Familia, unidad familiar y hogar: un análisis micro-geográfico de Cartagena (Nueva Granada) en 1777

After briefly reviewing the literature of the family and household in history and describing the setting of Cartagena in the late eighteenth century, the paper describes the format and reliability of a manuscript civil census carried out in 1777. Returns for three barrios of the city are analyzed to describe a range of attributes of residential units including: the type and frequency of family structures within residential. units; variations in size and compositionof residential units according to race and sex of their household heads; and the spatial distribution of residential units of various sizes and structural types.Después de revisar brevemente la literatura sobre la familia y la unidad familiar en la historia y describir el escenario de Cartagena a fines del siglo XVIII, este artículo describe el formato y la confiabilidad de un censo civil manuscrito, realizado en 1777. Se analizan los resultados de tres barrios de la ciudad para describir una variedad de atributos de las unidades residenciales, incluidos: el tipo y la frecuencia de las estructuras familiares dentro de las unidades residenciales; variaciones en el tamaño y composición de las unidades residenciales según la raza y el sexo de sus cabezas de unidad familiar; y la distribución espacial de unidades residenciales de varios tamaños y tipos estructurales

Beyond counting stillbirths to understanding their determinants in low-and middle-income countries: a systematic assessment of stillbirth data availability in household surveys

Objective: To systematically map data availability for stillbirths from all countries with DHS surveys to outline the limitations and challenges with using the data for understanding the determinants and causes of stillbirths, and for cross-country comparisons. Methods: We assessed data sources from the DHS program website, including published DHS reports and their associated questionnaires for surveys completed between 2005 and 2015. Results: Between 2005 and 2015, the DHS program completed 114 surveys across 70 LMICs. Ninety- eight (86.0%) surveys from 66 countries collected stillbirth data adequately to calculate a stillbirth rate, while 16 surveys from 12 countries did not. The method used to count stillbirths varied; 96 (84.2%) surveys used a live birth history with a reproductive calendar, while 16 (14.0%) surveys from 12 countries did a full pregnancy history. Based on assessment of questionnaires, antenatal and delivery care information for stillbirths was only available in 15 surveys (13.2%) from 12 countries (17.1%). Data on maternal conditions/complications were captured in 17 surveys (16.0%), but only in six could these be linked to stillbirths. Data on other recognized risk factors were scarce, varying considerably across surveys. Upon further examination of datasets from surveys with maternity care data on non-live births we found incomplete capture of these data; only two surveys had adequately and completely collected them for stillbirths. Conclusion: Substantial variation exists in DHS surveys in the measurement of stillbirths, with limited scope to examine risk factors or causes. Without immediate improvements our understanding of country-specific trends and determinants for stillbirths will remain hampered, limiting the development, and prioritization of programmatic interventions to prevent these deaths

Studies on the regulation of apolipoprotein E gene expression in macrophages

It was decided to investigate the regulation of apoE by the LXR subfamily of nuclear receptors. LXRs have atheroprotective properties due to their ability to upregulate the expression of genes involved in the reverse cholesterol transport process. ApoE is a direct target of these ligand-mediated transcription factors and a clearer understanding of the LXR-mediated transcription of apoE would aid the development of potential therapeutic agents for atherosclerosis. Therefore, the involvement of signal transduction pathways in the LXR-mediated regulation of apoE in macrophages was investigated. Through the use of commercially available inhibitors, we firstly identified a novel role for the JNK/SAPK MAPK, P13K and CK2 pathways in the LXR-mediated induction of apoE mRNA protein and secretion in human THP-1 macrophages. This inhibition of apoE induction was also shown to occur in human primary monocyte-derived macrophages and further investigations demonstrated the potential role of these cell signalling pathways in the LXR-mediated regulation of ABCA1, ABCG1 and LXRα. It was also found, for the first time, that treatment of THP-1 macrophages with the oxysterol LXR ligand, 22(R)-hydroxycholesterol, induced JNK phosphorylation and kinase activity, and the subsequent phosphorylation of the c-jun transcription factor. Treatment of THP-1 macrophages with the LXR ligand also resulted in the phosphorylation and activation of Akt, a downstream component of PI3K signalling. In addition CK2 activity was found to be increased in THP-1 macrophages treated with 22(R)-hydroxycholesterol. In conclusion, the studies presented in this thesis demonstrated, for the first time, an important role for the JNK/SAPK MAPK, P13K and CK2 pathways in the activation of macrophage apoE gene expression by the LXR subfamily of nuclear receptors. A potential role for these cell signalling pathways was also implicated in the LXR-mediated regulation of ABCA1, ABCG1 and LXRα

Family, household and home: a micro-geographic analysis of Cartagena (New Granada) in 1777

Después de revisar brevemente la literatura sobre la familia y la unidad familiar en la historia y describir el escenario de Cartagena a fines del siglo XVIII, este artículo describe el formato y la confiabilidad de un censo civil manuscrito, realizado en 1777. Se analizan los resultados de tres barrios de la ciudad para describir una variedad de atributos de las unidades residenciales, incluidos: el tipo y la frecuencia de las estructuras familiares dentro de las unidades residenciales; variaciones en el tamaño y composición de las unidades residenciales según la raza y el sexo de sus cabezas de unidad familiar; y la distribución espacial de unidades residenciales de varios tamaños y tipos estructurales.After briefly reviewing the literature of the family and household in history and describing the setting of Cartagena in the late eighteenth century, the paper describes the format and reliability of a manuscript civil census carried out in 1777. Returns for three barrios of the city are analyzed to describe a range of attributes of residential units including: the type and frequency of family structures within residential. units; variations in size and compositionof residential units according to race and sex of their household heads; and the spatial distribution of residential units of various sizes and structural types

Histological Chorioamnionitis Is Increased at Extremes of Gestation in Stillbirth: A Population-Based Study

Objective. To determine the incidence of histological chorioamnionitis and a fetal response in stillbirths in New South Wales (NSW), and to examine any relationship of fetal response to spontaneous onset of labour and to unexplained antepartum death. Study Design. Population-based cohort study. Setting. New South Wales Australia. Population. All births between 2002 and 2004 with stillbirths reviewed and classified by the state perinatal mortality review committee. Methods. Record linkage of the Midwives Data Collection and the Perinatal Death Database including placental histopathology and standardised cause of death classification. Results. 952 stillbirths were included. The incidence of histopathological chorioamnionitis was 22.6%, with a bimodal distribution. A fetal inflammatory response was present in 10.1% and significantly correlated with spontaneous onset of labour. The absence of a fetal inflammatory response was strongly associated with unexplained antepartum death. Conclusions. The increased incidence of histological chorioamnionitis at extremes of gestation is confirmed in the largest dataset to date using population data. This has important implications for late gestation stillbirth as the percentage of unexplained stillbirths increases near term

The influence of grandmothers on breastfeeding rates: a systematic review

Background: Exclusive breastfeeding for the first six months of an infant’s life has enormous potential to reduce mortality and morbidity. The older generation, particularly the infant’s grandmothers, play a central role in various aspects of pregnancy and child rearing decision-making within the family unit. This is particularly true in low- and middle-income countries where older women are seen as owners of traditional knowledge. Despite this, most health programs target the individual person most directly involved in the target behaviour – usually new mothers – without a commensurate understanding of who else influences those decisions. In this systematic review we aim to quantify the impact of the grandmother on influencing a mother’s breastfeeding practices. Methods: We conducted a systematic review using Web of Science, Scopus, and Medline databases using search terms for grandmother and breastfeeding. Eligible studies reported on the duration of exclusive breastfeeding and included estimates of effect of a grandmother’s influence including whether or not the grandmother lived with the infant’s family, the grandmother’s education, and the grandmother’s attitudes towards and prior experience with breastfeeding. Results: We identified 568 articles and, after review, 13 articles were assessed as meeting the selection criteria. They were conducted in both developed and developing countries and included cross-sectional surveys, prospective cohort studies and one randomised controlled trial. Eight studies examined the effects of attitudes or experiences of older generations with respect to breastfeeding and five of the eight found a significant positive impact on breastfeeding when grandmothers of the infants had had their own breastfeeding experience or were positively inclined towards breastfeeding, resulting in effects of between 1.6 to 12.4 times more likely to exclusively breastfeed or refrain from introducing solid foods. A Chinese study however found that highly educated grandmothers were associated with decreased exclusive breastfeeding. The majority of the studies were assessed to be of weak or moderate quality. Conclusions: This review found evidence that demonstrates that grandmothers have the capacity to influence exclusive breastfeeding. Programs that seek to influence exclusive breastfeeding should include grandmothers in their interventions to achieve maximum impact

A cross-sectional study of maternal perception of fetal movements and antenatal advice in a general pregnant population, using a qualitative framework

BACKGROUND: Maternal perception of fetal movements has been used as a measure of fetal well-being. Yet a Cochrane review does not recommend formal fetal movement counting compared to discretional fetal movement counting. There is some evidence that suggests that the quality of fetal movements can precede quantitative changes however there has been almost no assessment of how women describe movements and whether these descriptions may be useful in a clinical setting. Therefore we aimed to examine maternal perception of fetal movements using a qualitative framework. METHODS: Using a cross-sectional design we identified women during routine antenatal care at a tertiary referral hospital, in Sydney, Australia. Eligible women were pregnant ≥ 28 weeks, carrying a single child, > 18 years old, and with sufficient English literacy to self-complete a questionnaire. Post-natally the medical records were reviewed and demographic, pregnancy and fetal outcome data were extracted. Text responses to questions regarding maternal descriptions of fetal movements throughout pregnancy, were analysed using thematic analysis in an explicit process. RESULTS: 156 women participated. There was a general pattern to fetal movement descriptions with increasing gestation, beginning with words such as “gentle”, to descriptions of “strong” and “limb” movements, and finally to “whole body” movements. Women perceived and described qualitative changes to fetal movements that changed throughout gestation. The majority (83%) reported that they were asked to assess fetal movements in an implicit qualitative method during their antenatal care. In contrast, only 16% regularly counted fetal movements and many described counting as confusing and reported that the advice they had received on counting differed. CONCLUSIONS: This is the first study to use qualitative analysis to identify that pregnant women perceive fetal movements and can describe them in a relatively homogenous way throughout pregnancy that follow a general pattern of fetal growth and development. These findings suggest that women’s perception of fetal wellbeing based on their own assessment of fetal movement is used in an ad hoc method in antenatal care by clinicians