Screening tools for postpartum depression: validity and cultural dimensions

Objective: The purpose of this study is to review the main postpartum screening tools currently used in terms of their ability to screen for postnatal depression. Furthermore, the cultural characteristics of depressive postpartum symptomatology are examined.Method: A systematic literature search was conducted for the period 1987-2009, using the Medline electronic database for the following keywords: postpartum depression and postnatal depression. These terms were combined with: assessment, screening and psychometric tools. Results: Of the four screening tools reviewed and compared, the Edinburgh Postnatal Depression Scale (EPDS) and the Postpartum Depression Screening Scale (PDSS) presented substantial sensitivity and specificity as screening tools. However, none of the instruments could be rated flawless when applied to different cultural contexts. Conclusions: In addition to the EPDS, a new generation of instruments is currently available. Supplementary research is needed to substantiate their use as screening tools in general practice. Additional studies are needed to adapt and test instruments to detect postnatal depression within a wider range of languages and cultures.Key words: Acculturation; Postnatal depression; Postpartum depression; Scales; Screenin

The use of the computerized version of quality of life and health status questionnaires in a community sample in southern Brazil

CONTEXT AND OBJECTIVE: Computerized data collection is an efficient process and well accepted by patients with different disorders. Although computer-based systems have been used to assess health status and quality of life in various areas of healthcare, there is a lack of studies to investigate the effectiveness of these instruments in Brazil. The aims here were to assess the usability of the Portuguese-language versions of the Personal Health Scale (PHS) and the Multicultural Quality of Life Index (MQLI) in southern Brazil and to determine the correlation between these two questionnaires. DESIGN AND SETTING: This was a cross-sectional community-based survey in which participants completed computerized versions of these two questionnaires. METHODS: In a survey conducted in 16 different locations, 458 volunteers completed both questionnaires. Pearson correlation coefficients were generated between the scores of the two questionnaires. The inclusion criteria allowed all volunteers who were able to understand the questions in both questionnaires to participate in the study. RESULTS: The percentage of proper data collection via the computerized versions of the two questionnaires combined was 97.45%. A significant correlation (P < 0.01) between the PHS and the MQLI was observed. CONCLUSION: The computerized versions of the PHS and MQLI demonstrated efficient data collection patterns during the field survey trials. Health-related issues were significantly correlated with the overall experience of wellbeing and quality of life. The computerized versions of the PHS and MQLI are valid tools for research and clinical use in Brazi

Cesarean section is associated with increased peripheral and central adiposity in young adulthood : cohort study

Background: Cesarean section (CS) has been associated with obesity, measured by body mass index (BMI), in some studies. It has been hypothesized that this association, if causal, might be explained by changes in gut microbiota. However, little is known about whether CS is also associated with increased adiposity as measured by indicators other than BMI. Objective: To assess the association between CS and indicators of peripheral and central adiposity in young adults. Methods: The study was conducted on 2,063 young adults aged 23 to 25 years from the 1978/79Ribeira˜o Preto birth cohort, Sa˜o Paulo, Brazil. CS was the independent variable. The anthropometric indicators of adiposity were: waist circumference (WC), waist-height ratio (WHtR), waist-hip ratio (WHR), tricipital skinfold (TSF), and subscapular skinfold (SSF). The association between CS and indicators of adiposity was investigated using a Poisson model, with robust adjustment of variance and calculation of incidence rate ratio (IRR) with 95% confidence interval (95%CI), and adjustment for birth variables. Results: Follow-up rate was 31.8%. The CS rate was 32%. Prevalences of increased WC, WHtR, WHR were 32.1%, 33.0% and 15.2%, respectively. After adjustment for birth variables, CS was associated with increased risk of adiposity when compared to vaginal delivery: 1.22 (95%CI 1.07; 1.39) for WC, 1.25 (95%CI 1.10;1.42) for WHtR, 1.45 (95%CI 1.18;1.79) for WHR, 1.36 (95%CI 1.04;1.78) for TSF, and 1.43 (95%CI 1.08;1.91) for SSF. Conclusion: Subjects born by CS had a higher risk for increased peripheral and central adiposity during young adult age compared to those born by vaginal delivery. The association of CS with adiposity was consistently observed for all indicators and was robust after adjustment for a variety of early life confounders

Normal weight obesity is associated with metabolic syndrome and insulin resistance in young adults from a middle-income country

Objective: This population-based birth cohort study examined whether normal weight obesity is associated with metabolic disorders in young adults in a middle-income country undergoing rapid nutrition transition. Design and Methods: The sample involved 1,222 males and females from the 1978/79 Ribeira˜o Preto birth cohort, Brazil, aged 23–25 years. NWO was defined as body mass index (BMI) within the normal range (18.5–24.9 kg/m2) and the sum of subscapular and triceps skinfolds above the sex-specific 90th percentiles of the study sample. It was also defined as normal BMI and % BF (body fat) .23% in men and .30% in women. Insulin resistance (IR), insulin sensitivity and secretion were based on the Homeostasis Model Assessment (HOMA) model. Results: In logistic models, after adjusting for age, sex and skin colour, NWO was significantly associated with Metabolic Syndrome (MS) according to the Joint Interim Statement (JIS) definition (Odds Ratio OR = 6.83; 95% Confidence Interval CI 2.84–16.47). NWO was also associated with HOMA2-IR (OR = 3.81; 95%CI 1.57–9.28), low insulin sensitivity (OR = 3.89; 95%CI 2.39–6.33), and high insulin secretion (OR = 2.17; 95%CI 1.24–3.80). Significant associations between NWO and some components of the MS were also detected: high waist circumference (OR = 8.46; 95%CI 5.09–14.04), low High Density Lipoprotein cholesterol (OR = 1.65; 95%CI 1.11–2.47) and high triglyceride levels (OR = 1.93; 95%CI 1.02–3.64). Most estimates changed little after further adjustment for early and adult life variables. Conclusions: NWO was associated with MS and IR, suggesting that clinical assessment of excess body fat in normal-BMI individuals should begin early in life even in middle-income countries

Ensino de Design e Emoção: Uma análise das matrizes curriculares de graduação em Design na Região Sul do Brasil

Os cursos de graduação em Design no Brasil são responsáveis por formar profissionais que tenham como perfil a capacidade de articular habilidades, competências e conhecimentos, tais como visão sistêmica interdisciplinar, capacidade criativa, de expressão e reprodução visual, assim como conhecimento de aspectos econômicos, psicológicos e sociais aplicados a projetos. Neste contexto, o Design e Emoção é um dos campos do design que vem crescendo nas últimas décadas, e este trabalho teve como objetivo examinar o seu crescimento a partir da presença da temática em disciplinas de cursos de graduação nas universidades da Região Sul do Brasil. Realizou-se uma pesquisa documental analisando as matrizes curriculares e as ementas dos cursos de bacharelado e de tecnologia em Design, Design Gráfico e de Produto, e Desenho Industrial. Como resultado, verificou-se que apenas uma instituição conta com disciplina específica relacionada à D&amp;E, indicando a existência de uma oportuna lacuna curricular a ser preenchida.Â

Peso medio al nacer entre recién nacidos a término : tendencia, magnitud y factores asociados

A trend towards increasing birth weight has been shown, but factors that explain these trends have not been elucidated. The objectives of this study were to evaluate changes in mean birth weight of term newborns and to identify factors associated with them. All cohorts are population-based studies in which random samples of births (Ribeirão Preto, São Paulo State in 1978/1979, 1994 and 2010; Pelotas, Rio Grande do Sul State in 1982, 1993 and 2004; and São Luís, Maranhão State in 1997/1998 and 2010, Brazil). A total of 32,147 full-term, singleton live births were included. Mean birth weight reduced in the first study period (-89.1g in Ribeirão Preto from 1978/1979 to 1994, and -27.7g in Pelotas from 1982 to 1993) and increased +30.2g in Ribeirão Preto from 1994 to 2010 and +24.7g in São Luís from 1997 to 2010. In the first period, in Ribeirão Preto, mean birth weight reduction was steeper among mothers with high school education and among those born 39-41 weeks. In the second period, the increase in mean birth weight was steeper among mothers with low schooling in Ribeirão Preto and São Luís, females and those born 37-38 weeks in Ribeirão Preto and cesarean section in São Luís. Birth weight decreased in the first study period then increased thereafter. The variables that seem to have been able to explain these changes varied over time.Existem evidências de uma tendência de aumento do peso ao nascer, mas pouco se sabe sobre os fatores que explicam essa tendência. Avaliar as mudanças na média de peso ao nascer e identificar os fatores associados. Foram incluídas todas as coortes de base populacional com amostras aleatórias de nascimentos (Ribeirão Preto, São Paulo em 1978/1979, 1994 e 2010; Pelotas, Rio Grande do Sul em 1982, 1993 e 2004; São Luís, Maranhão em 1997/1998 e 2010, Brasil). Foi incluído um total de 32.147 nascidos vivos a termo, de feto único. A média de peso ao nascer diminuiu no primeiro período estudado (-89,1g entre 1978/1979 e 1994 em Ribeirão Preto e -27,7g entre 1982 e 1993 em Pelotas) e aumentou no segundo período, +30,2g entre 1994 e 2010 em Ribeirão Preto e +24,7g entre 1997 e 2010 em São Luís. No primeiro período, em Ribeirão Preto, a redução na média de peso ao nascer foi maior entre mães com escolaridade mais alta e crianças nascidas com 39-41 semanas de idade gestacional. No segundo período, o aumento na média de peso ao nascer foi maior entre mães com escolaridade mais baixa em Ribeirão Preto e São Luís, crianças do sexo feminino e nascidas com 37-38 semanas em Ribeirão Preto e crianças nascidas de cesárea em São Luís. O peso ao nascer diminuiu no primeiro período e aumentou desde então. As variáveis que parecem explicar essas mudanças variaram ao longo do tempo.Se ha mostrado una tendencia de aumento de peso al nacer, pero los factores que explican esta tendencia todavía no han sido elucidados. Evaluar los cambios en el peso medio al nacer de los recién nacidos a término e identificar factores asociados. Se trata de un estudio de todas las cohortes basadas en población, donde existe una muestra aleatoria simple de nacimientos (Ribeirão Preto, São Paulo en 1978/1979, 1994 y 2010; Pelotas, Rio Grande do Sul en 1982, 1993 y 2004; y São Luís, Maranhão en 1997/1998 y 2010, Brasil). Se incluyeron un total de 32.147 de nacimientos a término completo con embarazo de un único feto. El peso medio al nacer se redujo en el primer estudio del período (-89,1g en Ribeirão Preto desde 1978/1979 a 1994 y -27,7g en Pelotas desde 1982 a 1993) y se incrementó +30,2g en Ribeirão Preto desde 1994 a 2010 y +24.7g en São Luís desde 1997 a 2010. En el primer periodo, en Ribeirão Preto, la reducción del peso medio al nacer fue más pronunciada entre madres con una escolarización más alta y entre aquellos nacidos con 39-41 semanas. En el segundo período, el incremento en el peso medio al nacer fue más pronunciado entre las madres con una escolarización más baja en Ribeirão Preto y São Luís, mujeres y aquellos que nacieron con 37-38 semanas en Ribeirão Preto y en el área de cesáreas en São Luís. Disminuyó el peso al nacer durante el primer período de estudio y se vio incrementado después. Las variables que parecen capaces de explicar estos cambios varían a lo largo del tiempo

Relação entre nível geral de saúde, dor musculoesquelética e síndrome de burnout em professores universitários

O objetivo desse estudo foi verificar a relação entre nível de saúde geral, dor musculoesquelética, frequência de sintomas musculoesqueléticos e a síndrome de burnout em professores universitários. Foram avaliados 50 professores de uma universidade privada. O nível de saúde geral foi verificado pela versão em português da Personal Health Scale (PHS-Pt), a dor musculoesquelética pelo Questionário Nórdico de Sintomas Osteomusculares (QNSO) e a presença da síndrome de burnout pelo questionário Maslach Burnout Inventory - Human Services Survey (MBI-HSS). A maioria dos professores apresentou comprometimento do nível de saúde (escore total PHS-Pt=6,7±3,8), sendo que 70% apresentaram dor no pescoço e 64% na região lombar nos últimos 12 meses. Houve correlação positiva entre nível geral de saúde e a dimensão exaustão emocional do inventário de burnout. Porém, não houve correlação entre as dimensões do MBI-HSS e dor musculoesquelética.The aim of this study was to verify the relationship between general level of health, muskuloeskeletal pain and occurrence of burnout syndrome in college teachers. Fifty teachers from a private university were evaluated. The level of general health was evaluated by the Portuguese version of the Personal Health Scale (PHS-Pt), muskuloeskeletal pain was verified by Nordic Muskuloeskeletal Questionnaire (NMQ) and the occurrence of burnout syndrome was evaluated by the Portuguese version of the Maslach Burnout Inventory - Human Services Survey (MBI-HSS). The majority of the sample presented some compromising of general health level (total score PHS-Pt=6.7±3.8) with 70% presenting neck pain and 64% presenting lower back pain in the last year. Positive correlation occurred between burnout exhaustion dimension and level of general health. There were no correlation between MBI-HSS dimensions and muskuloeskeletal pain occurrence in the last year

Changes in infant and neonatal mortality and associated factors in eight cohorts from three Brazilian cities

Stillbirth (SBR), perinatal (PMR), neonatal (NMR) and infant mortality rates (IMR) are declining in Brazil and the factors associated with these falls are still being investigated. The objective of the present study was to assess changes in SBR, PMR, NMR and IMR over time and to determine the factors associated with changes in NMR and IMR in eight Brazilian cohorts. All cohorts are population-based (Ribeirão Preto in 1978/79, 1994 and 2010; Pelotas in 1982, 1993 and 2004; and São Luís in 1997/98 and 2010). Were included data on 41440 children. All indicators were decreased, except in the city of Pelotas, from 1993 to 2004, and except SBR in São Luís. Sociodemographic variables seem to be able to explain reductions of NMR and IMR in Ribeirão Preto, from 1978/79 to 1994, and in São Luís. In Ribeirão Preto, from 1994 to 2010 declines in NMR and IMR seem to be explained by reductions in intrauterine growth restriction (IUGR). Newborn’s gestational age had diminished in all cohorts, preventing even greater reductions of NMR and IMR. Improved sociodemographic variables and reduction of IUGR, seem to be able to explain part of the decrease observed. NMR and IMR could have been reduced even more, were it not for the worsening in gestational age distribution