Pregnancy planning and vitamin/mineral use during pregnancy: results from a study in Portugal.
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Female↗
Biomedical subjects
T Rodrigues
Publications and source records attributed to T Rodrigues.
Effects of nimesulide and its reduced metabolite on mitochondria.
1. We investigated the effects of nimesulide, a recently developed non-steroidal anti-inflammatory drug, and of a metabolite resulting from reduction of the nitro group to an amine derivative, on succinate-energized isolated rat liver mitochondria incubated in the absence or presence of 20 microM Ca(2+), 1 microM cyclosporin A (CsA) or 5 microM ruthenium red. 2. Nimesulide uncoupled mitochondria through a protonophoretic mechanism and oxidized mitochondrial NAD(P)H, both effects presenting an EC(50) of approximately 5 microM. 3. Within the same concentration range nimesulide induced mitochondrial Ca(2+) efflux in a partly ruthenium red-sensitive manner, and induced mitochondrial permeability transition (MPT) when ruthenium red was added after Ca(2+) uptake by mitochondria. Nimesulide induced MPT even in de-energized mitochondria incubated with 0.5 mM Ca(2+). 4. Both Ca(2+) efflux and MPT were prevented to a similar extent by CsA, Mg(2+), ADP, ATP and butylhydroxytoluene, whereas dithiothreitol and N-ethylmaleimide, which markedly prevented MPT, had only a partial or no effect on Ca(2+) efflux, respectively. 5. The reduction of the nitro group of nimesulide to an amine derivative completely suppressed the above mitochondrial responses, indicating that the nitro group determines both the protonophoretic and NAD(P)H oxidant properties of the drug. 6. The nimesulide reduction product demonstrated a partial protective effect against accumulation of reactive oxygen species derived from mitochondria under conditions of oxidative stress like those resulting from the presence of t-butyl hydroperoxide. 7. The main conclusion is that nimesulide, on account of its nitro group, acts as a potent protonophoretic uncoupler and NAD(P)H oxidant on isolated rat liver mitochondria, inducing Ca(2+) efflux or MPT within a concentration range which can be reached in vivo, thus presenting the potential ability to interfere with the energy and Ca(2+) homeostasis in the liver cell.
Animals↗
Influence of nonsteroidal anti-inflammatory drugs on calcium efflux in isolated rat renal cortex mitochondria and aspects of the mechanisms involved.
In the present study we investigated the influence of several nonsteroidal anti-inflammatory drugs on calcium efflux in isolated rat renal cortex mitochondria in order to assess their potential to disrupt cell calcium homeostasis, as well as aspects of the mechanisms associated with oxidation of mitochondrial pyridine nucleotides (NAD(P)H) and with inhibition of the process by cyclosporin A (CsA). Calcium efflux was estimated with arsenazo III as an indicator and the redox state of NAD(P)H was monitored fluorimetrically at the 366/450 nm excitation/emission wavelength pair. Dipyrone, paracetamol and ibuprofen did not induce calcium efflux even at 1 mM, piroxicam and salicylate were poor inducers, while diclofenac sodium and mefenamic acid were potent inducers releasing calcium even at 20 microM and 10 microM, respectively. In the presence of 10 microM calcium, CsA had no appreciable effect while in the presence of 30 microM calcium it delayed calcium efflux. Oxidation of mitochondrial NAD(P)H, concomitant with calcium efflux and inhibited by CsA, was observed only in the presence of 30 microM calcium. The results suggest that diclofenac sodium and mefenamic acid induce calcium efflux in mitochondria through both a mechanism intrinsic to the mitochondrial membrane permeability transition and a mechanism including the electroneutral Ca2+/nH+ porter.
Acetaminophen↗
Liver microsomal parameters related to oxidative stress and antioxidant systems in hyperthyroid rats subjected to acute lindane treatment.
Liver microsomal functions related to xenobiotic biotransformation and free radical production were studied in control rats and in animals subjected to L-3,3',5-triiodothyronine (T3) and/or lindane administration as possible mechanisms contributing to oxidative stress, in relation to the activity of enzymes (superoxide dismutase (SOD), catalase, glutathione peroxidase (GPx), and glucose-6-phosphate dehydrogenase (G-6PDH)) and content of lipid-soluble vitamins (alpha-tocopherol, beta-carotene, and lycopene) affording antioxidant protection. Lindane treatment in euthyroid rats at a dosage of 20mg/kg did not modify the content of liver microsomal cytochromes P450 and b5, the activity of NADPH-cytochrome P450 reductase and NADH-cytochrome b5 reductase, and the production of superoxide radical (O2.-), as well as antioxidant systems, except for the reduction in lycopene levels. Hyperthyroidism elicited a calorigenic response and increased specific and molecular activities of NADPH-cytochrome P450 reductase, O2.- generation, and G-6PDH activity, concomitantly with diminution in liver SOD and catalase activities and in alpha-tocopherol, beta-carotene, and lycopene levels. The administration of lindane to hyperthyroid animals led to a further increase in the molecular activity of NADPH-cytochrome P450 reductase and in the O2.- production/SOD activity ratio, and decrease of hepatic alpha-tocopherol content, in a magnitude exceeding the sum of effects elicited by the separate treatments, as previously reported for reduced glutathione depletion. Collectively, these data support the contention that the increased susceptibility of the liver to the toxic effects of acute lindane treatment in hyperthyroid state is conditioned by potentiation of the hepatic oxidative stress status.
Animals↗
[Risk factors for preterm labor].
OBJECTIVES: Most studies investigating preterm risk factors include medically induced preterm labor due to fetal or maternal complications and do not distinguish preterm labor from preterm premature rupture of membranes. Thus, the objective of this study was to determine the proportion of the three types of preterm birth and identify risk factors for spontaneous preterm labor in a sample of pregnant women who delivered at two level III units. STUDY DESIGN: From January to October 1996, we interviewed 385 women with live preterm newborns and, as controls, 357 mothers of term newborns. Preterm births were classified as preterm labor, preterm premature rupture of membranes and iathrogenic preterm. Independent associations between maternal sociodemographic, constitutional, nutritional and obstetric characteristics and preterm labor were identified using logistic regression analysis. RESULTS: In this sample of preterm births, 29% corresponded to preterm labor, 49% to preterm premature rupture of the membranes and 22% were iathrogenic preterm. The identified risk factors for preterm labor were multiple gestation, no paid work during pregnancy, less than six prenatal care visits, arm circumference less than 26 cm and previous preterm or low birth-weight. Gestational bleeding during the first or third trimester was significantly associated with preterm labor. CONCLUSIONS: As previously recognized, multiple gestation, prior preterm or low birthweight and gestational bleeding are established risk factors for preterm labor. However, prenatal care, maternal work and nutritional status have also been revealed as important issues in preterm risk, deserving special interest since they are susceptible to preventive intervention.
Adult↗
Role of prenatal care in preterm birth and low birthweight in Portugal.
BACKGROUND: It remains unclear if benefits of prenatal care can be attributed to the amount and content of care or to uncontrolled risk factors that might also affect its use. This study was designed to evaluate the independent association between prenatal care adequacy and adverse pregnancy outcomes, measured either as the occurrence of preterm birth or low birthweight. METHOD: We studied 3734 single liveborn infants. Information on mothers' use of prenatal care, and demographic, anthropometric, behavioural, clinical and obstetric characteristics were obtained through questionnaire. Prenatal care was classified as inadequate, intermediate or adequate based on Kessner's Adequacy of Prenatal Care Index. To estimate the association of adequacy of prenatal care and the defined outcomes, both crude and adjusted odds ratios (OR) and 95 per cent confidence intervals (95 per cent CI) were calculated by means of unconditional logistic regression. RESULTS: Adequate and intermediate (compared with inadequate) prenatal care was significantly associated with a lower risk of preterm (OR = 0.20, 95 per cent CI 0.12-0.32, and OR = 0.35, 95 per cent CI 0.23-0.54, respectively) or low birthweight (OR = 0.23, 95 per cent CI 0.15-0.35, and OR = 0.31, 95 per cent CI 0.20-0.46, respectively). After adjusting for maternal age, social class, marital status, complications of pregnancy and type of hospital, the risk of preterm delivery remained significantly lower for women receiving adequate (OR = 0.18, 95 per cent CI 0.11-0.28) or intermediate care (OR = 0.35, 95 per cent CI 0.23-0.54). Adjusted for maternal body mass index, marital status, cigarette smoking, pregnancy weight gain and complications, type of hospital, newborn sex and gestational age, a significant decreased risk of low birthweight remained for infants of women with adequate (OR = 0.39, 95 per cent CI 0.23-0.65) or intermediate care (OR = 0.47, 95 per cent CI 0.29-0.76). CONCLUSIONS: Our findings show that in a population with free access to prenatal care, the quantitative adequacy of prenatal care has an independent effect on pregnancy outcome, whether assessed through the occurrence of preterm births or low birthweight infants.
Adult↗
Independent effect of maternal birth weight on infant birth weight.
The relationship between the birth weights of the mother and her infant was evaluated in a sample of 106 women consecutively delivered of a single live birth. Women were included in the study if their birth weight was available in hospital files or from another reliable source. Women that were themselves a twin or had diseases complicated the course of the pregnancy were excluded. A positive significant correlation was found between mother and infant birth weights (r = 0.29, p = 0.003). This correlation remained significant (partial r = 0.22, p = 0.039) after adjusting for other covariables such as the mother's age, height, education, whether the pregnancy was planned, number of cigarettes smoked daily during pregnancy, month of first antenatal visit and number of visits, weight at end-pregnancy, gestational age and sex of the newborn. In the multiple linear regression model, mother's birth weight explained 3% of the variation observed in infant birth-weight. A weaker crude correlation was also found between mothers' birth weight and gestational age (r = 0.19, p = 0.06). This study shows that maternal birth weight is an independent predictor of infant birth weight, and confirms previous findings suggesting that this maternal factor has a stronger effect on the birth weight than on the gestational age of the newborn.
Birth Weight↗
[Difficulties encountered in gathering information on illegal abortion in the population of women].
Any attempt to study the practice of illegal abortion faces the problem of asking women about a delicate, sensitive issue that has many implications. This may make it difficult to obtain truthful information on the subject. Results related to methodological aspects are emphasized and their possible association with variables included in a cross-sectional study carried out among 1,955 women, of 15 to 49 years of age is analysed. The frequency and conditions under which induced abortion was performed in a region of S. Paulo State are investigated. The women were interviewed at home using a pre-tested, structured questionnaire. Most of the women interviewed declared they had never had an abortion nor had they thought of having one, and four percent referred to having had an induced abortion. However, another 16.7 percent said that they had taken tea or medicine at least once to bring on their menses. In this group, most of the women who thought they were pregnant at that time said they had had never an abortion, in spite of having bled after drinking tea or medicine. The results lead to the conclusion that women tend no omit information on the practice of abortion when questioned directly. This is especially true of those who use oral means to bring on their menses and who seemed not to consider this a way of inducing an abortion.
Abortion, Illegal↗
[Growth and development of children with low birth weight at their first birthday].
The aim of this prospective study was to evaluate the effect of low birthweight on growth and development at one year of age, in a cohort of infants born between March 1992 and March 1993 at Hospital de Famalicão. Information was obtained from 199 children, 89 low birthweight cases and 110 born with a normal (> or = 2500 g) weight. The infant mortality rate (56 vs 9 per 1000), the frequency of growth (32% vs 4%, p = 0.0000003) or developmental delay (30% vs 11%, p = 0.002) were significantly higher in low birthweight babies. However, all cases of developmental delay corresponded to minor impairments. At age one, children born with a normal weight presented mean higher values for weight (10.0 +/- 1.1 kg vs 9.2 +/- 1.2 kg; p = 0.000005), length (74.2 +/- 7.1 cm vs 72.9 +/- 3.1 cm, p = 0.0006) and head circumference (46.4 +/- 1.9 cm vs 45.8 +/- 1.6 cm; p = 0.004). Prenatal characteristics such as the planning of the pregnancy, gestational birth weight, diseases during the pregnancy, gestational age or twining, significantly affected development at one year of age, showing that delays can be prevented before a child is born. In addition, post-natal exposures, such as home conditions, energy and nutrient intake, or coping with vaccination schedules and the occurrence of diseases during the neonatal and post-neonatal periods were significantly associated to developmental delay.(ABSTRACT TRUNCATED AT 250 WORDS)
Child Development↗
Computer education: attitudes and opinions of first-year medical students.
Students' attitudes toward medical informatics were evaluated with self-administered questionnaires, answered by 140 (77%) first-year medical and dental students. Fourteen per cent classified their computer literacy as negligible and 49% as deficient. Ninety-six per cent had used a computer before and 59% used one regularly. Nineteen per cent had computer education in secondary school and a further 16% attended courses given by a computer company. Only 16% read regularly about informatics. These results are similar to those observed in more industrialized countries, except that high-school education is more deficient. To 93% of these students, computer literacy is important for doctors, and to 85% computers may be very useful in many areas of health care. In the opinion of 66% of students, the computer-based patient record will be available within the next 3 to 10 years. Women showed lesser computer literacy (77% computer illiteracy to 39% in men), but there were no relevant differences in attitudes, behaviour and beliefs towards medical informatics between gender, for the same level of computer literacy. Computer education in the undergraduate curriculum was demanded by 92%, and 75% of these preferred an elective course. Weekly hours suggested for lectures should be 1 (54%) or 2 (42%), and for hands-on practice 2 (54%) or 4 (31%) hours. The curriculum should include medical applications (83% of students), information science theory and technology (44%), micro-informatics (44%), bibliographic database search (27%), programming languages (23%) and statistical packages (23%). Gender, computer literacy or course did not correlate significantly with students' opinions about the contents of undergraduate education.
Attitude of Health Personnel↗
[Current characteristics associated with a history of induced abortion].
For the purpose of analysing the association between selected current socio-demographic characteristics and the history of induced abortion, 138 students of a Brazilian university, who had been pregnant at least once, were studied. These students were identified from among the 937 who returned, by mail, a self-administered, anonymous questionnaire distributed to all the female undergraduates. The subjects were divided into two groups, those who had and those who did not have a history of induced abortion. It was found that the largest percentage of women who had already had an induced abortion were of less than 24 years of age, were not living in marital union, had no religious affiliation and no living children at the time of the study. Analysis by logistic regression showed that having no living children was the only current characteristic associated with having had an induced abortion.
Abortion, Induced↗
[Maternal anthropometric characteristics. Risk of intrauterine growth retardation].
The aim of this study was to evaluate the association between maternal nutritional factors and intrauterine growth retardation (IUGR). We studied 1233 mothers who delivered single term newborns: 144 IUGR-birth weight less than one 10th percentile for sex and gestational age and 1119 controls-birth weight between the 10th and the 90th percentile. Maternal anthropometric factors (height, weight before and at the end of pregnancy, total and weekly weight gain and body mass index) were stratified according to quartiles of distribution in the studied population. Unconditional multiple logistic regression was used to estimate odds ratios (OR), adjusting each anthropometric parameter for non nutritional confounders (parity, smoking, gestational illness and history of low birth weight) and the effect of prepregnancy weight or weight gain. Mothers of IUGR cases showed significantly lower mean values of pre and end pregnancy weight, body mass index and total or weekly weight gain. Compared to the reference category (first quartile) women in upper quartiles of total or weekly weight gain, or end pregnancy weight showed significantly lower risks. For a total weight gain of 10-11 kg an OR of 0.43 was found, and that for a weekly gain of 238-297 g was 0.35. An end pregnancy weight between 63 and 68 kg had an OR or 0.45. However, compared to the second no evident benefit was found for the third or fourth quartiles of weight gains, where an increased risk of macrosomia can be anticipated. These results indicate that attitudes during prenatal care towards adequate weight gains may further reduce the risk of IUGR and the associated morbidity and mortality.
Adult↗
[Hypertension and well-being: a study with indapamide].
STUDY OBJECTIVE: Evaluate the clinical efficacy and quality of life of indapamide in patients with mild and moderate arterial systemic hypertension under indapamide. DESIGN: Open prospective design. SETTING: Outpatient clinics of the Instituto Nacional de Cardiologia Preventiva in Lisbon. PATIENTS: Thirty-two patients whose supine diastolic blood pressure was between 95 ans 115 mmHg without known secondary hypertension, unstable diabetes, cardiac, renal or hepatic failure, hypokalemia, coronary artery disease or stroke in the previous year. INTERVENTION: After a two week wash-out and four week placebo periods, indapamide has been given in a single daily dose of 2.5 mg at breakfast during 12 weeks. MEASUREMENTS AND MAIN RESULTS: The mean systolic/diastolic blood pressures was reduced from 155.7/103.7 to 138.6/86.1 mmHg (p < 0.0001). The mean standing systolic/diastolic blood pressure lowered from 160.2/103.7 to 141.6/85.9 mmHg (p < 0.0001). The questionnaires on quality of life and the analogic visual scale showed a progressive and significant improvement in general well-being. In the patient questionnaire the percentage of improvement was 80% (16/20 items) namely asthenia, headache, attention, dizziness, tinnitus and visual disturbance. In the physician questionnaire all the items improved. Biochemical acceptability was characterized by the stability of sodium, chlorine, glucose, creatinine, urea, cholesterol, triglycerides, uric acid and slight decrease in potassium from 4.38 to 4.14 mmol/l (p < 0.01) ranging in normal values. CONCLUSIONS: These results confirm the clinical efficacy of indapamide and its beneficial effects on quality of life in patients with mild and moderate hypertension when administered in monotherapy.
Adult↗
The use of mechanical and chemical restraints in nursing homes.
The use of mechanical and chemical restraints in nursing homes is a common practice, fraught with potential abuse. The patient's freedom of movement and right to an adequate medical and psychiatric evaluation are of the utmost importance. Restraints should be used only as a last resort and should not be a substitute for inadequate staffing or incomplete medical appraisal. Guidelines are offered that maximize the patients' freedom, maintain medical responsibility, and assure safety. Alternatives to the use of restraints are discussed.
Aged↗
Prison legal matters: is prison neglect creating super HIV?
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California↗
[Small for gestational age newborn infants. The effect of standard curves of birth weight on the calculation of the prevalence and of the risk factors].
Sampling decisions, statistical methods and criteria for dating pregnancy all influence birth-weight percentiles and the ability to classify a newborn as growth retarded or small for date. Consequently the prevalence of small for date, the type and the magnitude of risk factors associated with this condition, and the evaluation of preventive interventions are dependent on the standards used. In this study we established birthweight standards for sex and gestational age (36 to 41 weeks) in a sample of 7518 singleton newborns delivered from 1989-92 at Famalicão Hospital. Later, these reference percentiles were applied to a sample of 2210 to calculate the prevalence of small for date, to evaluate associated risk factors, and to compare these estimates with those obtained using Thompson or Lubchenco published charts. The prevalence of small for gestational age was significantly higher using local standards (9.9 or 10.0%) when compared with those obtained using Thompson (8.8%, p < 0.005) or Lubchenco (4.4%, p < 0.005) percentiles. However, the risk factors identified and the magnitude of the point estimates for odds ratios were similar regardless of the reference percentiles. This study shows a significant misclassification of newborns as small or adequate for gestational age that may affect individual prognosis, but this is not reflected in the type and the importance of detected risk factors at a group level.
Birth Weight↗