Darbo tikslas Ištirti mažų pagal nėštumo trukmę vaikų postnatalinį augimo pobūdį, hormonų profilį bei nustatyti prenatalinius ir ankstyvuosius postnatalinius veiksnius įtakojančius vaikų augimą ir metabolinius pokyčius iki brendimo Darbo uždaviniai 1. Ištirti mažų pagal nėštumo trukmę vaikų postnatalinio augimo pobūdį pirmaisiais 6 gyvenimo metais, lyginant juos su to paties amžiaus vaikais, gimusiais atitinkančio nėštumo trukmei svorio ir ūgio. 2. Įvertinti tėvų ir naujagimių antropometrinių rodiklių bei hormonų profilio gimimo metu įtaką mažų pagal nėštumo trukmę vaikų augimui nuo gimimo iki 6 metų. 3. 6 metų mažiems ir atitinkantiems nėštumo trukmę vaikams ištirti hormonų profilį (insulinoidinį augimo faktorių–I (IGF–I), IGF–I surišantį baltymą–3 (IGFBP–3) leptiną, adiponektiną), jautrumą insulinui bei lipidų profilį. 4. Nustatyti gimimo svorio ir ankstyvojo postnatalinio augimo įtaką vaikų nutukimo, atsparumo insulinui bei dislipidemijos rizikai iki brendimo. Mažiems pagal nėštumo trukmę vaikams anksti nustatyti pradiniai metaboliniai pakitimai (sumažėjęs jautrumas insulinui, padidėjęs leptino ir sumažėjęs adiponektino kiekis, dislipidemijos požymiai, gliukozės tolerancijos sutrikimas), žemaūgiškumas, polinkis nutukimui gali suteikti savalaikę informaciją bei galimybę pritaikyti ankstyvas profilaktines priemones nutukimui bei 2 tipo cukrinio diabeto, širdies ir kraujagyslių ligų išsivystymui vyresniame amžiuje. / Aim The present study aims to explore the postnatal growth pattern and hormonal profile in small for gestational age children and to identify prenatal and early postnatal risk factors of short stature and postnatal metabolic changes in early prepubertal age. Objectives: 1. To explore the postnatal growth pattern of children born small for gestational age during the first six years of life in comparison with children of appropriate for gestational age birth size. 2. To evaluate the impact of parental axiology, neonatal anthropometry and hormonal status at birth on the early postnatal growth of small for gestational age children. 3. To investigate hormonal profile (insulin like growth factor-1, insulin like growth factor binding protein-3, adiponectin and leptin), insulin sensitivity and lipid profile in six-year-old small and appropriate for gestational age children. 4. To evaluate the influence of birth size and postnatal growth pattern on the risk of obesity, insulin resistance and dyslipidemia in small for gestational age children during the late prepubertal period.

[pt] Os efeitos resultantes da atuação do homem sobre o meio ambiente vêm confirmar que a maneira com que o crescimento econômico é traçado, só pode conduzir para o pior dos resultados, quando se refere à questão ambiental, que é o cenário caótico. Portanto,não basta ter a preocupação somente com a qualidade do produto ou serviço, é preciso considerar também a qualidade ambiental. Diante da responsabilidade das empresas em manter uma postura de convívio mais harmonioso entre os seus processos e o meio ambiente, as normas ambientais (destacando os regulamentos para o Sistema de Gestão Ambiental) são, entre as tecnologias disponíveis, as que proporcionam os melhores resultados para as organizações assumirem suas obrigações diante das questões ambientais. Este trabalho é fruto de uma pesquisa teórica e da análise da experiência de uma empresa do ramo siderúrgico, a Companhia Siderúrgica de Tubarão (CST). Dentre seus resultados, encontra-se a comprovação da importância da implantação e manutenção de um Sistema de Gestão Ambiental (SGA) e a constatação deste como uma inovação tecnológica gerencial. / [en] The effects resulting from the action over the environment confirm that the way in which the economical increase is projected will cause the worst result, concerning to environmental matters, which is a chaotic as state. Therefore it is not eno ugh to be worried about the quality of the product or the service, it is necessary to consider the environmental quality as well. Considering the responsibility of the companies in keeping a harmonius conviviality between their processes and the enviro nment, the environmental standards (particularly the Environmental Administration System rules) are the technologies that provide the best results in order to get those organizations able to undertake their obligations to the environmental matters. This dissertation is the outcome of a the oretical research as well as an empirical analysis of a company in the metallurgy - Steel Metallurgy Company in Tubarão (CST). On of its results is the confirmation of the importance of the implantation and maintenance of an Environmental Administration System (SGA) and its corroboration as managing technological innovation.

The aim of these studies was to increase knowledge about hospital feeding routines in high-risk neonates. A retrospective medical chart review procedure was used to study routines at the neonatal units of two Swedish hospitals. In Papers I and II, the sample (Uppsala n=21 and Umeå n=21) comprised of small for gestational age (SGA) infants, in Papers III (Uppsala n=64 and Umeå n=59) and IV (n=127), the samples comprised of appropriate for gestational age (AGA) infants. Paper I indicated large enteral/oral milk volumes rendered i.v. administration of glucose unnecessary, reduced weight loss and helped SGA infants regain birth weight earlier. More rapid postnatal growth did not remain up to 18 months with corrected age in any growth variable (Paper II). In Paper III, effects were compared whether the infants’ volume of breast milk intake in hospital was estimated by “clinical indices” or determined by test-weighing. Infants treated in hospitals where test-weighing was practised attained exclusive breastfeeding at an earlier postmenstrual age (PMA), and they were discharged at an earlier PMA. However, the two study units were similar regarding the proportion of infants attaining exclusive breastfeeding. Paper IV revealed preterm AGA infants with higher standard deviation scores (SDS) at birth had more negative changes from birth to discharge for all growth variables. Conclusions: Papers I and II indicated that early initiation of enteral/oral feeding with proactive increases in milk volume was beneficial short term. No evidence was found for a proactive nutrition regimen with initial large volumes of milk resulting in a different pattern of growth up to the corrected age of 18 months. Test-weighing before and after breastfeeding might help infants to attain exclusive breastfeeding at an earlier PMA (study III). Finally, preterm AGA infants with higher SDS at birth are at higher risk of inadequate growth during their hospital stay (study IV).

No description available.

Globally, in both developed and developing countries, the twinning rates have increased since the early 70’s. A large proportion of twins are born preterm and/or small-for-gestational-age (SGA) and/or with a low birth weight. Several studies have been performed on the long-term effect of these non-optimal birth characteristics on future reproductive performance and morbidity. Yet, most studies exclude twins or higher order pregnancies and thus the findings are based on singleton pregnancies only. The aim of the present thesis was therefore to investigate the impact of non-optimal birth characteristics in terms of preterm birth, small-for-gestational age, and low birth weight, on the reproductive pattern and morbidity among twins and singletons Furthermore, the present thesis attempted to establish whether twins and singletons were affected in the same manner. The studies included in this thesis are prospective population-based register studies, including all men and women, alive and living in Sweden at age 13, who were born between 1973 and 1983 (1,000,037 singletons and 16,561 twins) for the first three studies with follow-up till the end of 2006 and 2009. The last study included all men and women, alive and living in Sweden at age 13, who were born between 1973 and 1993 (2,051,479 singletons and 39,726 twins) with follow-up till the end of 2012. In general, twins were found less likely to reproduce between 13 and 33 years of age compared with singletons. Stratifying data by different birth characteristics, it was found that twins had a lower likelihood of reproducing on several different birth characteristics (appropriate-for-gestational-age, normal birth weight, low birth weight, term birth, preterm birth). However, twins born very preterm had an increased likelihood of reproducing compared with singletons born very preterm. Not taking birth characteristics into account, twinning was associated with a higher degree of hospitalization. However, accounting for the diverging birth characteristics this difference diminished and for some diagnoses the relationship was reversed such that twins were actually less likely to be hospitalized compared with singletons. In terms of the heritability of non-optimal birth characteristics singleton mothers born preterm were more predisposed to give birth to a child that was preterm while singleton mothers born SGA more often gave birth to a child either born preterm or SGA. Among twins this heritability was not as evident. The only difference observed was among twin mothers born SGA who were more likely to give birth to a child born SGA. In the extended cohort comprising those born between 1973 and 1993, male and female twins were found to be less likely to become parents compared with singletons. No difference was found among women in terms of having a second child, while male twins were more likely to have a second child compared with male singletons. It was also found that the likelihood of becoming a first-time parent and second-time parent was positively associated with the number of siblings.

The aim of this study is to examine the long-term cognitive effects and educational outcomes of being born small-for-gestational-age (SGA). It also assesses whether the family’s attitude towards education modifies the effect of SGA on cognitive performance. A total of 9598 children born in 1953 and living in the Stockholm metropolitan area in 1963 were included in this study. Data were obtained from the Stockholm Birth Cohort. Multiple ordinary least square regressions analyses suggest that SGA children have lower mean verbal, spatial and numerical test scores than appropriate-for-gestational-age (AGA) children. However, these differences are small. Other results from modification analyses indicate that the effect of SGA status on cognitive performance is modified by the family’s attitude towards education. Additional logistic regression analyses suggest that the unadjusted difference in log odds of attaining higher education is largely explained by the family’s attitude towards education. The results suggest that the detrimental influences of being born SGA on some cognitive and educational outcomes are limited and may be reduced.

This qualitative study investigated the roles students play in institutional decision-making, and in particular how the students perceive both what their roles should be and what their roles actually are. Five Student Government Association (SGA) presidents, serving sequential one-year terms from 1999 to 2004 at one campus of a multi-campus two-year public college located in a large metropolitan area in the southeast, were interviewed. The qualitative research methodology employed thematic analysis to describe the students' perceptions in the context of both the letter and spirit of policy implementation regarding institutional decision-making. Through analysis of interviews, institutional documents, and documents at the statewide system level, this investigation explored a wide array of variables that affect the roles students play in institutional decision-making. Framed through a critical lens, this study argues that student involvement in institutional decision-making is necessary to engage students as active citizens capable of civil discourse that results in informed action for the benefit of the community in which the citizens are engaged, perpetuating a democratic society. However, this is not what the students perceived from their experiences in institutional decision-making. Based on the data, this study concludes that students play an advisory role at best, but more frequently are co-opted into serving the desired ends of the administration in a hegemonic fashion. This study offers both suggestions for praxis, and raises questions for further research, in an attempt to reconcile the tensions between the corporatization of higher education and the cultivation of democracy.

Clinicians use growth curves to assess infant health. Most children are measured on growth curves that contain percentiles for height, weight, and head circumference by sex. Preterm infants have their own growth curves. Infants who present with measurements below the 10th percentile are considered small-for-gestational age (SGA), and infants who present with measurements above the 90th percentile are considered large-for-gestational age (LGA). Growth curves and centiles can be generated using 3 and 4 parameter distribution models. To date, no studies have been published to investigate whether growth curves generated using a 3- or 4-parameter model differ significantly. Additionally, researchers have found mixed results when exploring the association between race and pregnancy/delivery. Black mothers may have greater risks and babies with lower weights than babies born to White mothers (Borrell, Rodriguez-Alvarez, Savitz, & Baquero, 2016), and growth curves that do not consider race may misclassify non-White babies (Buck-Louis et al., 2015). In this study, I had two specific aims: (1) to compare the preterm infant growth curves and centiles generated using 3 and 4 parameter methods (Lamba Mu Sigma [LMS] and Box-Cox Power Exponential [BCPE], respectively) and assess each model for adequate fit, and (2) to use percentile cut points from race-specific and non-race-specific LMS curves to classify babies in a validation dataset as SGA or LGA. Regarding the differences in curves generated from the LMS and BCPE distributions, the curves produced using the BCPE distribution had a lower GAIC in some cases but model fit criteria for the LMS curves were adequate. The simpler models generated by the LMS method were retained for birth length, head circumference, and weight by sex with an explanatory variable of gestational age. For aim 2, results indicated that race-specific curves classified babies within expected ranges. Non-race-specific curves overidentified Black babies as SGA and underidentified them as LGA. More research is required to test if this relationship persists for babies delivered at full term.

Les variants viraux impliqués dans la transmission du VHC ont rarement été étudiés en raison des difficultés rencontrées pour recruter des patients au stade de la primo-infection. Pour mener cette étude, nous avons analysé le goulot d’étranglement génétique subit par les quasi-espèces virales au cours de 3 accidents d’exposition au sang impliquant des représentants du personnel soignant contaminés par piqûre d’aiguille. En utilisant la technique d’amplification de génomes uniques nous avons obtenu les gènes codant les glycoprotéines d’enveloppe virales E1E2 des variants viraux présents dans ces quasi-espèces. Ces gènes ont été séquencés et soumis à une analyse phylogénétique. Nous avons ensuite pu étudier les propriétés phénotypiques des glycoprotéines d’enveloppe dérivées de variants qui apparaissent au stade très précoce de l’infection. Pendant cette période, le VHC pourrait être plus vulnérable à l’élimination par des vaccins préventifs ou par des immunothérapies. / Little is known about the transmitted variants responsible for the spread of HCV infection, principally because of the difficulties to recruit patients early enough in infection. To address this issue, we proposed to track the genetic bottleneck event in HCV quasispecies, leading to productive clinical infection in three health care workers accidentally contaminated through needlestick accidents. By using a single genome amplification (SGA) approach we identified genes coding the viral envelope glycoprotein E1E2 which composed these quasispecies. The E1E2 sequences were then directly sequenced and subjected to a phylogenetic analysis. By cloning these full-length E1E2 sequences, we investigated the phenotypic properties of the envelope glycoproteins potentially involved in selective HCV transmission and early stage of infection, a period during which the virus might be most vulnerable to elimination by preventive vaccines or immunotherapies.

Untersuchungen haben gezeigt, dass unterdurchschnittlich leichte Neugeborene für zahlreiche Erkrankungen ein erhöhtes Risiko tragen. Beschrieben ist unter anderem das vermehrte Auftreten psychosozialer Probleme sowie metabolischer und kardiovaskulärer Spätfolgen. Inzwischen sind zahlreiche mögliche Ursachen einer intrauterinen und postnatalen Wachstumsretardierung beschrieben worden. Unter diesen Ursachen finden sich auch genetische Veränderungen von Proteinen der endokrinologischen Wachstumsregulierung. So wurden Mutationen im GH1 Gen, in Entwicklungsgenen von GH produzierenden Zellen, im IGF-I Gen und schließlich auch im IGF-I Rezeptor Gen identifiziert. Mutationen im letztgenannten Gen stellen den neuesten Forschungszweig dar und wurden bisher weltweit bei lediglich 19 Patienten festgestellt. Mit dieser Arbeit wird ein weiterer Patient mit einer heterozygoten IGF-I Rezeptormutation beschrieben. Neben einer ausführlichen klinischen Beschreibung war die Analyse der Kausalzusammenhänge von Mutation und klinischem Bild Hauptziel dieser Studie. Über eine ausgeprägte intrauterine und postnatale Wachstumsretardierung hinaus präsentierte die betroffene Patientin eine mentale Entwicklungsverzögerung. Durch verschiedene molekularbiologische Methoden konnte eine gestörte intrazelluläre Prozessierung des veränderten Rezeptorproteins nachgewiesen werden. Beobachtet wurde eine fehlende Zelloberflächenexpression aufgrund einer Retention von Rezeptorvorstufen im Endoplasmatischen Retikulum. Damit wurde ein neuer Mechanismus der IGF-I Resistenz beschrieben.