Prevalence of perinatal depression and associated factors

Orientador: José Guilherme CecattiTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: Objetivos: Este estudo propõe a realizar uma revisão sitemática da literatura científica internacional sobre a prevalência de Depressão Pós-Parto (DPP) e Depressão Gestacional (DG) e uma investigação prospectiva da ocorrência destas condições no contexto de dois serviços de saúde de referência para a atenção materno-infantil nas cidades de Recife (PE) e de Campinas (SP) e identificar fatores associados a essa ocorrência. Método: Para o primeiro objetivo do estudo, foi realizada uma ampla busca na literatura científica internacional nos bancos de dados eletrônicos por artigos publicados de 2000 a junho de 2010, sem restrição de língua, e com buscas manuais de referências secundárias. Incluímos estudos originais de corte transversal, coorte, caso-controle, ensaios controlados aleatorizados e análises de banco de dados. Excluíram-se estudos que usaram populações específicas ou com limitações metodológicas. Para o segundo objetivo foi realizado um estudo de coorte prospectivo, com duas abordagens transversais consecutivas, onde 266 gestantes dos dois centros foram incluídas e estratificadas por possíveis fatores de risco, com a ocorrência de depressão avaliada em dois diferentes tempos, no início do terceiro trimestre da gestação e entre 4 a 6 semanas de puerpério. Foram incluídas mulheres grávidas no início do terceiro trimestre da gestação (entre 30 a 35 semanas) que estavam dispostas a retornar para as avaliações puerperais ou serem contatadas por telefone. O desfecho principal foi a ocorrência de escore EPDS (Edinburgh Postnatal Depression Scale) ?12. Os possíveis fatores de risco para DPP foram avaliados nos dois grupos (com e sem depressão), sendo estimadas as razões de prevalência com seus respectivos IC95%. Resultados: Para a revisão sistemática, 487 artigos foram revisados e 102 incluídos. A prevalência de DG foi de 12,93% (IC99% 12,64-13,22) com base em 86.637 mulheres. A prevalência de DPP foi de 12,61% (IC99% 12.36-12.86) baseada em 120.936 mulheres. Não houve diferença significativa na prevalência usando instrumentos de rastreamento ou diagnóstico. Os países em desenvolvimento tiveram uma prevalëncia global de DPP que foi o dobro dos países desenvolvidos. Houve também uma tendência significativa na diminuição da prevalência com o aumento do tamanho amostral. No segundo estudo completaram as duas entrevistas 170 mulheres em Recife e 96 em Campinas. A prevalência de depressão foi 30,1% na gestação e 10,2% no puerpério. Os fatores associados com a depressão gestacional foram a menor escolaridade (RP 2,08; IC95% 1,01-4,31), baixa classe econômica (1,98; IC95% 1,12-3,53) e ausência do companheiro (1,84; IC95% 1,24-2,74). Os fatores associados com a DPP foram a cor da pele não branca (2,63; IC95% 1,10-6,29), a ausência de um companheiro (2,87; IC95% 1,37-6.04) e a ocorrência de violência psicológica (2,96; IC95% 1,46-5,98) ou sexual (5,08; IC95% 1,21-21,28). O desempenho do escore anteparto alterado como preditor de alteração do pós-parto apresentou sensibilidade de 81,5%, especificidade de 75,7% e valor preditivo positivo de 97,3%. Não houve diferença no escore entre os centros em nenhum dos períodos analisados. Conclusões: A revisão sistemática enfatizou a necessidade de se ampliar o foco da pesquisa quando se trata de rastreamento e diagnóstico de DPP, considerando que uma perspectiva global possibilitou valiosas recomendações sobre a condição. Os dados do presente estudo mostram que a prevalência de DPP é de cerca de 10% e se relaciona com condições sócio demográficas desfavoráveis. Além disso, sugere que é factível a utilização da escala de Edimburgo para triagem de mulheres no pré-natal que possam vir a apresentar DG ou DPPAbstract: Objectives: we propose to perform a systematic review of the international scientific literature on the prevalence of Postpartum Depression (PPD) and Gestational Depression (GD) and a prospective investigation on the occurrence of these conditions in the context of two referral health services from Recife (PE) and Campinas (SP) and identify factors associated with this occurrence. Method: For the first objective, a comprehensive search in the international scientific literature was performed in electronic databases for articles published from 2000 to June 2010, with no language restriction, with hand searches of secondary references. We included original cross-sectional, cohort, case-control studies, randomized controlled trials and database analysis. We excluded studies that used specific populations or with methodological limitations. For the second objective a prospective cohort study was developed with two consecutive cross sectional approaches, including 266 pregnant women from both centers, stratified according to possible risk factors, and the occurrence of depression assessed in two diferente periods, at the beginning of the third trimester and between 4 and 6 weeks of the postpartum period. Pregnant women who were between 30 and 35 weeks of pregnancy and who accepted to return for postpartum evaluation or to be contacted by phone were included. The main outcome was the occurrence of EPDS (Edinburgh Postnatal Depression Scale) scores ?12. The possible risk factors for PPD were evaluated in both groups (with and without depression), and the prevalence ratios with their respective 95%CI were estimated. Results: For the systematic review, 487 articles were reviewed, and 102 included. The prevalence of GD was 12.93% (99%CI 12.64-13.22), based on 86,637 women. The prevalence of PPD was 12.61% (99%CI 12.36-12.86), based on 120,936 women. No statistically significant difference was found in the prevalence using screening or diagnostic instruments. Developing countries have a significant double overall prevalence of PPD as compared to developed settings. There was a significant trend in decreasing the prevalence with the increase in the sample size. For the second study 170 women completed the two interviews in Recife and 96 in Campinas. The prevalence of GD was 30.1% and of PPD was 10.2%. The factors associated with GD were low literacy (PR 2.08; 95%CI 1.01-4.31), low socioeconomic class (1.98; 95%CI 1.12-3.53) and absence of a partner (1.84; 95%CI 1.24-2.74). The factors associated with PPD were non white skin color (2.63; 95%CI 1.10-6.29), the absence of a partner (2.87; 95%CI 1.37-6.04) and the occurrence of psychological (2.96; 95%CI 1.46-5.98) or sexual violence (5.08; 95%CI 1.21-21.28). The performance of an abnormal antepartum score as predictor of abnormal postpartum score showed a sensitivity of 81.5%, specificity of 75.7% and positive predictive value of 97.3%. There was no difference in the scores between the centers in none of periods evaluated. Conclusions: The systematic review emphasized the need to broaden the research focus when dealing with screening and diagnosis of PPD, because a global perspective provided valuable insight on the condition. The results of the cohort study show that the prevalence of PPD is around 10% and is related to unfavorable socio demographic conditions. In addition, they suggest that it is feasible to use the Edinburgh scale during prenatal care for screening women who may have GD or PPDDoutoradoSaúde Materna e PerinatalDoutor em Ciências da Saúd

Incidence and risk factors for Preeclampsia in a cohort of healthy nulliparous pregnant women: a nested case-control study

The objective of this study is to determine the incidence, socio-demographic and clinical risk factors for preeclampsia and associated maternal and perinatal adverse outcomes. This is a nested case-control derived from the multicentre cohort study Preterm SAMBA, in five different centres in Brazil, with nulliparous healthy pregnant women. Clinical data were prospectively collected, and risk factors were assessed comparatively between PE cases and controls using risk ratio (RR) (95% CI) plus multivariate analysis. Complete data were available for 1,165 participants. The incidence of preeclampsia was 7.5%. Body mass index determined at the first medical visit and diastolic blood pressure over 75 mmHg at 20 weeks of gestation were independently associated with the occurrence of preeclampsia. Women with preeclampsia sustained a higher incidence of adverse maternal outcomes, including C-section (3.5 fold), preterm birth below 34 weeks of gestation (3.9 fold) and hospital stay longer than 5 days (5.8 fold) than controls. They also had worse perinatal outcomes, including lower birthweight (a mean 379 g lower), small for gestational age babies (RR 2.45 [1.52-3.95]), 5-minute Apgar score less than 7 (RR 2.11 [1.03-4.29]), NICU admission (RR 3.34 [1.61-6.9]) and Neonatal Near Miss (3.65 [1.78-7.49]). Weight gain rate per week, obesity and diastolic blood pressure equal to or higher than 75 mmHg at 20 weeks of gestation were shown to be associated with preeclampsia. Preeclampsia also led to a higher number of C-sections and prolonged hospital admission, in addition to worse neonatal outcomes9CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQ401636/2013-5Bill and Melinda Gates FoundationGates Foundation [OPP1107597]; CNPqNational Council for Scientific and Technological Development (CNPq) [401636/2013-5

Sensitivity of South American tropical forests to an extreme climate anomaly

The tropical forest carbon sink is known to be drought sensitive, but it is unclear which forests are the most vulnerable to extreme events. Forests with hotter and drier baseline conditions may be protected by prior adaptation, or more vulnerable because they operate closer to physiological limits. Here we report that forests in drier South American climates experienced the greatest impacts of the 2015–2016 El Niño, indicating greater vulnerability to extreme temperatures and drought. The long-term, ground-measured tree-by-tree responses of 123 forest plots across tropical South America show that the biomass carbon sink ceased during the event with carbon balance becoming indistinguishable from zero (−0.02 ± 0.37 Mg C ha−1 per year). However, intact tropical South American forests overall were no more sensitive to the extreme 2015–2016 El Niño than to previous less intense events, remaining a key defence against climate change as long as they are protected

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Differential cross section measurements for the production of a W boson in association with jets in proton–proton collisions at √s = 7 TeV

Measurements are reported of differential cross sections for the production of a W boson, which decays into a muon and a neutrino, in association with jets, as a function of several variables, including the transverse momenta (pT) and pseudorapidities of the four leading jets, the scalar sum of jet transverse momenta (HT), and the difference in azimuthal angle between the directions of each jet and the muon. The data sample of pp collisions at a centre-of-mass energy of 7 TeV was collected with the CMS detector at the LHC and corresponds to an integrated luminosity of 5.0 fb[superscript −1]. The measured cross sections are compared to predictions from Monte Carlo generators, MadGraph + pythia and sherpa, and to next-to-leading-order calculations from BlackHat + sherpa. The differential cross sections are found to be in agreement with the predictions, apart from the pT distributions of the leading jets at high pT values, the distributions of the HT at high-HT and low jet multiplicity, and the distribution of the difference in azimuthal angle between the leading jet and the muon at low values.United States. Dept. of EnergyNational Science Foundation (U.S.)Alfred P. Sloan Foundatio

Penilaian Kinerja Keuangan Koperasi di Kabupaten Pelalawan

This paper describe development and financial performance of cooperative in District Pelalawan among 2007 - 2008. Studies on primary and secondary cooperative in 12 sub-districts. Method in this stady use performance measuring of productivity, efficiency, growth, liquidity, and solvability of cooperative. Productivity of cooperative in Pelalawan was highly but efficiency still low. Profit and income were highly, even liquidity of cooperative very high, and solvability was good

Juxtaposing BTE and ATE – on the role of the European insurance industry in funding civil litigation

One of the ways in which legal services are financed, and indeed shaped, is through private insurance arrangement. Two contrasting types of legal expenses insurance contracts (LEI) seem to dominate in Europe: before the event (BTE) and after the event (ATE) legal expenses insurance. Notwithstanding institutional differences between different legal systems, BTE and ATE insurance arrangements may be instrumental if government policy is geared towards strengthening a market-oriented system of financing access to justice for individuals and business. At the same time, emphasizing the role of a private industry as a keeper of the gates to justice raises issues of accountability and transparency, not readily reconcilable with demands of competition. Moreover, multiple actors (clients, lawyers, courts, insurers) are involved, causing behavioural dynamics which are not easily predicted or influenced. Against this background, this paper looks into BTE and ATE arrangements by analysing the particularities of BTE and ATE arrangements currently available in some European jurisdictions and by painting a picture of their respective markets and legal contexts. This allows for some reflection on the performance of BTE and ATE providers as both financiers and keepers. Two issues emerge from the analysis that are worthy of some further reflection. Firstly, there is the problematic long-term sustainability of some ATE products. Secondly, the challenges faced by policymakers that would like to nudge consumers into voluntarily taking out BTE LEI

Search for stop and higgsino production using diphoton Higgs boson decays

Results are presented of a search for a "natural" supersymmetry scenario with gauge mediated symmetry breaking. It is assumed that only the supersymmetric partners of the top-quark (stop) and the Higgs boson (higgsino) are accessible. Events are examined in which there are two photons forming a Higgs boson candidate, and at least two b-quark jets. In 19.7 inverse femtobarns of proton-proton collision data at sqrt(s) = 8 TeV, recorded in the CMS experiment, no evidence of a signal is found and lower limits at the 95% confidence level are set, excluding the stop mass below 360 to 410 GeV, depending on the higgsino mass

Impacts of the Tropical Pacific/Indian Oceans on the Seasonal Cycle of the West African Monsoon

The current consensus is that drought has developed in the Sahel during the second half of the twentieth century as a result of remote effects of oceanic anomalies amplified by local land–atmosphere interactions. This paper focuses on the impacts of oceanic anomalies upon West African climate and specifically aims to identify those from SST anomalies in the Pacific/Indian Oceans during spring and summer seasons, when they were significant. Idealized sensitivity experiments are performed with four atmospheric general circulation models (AGCMs). The prescribed SST patterns used in the AGCMs are based on the leading mode of covariability between SST anomalies over the Pacific/Indian Oceans and summer rainfall over West Africa. The results show that such oceanic anomalies in the Pacific/Indian Ocean lead to a northward shift of an anomalous dry belt from the Gulf of Guinea to the Sahel as the season advances. In the Sahel, the magnitude of rainfall anomalies is comparable to that obtained by other authors using SST anomalies confined to the proximity of the Atlantic Ocean. The mechanism connecting the Pacific/Indian SST anomalies with West African rainfall has a strong seasonal cycle. In spring (May and June), anomalous subsidence develops over both the Maritime Continent and the equatorial Atlantic in response to the enhanced equatorial heating. Precipitation increases over continental West Africa in association with stronger zonal convergence of moisture. In addition, precipitation decreases over the Gulf of Guinea. During the monsoon peak (July and August), the SST anomalies move westward over the equatorial Pacific and the two regions where subsidence occurred earlier in the seasons merge over West Africa. The monsoon weakens and rainfall decreases over the Sahel, especially in August.Peer reviewe