The impact of gestational weight gain on fetal and neonatal outcomes: the Araraquara Cohort Study

BACKGROUND

Gestational weight gain (GWG) is an important indicator for monitoring maternal and fetal health.

OBJECTIVE

To evaluate the effect of GWG outside the recommendations of the Institute of Medicine (IOM) on fetal and neonatal outcomes.

STUDY DESIGN

A prospective cohort study with 1642 pregnant women selected from 2017 to 2023, with gestational age ≤ 18 weeks and followed until delivery in the city of Araraquara, Southeast Brazil. The relationship between IOM-recommended GWG and fetal outcomes (abdominal subcutaneous tissue thickness, arm and thigh subcutaneous tissue area and intrauterine growth restriction) and neonatal outcomes (percentage of fat mass, fat-free mass, birth weight and length, ponderal index, weight adequateness for gestational age by the Intergrowth curve, prematurity, and Apgar score) were investigated. Generalized Estimating Equations were used.

RESULTS

GWG below the IOM recommendations was associated with increased risks of intrauterine growth restriction (IUGR) (aOR 1.61; 95% CI: 1.14-2.27), low birth weight (aOR 2.44; 95% CI: 1.85-3.21), and prematurity (aOR 2.35; 95% CI: 1.81-3.05), and lower chance of being Large for Gestational Age (LGA) (aOR 0.38; 95% CI: 0.28-0.54), with smaller arm subcutaneous tissue area (AST) (-7.99 g; 95% CI: -8.97 to -7.02), birth length (-0.76 cm; 95% CI: -1.03 to -0.49), and neonatal fat mass percentage (-0.85%; 95% CI: -1.12 to -0.58). Conversely, exceeding GWG guidelines increased the likelihood of LGA (aOR 1.53; 95% CI: 1.20-1.96), with lower 5th-minute Apgar score (aOR 0.42; 95% CI: 0.20-0.87), and increased birth weight (90.14 g; 95% CI: 53.30 to 126.99).

CONCLUSION

Adherence to GWG recommendations is crucial, with deviations negatively impacting fetal health. Effective weight control strategies are imperative.

Sobrevivência de Empresas Nascentes: Influência do Capital Humano, Social, Práticas Gerenciais e Gênero

Resumo Analisa-se a influência do capital humano do empreendedor, o seu capital social e a adoção de práticas gerenciais na sobrevivência de empresas em seus primeiros anos de atividade. De forma inédita, verifica-se como o efeito desses fatores varia de acordo com o gênero, masculino ou feminino, do empreendedor. Usando uma base de 2.000 empresas cadastradas na Junta Comercial do Estado de São Paulo (Jucesp), entre 2003 e 2007, foram ajustados dois modelos econométricos para mensurar o efeito dessas variáveis na sobrevivência de empresas nascentes. Os resultados sugerem que a adoção de práticas gerenciais e alguns aspectos ligados ao capital humano do empreendedor podem favorecer a sobrevivência da empresa. O efeito de competências superiores e capital social sobre a sobrevivência foram maiores para mulheres do que para homens. Os resultados sugerem que empreendedoras enfrentam mais barreiras à constituição de novos negócios, exigindo, portanto, configurações distintas de recursos para atenuar essas barreiras e aumentar a probabilidade de sobrevivência das empresas nascentes.

Apolipoprotein E genotype is related to nitric oxide production in platelets

The presence of the epsilon4 allele of apolipoprotein E (APOE) is considered a risk factor for sporadic Alzheimer's disease (AD). Our recent data demonstrated that the systemic modulation of oxidative stress in platelets and erythrocytes is disrupted in aging and AD. In this study, the relationship between APOE genotype and oxidative stress markers, both in AD patients and controls, was evaluated. The AD group showed an increase in the content of thiobarbituric acid-reactive substances (TBARS) and in the activities of nitric oxide synthase (NOS) and Na, K-ATPase, when compared to controls. Both groups had a similar cGMP content and superoxide dismutase activity. APOE epsilon4 allele carriers showed higher NOS activity than non-carriers. These results suggest a possible influence of APOE genotype on nitric oxide (NO) production that might enhance the effects of age-related specific factor(s) associated with neurodegenerative disorders.

Self-reported and neuropsychological measures of impulsivity in pathological gambling

Pathological Gambling is an impulse control disorder. Impulsivity has been investigated separately by neuropsychological tests and self-report scales. Although some studies have tried to correlate these approaches, their interaction has not been sufficiently explored among pathological gamblers (PG). In this study, we have compared 214 PG (162 with comorbidity and 52 with no comorbidity) to 82 healthy volunteers regarding the reaction time and number of errors at Go/No-go tasks, and scores on the Barratt Impulsiveness Scale (BIS). PG have committed more errors at the Go/No-go tasks and presented higher scores on the self-report scale. The neuropsychological tests and BIS composed a multinomial logistic model that discriminated PG from non-gamblers better than models having one or another type of measure. Impulsivity seems to be a multi-dimensional phenomenon, and PG a heterogeneous population in which different types of impulsivity are present.

Cardiac arrhythmias and atrioventricular block in a cohort of asymptomatic individuals without heart disease

AIMS

To evaluate cardiac arrhythmias and rhythm disturbances on 24 h ambulatory electrocardiographic monitoring in a cohort of asymptomatic healthy individuals with normal clinical examination.

METHODS AND RESULTS

625 asymptomatic healthy individuals, in the age range 15-83 (mean 42, SD 11.9) years; 276 (44.2%) men and 349 (55.8%) women were submitted to 24-hour ambulatory electrocardiographic monitoring. Statistical analysis was performed with likelihood ratio test and automatic backward logistic regression. The frequency of atrial arrhythmias (p < 0.0001; OR 1.059; 95% CI 1.050-1068) and of ventricular arrhythmias (p < 0.0001; OR 1.023; 95% CI 1.017-1.029) increased for each age increase of 1 year; neither atrial nor ventricular arrhythmias demonstrated a statistically significant difference relative to gender. Transient second-degree atrioventricular block (Mobitz I) was observed in 14 (2.2%) individuals and was more frequent in individuals with resting heart rate <60 bpm (p = 0.006; OR 6.7, 95% CI 1.7-25.5).

CONCLUSION

The frequency of atrial and ventricular arrhythmias increased with age and did not demonstrate a significant difference relative to gender. Transient atrioventricular block was more frequent in individuals with lower resting heart rate.

Cognitive performance in depressed patients after chronic use of antidepressants

RATIONALE

Depressive disorders are conditions that often require continuous treatment, and it is therefore important to evaluate the consequences of prolonged administration. There are few studies assessing cognitive functions of depressed patients after long-term use of antidepressants.

OBJECTIVES

This study evaluated the cognitive performance of depressed patients treated with antidepressants for at least 6 months.

METHODS

Patients with major depression (DSM-IV) using imipramine for 2.4+/-0.6 years (mean+/-SE), clomipramine for 2.8+/-1.2 years, fluoxetine for 1.8+/-0.3 years and sertraline for 1.5+/-0.3 years were compared to matched controls (sex, age and educational level) without any psychiatric diagnosis. Memory evaluation consisted of episodic, implicit and working memory tests as well as metamemory assessment.

RESULTS

(a) Psychomotor performance of patients taking imipramine was worse than that of controls in inserting pins and a visual reaction time task; on the performance of tapping the difference from controls varied according to dose/weight for patients taking clomipramine and fluoxetine. (b) For memory tests, differences between patients taking sertraline and controls were observed in the number of digits and words recalled; the difference between patients and controls varied according to dose/weight on the number of familiar words correctly completed for patients taking clomipramine and on digit span backward for those taking sertraline. (c) Metamemory was worse in all patient groups irrespective of patients' clinical state.

CONCLUSIONS

The impairment in psychomotor and memory performances associated with these antidepressants seems to be of low intensity and of questionable clinical relevance.

Influence of age, gender, and serum triglycerides on heart rate in a cohort of asymptomatic individuals without heart disease

BACKGROUND

Age, sex and blood lipids were demonstrated in epidemiological studies to influence heart rate measured on physical examination, on 12-lead electrocardiogram or with automatic devices for short-term measurements. We hypothesized that in healthy individuals, age, sex and other clinical variables may also influence heart rate measured on 24-h ambulatory electrocardiographic monitoring.

METHODS

We studied 625 asymptomatic individuals with normal clinical examination, aged 15 to 83 (mean 42, standard deviation 11.9) years, 276 (44.2%) men and 349 (55.8%) women. Heart rate was evaluated on 24 h ambulatory electrocardiographic monitoring. Variables selected in univariate analysis (chi(2) and Student t tests) were further submitted to multivariate analysis with canonical correlation to assess the strength of associations between heart rate and other variables, and multiple linear regression models to generate reference curves.

RESULTS

Age was the most significant influence on canonical variable of heart rate relative to other clinical and laboratory variables (0.55; p<0.01). There was an increase in the minimum heart rate and a decrease of maximum heart rate with increasing age in both genders. The increase was steeper in men and the decrease was steeper in women. Minimum heart rate increased with increasing serum triglycerides and decreased as estimated maximum oxygen consumption increased.

CONCLUSIONS

There was a narrower variation of heart rate with increasing age in both genders in healthy individuals. This variation was less pronounced in women. In addition, status of body haemostasis associated with peculiar metabolic conditions expressed in serum triglycerides levels may also be associated with heart rate.

Expression of depressive symptoms in a nonclinical Brazilian adolescent sample

OBJECTIVE

This study aimed to detect the prevalence of depressive symptomatology and its expression in a nonclinical Brazilian adolescent student sample.

METHOD

A sample of students from private and public schools (n = 1555, aged 13 to 17 years) answered the Beck Depression Inventory (BDI). We performed factor analysis of the BDI as an indicator of the expression of depressive symptomatology. The following cut-off scores defined nonclinical subgroups: "nondepressed," BDI < 15; "dysphoria," BDI 16 to 20; and "depressed," BDI > 20. We used discriminant analysis to test whether these subgroups could be separated by the depression-specific and nonspecific items.

RESULTS

The point prevalence of depression was 7.6%, according to the BDI cut-off of 20. Girls had higher scores than boys in several items. Scores increased with age. Students from public schools had higher scores than did private school students. Factor analysis showed 2 common factors for the total sample and for each sex: the cognitive affective dimension and the somatic nonspecific dimension. In the adolescents showing clinical depression, items related to self-depreciation, sense of failure, guilty feelings, self-dislike, suicidal wishes, and distortion of body image were common components of BDI factors. Discriminant analysis showed that the BDI highly discriminates depressive symptomatology in adolescent students and also measures specific aspects of depression.

CONCLUSIONS

The BDI is useful as a measure of specific aspects of depression in nonclinical adolescent samples; it was able to detect depression in approximately 7% of the surveyed population. The expression of depressive symptoms in a Brazilian adolescent population is compatible with international studies in this age group. Detecting depressive symptoms in a school population is a critical preventive strategy; to avoid damage to the learning process, it should be followed with further referral to treatment when needed.

Premenstrual dysphoric symptoms amongst Brazilian college students: factor structure and methodological appraisal

OBJECTIVES

The present study aims to assess the factor structure of the DSM-IV Premenstrual Dysphoric Disorder (PMDD) symptoms and its relationship with depressive symptoms.

METHODS

We evaluated retrospectively PMDD symptoms in 513 female college students, through a self-reporting questionnaire based on DSM-IV criteria, in addition to the Beck Depression Inventory (BDI). Principal component analysis on PMDD symptom data was performed to assess its dimensional structure.

RESULTS

In this non-clinical sample, the analysis indicated a higher importance of the dysphoric dimension, but physical symptoms as well as "being out of control" or "overwhelmed" should also be viewed as major symptoms of PMDD. Behavioural symptoms are of secondary importance. The mean BDI score of PMDD group was significantly higher (p < 0.05) than non-PMDD group.

CONCLUSION

The factor structure of the total sample was similar to the symptom structure suggested by DSM-IV diagnostic criteria. Depressive symptoms should be viewed as a confounding variable in PMDD.

Maternal psychological stress and distress as predictors of low birth weight, prematurity and intrauterine growth retardation

OBJECTIVES

To evaluate: (1) the associations between maternal psychological stress, distress and low birth weight (LBW), prematurity and intrauterine growth retardation (IUGR); (2) the interactions between maternal stress, distress and smoking, alcohol and coffee intake; (3) the prevalences of stress and distress in pregnancy.

DESIGN

Longitudinal cohort study.

SETTING

Jundiaí city, São Paulo state, Brazil.

SUBJECTS

A total of 865 pregnant women who attended antenatal care between September 1997 and August 2000.

METHODS

Measures of stress and distress were obtained, by interview, three times in pregnancy: at a gestational age (GA) lower than 16 weeks, from 20 to 26 weeks and from 30 to 36 weeks. Stress was investigated by the perceived stress scale, PSS, and distress by both the general health questionnaire, GHQ, and the State Trait Anxiety inventories, STAI. The outcomes were: LBW (birth weight <2500 g), prematurity (gestational age (GA) at birth <37 weeks) and IUGR (birth weight for GA <or=10th percentile of William's curve). The associations between the outcomes and the psychological measures were assessed in multiple logistic regression models.

RESULTS

Maternal distress was associated with LBW (RR=1.97, P=0.019) and prematurity (RR=2.32, P=0.015), respectively. There was an interaction between distress and smoking in the second interview (P=0.05). The prevalences of stress and distress in the different interviews of pregnancy varied from 22.1 to 52.9%.

CONCLUSIONS

The present study has confirmed that distress is associated with both birthweight and GA. Further research is needed to evaluate the effectiveness of psychological interventions that can improve maternal and foetal well-being.

Memory performance in panic disorder patients after chronic use of clomipramine

This study investigated the chronic use (6.3 +/- 0.5 years; mean +/- SEM) of therapeutic doses of clomipramine (57.0 +/- 8.0 mg/day) by outpatients with panic disorder/agoraphobia who were currently in remission to assess impairment of memory and psychomotor functions. In addition, the association between test performance and serum levels of clomipramine (CMI) and its active metabolite desmethylclomipramine (DCMI) was also assessed. Patients and healthy volunteers matched for sex, age and educational level were submitted to rating scales and to memory and psychomotor tests. There was no significant difference between groups regarding any variable, except for metamemory. Significant associations were found between (i) longer-term clomipramine treatment and poorer performance in the implicit test and (ii) higher serum levels of clomipramine or desmethylclomipramine, or both (CMI + DCMI) and lower performance in central executive tests and metamemory. The results showed that low doses of CMI chronically administered to panic patients are associated with diminished metamemory and impaired priming and working memory. Further investigations are needed to confirm these results and to determine whether the chronic use of higher therapeutic doses of tricyclic antidepressants is associated with more intense deleterious effects on memory and psychomotor functions.

Social adjustment in depressed patients treated with venlafaxine and amitriptyline

Social dysfunction is often associated with depressive disorders and its evaluation is an important measure of treatment outcome. The aim of this study was to assess the effect of two treatments, venlafaxine and amitriptyline, on the social functioning of depressed patients. Twenty-eight outpatients, meeting criteria for recurrent or single major depressive episodes, took part in a double-blind, 8-week trial with amitriptyline or venlafaxine (maximum of 150 mg/day) and were assessed by the Self-Report Social Adjustment Scale (SAS-SR) before and at the end of treatment. The scale was also applied to a carefully selected non-psychiatric sample. Both drugs showed the same efficacy on a clinical scale, but venlafaxine improved social functioning more than amitriptyline as only venlafaxine-treated patients reached SAS-SR values estimated for normal subjects. This effect might be linked to the higher rate of side-effects observed with amitriptyline.

Validation of the Portuguese version of the Social Adjustment Scale on Brazilian samples

BACKGROUND

Social dysfunction is reported in several psychiatric diseases and its evaluation is becoming an important measure of treatment outcome. The aim of this study was to obtain normative data, to test the validity and the ability of the Portuguese version of the Self-Report Social Adjustment Scale (SAS-SR) to detect different clinical conditions.

METHODS

The Portuguese version of the SAS-SR was applied to a carefully selected non-psychiatric sample, and to depressed, panic, bulimic and cocaine-dependent patients. Depressed and panic patients were evaluated in two different clinical conditions: acutely symptomatic and in remission.

RESULTS

SAS overall and sub-scale scores of the normal sample were consistently lower than all patient groups, indicating better social adjustment in all areas. Panic patients were impaired to a lower level than depressed and cocaine-dependent patients in overall adjustment. Depressed patients in remission, although in better condition, were still impaired in relation to normal subjects in overall social functioning, leisure time and marital areas. In panic patients in remission, normalization was not achieved in overall functioning, work and marital areas.

LIMITATIONS

Sample size was small in some groups and the evaluation was cross-sectional.

CONCLUSIONS

The Portuguese version of SAS-SR is a useful instrument for detecting differences between psychiatric patients and normal subjects and for the evaluation of different clinical conditions, recommending its use in outcome studies.

Psychometric properties of the Portuguese version of the State-Trait Anxiety Inventory applied to college students: factor analysis and relation to the Beck Depression Inventory

The psychometric properties of the Portuguese version of the trait form of the State-Trait Anxiety Inventory (STAI-T) and its relation to the Beck Depression Inventory (BDI) were evaluated in a large Brazilian college student sample containing 845 women and 235 men. STAI-T scores tended to be higher for women, singles, those who work, and subjects under 30 years. Factor analysis of the STAI-T for total sample and by gender yielded two factors: the first representing a mood dimension and the second being related to worrying or cognitive aspects of anxiety. In order to study the relation between anxiety and depression measures, factor analysis of the combination of the 21 BDI items and the 20 STAI-T items was also carried out. The analysis resulted in two factors that were analyzed according to the tripartite model of anxiety and depression. Most of the BDI items (measuring positive affectivity and nonspecific symptoms of depression) were loaded on the first factor and four STAI-T items that measure positive affectivity. The remaining STAI-T items, all of them measuring negative affect, remained in the second factor. Thus, factor 1 represents a depression dimension and factor 2 measures a mood-worrying dimension. The findings of this study suggest that, although widely used as an anxiety scale, the STAI-T in fact measures mainly a general negative affect.

Psychometric properties of the Portuguese version of the Beck Depression Inventory on Brazilian college students

The psychometric properties of the Portuguese version of the Beck Depression Inventory were studied on a large Brazilian college student sample (N= 1,080; 845 women, 235 men). The BDI scores according to sociodemographic characteristics and mean individual item scores for total sample and by gender were compared. BDI scores tend to be higher for women, for those who work, and for the younger participants. The reliability of the inventory estimated by alpha coefficient was high for the total sample (.86) and subgroups. Factor analysis showed three factors for the total sample (low self-esteem, cognitive-affective, and somatic) and two for each gender. Women combined affective and low self-esteem whereas men combined somatic and low self-esteem in the same dimension. Discriminant analysis showed that BDI highly discriminates depressive symptomatology in college students and measures specific aspects of depression.

Variações sazonais nas características do sêmen de garanhões e sua relação com a fertilidade do plantei

Foi estudada a influência da estação do ano sobre a concentração, a motilidade progressiva e a percentagem de anormalidades morfológicas em espermatozóides de garanhões, tendo-se registrado também a fertilidade do plantei durante a estação de monta inserida no período estudado. O sêmen de 7 garanhões foi colhido mensalmente, durante 12 meses, para os exames microscópicos e as coberturas foram efetuadas por monta natural. A concentração mais alta de espermatozóides foi observada no outono e no inverno e a mais baixa na primavera; dentre os meses, a maior concentração foi registrada em julho e a menor em junho, mas as diferenças entre as estações e entre os meses não foram estatisticamente significantes. A maior taxa de motilidade progressiva foi registrada no verão e a menor na primavera; dentre os meses, a taxa mais alta ocorreu em julho e a mais baixa em abril, tendo sido significativas as diferenças entre os meses (P<0,05%) e entre as estações (P<0.10). A maior proporção de espermatozóides anormais foi registrada no verão (P<0,05): dentre os meses, a maior proporção ocorreu em janeiro e a menor em março, mas as diferenças não foram estatisticamente significantes. Durante a estação de monta, a fertilidade do plantel, medida pela percentagem de prenhez por ciclo, apresentou uma elevação linear desde 29% em outubro até 95% em fevereiro, não apresentando nenhuma relação aparente com as características do sêmen estudadas.

A manufacturing excellence team-based learning process for our foundation workers

Foundation workers, people who do the daily tasks to serve customers, have long been ignored and misused in the productivity equation. Every person in a company can and must contribute to improved performance. Equipping out foundation workforce with knowledge and skills via a team-based education and training process is prerequisite to their effective engagement in the business management process.