The phenomenon of pregnancy — a psychological view

Pregnancy is a very specific and complex period in a woman’s life. The accompanying changes are observed not only on the biological/physiological plane but also in her psychological and social functioning. Altered psychological functioning can occur from the very beginning to the end of pregnancy, including the postpartum period. During pregnancy, visible changes occur in the body's appearance, as well as in femininity, affections, and sexuality, whereas the woman's position and role are gaining new qualities. To a greater or lesser degree, every expectant mother experiences psychological am­bivalence, frequent mood changes from exhaustion to exaltation, emotional disturbances, and/or mixed anxiety-depressive disorder. In addition, pregnancy causes a number of specific apprehensions concerning the course and outcome, which makes the woman particularly vulnerable and requires adequate treatment, depending on the adaptive capacities of her personality. Furthermore, from a psychosocial aspect, pregnancy could be considered a specific highly emotional state, which may be a potent stressor. Perinatal maternal stress can lead to different complications that may have far-reaching consequences for both somatic and psychic functioning of the newborn. This review considers pregnancy as a complex psychological phenomenon and explores multiple changes in the woman's psychological functioning in both normal and psychologically complicated courses of pregnancy

Protokół z antagonistą GnRH vs. długi protokół z agonistą GnRH u pacjentek z zespołem policystycznych jajników przygotowywanych do IVF: porównanie wyników klinicznych i jakości zarodków

Objectives: Polycystic ovary syndrome (PCOS) is a common endocrine disorder, primarily affecting women of the reproductive age. The aim of the study was to assess the clinical efficacy and embryo quality in flexible gonadotropin-releasing hormone (GnRH) antagonist protocol in comparison to the long GnRH agonist protocol in PCOS women undergoing in vitro fertilization (IVF). Material and methods: This prospective, randomized study was conducted at the Department of Gynecology and Obstetrics, Clinical Center Niš, Serbia, between 2013 and 2014. The treatment included either a flexible GnRH antagonist protocol (n = 45, antagonist group) or a long GnRH agonist protocol (n = 45, agonist group). Results: The length of the stimulation, total amount of gonadotropins used, as well as the average number of the aspirated and mature oocytes were higher in the agonists group. The endometrial thickness was also greater in the agonists group. A higher number of Class I and Class IV embryos were obtained after the agonist treatment and higher number of Class II and Class III embryos were obtained after the antagonist treatment. Pregnancy, implantation, and miscarriage rates were comparable between the groups. Conclusions: The GnRH antagonist protocol in PCOS patients has a pregnancy rate comparable to that of the GnRH agonist protocol. Since this protocol has a lower rate of complications and is more convenient for patients, we believe that the GnRH antagonist protocol should be used as the first-line treatment for PCOS patients in an IVF program.Cel pracy: Zespół policystycznych jajników (PCOS) jest częstym zaburzeniem endokrynologicznym, głównie dotyczącym kobiet w wieku reprodukcyjnym. Celem badania była ocena skuteczności klinicznej oraz jakości zarodków uzyskanych w protokole flexible z antagonistą GnRH w porównaniu do protokołu długiego z agonistą GnRH u kobiet z zespołem PCO poddanych zapłodnieniu pozaustrojowemu (IVF). Materiał i metoda: To prospektywne, randomizowane badanie przeprowadzono w Klinice Ginekologii i Położnictwa w Clinical Center Niš, w Serbii, w latach 2013–2014. Leczenie polegało na zastosowaniu protokołu flexible z antagonistą GnRH (n = 45) lub długiego protokołu z agonistą GnRH (n = 45). Wyniki: Długość stymulacji, całkowita liczba użytych gonadotropin, jak również średnia liczba zaaspirowanych i dojrzałych oocytów była wyższa w grupie z agonistą. Grubość endometrium była również wyższa w grupie z agonistą. Wyższą ilość zarodków klasy I i IV uzyskano po podaniu agonisty natomiast a po leczeniu antagonistą uzyskano wyższą ilość zarodków klasy II i III. Liczba uzyskanych ciąż, implantacji i poronień była porównywalna w obu grupach. Wnioski: Protokół z antagonistą GnRH u pacjentek z PCOS ma porównywalny odsetek ciąż jak protokół z agonistą GnRH. Ponieważ protokół z antagonistą GnRH ma mniejszą liczbę powikłań i jest wygodniejszy dla pacjentek, uważamy że powinien być stosowany jako leczenie pierwszego rzutu pacjentek z PCOS w programie zapłodnienia pozaustrojowego

Non-Dipping Patten of Blood Pressure and Gestational Hypertension

Gestational hypertension (GH) is one of the entities of the hypertensive disorders in pregnancy (HDP), a major cause of maternal, fetal, and neonatal morbidity and mortality. Also, the HDP have been recognized as an important risk factor for cardiovascular diseases. Thus, women who develop GH or preeclampsia (PE) are at increased risk of hypertension, ischemic heart disease and stroke in later life. An ambulatory blood pressure monitoring (ABPM) takes an important role in diagnosing of hypertension in pregnancy. Also, it has been shown that ABPM had higher accuracy in the prediction of GH, premature childbirth and low birth weight, compared with the conventional blood pressure (BP) measurements. In addition, we have found that non-dipping pattern of BP is very highly related with worse pregnancy outcome in a term of preterm delivery and intrauterine growth restriction. Also, it is associated with worse maternal hemodynamics, more impaired systolic function and more pronounced cardiac remodeling compared to women with GH and dipping pattern of BP. This review aimed to explore the (a) current classifications of the HDP; (b) pathogenesis of GH and PE; (c) physiological changes of BP and maternal hemodynamics in pregnancy; and (d) pathophysiological changes of BP and maternal cardiac function, especially in a term on BP pattern

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.Peer reviewe

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

Prevention of child obesity as a measure of preventing malignant diseases

Numerous investigations documented that there is a significant correlation between obesity and the onset of malignant neoplasms. It has been known for decades that Vojvodina is an area characterized by frequent occurrence of obesity with adult population, which starts much earlier in childhood. Good knowledge of incidence in child obesity is a first step in the prevention of malignant diseases. The study encompassed the anthropometric measurements (body height and body weight) of 3298 boys and 3146 girls aged from 6 to 15 years, from 10 primary schools of the wider area of the city of Novi Sad. The measurement data served as the basis to calculate the body mass index (BMI). On the basis of BMI the incidence of the overall obesity (³P85) among the examined boys on the territory of Novi Sad community was found to be 16.59%. Overweight (P85 - P95) was observed in 10.28%, and obesity (³P95) in 6.31% boys. The analysis of the nutrition status among the examined schoolgirls on the territory of Novi Sad community, on the basis of BMI, showed that overall obesity (³P85) was present in 14.69% of schoolgirls; overweight (P85 - P95) was found in 9.38%, and obesity (³P95) in 5.31% of the examined schoolgirls. The high percentage of obese schoolchildren cannot be considered as desirable, especially if it is taken into account that there has been a significant increase compared with the previous examination

Nutritional status, eating and physical activity habits of Medical students

The aim of this study was to determine the association between nutritional status of students, dietary habits, and behavior and habits in physical activity. The study was conducted as a cross sectional study. Data collection was performed in September and October 2013, and conducted through questionnaires. The survey included 92 students of all majors study the Medical school, University of Novi Sad. Analyzing the nutritional status of all students in this study, 68.48% were normal weight students, underweight 10.87%, and 20.65% overweight and obese. Differences in nutritional status and dietary habits were confirmed, but were not highly statistically significant. Comparing the coefficient of variation it was found that examined students are more homogeneous with respect to the behavior and habits of physical activity (13.83%), less homogeneous in relation to nutritional status (14.61%) and the least homogeneous with respect to eating habits (15.18%). Based on the obtained results it can be concluded that eating habits and habits in physical activity of students of different majors of Medical school in Novi Sad are very similar without any confirmed differences between the analyzed groups of students. For more concrete results study should include students from other faculties

Designing an IT Ecosystem for Pregnancy Care Management Based on Pervasive Technologies

Pregnancy care is a topic of interest for both academia and practitioners. Novel pervasive technologies and applications, such as mobile technologies, wearables and IoT, open a wide corpus of possibilities for fostering pregnancy care management, and reducing risks and problems, improving communication among stakeholders and society development. This article introduces a model of a pregnancy care IT ecosystem based on the integration of various services in a semantically enriched e-health ecosystem. As proof of concept, both the web and mobile applications that aim to help pregnant women and gynaecologists were designed and employed in a real environment. An evaluation of the developed ecosystem was performed on a sample of 500 pregnant women and 100 doctors. After pilot usage, a survey was used to collect the data from participants, and assess the acceptance of the developed system. Results show that quality, usability and usefulness are on a high level, and that both pregnant women and doctors are ready for more extensive use of the system. In addition, research findings imply that employing pervasive technologies could bring significant benefits to all the parties in pregnancy care systems

PREGLEDNI CLANCI REVIEW ARTICLES 63 Klinicki eentar Vojvodine, Novi Sad Klinika za ginekologiju i akuserstvo Pregledni clanak Reviewarticle ABORTUS LEKOVIMA -SAVREMENA METODA PREKIDA TRUDNOCE MEDICAL ABORTION -MODERN METHOD FOR TER}vfINATION OF PREGNANCY

Lekovi koji se koriste za prekide trudnoce Prostaglandini Prirodni prostaglandini PGF2alfa i PGE2 imaju vaznu ulogu u regulaeij i uterine aktivnosti, narocito u odnosu na porodaj. PGE2 ima jace dejstvo na grlic i izaziva njegovo orneksavanje i dilataeiju, a PGF2 alfa jace deluje na izazivanje kontrakeija materiee. Oba deluju na glatku muskulaturu digestivGodisnje se u svetu izvrsi oko 46 miliona abortusa [1], mada najnoviji podaei iz 2007. ukazuju na cinjenicu da se njihov broj smanjuje i da iznosi 41 milion ABORTUS LEKOVIMA -SAVREMENA METODA PREKIDA TRUDNOCE MEDICAL ABORTION -MODERN METHOD FOR TER}vfINATION OF PREGNANCY Aleksandra KAPAMADZIJA, Jelka VUKELIC, Artur BJELICA i Vesna KOPITOVIC Sazetak -Savremene metode prekida trudnoce lekovima u danasnje vreme su dostupne zenarna mnogih zemalja u razlicitom dijapazonu i protokolima. Otkricem sinergistickog delovanja antiprogestina (mifepriston) i sintetskog analoga prostaglandina E1 (misoprostol), na prekide rane trudnoce, a i na prekide trudnoce u drugom trimestru, razvila se nova, vrlo efikasna i sigurna metoda medikamentoznog abortusa. Danas postoje utvrdene seme davanja ovih lckova u raznim gestacijskim starostima trudnoce koje daje Svetska zdravstvena organizacija na osnovu mnogobrojnih studija radcnih na ovorn podrucju. U Francuskoj je cak odobren medikamentozni abortus do navrsenih sedam gestacijskih nedelja u kucnim uslovima. Protokol prekida trudnoce lekovima u periodu 9-12. gestacijske nedelje jos se ispituje, a za abortuse u drugom trimestru postoji vise sema koje se jos uvek usavrsavaju. Ukoliko dode do nezeljene trudnoce, potrcbno je zenama ornoguciti izbor i ove savrernene metode medikamentoznog abortusa za koju se odlucuje oko polovina zena u zemljama u kojimaje ona dostupna. Kljucne reci: Indukovani abortus: Abortifikujuci agensi: Nezeljena trudnoca; Mifepriston: Mizoprostol; Prostaglandini Uvod nog trakta, perifernog vaskularnog sistema i bronhija, te mogu da izazovu povracanje, dijareju i hipotenziju. PGF2 alfa moze da izazove i bronhospazam. Za prekide trudnoce, ovi prirodni prostaglandini kasnih sezdesetih godina proslog veka bili su dostupni kao dinoprost (PGF2alfa) i dinoproston (PGE2) za intravensku, intra-i ekstraamnijalnu primenu, a dinoproston i u obliku vaginalnog pesara. Zbog nj ihovog kratkog poluzivota i rizika od nezeIjenih i poteneijalno opasnih nuspojava, oni su napusteni zbog preovladavanja sintetskih analoga prostaglandina -karboprost trometamin (PGF2 alfa analog), sulproston (PGE2 analog), gemeprost i mizoprostol-(PGE1 analozi) Mizoprostol (misoprostol), sintetski analog prostaglandina E 1, registrovan je u preko 80 zemalja sirom sveta pod fabrickim nazivom Citotec R kao lek za lecenje i preveneiju ulkusa zeluca i duodenuma, narocito kod paeijenata koji su na redovnoj terapiji nesteroidnim antiinflamatornim lekovima. On je gastricni antisekretorni agens sa protektivnim faktorom na gastrointestinalnu sluzokozu. Lek inhibira gastricnu sekreeiju kiseline i stiti sluzokozu od iritirajucih i drugih efekata nekih lekova. Mizoprostol redukuje sekreeiju gastricne kiseline direktnim dejstvom na parijetalne celije. On takode inhibira nocno lucenje zeludacne kiseline. Kada se koristi u normalnim dozarna, ponekad moze da izazove dijareju, verovatno stimulaeijom sekreeije intestinalnh fluida i efektom na motilitet erev