinência do emprego do conceito sociológico de classe social ao estudo de eventos perinatais que, articulado a esquemas teóricos mais elaborados do campo da Perinatologia, permite ampliar o nível de explicação do fenômeno. / This work searches for empirical sustenance concerning reflection on basic hypotheses whereby the health dickness process in the perinatal periode expresses particular conditions which families are undergoing especially as to their insertion in social classes, on one hand, and especially on the other, articulation of biological and social conditions in permanent relation. It is based on a sample of women-in-labour and newborn children in hospitals in São Luis do Maranhão, Brazil. It is concluded that Sociological concept of social class is pertinent whilst studying perinatal events along with more elaborate theoretical schemes in the field of Perinatology.

Partindo de hipóteses básicas onde o processo saúde-doença no período perinatal apresenta-se, por um lado, como expressão de condições particulares ás quais famílias estão submetidas, de maneira diferencial, em função de sua adscrição de classe e, por outro, como expressão da articulação de um conjunto de condições biológicas e sociais em permanente relação, o presente trabalho procura, em uma amostra de parturientes e recém-nascidos de hospitais de São Luis do Maranhão, refletir sobre o assunto. Conclui pela pertinência do emprego do conceito sociológico de classe social ao estudo de eventos perinatais que, articulado a esquemas teóricos mais elaborados do campo da Perinatologia, permite ampliar o nível de explicação do fenômeno. / This work searches for empirical sustenance concerning reflection on basic hypotheses whereby the health dickness process in the perinatal periode expresses particular conditions which families are undergoing especially as to their insertion in social classes, on one hand, and especially on the other, articulation of biological and social conditions in permanent relation. It is based on a sample of women-in-labour and newborn children in hospitals in São Luis do Maranhão, Brazil. It is concluded that Sociological concept of social class is pertinent whilst studying perinatal events along with more elaborate theoretical schemes in the field of Perinatology.

A community-based randomised controlled trial was conducted in the district Larkana of Sindh province of Pakistan. The new model was based on reorganising the existing maternal health services. Three sub-districts were randomly assigned to the intervention group and four to the control group. The intervention consisted of integrating traditional birth attendants with the health care system, the use of safe delivery packs and the provision of antenatal care by doctors. Over one year 19,525 women were recruited and followed up. The proportion of referrals was higher in the intervention group (10.0 Vs 6.9 %; odds ratio 1.50 [95% Cl 1.26-1.74]). Significant differences were also found in some pregnancy complications including haemorrhage, obstructed labour and puerperal sepsis. Perinatal mortality in the intervention group was 83, compared to 118 per 1000 births for the control group, odds ratio 0.69 (95% Cl 0.53-0.85)(P<O.OOI). Maternal mortality ratio was also lower in the intervention group (303 Vs 439 per 100,000 live births), but this reduction did not achieve statistical significance (odds ratio 0.74,95% C I 0.23-1.24). Implementation of such a model could significantly improve the effectiveness of maternal health services in rural settings in Pakistan.

Chronic inflammatory and neuropathic pain states are poorly understood, and currently inadequately treated. Clinically, the symptoms of such pain states include allodynia (interpretation of innocuous stimuli as noxious), hyperalgesia (increased sensitivity to noxious stimuli) and spontaneous (non-evoked) pain. Additionally, chronic pain states are often associated with affective disorders such as anxiety and depression which can further reduce the individual’s quality of life. It is highly likely that neuropathic pain could occur in combination with chronic inflammation, for example as a result of post-surgical infection. When such injuries occur in early life, during the continuing development of the nervous system, it is possible that longterm adverse changes in sensory processing may occur. To investigate this, we have developed a rodent model of chronic pain with both a neuropathic and inflammatory component, designed to investigate the consequence of these to injuries coinciding. Furthermore, we are also investigating the effect of gestational stress, which has been shown to alter the stress responsiveness of the offspring and may also affect pain processing. To study the effect that prenatal stress may have on pain processing, we have utilised the rodent resident/intruder paradigm as a model of social stress to determine the outcomes of the combination of these adverse perinatal events. We find that a combined inflammatory and neuropathic injury in the adult rat increases sensitivity to both mechanical and thermal stimuli and also increases spontaneous pain, when compared to inflammation or nerve injury alone. We show that neuropathic pain can be induced in neonatal (P8) rats; however there is little response to inflammation at P8 and a combination of these two injuries does not have the additive effect on sensitivity that occurs in the adult. Upon recovery from neonatal nerve injury, we find that a subsequent noxious challenge (formalin) alters nocifensive behaviour, when compared to the formalin response of naïve (no prior injury) animals, indicating long-lasting changes to nociceptive processing. Interestingly, when nerve injury is carried out in adult animals, nocifensive behaviour in response to formalin is not altered compared to naïve controls. Calcium entry through the NMDA receptor and subsequent CaM Kinase IIα activation has been implicated as a crucial factor in long term potentiation (LTP) and the maintenance of sensitised states. In adult models of chronic pain, which may involve LTP mechanisms, we have shown an increased association of CaM Kinase IIα with NR2A/B spinal immunoprecipitates ipsilateral to injury. Furthermore, a different mechanism may be involved in neonatal pain states, as we have shown that spinal CaM Kinase IIα expression increases with development and is present at very low levels at the time of surgery in our pain models. Additionally, a number of other proteins associated with the NMDA receptor complex are developmentally regulated, and their involvement in the initiation and maintenance of chronic pain is likely to differ between the adult and the neonate. We further show that exposure to prenatal stress does not alter the thresholds to mechanical stimuli in adult or early life pain models, however the combination of prenatal stress and postnatal injury results in an enhanced response to formalin in later life, indicating that programming of stress and/or pain pathways has occurred as a result of these early life events. In addition to the development of a novel model of chronic pain, this study highlights the long-term impact that adverse perinatal events can have on offspring.

No description available.

No description available.

Health disparity research indicates that health illiteracy is associated with poorer health outcomes, greater risk of hospitalization, higher emergency room utilization, and increased death (Collins, Currie, Bakken, Vawdrey & Stone, 2012; Skopelja, Whipple & Richwine, 2013). Health information is increasingly being transitioned to online formats and according to Usher and Skinner (2010) the newest challenge that healthcare consumers face in taking control of their health is their ability to access, evaluate and incorporate the large amount of health information available on the Internet. Achieving a better understanding of the eHealth literacy levels of Aboriginal women and how they use technology to access health information may support better health outcomes in a variety of settings including the perinatal period which is important not only for the mother’s health, but her child’s as well. This mixed methods study explored the eHealth literacy knowledge, attitudes and skills of urban Aboriginal women in the perinatal period residing in a small city in British Columbia. A convergent parallel design was used to collect both qualitative and quantitative data from five study participants. Due to the small sample size study findings need to be interpreted with caution. The results may demonstrate that urban Aboriginal women in the perinatal period are comfortable and competent in accessing health information on the Internet. They identified the following as areas for improvement: (1) identifying if the information they retrieve is credible, (2) improving the cultural appropriateness of health information and websites, (3) improving access through continuing to build technology and search skills for Aboriginal women, and (4) supporting better access to the Internet and technology equipment for those Aboriginal women still affected by the digital divide. / Graduate

En el presente trabajo, se estudiaron 160 pacientes, con Diagnóstico de Preeclampsia leve y severa, igualmente se estudiaron a los recién nacidos de las madres con Preeclampsia en el Hospital Nacional Sergio E. Bernales - Collique, Lima Enero-Diciembre 2005. El Objetivo del presente estudio, fue determinar la morbimortalidad materno perinatal y los factores asociados a la Preeclampsia en las gestantes atendidas en el año 2005. El método utilizado, fue el Descriptivo Transversal Retrospectivo, cuya población de estudio fueron las gestantes que culminaron en parto con diagnóstico de Preeclampsia, con la técnica de Revisión de historias clínicas maternas y neonatales, reportes operatorios y los carné de controles prenatales. En el presente estudio se observo lo siguiente: de 160 gestantes atendidas con diagnostico de Preeclampsia, 83 (51.9%) fueron de grado severo, el rango de edades de las gestantes se encontró entre los 19 – 35 años, un 13.1% se encontraban dentro de la categoría de Obesidad según el IMC al inicio de la gestación, 81 pacientes eran nulíparas; 45 de ellas ( 55.6%) presentaban preeclampsia severa, además 86 pacientes ( 53.75%) se encontraban con una edad gestacional entre las 28 – 37 semanas ( pre-término) y 115 pacientes (71.9%) culminaron el parto por cesárea. Dentro de las patologías maternas que se observaron en las gestantes preeclámpticas con mas frecuencia en forma descendente tenemos la hemorragia post – parto (21.9%); desprendimiento prematuro de placenta (13.8%), hemorragia del 2do o 3er trimestre (5.6%) y un 10.6% presentaron otras patologías menos frecuentes entre ellas están la Endometritis y la ITU. Además 5 gestantes (3.1%) llegaron a presentar Eclampsia. Ninguna gestante falleció a causa de la preeclampsia. Todos estos resultados si tuvieron significancia estadística ( X = 0.05). Dentro de las patologías neonatales asociadas mas frecuentemente con preeclampsia tenemos: La ictericia neonatal (51.3%) la Asfixia Neonatal (29.3%), la hipoglicemia (17.5%), BPN (14.4%) y la sepsis (11.9%) y solo el 3.1% de los recién nacidos de madres preeclámpticas fallecieron.

Perinatal drug abuse is becoming a profound issue facing the health and wellbeing of neonates. The community serviced by the project site, which lies within the boundaries of an Indian Reservation, suffers from perinatal drug abuse at a higher rate than state and federal averages. The purpose of this project was to provide the project site with a policy to consistently screen for perinatal drug abuse. Lave's theory of situational learning and the Sanford Way model for quality improvement framed this project. To guide policy development, data were compiled through a systematic review of current literature, national and state guidelines, state law, local tribal government, and community stakeholders. Data included: (a) studies completed in the past 10 years specifically targeting drug abuse in child-bearing aged women, with intentional exclusion of tobacco and alcohol studies; (b) prevalence of illicit drug abuse in child bearing aged women at a local, state, and national levels; and (c) local, state, and national guidelines, as well as state law, for perinatal drug abuse intervention and screening. In addition, interviews and meetings with local stakeholders were completed and their feedback was incorporated into the development of the perinatal drug abuse screening and intervention policy. To evaluate policy effectiveness, it is proposed that perinatal drug screens ordered at the project site be monitored for six months prior to and after implementation of the new policy. The desired outcome will be that providers consistently intervene with perinatal drug abuse in a non-biased fashion. This quality improvement project will create a positive social change by allowing non-biased intervention with perinatal drug abuse using evidence-based practice and by promoting nursing-driven policy development.

Rationale: The rate of acquisition of drug self-administration may serve as a predictor of later drug-taking behavior, possibly influencing vulnerability to initiate drug use. Objectives: The present study examined the effects of perinatal (gestation/lactation) lead exposure on adult rates of acquisition of intravenous (i.v.) heroin self-administration and cocaine self-administration using an automated procedure that included both Pavlovian and operant components. Methods: For Experiment 1, female rats were gavaged daily with 0 or 16 mg lead for 30 days prior to breeding with nonexposed males. Metal administration continued through pregnancy and lactation and was discontinued at weaning (postnatal day [PND] 21). Animals born to control or lead-exposed dams received indwelling jugular catheters as adults and subsequently were tested daily in a preparation where sessions included an initial 3-hr autoshaping period followed by a 3- hr self-administration period. During autoshaping, heroin (.018 mg/kg) infusions were paired with the extension and retraction of a lever when a lever press was not made for 15 sec, while infusions occurred during self-administration only when a lever press was executed (FR-1). The criterion for acquisition was a 2-day period during which a mean of 10 infusions/session occurred during self-administration. Animals were given 35 days to reach criterion. Results: Findings from Experiment 1 showed the proportion of rats meeting the lever-press response criterion for heroin when tested as adults was lower among lead-exposed animals. In Experiment 2, cocaine (.20 mg/kg) was presented to animals that underwent the same metal-exposure regimen, surgical procedures and methods with variations only in the number of infusions that were automatically administered during the Pavlovian component. Criterion for cocaine acquisition was a mean of 50 infusions over a two-day. In Experiment 2, a greater proportion of leadexposed animals reached the criterion for cocaine acquisition. Conclusions: Developmentally lead-exposed animals showed a decrease in vulnerability to initiate drug-taking behavior when presented with heroin in the adult phase, relative to controls. In contrast, developmentally lead-exposed animals showed an enhanced vulnerability to reach the criterion for cocaine self-administration. Clinical relevance of developmental exposure to lead and the attendant vulnerability to self-administer drugs of abuse is discussed.