O puerpério é considerado uma fase de modificações biossocioculturais que, muitas vezes, não são compreendidas pela mulher, o que exige maior atenção dos profissionais, dos familiares e das redes de contato envolvidos em seu cuidado. A literatura e a prática profissional mostram que as crenças sobre o cuidado da puérpera têm relevância em seu cotidiano e, muitas vezes, se sobrepõem às orientações recebidas na instituição de saúde. Diante desta situação, este estudo teve como objetivo: explorar as práticas de cuidado adotadas no pós-parto pela mulher usuária de uma Unidade Básica de Saúde da cidade de Rio Claro, SP. Trata-se de estudo qualitativo, que teve como referencial teórico o Modelo de Competência Cultural de Purnell e cujos dados foram tratados pelo Discurso do Sujeito Coletivo (DSC). A pesquisa foi aprovada por Comitê de Ética em Pesquisa e atendeu à Resolução 196/96. Os dados foram coletados em 2011, por meio de entrevistas realizadas com 20 puérperas entre o 30º e 45º dias de pós-parto. Identificou-se a condição sociodemográfica e familiar das entrevistadas, além de sua vivência no puerpério. Os dados mostraram que as puérperas eram jovens, apresentavam baixo índice de tabagismo, etilismo e drogadição, com renda média em torno de 3 salários mínimos. Os relatos obtidos originaram 21 DSC, cujos conteúdos mostraram a influência de crenças sobre as práticas de cuidado no puerpério; crenças que foram transmitidas intergerações pelos cuidadores de sua rede familiar e cultural. Os profissionais de saúde se fizeram presentes por meio de orientações de práticas, com enfoque no biológico, oferecidas de maneira verticalizada e, por vezes, fragmentada e divergente, o que demonstrou sua dificuldade em acompanhar as influências culturais envolvidas no processo. Por conta disso, as práticas de cuidado no puerpério sofreram maior influência das crenças e dos padrões da cultura da mulher, como também das informações obtidas na internet, que preencheram lacunas e apontaram caminhos para a mulher seguir com maior segurança nesta fase do ciclo gravídico-puerperal. Diante dos achados, propõem-se o estabelecimento de estratégias para incorporação da bagagem cultural da mulher à assistência prestada pelo profissional de saúde, de modo a prover o cuidado culturalmente competente; a programação de grupos voltados à educação em saúde, focados na vivência do puerpério, para a mulher e sua rede de contato; a implementação da Estratégia Saúde da Família; e a inclusão do egresso de curso de Obstetrícia nos programas de saúde dos municípios, para agregar este novo profissional no cuidado da mulher e de seu recém-nascido. / Puerperium is considered a phase with biological, social and cultural changes often not correctly understood by women, the main reason why requires special attention from professionals, and caregivers networks involved on the care. Literature and professional practice shows that beliefs about postpartum care has a strong relevance in a womans routine and often overlaps guidance received at the health institutions. From this perspective, this study had as objective to explore practices adopted in postpartum by women served in the Basic Health Unit in a city of Rio Claro state of São Paulo (Brazil). This is a qualitative study and followed Purnell Cultural Competence Model as a theoretical approach and whose data was treated by the Collective Subject Speech (CSS). The data was approved by Ethics in Research Committee and complied with Resolution 196/96. The data was collected in 2011 through interviews with 20 women in the puerperium between 30 and 45 days of postpartum. We identified social and demographic conditions from each interviewed as well as from her family, besides their experiences at the puerperal period. The data showed that women in the puerperium were young, had low smoking rates, alcoholism or drugs addictions, and on average had an income that was equivalent to 3 minimum salaries. The reports had originated 21 CSS, and the contents showed the stronger beliefs influence on postpartum care practices; beliefs that were passed by intergenerational family and cultural caregivers. Health professionals demonstrated their presence through guidelines with practices with a biological focus and offered in a vertical manner, and sometimes divergent and fragmented, which demonstrated difficulty in following the cultural influences involved in the process. For this reason, puerperal care practices had suffered greatly due to the influence of beliefs and cultural woman patterns, as well as information obtained from the Internet. The Internet filled gaps and provided greater security methods to follow at pregnancy stage, childbirth as well as at puerperium. Upon reviewing the results, it is suggested that the following take place to incorporate the cultures of women to the experiences of the health care professionals to provide a culturally competent care; programming groups on health education focused on the puerperium experience for women and her caregivers; the implementation of Family Health Program, and the inclusion of Midwifery in the health programs to allow this new professional to take care the woman and her newborn.

O estômago do rato completa sua maturação durante a fase de transição alimentar, em que ocorre ingestão de ração juntamente com leite materno. No desmame precoce (DP) esta fase é interrompida e provoca elevação da corticosterona (CORT). Nosso objetivo foi avaliar, através do tratamento com RU486 (RU), se a CORT elevada modifica a maturação gástrica. Grupos experimentais: amamentado (A), ARU, DP e DPRU. Resultados de PCRq, em filhotes: o DP elevou a expressão de Muc5ac, Bhlha15, Pgc e diminuiu a expressão de Pga5, enquanto que o RU486 reverteu os resultados para Pgc e Muc5ac,. Ainda em filhotes, DP aumentou o número de células mucosas do colo (CMCs), células Mist1-positivas e PGC-positivas, e o RU486 reverteu o resultado para as CMCs e para as PGC-positivas. Em adultos, obtivemos os seguintes dados: redução de Pga5, causada pelo RU486; manutenção dos efeitos do DP sobre Pgc; manutenção dos dados, tanto de DP quanto de RU486, sobre as CMCs; e dos efeitos do RU486 sobre as células PGC-positivas. Portanto, a CORT elevada pelo DP é fundamental na maturação gástrica. / Rat´s gastric mucosa completes their maturation throughout the food transition process, when pups ingest chow and maternal milk. Early weaning (EW) consists in an abrupt suckling (S) interruption that increases corticosterone (CORT) levels. Our aim was to evaluate, using RU486 (RU), if these increase in CORT levels could affect gastric maturation. Experimental groups: S, SRU, EW and EWRU. By RT-qPCR, in 17-d-old rats, EW increased Muc5ac, Bhlha15 and Pgc and decreased Pga5 expression, while RU486 reverted the results for Pgc and Muc5ac. In 17 and 18-d-old pups, EW increased mucous neck cells (MNC), Mist1-positive and PGC-positive cells, although CORT inhibition reverted the result for MNC and PGC. In 30-d-old rats, we had the following results: reduction on Pga5 expression provoked by RU486; the results over Pgc were maintained; the results, caused both by EW as RU486, over MNC were maintained, as well as the effects of RU486 over PGC-positive cells. We concluded that the increase in CORT levels, caused by EW, plays a fundamental role in gastric maturation.

Muitos fatores podem influenciar o desenvolvimento placentário e fetal na égua, dentre eles destaca-se a idade, a paridade e o porte materno. A produção de hormônios esteroides pela unidade feto-placentária também pode ser influenciada pela paridade e raça, porém não existem relatos prévios que relacionem os efeitos da idade da égua sobre a produção desses hormônios na gestação. Este trabalho conta com três objetivos principais: o primeiro investigou a influência do número de partos e da idade materna sobre a eficiência placentária e a biometria do potro ao nascimento, utilizando a análise estereológica da placenta a termo. O segundo determinou a influencia da biometria parental na macro e microscopia placentária e consequências para o desenvolvimento fetal e para o crescimento, comportamento e funções fisiológicas pós-natais. Por último foi avaliada a influência da idade e paridade materna, e da raça do potro sob a produção de estrógenos, progesterona e cortisol plasmáticos em éguas prenhes. Quarenta fêmeas gestantes foram categorizadas de acordo com a idade (Id1: 4 a 8 anos; Id2: 8 a 12 anos; Id3: ≥ 13 anos), a pluriparidade (Par1: nulíparas, Par 2: 1 a 3 partos; Par3: ≥ 4partos) e a raça do produto (MP: Mangalarga Paulista; BH: Brasileiro de Hipismo). As coletas de plasma foram realizadas semanalmente a partir do quinto mês de gestação até o termo, e a quantificação dos hormônios foi realizada pela técnica de Espectrometria de Massas. Os partos foram acompanhados a campo e dados do escore Apgar, comportamento e amostras sanguíneas para análise bioquímica dos potros foram coletados nas primeiras doze horas de vida. As membranas corioalantóides foram recolhidas após o delivramento, pesadas e fotografadas em escala. Foram coletados fragmentos correspondentes às regiões do corpo do útero, corno uterino gestante e corno uterino contralateral para análise estereológica. Parâmetros de crescimento dos neonatos foram comparados do nascimento até os dois anos de idade, assim como foram coletados dados da altura, peso e perímetro torácico materno e paterno. Não foram observadas diferenças significativas na quantificação de esteróides quando considerados os fatores número de partos e raça do produto para a categorização das fêmeas. As concentrações de estrógenos foram estatisticamente superiores no grupo Id2 em relação ao Id3, em alguns meses do período gestacional avaliado. Foi observado que a idade e a paridade materna influenciam o desenvolvimento dos microcotilédones e a densidade total de superfície dos vilos, bem como a vascularização e a composição tecidual das diferentes regiões da placenta, contribuindo de fato para uma maior área de contato materno-fetal e transferência de gases e nutrientes entre mãe e feto, culminando com o nascimento de potros mais altos, mais pesados e com maior circunferência torácica. O porte paterno, e principalmente o materno, influenciou o desenvolvimento das vilosidades fetais e a área de superfície de contato materno-fetal, com efeito positivo no desenvolvimento e no crescimento fetal, resultando no nascimento de potros com melhores respostas adaptativas e metabólicas. Também destaca-se que o período de vida intrauterino foi determinante para a taxa de crescimento pós-natal até os 24 meses de vida. / Many factors may influence placental and fetal development in the mare, like age, parity and maternal size. The production of steroid hormones by fetal-placental unit can also be influenced by parity and breed, but there are no previous reports relating the effects of the mares age on the production of these hormones during pregnancy. This paper has three main objectives: the first investigated the influence of maternal age and parity on placental efficiency and size of the foal at birth, using stereological analysis of the term placenta. The second determined the influence of parental size on macro and microscopy of the placenta and consequences for fetal development and growth, behavior and postnatal physiological functions. Finally, the influence of maternal age and parity was evaluated, and the breed´s foal in the production of plasmatic oestrogens, progesterone and cortisol in pregnant mares. Forty pregnant females were categorized according to age (Id1: 4-8 years; Id2: 8-12 years; Id3: ≥ 13 years), parity (Par1: nulliparous, Par2: 1 to 3 births; Par3: ≥ 4 births) and foal´s breed (MP: Mangalarga Paulista; BH: Brazilian Sporthorse). Plasma samples were collected weekly from the fifth month of pregnancy to term, and quantification of hormones was performed by Mass Spectrometry. Deliveries were accompanied and Apgar score, behavior and blood samples for biochemical analysis of the foals were collected within the first twelve hours of life. The chorioallantoic membranes were collected after delivery, weighed and photographed to scale. Tissue sections were collected from regions: uterine body, pregnant uterine horn and contralateral uterine horn to be analyzed stereologically. Neonate´s growth parameters were compared from birth up to two years old, as well as data on maternal and paternal height, weight, and thoracic perimeter were collected. No significant differences were observed in the quantification of steroids when considering maternal parity and foal´s breed for the mares groups. The concentrations of oestrogens were significantly higher in Id2 group when compared with Id3, in some months of the gestational period evaluated. It was observed that maternal age and parity influence the development of the microcotyledons and total villi surface density, as well as the vascularization and tissue composition of different regions of the placenta, contributing in fact to a larger area of fetomaternal contact and transfer of gases and nutrients between mother and fetus, culminating with foals that were taller, heavier and with larger thoracic circumference at birth. The paternal, and mainly maternal size, influenced the development of fetal villi and the area of fetomaternal contact surface with a positive effect on the development and fetal growth, resulting in the birth of foals with better metabolic and adaptive responses. It also highlights that the period of intrauterine life was decisive for the postnatal growth rate up to 24 months of life.

O estômago do rato completa sua maturação durante a fase de transição alimentar, em que ocorre ingestão de ração juntamente com leite materno. No desmame precoce (DP) esta fase é interrompida e provoca elevação da corticosterona (CORT). Nosso objetivo foi avaliar, através do tratamento com RU486 (RU), se a CORT elevada modifica a maturação gástrica. Grupos experimentais: amamentado (A), ARU, DP e DPRU. Resultados de PCRq, em filhotes: o DP elevou a expressão de Muc5ac, Bhlha15, Pgc e diminuiu a expressão de Pga5, enquanto que o RU486 reverteu os resultados para Pgc e Muc5ac,. Ainda em filhotes, DP aumentou o número de células mucosas do colo (CMCs), células Mist1-positivas e PGC-positivas, e o RU486 reverteu o resultado para as CMCs e para as PGC-positivas. Em adultos, obtivemos os seguintes dados: redução de Pga5, causada pelo RU486; manutenção dos efeitos do DP sobre Pgc; manutenção dos dados, tanto de DP quanto de RU486, sobre as CMCs; e dos efeitos do RU486 sobre as células PGC-positivas. Portanto, a CORT elevada pelo DP é fundamental na maturação gástrica. / Rat´s gastric mucosa completes their maturation throughout the food transition process, when pups ingest chow and maternal milk. Early weaning (EW) consists in an abrupt suckling (S) interruption that increases corticosterone (CORT) levels. Our aim was to evaluate, using RU486 (RU), if these increase in CORT levels could affect gastric maturation. Experimental groups: S, SRU, EW and EWRU. By RT-qPCR, in 17-d-old rats, EW increased Muc5ac, Bhlha15 and Pgc and decreased Pga5 expression, while RU486 reverted the results for Pgc and Muc5ac. In 17 and 18-d-old pups, EW increased mucous neck cells (MNC), Mist1-positive and PGC-positive cells, although CORT inhibition reverted the result for MNC and PGC. In 30-d-old rats, we had the following results: reduction on Pga5 expression provoked by RU486; the results over Pgc were maintained; the results, caused both by EW as RU486, over MNC were maintained, as well as the effects of RU486 over PGC-positive cells. We concluded that the increase in CORT levels, caused by EW, plays a fundamental role in gastric maturation.

Os objetivos do estudo foram: analisar a influência dos sintomas depressivos na qualidade de vida relacionada à saúde percebida por mulheres na gestação de baixo risco e pós-parto e verificar os fatores socioeconômicos e obstétricos associados à qualidade de vida e aos sintomas depressivos. Trata-se de um estudo longitudinal, com inclusão de 313 gestantes matriculadas em 11 Unidades Básicas de Saúde da zona sul do Município de São Paulo, SP. As participantes foram seguidas em quatro etapas: 20ª, 28ª, 36ª semanas de gestação e 45 dias após o parto, com ± 2 semanas em cada etapa. A coleta dos dados foi de julho de 2008 a março de 2010. A amostra final das quatro etapas constou de 132 mulheres. Os dados sociodemográficos e obstétricos foram obtidos por meio de entrevista na primeira etapa, com exceção dos do pós-parto, que foram coletados na quarta etapa. Para avaliação dos sintomas depressivos, foi utilizada a Edinburgh Postnatal Depression Scale (EPDS) e para avaliação da qualidade de vida relacionada à saúde, o questionário Medical Outcomes Study 36-Item Short Form Health Survey (MOS-SF36), que foram autoaplicados nas quatro etapas. O estudo foi aprovado pelo Comitê de Ética em Pesquisa - Parecer nº 154/08-CEP/SMS. Os escores médios dos domínios do MOS-SF36 apresentaram declínio ao longo da gestação com recuperação no pós-parto, exceto Estado Geral de Saúde e Saúde Mental, com diferença significativa para Capacidade Funcional (p<0,000), Aspectos Físicos (p=0,001), Dor (p<0,001) e Vitalidade (p=0,002). A proporção de gestantes com sintomas depressivos variou nas quatro etapas, sendo de 29,5% na 20ª, 24,2% na 28ª, 24,5% na 36ª semanas de gestação e 33,6% com 45 dias de pós-parto. Houve correlação inversa significativa em todos os domínios do MOS-SF36 e a EPDS, com variação no coeficiente de Spearman de 0,234 a 0,785. Nas quatro etapas, os escores médios dos domínios mostraram diferenças significantes, na comparação entre gestantes sem e com sintomas depressivos, exceto Dor, na segunda etapa e Aspectos Físicos na quarta. Na regressão logística da qualidade de vida relacionada à saúde, os sintomas depressivos foram um fator de risco em todos os domínios, exceto Aspectos Físicos. Para os sintomas depressivos, as variáveis associadas foram situação conjugal, anos de estudo e número de consultas de pré-natal, como fatores de proteção e queixas como fator de risco. A presença dos sintomas depressivos na gestação e puerpério altera a percepção subjetiva da qualidade de vida relacionada à saúde em gestantes de baixo risco. / The aims of the present study were to analyze the influence of depressive symptoms on the health related quality of life (HRQOL) perceived by low risk pregnant women and at postpartum and verify the socioeconomic and obstetric factors associated with the quality of life and depressive symptoms. This is a longitudinal study and it was conducted with 313 pregnant women enrolled in 11 Basic Health Units of the southern area of São Paulo City, SP. The participants were followed up at their 20th, 28th, 36th weeks of gestation and 45 days postpartum, with ± 2 weeks in each periods. Data was collected from July 2008 to March 2010. The final sample of four periods consisted of 132 women. Sociodemographic and obstetric data was obtained by interviewing subjects in the first period and postpartum data in the fourth period. For the assessment of depressive symptoms, Edinburgh Postnatal Depression Scale (EPDS) was used and to assess the health related quality of life (HRQOL), the questionnaire Medical Outcomes Study 36-Item Short Form Health Survey (MOS-SF36), which were self-administered in four stages. The study was approved by the Ethics in Research Committee nº 154/08-CEP/SMS. The mean scores of the domains of MOS-SF36 presented decline over the gestation with postpartum recovery, except in General (Health) and Mental Health, with a significant difference in Physical Functioning (p<0,000), Role Limitation due to Physical Problems (p=0,001), Bodily Pain (p<0,001) and Vitality (p=0,002). The proportion of pregnant women with depressive symptoms was 29.5% at 20th, 24.2% at 28th, 24.5% at 36th weeks of gestation and 33.6% at 45 days postpartum. There was a significant inverse correlation among all domains of the MOS-SF36 and the EPDS, with Spearman coefficients range of 0.234 to 0.785. At the four periods, the mean scores of the domains showed significant differences between pregnant subjects with or without depressive symptoms except Bodily Pain in the second period and Role Limitation due to Physical Problems in the fourth one. At HRQOL logistic regression the depressive symptoms were a risk factor in all domains, except Role Limitation due to Physical Problems. To depressive symptoms, the associated factors were marital status, years of education and the number of prenatal consultations as protective factors and complaints as a risk factor. The presence of depressive symptoms at pregnancy and postpartum changes the subjective perception of Health related quality of life in low risk pregnant women.

Childbirth can be associated with short and long-term psychological morbidity including depression, anxiety and trauma symptoms. Some previous studies have used psychological interventions to reduce postpartum distress but have primarily focussed on attempting to relieve symptoms of depression with little recognition of trauma symptoms. Furthermore, the intervention used in these studies has generally been poorly documented. The first aim of the present study was to develop a counselling framework, suitable for use by midwives, to address psychological trauma following childbirth. Multiple methods were used to develop the intervention including focus groups with women and midwives. Both the women and midwives gave unequivocal support for postpartum debriefing. Themes that emerged from the focus groups with women included the need for opportunities to talk about their birth experience, an explanation of events, an exploration of alternative courses of action that may have resulted in a different birth experience, talking about their feelings such as loss, fear, anger and self-blame, discussing social support, and discussing possible future childbearing. There was a high level of agreement between the women's and midwives' views. These themes were synthesized with contemporary literature describing counselling interventions to assist in reconciling a distressing birth experience and a model for understanding women's distressing birth experiences to develop a counselling framework. The counselling intervention was then tested using a randomised controlled study involving 400 women recruited from antenatal clinics of three public hospitals. When interviewed within seventy-two hours of birth, 103 women reported a distressing birth experience and were then randomised into either the treatment or control group. Women in the intervention group had the opportunity to debrief at the initial postpartum interview (< 72 hours postpartum) and at four to six weeks postpartum. The prevalence of posttraumatic stress disorder was quite high; 9.6% of participants meeting the diagnostic criteria for acute PTSD at four to six weeks postpartum. Fewer participants (3.5%) met the diagnostic criteria for chronic PTSD at three months postpartum. As with previous research relating to childbearing women, few demographic factors or antenatal psychological factors were associated with the development of a PTSD symptom profile following childbirth. The development of PTSD symptom profile was strongly associated with obstetric intervention and a perception of poor care in labour. This finding is also consistent with previous research. Emotional distress was reduced for women in the intervention group in relation to the number of PTSD symptoms [t (101) = 2.144, p = .035], depression [c2 (1) = 9.188, p = .002], stress [c2 (1) = 4.478, p = .029] and feelings of self-blame [t (101) = -12.424, p <.001]. Confidence about a future pregnancy was higher for these women [t (101) = -9.096, p <.001]. Although there was not a statistically significant difference in the number of women with a PTSD symptom profile at three months postpartum, fewer women in the intervention group (n=3) than in the control group (n=9) met PTSD criteria. Likewise, there were fewer women in the intervention group (n=1) with anxiety levels above mild than in the control group (n=6). Importantly, this study found that offering women who have had a traumatic birth the opportunity for counselling using the framework documented in this dissertation was not harmful. This finding is in contrast to previous findings of other studies. The intervention was well received by participants. All the women in the intervention group found the counselling sessions helped them come to terms with their birth experience. Maternity service providers need to be cognizant of the prevalence of this debilitating condition and be able to identify women at risk for early intervention and referral to a mental health practitioner if appropriate. This research offers further support for the compelling need to implement changes to the provision of maternity services that reduce rates of obstetric intervention and humanise service delivery as a means of primary prevention of birth-related PTSD.

Experimental and clinical data have documented the adverse effects of perinatal ethanol intoxication on peripheral organs and the central nervous system. There is little known, however, about potential damaging effects of perinatal ethanol on the developing visual system. The purpose of this study was to examine the effects of neonatal ethanol intoxication on RGC morphology, estimate the total number of neurons in RGC layer and dorsolateral geniculate nucleus (dLGN), and on the eye-specific fiber segregation in the dLGN), in YFP and C57BL/6 mice pups. Ethanol (3 g/kg/day) was administered by intragastric intubation throughout postnatal days (PD) 3-20 or 3-10. Intubation control (IC) and untreated control (C) groups were included. Blood alcohol concentration (BAC) was measured in separate groups of pups on PD3, PD10, and PD20 at 4 different time points, 1, 1.5, 2 and 3 h after the second intubation. Numbers neurons in the RGCs and dLGN were quantified on PD10, PD20 using unbiased stereological procedures. The RGC images were taken using a confocal microscope and images were traced using Neurolucida software. On PD9, intraocular injections of cholera toxin-

Project (Ed.S.)--James Madison University, 2009. / Includes bibliographical references.

Σκοπός: Η μεταγεννητική αύξηση των παιδιών που εκτέθηκαν στον καπνό του τσιγάρου ενδομητρίως δεν είναι πλήρως κατανοητή. Σκοπός της παρούσας μελέτης είναι να ερευνήσει την αύξηση παιδιών των οποίων οι μητέρες κάπνιζαν στη διάρκεια της εγκυμοσύνης, κατά τα πρώτα έξι χρόνια της ζωής τους. Μέθοδοι: Το βάρος σώματος, το μήκος σώματος και η περίμετρος κεφαλής μετρήθηκαν στη γέννηση και κατόπιν ετησίως για έξι έτη σε 100 παιδιά των οποίων οι μητέρες κάπνιζαν (ομάδα μελέτης) και 100 παιδιά των οποίων οι μητέρες δεν κάπνιζαν (ομάδα ελέγχου). Αποτελέσματα: Το βάρος και η περίμετρος κεφαλής ήταν σημαντικά μικρότερα στα νεογνά των οποίων οι μητέρες κάπνιζαν >15 τσιγάρα την ημέρα, αλλά η διαφορά έχασε τη στατιστική σημαντικότητα στον τρίτο χρόνο της ζωής. Το μήκος ήταν σημαντικά μικρότερο στα νεογνά της ομάδας μελέτης στη γέννηση και ακολουθούσε αύξηση της διαφοράς από το φυσιολογικό έως το δεύτερο έτος, οπότε η μέση διαφορά των παιδιών που οι μητέρες τους κάπνιζαν >15 τσιγάρα την ημέρα από τα παιδιά της ομάδας ελέγχου ήταν -3,4 εκατοστά (p<0,0001). Στη συνέχεια, τα παιδιά των καπνιστριών μητέρων παρουσίασαν επιτάχυνση του ρυθμού αύξησης και η διαφορά από την ομάδα ελέγχου στα 3, 4, 5 και 6 χρόνια ζωής ήταν -2,5 (p<0,0001), -2,2 (p=0,005), -2,1 (p=0,013), και -1,9 εκατοστά (p=0,055), αντίστοιχα. Η καθυστερημένη αύξηση σχετιζόταν με το κάπνισμα αυτό καθ’εαυτό και δείχθηκε ότι η καθυστέρηση της αύξησης είναι ανεξάρτητη από πολλούς συμπαράγοντες. Επίσης, στη γέννηση υπήρχε σημαντική αρνητική συσχέτιση μεταξύ του αριθμού των τσιγάρων που καπνίζονταν ημερησίως και των παραμέτρων αύξησης που μελετήθηκαν. Η αρνητική συσχέτιση παρέμεινε σημαντική έως τον έκτο χρόνο ζωής μόνο για το ύψος. Συμπέρασμα: Το μήκος παρουσιάζει την πιο επίμονη καθυστέρηση της αύξησης από τις παραμέτρους που μελετήθηκαν, δηλαδή το βάρος σώματος και την περίμετρο κεφαλής, αλλά μετά το δεύτερο έτος της ζωής συμβαίνει επιτάχυνση της αύξησης, και έτσι η ενδομήτρια έκθεση στον καπνό του τσιγάρου φαίνεται να μην έχει μόνιμη επίδραση στην τελική αύξηση των παιδιών. / Objectives: Postnatal growth in children exposed in utero to tobacco smoke is not well understood. This study investigated growth during the first 6 years in children whose mothers smoked during pregnancy. Materials and Methods: Weight, length, and head circumference were measured annually for 6 years in 100 children in each group of smoking (study) and non smoking (control) mothers. Results: Weight and head circumference were significantly smaller in the neonates whose mothers smoked >15 cigarettes/day, but the difference disappeared by 3 years of life. Length was significantly smaller in the study neonates at birth, followed by increasing divergence from normality up to 2 years, when the mean difference of children whose mothers smoked >15 cigarettes/day from control children was -3.4 cm (p<0.0001). Subsequently, they manifested catch-up growth, and the difference from the controls at 3, 4, 5, and 6 years was -2.5 cm (p<0.0001), -2.2 cm (p=0.005), -2.1 cm (p=0.013), and -1.9 cm (p=0.055), respectively. Discussion: The delayed growth was related to smoking per se and appeared to be independent of several confounding factors. At birth, there was a significant negative correlation between the number of cigarettes smoked per day and the growth parameters studied; it remained significant up to the sixth year only for length. Conclusion: Length exhibits the most persistent growth delay of the parameters studied, but catch-up growth occurs after the second year of life, and thus, intrauterine exposure to tobacco smoke seems to have no permanent effect on children’s growth.

Tyrimo tikslas - nustatyti psichologinės adaptacijos ir socialinių, demografinių bei sveikatos veiksnių sąsajas pogimdyminiu laikotarpiu. Tyrime dalyvavo 200 tiriamųjų. Tiriamųjų grupę sudarė pagimdžiusios moterys, gulinčios po gimdymo Vš.Į. Ukmergės ligoninės akušerijos skyriuje ir Kauno Vš.Į. 2-os klinikinės ligoninės filialo P.Mažylio gimdymo namuose. Siekiant nustatyti psichologinės adaptacijos ir socialinių, demografinių bei sveikatos veiksnių sąsajas pogimdyminiu laikotarpiu buvo naudoti šie klausimynai: „Savęs vertinimo klausimynas po gimdymo“, „Edinburgo pogimdyminės depresijos skalė“, „Spilbergerio C. D. Nerimo skalė“. Demografiniams, socialiniams ir sveikatos veiksniams nustatyti buvo naudojami Ž. Jankauskienės ir tyrimo autorės sudaryti klausimai. Tyrimo rezultatai parodė, kad moterų psichologinė adaptacija pogimdyminiu laikotarpiu yra susijusi su demografiniais rodikliais: vyresnio amžiaus moterys, ištekėjusios, turinčios aukštąjį išsilavinimą bei gyvenančios mieste yra geresnės psichologinės adaptacijos. Darbo ir vaikų turėjimas, didesnės pajamos, planuotas nėštumas, partnerio parama nėštumo metu, sveikatai palankus elgesys siejasi su geresne moterų psichologine adaptacija pogimdyminiu laikotarpiu. Šio tyrimo rezultatai parodė, kad nėštumo komplikacijos siejasi su blogesne psichologine adaptacija pogimdyminiu laikotarpiu. Gimdymo sužadinimas, gimdymo skausmo malšinimas yra susiję su moterų psichologine adaptacija pogimdyminiu laikotarpiu, tačiau natūralus... [toliau žr. visą tekstą] / The task of this study – to determine correlations between psychological adaptation, socio-demographic and health factors during postnatal period. The group of 200 women participated in this study. The group consisted of women after childbearing in Ukmergė hospital midwifery department and Kaunas 2nd hospital chapter, P.Mažylis midwifery house. Determining the correlations between psychological adaptation, socio-demographic and health factors was done by using The Postpartum self-evaluation questionnaire, Edinburgh Postnatal Depression Scale (EPDS), and Spielberger C.D. Stait Trait Anxiety Scale. Socio-demographic and health factors were determined using the questionnaire developed by Ž. Jankauskienė and the author of this study. The results of this study showed that psychological adaptation of women during the postnatal period is correlative with demographic factors: older, married and having a high school education women, living in bigger towns show better psychological adaptation. A better psychological adaptation is also correlated with having a job, children, bigger income, planned childbearing, help of the partner and healthy habits. The results of this study also shoved that complications during pregnancy correlate with poorer psychological adaptation during postnatal period. The stimulation of labour, using anesthetics during labour correlate with psychological adaptation during postnatal period. Natural childbirth, Cesarean section and childbirth with the help of... [to full text]