Thesis (Ph.D. (Public Health)) -- University of Limpopo, 2022 / There has a significant rise in the number of HIV-infected adolescents who were missed as children and are diagnosed with perinatally acquired HIV as teenagers. In 2013, perinatally acquired HIV was estimated at around 10 000 infections globally, a figure which ballooned to38 000 by 2017. Adolescents living with perinatal HIV experience emotional upheaval as a result of their positive HIV diagnosis, which is exacerbated by real or perceived negative effects on their relationships, career, and family aspirations. They face the same challenges as other adolescents, along with the added complexity of personal decisions relating to their sexual conduct having a direct impact on the global cause to eradicate HIV/AIDS. An extensive body of literature indicates a need for emotional and psychosocial support as existing management focuses mainly on the physical aspects of infection and treatment. Aim of the study The aim of the study was to explore the challenges faced by adolescents living with perinatal HIV infection and to evaluate the designed user-friendly support programme in response to formative findings of the research in selected clinics and community health centres in the Vhembe District of the Limpopo Province in South Africa. Methodology A mixed-methods sequential exploratory design was employed to fulfil the purpose of the study. Data was collected in two phases. In qualitative phase- a total of 21 participants were interviewed using a semi-structured interview guide. The sample was purposefully selected from adolescents living with HIV/AIDS. In quantitative phase a total of 213 people participated in data collection using a questionnaire. Thematic approach was used to analyse qualitative data using Tesch’s eight steps of qualitative data analysis. Quantitative data was analysed using SPSS version 25. Descriptive statistics was used to explain and summarize data. Fischer’s test was done to establish significance of association between alcohol used, condom use and between age and gender. The results The results revealed that adolescents with perinatally acquired HIV face more challenges. They had psychosocial, emotional and economic challenges more than their peers. The current HIV/AIDS management and care has not yet recognised the specific needs these adolescents have related to their care. They have been incorporated into the general adulthood HIV/AIDS making their transition from childhood adolescence difficult. Suggestions for a mentor, and ARV modification were made and a need for a support programme emerged as one of the major themes

Introduction. Après 40 ans de recherche, l’éradication de la pandémie mondiale à VIH n’est pas encore à notre portée. Si le Canada a connu une raréfaction des cas de transmissions verticales, en 2019 on compte plus de 1,8 million d’enfants infectés par le VIH. Durant l’infection à VIH, la thérapie antirétrovirale (TAR) et les réponses immunitaires à médiation cellulaire, y compris celles véhiculées par les lymphocytes T cytotoxiques CD8+ (CTL), jouent aussi un rôle important dans la limitation de la réplication virale. L’atteinte et le maintien d’une suppression virale soutenue (SVS) sous l’effet de la TAR sont associés à une limitation de taille du réservoir cellulaire du VIH pédiatrique. Si l’on possède beaucoup d’informations sur le développement et l’évolution des réponses immunitaires à médiation cellulaire dirigées contre le VIH chez l’adulte, ce n’est pas le cas au niveau pédiatrique. Cette thèse avait pour but de caractériser la complexité phénotypique et fonctionnelle de la réponse antivirale des cellules CD8+ chez les enfants et les adolescents infectés par le VIH-1. Objectifs : Caractériser les réponses anti-VIH-1 à médiation cellulaire chez les enfants et les adolescents infectés. Mesurer la réponse immunitaire dirigée spécifiquement contre la protéine Gag du VIH-1. Nous avons aussi étudié l’expression des marqueurs d’épuisement des cellules T chez l’enfant et l’adolescent infectés verticalement, ainsi que le transcriptome des cellules T CD8+ effectrices mémoires. Résultats : Les enfants et les adolescents sont capables de développer des réponses à médiation cellulaire dirigées spécifiquement contre le VIH-1, et cela malgré une longue période sous TAR. Les réponses observées sont influencées par l’âge et la proportion de vie cumulative sous SVS (cPLUS). Les réponses IFN- spécifiques au VIH sont augmentées avec l'âge en termes d'amplitude et de spectre de reconnaissance antigénique et sont diminuée avec une cPLUS plus faible, ce qui pourrait refléter une exposition moindre aux antigènes du VIH. Les mécanismes de l'expansion quantitative des réponses des lymphocytes T sont différents de ceux qui conduisent à l'élargissement du spectre de reconnaissance des antigènes viraux par les lymphocytes T de l’hôte. L’âge et la cPLUS exerçaient une influence sur l’expression des récepteurs inhibiteurs, ce qui pourrait contribuer à la difficulté d’atteindre et de maintenir une SVS ainsi que la progression plus rapide de l’infection chez les enfants vivant avec le VIH. Comparativement aux lymphocytes T CD4+, des fréquences plus élevées de lymphocytes T CD8+ exprimaient des récepteurs inhibiteurs et exprimaient un plus grand nombre de récepteurs différents. Cette tendance était influencée par l'âge. Cela indique que les lymphocytes T CD8+ sont plus épuisés que les lymphocytes T CD4+, ce qui pourrait contribuer à la persistance du VIH de l'enfance à l'âge adulte sous TAR. Cependant, les corrélations des fréquences de cellules exprimant des récepteurs inhibiteurs avec l'ampleur des réponses immunitaires à médiation cellulaire spécifiques au VIH suggèrent fortement que ces cellules n'étaient pas fonctionnellement épuisées. L’âge et la cPLUS exerçaient une influence déterminante sur l’expression de certains gènes. L’exploitation de technologies récentes pour l’étude du transcriptome des cellules T CD8+ mémoires au niveau unicellulaire nous ont permis d’obtenir une grande quantité de données à partir qu’un faible échantillon de cellules. Les participants avec une longue cPLUS avaient une fréquence plus grande de cellules exprimant CD69 et exprimant des gènes stimulés par l'interféron (ISG). Cependant, chez ces patients, on observait également une expression moindre des gènes associés à l’épuisement. Conclusion. Nous avons apporté des réponses quant aux mécanismes de la réponse immunitaire pédiatrique, mais aussi d’identifier les facteurs qui peuvent l’influencer. Cependant, l’écriture de la thèse a révélé une carence importante dans la compréhension des mécanismes de l’immunité au niveau pédiatrique au niveau de la littérature. Pour dépasser les limites des études pédiatriques, il existe un besoin constant de mettre en place des techniques de suivi immunitaire réalisables sur de petits échantillons biologiques. / Introduction. After 40 years of research, the eradication of the global HIV pandemic is not yet within our reach. While Canada has experienced a decline in cases of vertical transmission, in 2019 there were more than 1.8 million children infected with HIV. During HIV infection, antiretroviral therapy (ART) and cell-mediated immune responses, including those mediated by CD8+ cytotoxic T lymphocytes (CTL), also play an important role in limiting viral replication. The achievement and maintenance of sustained viral suppression (SVS) under the effect of ART are associated with a limitation in the size of the cellular reservoir of HIV at the pediatric level. While there is a lot of information on the development and evolution of cell-mediated immune responses against HIV, this is not the case at the pediatric level. This thesis aimed to characterize the phenotypic and functional complexity of the antiviral response of CD8+ cells in children and adolescents infected with HIV-1. Objectives: To characterize cell-mediated anti-HIV-1 responses in infected children and adolescents. To measure the immune response directed specifically against the Gag protein of HIV-1. To study the expression of T cell exhaustion markers in vertically infected children and adolescents, as well as the transcriptome of effector memory CD8+ T cells. Results: Children and adolescents are able to develop cell-mediated responses specifically directed against HIV, despite SVS under ART. The immune responses observed are influenced by age and the proportion of cumulative life on SVS (cPLUS). HIV-specific IFN- responses are increased with age in terms of amplitude and antigen recognition spectrum and are decreased with lower cPLUS, which may reflect shorter exposure to HIV antigens. Two distinct mechanisms of T cell responses were observed. On one hand quantitative expansion of T cell responses and on the other hand the broadening of the T cells spectrum of viral antigens recognition. Age and cPLUS exerted an influence on the expression of inhibitory receptors, which could contribute to the difficulty of achieving and maintaining SVS as well as the more rapid progression of infection in children living with HIV. Compared to CD4+ T cells, higher frequencies of CD8+ T cells expressed inhibitory receptors and expressed more different type of receptors. This trend was influenced by age. This indicates that CD8+ T cells are more depleted than CD4+ T cells, which may contribute to the persistence of HIV from childhood to adulthood on ART. However, correlations of frequencies of cells expressing inhibitory receptors with the magnitude of HIV-specific cell-mediated immune responses strongly suggest that these cells were not functionally exhausted but rather recently activated. Age and cPLUS exerted a determining influence on the expression of certain genes. The exploitation of recent technologies for the study of the transcriptome of memory CD8+ T cells at the single-cell level has enabled us to obtain a large amount of data from only a small biological sample. Participants with long cPLUS had a higher frequency of cells expressing CD69 and ISGs. However, in these patients, there was also a lower expression of genes associated with exhaustion. Conclusion. We have provided answers as to the mechanisms of the pediatric immune response but also identify the factors that can influence it. However, the writing of the thesis revealed an important deficiency in the understanding of the immunity mechanisms at the pediatric level in current literature. To overcome limits in pediatric studies, there is a constant need to set up immune monitoring techniques that can be performed on small biological samples Keywords: HIV, perinatal infection, inhibitory receptors, immune response, sustained viral suppression.

Substance use disorders (SUDs) among pregnant and perinatal women continue to be a national public health crisis. Furthermore, nursing students and perinatal nurses have historically negative and punitive attitudes toward this vulnerable population of women. As nurses are primary care providers for pregnant and perinatal women, this is troublesome as perinatal patients express feeling stigmatized by nurses whom they should be able to trust. This contributes to the reluctance of women to seek needed medical and prenatal care. Tennessee was the first state to criminalize drug use in pregnancy and has higher neonatal abstinence syndrome (NAS) rates, which were more than 2 times the national average in 2017. The purpose of this descriptive cross-sectional non-experimental study was to examine how formal SUD nursing education, personal experiences, and participant characteristics predict attitudes and knowledge of nursing students and practicing perinatal nurses in Tennessee toward pregnant and perinatal women with an SUD. The sample consisted of 262 nursing students and 99 perinatal nurses across the west, middle, and eastern regions of Tennessee. A linear multiple regression showed that having a personal experience with a close friend with an SUD was predictive of improved knowledge scores of pregnant and perinatal SUDs. Independent samples t-tests were non-significant between formal SUD nursing education and attitudes and knowledge. Additionally, non-significant findings were seen between having a personal experience with a family member with an SUD and attitudes and knowledge. The findings suggest that Tennessee nursing education efforts were not influential in positively affecting attitudes and knowledge scores toward pregnant and perinatal women with an SUD. Future studies focused on exploring various educational interventions to promote knowledge, improve attitudes, and empathy in nursing populations toward pregnant and perinatal women with an SUD are warranted.

Перинатальный артериальный ишемический инсульт - это цереброваскулярное заболевание, возникающее между 20-й неделей беременности и 28-м послеродовым днем, вызывающее двигательный и немоторный дефицит, причем церебральный паралич является частым исходом. Молодой мозг реагирует, реорганизуя свои поврежденные сети в ипсилезионное и/или контральезионное полушария, причем последнее больше связано с двигательными нарушениями. Префронтальная кора считается одной из наиболее уязвимых областей с когнитивным дефицитом, возникающим с задержкой, из-за ее длительного развития, достигающего своего пика синаптогенеза после первого послеродового года, в то время как другие области, такие как первичная кора, обычно проходят свою основную фазу синаптогенеза в течение первого послеродового семестра. Таким образом, раннее обнаружение низкого синаптогенеза может быть ранним признаком настоящего или предстоящего дефицита и привести к раннему вмешательству. Бета-диапазон недавно был предложен в качестве возможного биомаркера синаптогенеза, причем активность ГАМК связана с нейропластичностью и синаптогенезом. Основной целью настоящего исследования является установление роли абсолютной бета-1 мощности в синаптогенезе и исследование уязвимости префронтальной коры головного мозга. Были набраны сорок типичных детей и 10 детей с перинатальным артериальным ишемическим инсультом в их подкорковой средней мозговой артерии и были созданы 3 возрастные подгруппы: 5-месячная, 10-месячная и 24-месячная подгруппы. Запись ЭЭГ и тест Бейли-III использовались для измерения их фоновой активности и уровня развития. Хотя статистический анализ с помощью непараметрических инструментов (U-тест Манна-Уитни, тест Крускалла Уоллиса) не показал решающих результатов, потенциальная связь бета-диапазона с синаптогенезом может быть обнаружена при наблюдении низкой мощности бета-1 в моторных и когнитивных областях мозга и низкой моторной и когнитивной производительности, а также при обнаружении заднего или переднего созревания. Кроме того, ранняя уязвимость префронтальной коры может быть обнаружена в снижении двусторонней бета-1 мощности у 24-месячных детей с перинатальным инсультом, по сравнению с типичными детьми и более ранними односторонними различиями, наряду с некоторыми когнитивными дефицитами, которые начинают проявляться в той же группе. / Perinatal Arterial Ischemic Stroke is a cerebrovascular disease occurring between the 20th gestational week and the 28th postnatal day, causing motor and non-motor deficits with cerebral palsy being a frequent outcome. The young brain reacts by reorganizing its injured networks to ipsilesional and/or contralesional hemisphere with the latter relating more to motor impairment. The Prefrontal Cortex is considered one of the most vulnerable areas with cognitive deficits emerging with a delay, due to its lengthy development reaching its synaptogenesis peak after the first postnatal year, while other areas, such as the Primary Cortices undergo generally their major synaptogenesis phase during the first postnatal semester. So early detection of low synaptogenesis could be an early mark of present or upcoming deficits and lead to an early intervention. Beta band has been recently suggested as a possible biomarker of synaptogenesis with GABA’s activity being connected with neuroplasticity and synaptogenesis. The main goal of the current study is to establish the role of of the absolute beta-1 power to synaptogenesis and the investigate the vulnerability of the Prefrontal Cortex. Fourty typical children and 10 children with Perinatal Arterial Ischemic Stroke in their subcortical Middle Cerebral Artery were recruited and were created 3 age subgroups; 5month, 10month and 24month subgroup. EEG recording and Bayley-III test were used to measure their background activity and developmental level. Although the statistical analysis via non-parametric tools (Mann-Whitney U-test, Kruskall Wallis test) didn’t show decisive results, a potential connection of beta-band with synaptogenesis could be detected when observing low beta-1 power in motor and cognitive brain areas and low motor and cognitive performance and also by detecting a posterior to anterior maturation. Moreover the early vulnerability of Prefrontal Cortex may be found in the decreased bilateral beta-1 power in the 24month children with perinatal stroke, when compared with the typical children and the earlier unilateral differences, along with some cognitive deficits which begin to emerge in the same group.

No description available.

Obsessive-compulsive disorder (OCD) is heterogeneous. Clinical presentation of OCD differs by sex and age-of-onset and evidence supports classification based on these subtypes. The prevalence of OCD in the general population is 2%. However, it has been established that women tend to experience onset and exacerbation of OCD during reproductive milestones. In particular, the prevalence of postpartum OCD is between 4 to 9%. This study seeks to examine the effects of past childhood maltreatment and S/Lg-allele status of the 5-HTTLPR polymorphism on perinatal obsessive-compulsive symptoms and aberrant resting state functional connectivity in the postpartum period. Forty women participated in the first visit and sixteen women have been followed up with in the postpartum period. 5-HTTLPR genotype was determined from whole blood samples via polymerase chain reaction and a restriction fragment length digest. We used the Yale-Brown Obsessive-Compulsive Scale and Perinatal Obsessive-Compulsive scale to measure symptom severity. Resting state functional connectivity was determined from functional magnetic resonance imaging data. Obsessive-compulsive symptoms during late pregnancy are significantly predicted by 5-HTTLPR genotype, past history of total childhood maltreatment or childhood emotional neglect and trait anxiety symptoms. Whereas obsessive-compulsive symptoms during the postpartum period are predicted by poor sleep quality and childhood emotional maltreatment or 5-HTTLPR genotype, childhood emotional maltreatment and trait anxiety symptoms. Seed to region-of-interest analysis was employed to evaluate resting state functional connectivity differences between OCD patients and healthy controls in the postpartum period. Compared to healthy controls, OCD patients show greater connectivity between the caudate nucleus with the orbitofrontal cortex, the pars triangularis and the cingulate area. The insular cortex shows decreased connectivity between the right and left, the dorsal anterior cingulate area and the pars opercularis. The amygdala has increased connectivity with the cingulate area, the calcarine fissure, the supramarginal gyrus and decreased connectivity with the gyrus rectus. The above clinical and neuroimaging findings are in line with past work. However, this is the first study to show both 5-HTTLPR genotype and history of childhood maltreatment predict obsessive-compulsive symptoms in a perinatal population. Further, the resting state data replicates findings in the OCD literature but the study is the first to show this in postpartum women. This study serves as a platform for future work to further investigate both gene-environment interactions and distinct neuroimaging correlates in perinatal OCD. / Thesis / Master of Science (MSc)

Background: Intimate partner violence (IPV) is not only considered a serious public health issue and a cause of human suffering (National Center for Injury Prevention of the Centers for Disease Control and Prevention, 2015), IPV can be a barrier to utilization of care in vital life phases (Bonomi et al, 2009; Snow Jones, Dienemann, & Schollenberger, 2006), and a determinant of many serious negative health outcomes for affected individuals and their families (Silverman et al, 2020). As a significant contributor to health, social, and economic disparities, violence jeopardizes the fabric of families and transcends all levels of socioeconomic status (Rhodes, 2012). Among those who suffer serious to fatal consequences as a direct result of IPV, the perinatal period has only recently received special attention in research and is extremely scarce (WHO, 2011). This is particularly the case as the exposure/context of IPV may be further complicated by societal crises such as natural disasters and pandemics, where the threat of violence and its health consequences may be heightened (Yehuda et al, 2008). Objectives: The objectives of this dissertation were to address the knowledge gaps pertaining to perinatal IPV and violence experiences during the COVID-19 pandemic. It had three specialist articles, two of which were reviews of the literature, and one was a population-based empirical study. The objectives of the dissertation were as follows: 1) To explore uni- and bi-directional IPV prevalence estimates and associated factors during the perinatal period (Paper I) (Mojahed et al, 2021a); 2) To investigate a broader range of pre- pandemic contexts of social and geographical isolation and their associations with IPV, as well as to provide reliable, preliminary knowledge of their potential impact during the COVID- 19 pandemic (Paper II) (Mojahed et al, 2021b; 3) To explore the 12-month prevalence of psychological, physical, and sexual IPV within an existing cohort, which consists of women and men, as well as to detect any possible changes during the COVID-19 pandemic in the experienced IPV behaviors as opposed to pre-pandemic times (Paper III) (Mojahed et al, 2023); 4) To explore factors that could prospectively predict IPV victimization (Paper III). Materials and Methods: Paper I involved a qualitative synthesis of the literature. Due to the heterogeneity of prevalence studies and varying violence definitions, quantitative analyses were not feasible for this review. The paper investigated prevalence estimates of perinatal IPV among intimate partners and explored associated factors. Information such as author, year of publication, recruitment setting, study design, sample size, directionality of IPV, prevalence estimates, and types of violence were extracted and tabulated. The integrative ecological model was used to consider population characteristics and (gender-based) associated factors relevant to IPV prevalence. Paper II was a rapid review conducted following Cochrane guidelines to address the urgency of studying IPV in the context of the COVID-19 pandemic. The review focused on the correlation between social and geographical isolation and IPV. Paper III utilized data from the population-based longitudinal study DREAMCORONA. Descriptive analyses were performed to determine the prevalence of IPV victimization among women and men, examining changes during the pandemic. Pearson correlation analyses and multiple logistic regression analysis were conducted to identify associations and potential predictors of IPV. The results were presented as odds ratios with confidence intervals. Results: In Paper I, several key findings were reported. Psychological uni-directional IPV against female partners was most prevalent during pregnancy. Studies comparing IPV prevalence before and after childbirth showed mixed results, with some reporting a decrease and others reporting an increase in IPV after birth. Risk factors at the individual, family, community, and societal levels were identified, including socioeconomic status, substance use, insufficient prenatal care utilization, low self-esteem, unplanned pregnancy, lack of support, and certain social and ethnic identities. Paper II found that lack of social support increased the risk of IPV victimization, and the compounding effect of social and geographical isolation heightened this risk. It also revealed that social isolation correlated with physical and sexual IPV among female drug users and predicted various forms of IPV among immigrant women. In Paper III, it was found that around 50% of women and 40% of men experienced some form of IPV in the last 12 months. Psychological aggression was the most prevalent form of violence reported. The majority of women and men reported no change in victimization by psychological and physical violence during the pandemic. On the other hand, about a quarter of (expectant) mothers (27%) and fathers (22-24%) reported an increase in psychological and physical IPV. With regard to sexual violence, neither mothers nor fathers reported any changes during the pandemic. Higher partnership satisfaction reduced the likelihood of IPV victimization, while symptoms of anger-hostility increased this probability. Conclusions: Considering the burden of perinatal IPV and the impact of the COVID-19 pandemic on IPV, this dissertation highlights the urgent need for effective preventive interventions. The findings suggest the importance of initiating antenatal care and delivering in clinical settings, as these factors were associated with a lower risk of perinatal IPV. Routine screening for IPV in obstetric care is crucial, and healthcare providers should be aware of the elevated risk for mental health distress among perinatal partners exposed to IPV. As experiences of IPV remained largely unchanged during the pandemic, there is a strong recommendation to strengthen and improve access to support services. Alternative support measures such as messenger services and telemedicine should be accessible and reliable for victims of severe IPV who may face increased isolation. Raising awareness about IPV is essential for individuals in informal and formal sectors, as well as family and friends within the immediate social network of those at risk. The findings also support the use of programs targeting adverse interaction patterns, particularly psychological aggression. Future research should focus on associated factors of IPV during the peripartum period and other critical life phases or societal events. It is crucial to adopt ecological and intersectional perspectives to gain a comprehensive understanding of IPV. Furthermore, including the perspective of the other partner in IPV research can provide valuable context for better prevention and intervention strategies.

The purpose of the study was to determine the causes, of the increased perinatal mortality, identify and describe other factors contributing to the increased perinatal mortality rate in a rural healthcare facility situated in Sekhukhune district in Limpopo province, and to formulate the recommendations that will reduce the perinatal mortality rate based on the results. A quantitative, descriptive, cross-sectional and retrospective design was conducted. The study population was one hundred and sixty two (162) records of babies who died in the perinatal facility from the 1st January 2015 to the 31st December 2015 with a gestational age of about 28 weeks or more. No sampling was done, but a census was used. The sample comprised of one hundred and sixty two (162) of all the records related to perinatal mortality. Data were collected from patients’ records by using a checklist. Analysis of the data was performed by the IBM Statistical Package for Social Sciences (SPSS) version 14 computer software. Frequency tables and pie graphs were used to present the data. The results indicated that 75.3% (n=122) of the records were associated with health personnel as a factor contributing to perinatal mortality. Furthermore, preterm cases accounted for 45.1% (n=73) and prematurity accounted for 37.0% (n=60) of the cases of perinatal mortality. Therefore, preterm births and prematurity are risk factors that should be managed immediately after birth, and all babies should be managed prior to being transferred to the other healthcare institutions. The recommendations are that the education of patients about early antenatal visit, signs of labour and danger signs during pregnancy and training of healthcare workers on record-keeping have to be done on a continuous basis. Managers should conduct quality improvement programmes, benchmarking and implement maternal and neonatal guidelines in the clinical area throughout pregnancy. / Health Studies / M. P. H. (Health Studies)

Submitted by isabela.moljf@hotmail.com (isabela.moljf@hotmail.com) on 2017-05-19T11:00:27Z No. of bitstreams: 1 mariadaconsolacaomagalhaes.pdf: 3358023 bytes, checksum: 11bd3472d372f91b765a67807ee928ff (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-05-19T14:32:48Z (GMT) No. of bitstreams: 1 mariadaconsolacaomagalhaes.pdf: 3358023 bytes, checksum: 11bd3472d372f91b765a67807ee928ff (MD5) / Made available in DSpace on 2017-05-19T14:32:48Z (GMT). No. of bitstreams: 1 mariadaconsolacaomagalhaes.pdf: 3358023 bytes, checksum: 11bd3472d372f91b765a67807ee928ff (MD5) Previous issue date: 2011-08-26 / É considerado um caso de morbidade materna extremante grave (MMEG) ou near miss uma mulher que quase foi a óbito, mas sobreviveu a complicação que ocorreu durante a gravidez, parto ou até 42 dias do término da gestação. Os critérios para identificação de casos de MMEG têm sido discutidos por diversos autores que levam em consideração as condições clínicas, laboratoriais e/ou manejo dos casos. Os sistemas de informação em saúde disponíveis atualmente no Brasil, tais como o SIH-SUS (Sistema de Informações Hospitalares do SUS), Sistema de informação sobre Nascidos vivos (SINASC) e Sistema de Informação sobre Mortalidade (SIM) contam com grande número de dados que poderiam contribuir para estudos da morbidade materna. Este trabalho tem como objetivos analisar a situação da morbimortalidade materna e infantil a partir dos Sistemas de Informações em Saúde; adequar os critérios de MMEG; identificar e analisar os casos de MMEG na base de dados do SIH-SUS visando subsidiar o planejamento das ações de saúde materna. Entre as 8620 mulheres residentes em Juiz de Fora, MG, no período de 2006 e 2007, internadas com causas codificadas dentro do Capítulo XV da CID-10 ou que receberam procedimentos obstétricos, 326 apresentaram alguma condição clínica e/ou procedimento selecionado como MMEG e uma foi a óbito. A taxa de mortalidade materna foi 12,0 por 100.000 mulheres. A letalidade 3,1 por mil mulheres e a prevalência de MMEG, 39,0 por 1000 mulheres. A média de tempo de internação foi de 3,5 e 10,5 dias para as mulheres sem e com morbidade, respectivamente. O tempo de internação maior que quatro dias foi 13 vezes mais alto entre as mulheres que apresentaram MMEG. A razão de prevalência para permanência do recém-nascido após alta da mãe, ter filhos nascidos mortos e óbito da criança antes da alta da mãe foi mais elevada entre as mulheres com MMEG, respectivamente 2,52, 4,86 e 4,41. As variáveis tempo de internação, número de internações e filhos nascidos mortos mostraram-se como fatores preditores para a MMEG na análise de regressão logística (p < 0,001). Entre os procedimentos/condições selecionados os mais frequentes foram a transfusão de hemoderivados, “permanência a maior” e pré-eclampsia grave/eclampsia, com prevalências de morbidades específicas de 15,7/1000, 9,5/1000 e 8,2/1000, respectivamente. A razão de prevalência de MMEG encontrada e as prevalências específicas de transfusão de hemoderivados e pré-eclampsia grave/eclampsia são achados consistentes com a literatura existente e demonstram que o uso de associação de algumas tabelas do SIH-SUS tem grande potencial para identificação dos casos de MMEG. O critério utilizado para identificação dos casos é factível e pode contribuir para a vigilância da morbimortalidade materna e para ampliar o conhecimento sobre os aspectos que a envolve, contribuindo assim para a melhoria na qualidade da assistência à mulher no período gravídico-puerperal. / An extremely severe maternal morbidity (ESMM) case, or near miss, is one in which the woman almost died due to gestation/delivery-related problems, or any problem occurring up to 42 days after the end of gestation, but survived because of the care received or sheer chance. The criteria for identification of ESMM cases have been discussed by several authors, who take into account clinical and laboratory features and/or case management. Health information systems available in Brazil, such as the Hospital Information System (Sistema de Informações Hospitalares – SIH-SUS), Live-birth Information System (Sistema de Informações sobre Nascidos Vivos – SINASC) and Mortality Information System (Sistema de Informações sobre Mortalidade – SIM) comprise a large number of data, which could contribute to studies on maternal morbidity. This study aimed to: assess maternal and childhood morbimortality from the SIH-SUS, adequate the ESMM criteria, and identify and analyze the ESMM cases within the SIH-SUS database, with a focus on the planning of maternal health interventions. Of the 8620 women living in Juiz de Fora, MG, Brazil, admitted to hospital with a diagnosis belonging to chapter XV of the ICD-10, or who underwent an obstetric procedure, in the period 2006-2007, 326 had a clinical condition and/or procedure selected as ESMM, with 1 death. Maternal mortality rate was 12.0/100,000 women. Case-fatality rate was 3.1/1,000 women, and ESMM rate was 39.0/1,000 women. Mean hospital stay length ranged from 10.5 to 3.5 days, for women with and without ESMM, respectively. Hospital stay length over 4 days was 13 more likely for ESMM women. Prevalence ratios of newborn hospital stay after the mother`s discharge, stillbirth, and child`s death before the mother`s discharge were higher for ESMM women, being 2.52, 4.86, and 4.41, respectively. The variables hospital stay length, number of admissions, and number of stillbirths were predictors of ESMM on logistic regression analysis (p < 0.001). Of the selected procedures/conditions, the most frequent ones were blood derivatives transfusion, longer hospital stay, and severe pre-eclampsia/eclampsia, with specific morbidity prevalence rates of 15.7/1,000, 9.5/1,000 and 8.2/1,000, respectively. The ESMM prevalence ratio found and the specific prevalence rates of blood derivatives transfusion and severe pre-eclampsia/eclampsia are consistent with literature data, and show that the association use of the SIH-SS tables has significant potential to identify ESMM cases. The criterion used for case identification is feasible and may contribute to maternal morbimortality surveillance, increasing our knowledge about its associated features and contributing to better prenatal/puerperal care.

La nutrition périnatale conditionne durablement les fonctions physiologiques, avec des conséquences sur la susceptibilité à développer des maladies métaboliques à l’âge adulte. Le microbiote représente un des acteurs de cette empreinte nutritionnelle. L’objectif est de déterminer chez le porc l’impact d’une supplémentation périnatale en fructo-oligosaccharides à courte chaîne (scFOS) sur le développement des fonctions immunitaires et endocrines intestinales et les conséquences sur la santé métabolique de l’adulte en situation de déséquilibre nutritionnel.La supplémentation maternelle en scFOS, en modifiant le microbiote de la mère et de la descendance et la qualité du lait, accélère la maturation du système immunitaire intestinal des porcelets allaités.La fenêtre d’exposition (maternelle vs post-sevrage) conditionne la nature des modifications immunes induites par les scFOS. La supplémentation périnatale en scFOS modifie la réponse métabolique de l’adulte à un régime déséquilibré en stimulant la fonction endocrine intestinale et la sensibilité du pancréas au glucose, en réduisant les risques d’inflammation, et en modifiant l’homéostasie métabolique, associé à des modulations du microbiote.En résumé, la consommation périnatale de prébiotiques programme le phénotype métabolique et immunitaire de l’adulte via des modulations persistantes du microbiote. L'approche intégrée des données a permis d’identifier des acteurs moléculaires impliqués dans l’adaptation différentielle des individus à un régime déséquilibré en fonction de leur alimentation périnatale. / Perinatal scFOS supplementation modifies metabolic response to an unbalanced diet in adults by stimulating intestinal endocrine function and pancreas sensitivity to glucose, by reducing risks of inflammation, and in fine by changing metabolic homeostasis in association with modifications of microbiota.In summary, prebiotic consumption during perinatal life programs the immune and metabolic phenotype of adults through persistent modulations of intestinal microbiota. The integrated approach of data enables us to identify molecular actors involved in the differential adaptation of individuals to an unbalanced diet according to their perinatal nutrition.