Paternal DDT exposure induces sex-specific programming of fetal growth, placenta development and offspring's health phenotypes in a mouse model.

Mounting evidence suggests that environmentally induced epigenetic inheritance occurs in mammals and that traits in the progeny can be shaped by parental environmental experiences. Epidemiological studies link parental exposure to environmental toxicants, such as the pesticide DDT, to health phenotypes in the progeny, including low birth and increased risk of chronic diseases later in life. Here, we show that the progeny of male mice exposed to DDT in the pre-conception period are born smaller and exhibit sexual dimorphism in metabolic function, with male, but not female, offspring developing severe glucose intolerance compared to controls. These phenotypes in DDT offspring were linked to reduced fetal growth and placenta size as well as placenta-specific reduction of glycogen levels and the nutrient sensor and epigenetic regulator OGT, with more pronounced phenotypes observed in male placentas. However, placenta-specific genetic reduction of OGT only partially replicates the metabolic phenotype observed in offspring of DDT-exposed males. Our findings reveal a role for paternal pre-conception environmental experiences in shaping placenta development and in fetal growth restriction. While many questions remain, our data raise the tantalizing possibility that placenta programming could be a mediator of environmentally induced intergenerational epigenetic inheritance of phenotypes and needs to be further evaluated.

Indoor Content Delivery Solution for a Museum Based on BLE Beacons.

The digital transformation advancement enables multiple areas to provide modern services to their users. Culture is one of the areas that can benefit from these advances, more specifically museums, by presenting many benefits and the most emergent technologies to the visitors. This paper presents an indoor location system and content delivery solution, based on Bluetooth Low Energy Beacons, that enable visitors to walk freely inside the museum and receive augmented reality content based on the acquired position, which is done using the Received Signal Strength Indicator (RSSI). The solution presented in this paper was created for the Foz Côa Museum in Portugal and was tested in the real environment. A detailed study was carried out to analyze the RSSI under four different scenarios, and detection tests were carried out that allowed us to measure the accuracy of the room identification, which is needed for proper content delivery. Of the 89 positions tested in the four scenarios, 70% of the received signals were correctly received throughout the entire duration of the tests, 20% were received in an intermittent way, 4% were never detected and 6% of unwanted beacons were detected. The signal detection is fundamental for the correct room identification, which was performed with 96% accuracy. Thus, we verified that this technology is suitable for the proposed solution.

Characteristics, prevalence and sources of stress in individuals who discontinue assisted reproductive technology treatments: a systematic review.

By considering the reasons behind discontinuing assisted reproductive technology (ART) treatment, several studies have indicated that 'stress' is an important issue, but the prevalence of stressors and stress responses, either acute or chronic, remains unclear. In this systematic review, we evaluated the characteristics, prevalence and causes of what was perceived and reported as 'stress' by couples who discontinued ART treatment. Electronic databases were systematically searched, and studies were considered eligible if they evaluated stress as a possible reason for ART discontinuation. Twelve studies were included, with 15,264 participants from eight countries. In all studies, 'stress' was assessed through generic questionnaires or medical records, not by validated stress questionnaires or biomarkers. The prevalence of 'stress' ranged from 11-53%. When the results were pooled, 'stress' was cited as a reason for ART discontinuation by 775 out of 2507 participants (30.9%). Clinical factors associated with worse prognosis, physical discomfort due to treatment procedures, family demands, time pressure and economic burden were identified as sources of 'stress' that contributed to ART discontinuation. Precisely knowing the characteristics of the stress associated with infertility is essential to devise preventive or supportive interventions to help patients to cope and endure the treatments. Further studies are necessary to investigate whether the mitigation of stress factors can reduce ART discontinuation rates.

Mindfulness-based program to support lifestyle modification and weight loss in infertile women: randomized controlled trial.

OBJECTIVE: We evaluated the short-term effects of a mindfulness-based program (MBP) on weight loss through lifestyle modification in infertile women who were overweight or obese. METHODS: The participants were randomly assigned to 8 consecutive weekly sessions of MBP plus diet or diet alone. Both groups received a customized dietary plan. Body measures were taken and a questionnaire was applied to evaluate dietary habits at baseline and three months later. RESULTS: The study was completed by 28 women in the MBP group and 24 in the control group. Body weight decreased 1.8 kg (2.1%) in the MBP group (p = 0.001, follow-up vs. baseline) and 1.7 kg (1.9%) in the control group (p = 0.035). There was an average reduction of 2.9 cm of waist circumference in the MBP group (p = 0.008) and 0.3 cm in the control group (p = 0.633). There was a significant reduction in the daily energy intake of the women attending the MBP (mean difference -430 Kcal/day, p=0.010) whereas no significant change was observed in the control group. CONCLUSION: In the short term, this MBP did not affect weight loss in infertile women, but the MBP intervention contributed to reduce waist circumference, possibly due to a significant decrease in food energy intake. TRIAL REGISTRATION NUMBER: RBR-7by76r.

Contrarreformas neoliberais e suas inflexões para o trabalho profissional da(o) assistente social na previdência social brasileira: particularidades da Gerência Executiva/GEX-Belém/Pará / Neoliberal counter-reform and its interferences for the professional job execution of social work in brazilian social security: particularities of Gerência Executiva/GEX-Belém/Pará

O presente artigo procurou problematizar e analisar as contrarreformas neoliberais, no Brasil e as suas inflexões para o trabalho profissional da(o) assistente social que atua na previdência social, em particular, na GEX/Belém-Pará. Teve por base os resultados parciais de uma pesquisa empírica sobre o trabalho e saúde dessa(e)s profissionais que atuam na seguridade social, a partir de uma abordagem qualitativa. Os instrumentos de coleta de dados foram questionários e entrevistas individuais com 9 das 16 assistentes sociais que atuam na referida gerencia. A luz da teoria marxista e do método materialista histórico dialético, os dados obtidos foram analisados, permitindo a constatação de que as contrarreformas neoliberais desde os anos 1970 têm se constituído estratégias para o enfretamento à crise do capitalismo na contemporaneidade, provocando profundas mudanças na política da previdência social, com inflexões para o trabalho profissional da(o) assistente social, em geral e, em particular na GEX-Belém/Pará. As inflexões dessas contrarreformas para o trabalho profissional trabalho desse(a)s profissionais na ­ GEX/Belém-Pará se manifestam tanto no que se refere à forma com a introdução de novas tecnologias (INSS Digital), acelerando a demanda por respostas imediatas etc., quanto ao conteúdo, na medida em que o Estado reduz o orçamento para a política de seguridade social e fomenta, na previdência social o seguro privado que favorece o lucro dos banqueiros internacionais, tendo por consequência, o aumento as demandas para o Serviço Social nesse espaço sócio-ocupacional, conduzindo à intensificação do trabalho provocada pela adoção de novas formas da gestão da força de trabalho, a exemplo da polivalência e do gerenciamento de metas

This article sought to problematize and analyze neoliberal counterreforms in Brazil and their inflections for the professional work of social workers who work in social security, in particular, at GEX/Belém-Pará. It was based on the partial results of an empirical research on the work and health of these professionals working in social security, based on a qualitative approach. The data collection instruments were questionnaires and individual interviews with 9 of the 16 social workers who work in that management. In the light of Marxist theory and the dialectical historical materialist method, the data obtained were analyzed, allowing the observation that the neoliberal counterreforms since the 1970s have been strategies to face the crisis of contemporary capitalism, causing profound changes in the politics of social security, with inflections for the professional work of the social worker, in general and, in particular, at GEX-Belém/Pará. The inflections of these counterreforms for the professional work of these professionals at ­ GEX/Belém-Pará are manifested both in terms of form with the introduction of new technologies (INSS Digital), accelerating the demand for immediate responses, etc., in terms of content, as the State reduces the budget for social security policy and promotes, in social security, private insurance that favors the profits of international bankers, with the result that the demands for Social Work in this space increase. socio-copational, leading to the intensification of work caused by the adoption of new forms of workforce management, such as polyvalence and goal management

Enabling Technologies for Urban Smart Mobility: Recent Trends, Opportunities and Challenges.

The increasing population across the globe makes it essential to link smart and sustainable city planning with the logistics of transporting people and goods, which will significantly contribute to how societies will face mobility in the coming years. The concept of smart mobility emerged with the popularity of smart cities and is aligned with the sustainable development goals defined by the United Nations. A reduction in traffic congestion and new route optimizations with reduced ecological footprint are some of the essential factors of smart mobility; however, other aspects must also be taken into account, such as the promotion of active mobility and inclusive mobility, encouraging the use of other types of environmentally friendly fuels and engagement with citizens. The Internet of Things (IoT), Artificial Intelligence (AI), Blockchain and Big Data technology will serve as the main entry points and fundamental pillars to promote the rise of new innovative solutions that will change the current paradigm for cities and their citizens. Mobility-as-a-service, traffic flow optimization, the optimization of logistics and autonomous vehicles are some of the services and applications that will encompass several changes in the coming years with the transition of existing cities into smart cities. This paper provides an extensive review of the current trends and solutions presented in the scope of smart mobility and enabling technologies that support it. An overview of how smart mobility fits into smart cities is provided by characterizing its main attributes and the key benefits of using smart mobility in a smart city ecosystem. Further, this paper highlights other various opportunities and challenges related to smart mobility. Lastly, the major services and applications that are expected to arise in the coming years within smart mobility are explored with the prospective future trends and scope.

Mindfulness-based intervention for college faculties and students in Brazil.

Background: Teacher and students' stress has been a challenge in education. An approach to stress reduction is mindfulness training. The Mindfulness-based stress reduction (MBSR) has been used to improve the condition of individuals with various health outcomes. The aim of this study was to examine whether MBSR may improve depression, well-being, and perceived stress of Brazilian college faculty and students. Methods: MBSR was performed with college faculty and students from Centro Universitario de Belo Horizonte (UniBH). Participants answered questionnaires (Psychological General Well-Being Index, Perceived Stress Scale, and Beck Depression Index) at the beginning and end of the intervention. A control group of teachers also answered the questionnaires but did not participate in the MBSR intervention. Statistical analyses were performed using paired Student's t-test (P < 0.05 significance). Results: The MBSR intervention positively impacted all conditions measured in the questionnaires in faculty and students who attended the intervention. Faculty and students in the control group had shown conditions being maintained or worsened. Discussion: The MBSR was effective as faculty and students from the experimental group exhibited improvement in general well-being, depression levels, and perceived stress after attending the intervention.

Perda gestacional de repetição: aspectos psíquicos e terapias comportamentais / Recurrent pregnancy loss: psychic aspects and behavioral therapies

A perda gestacional de repetição (PGR) é definida classicamente como três perdas consecutivas antes de 20 semanas de gestação. Ela afeta aproximadamente 3% dos casais que tentam conceber, quando se consideram pelo menos duas perdas, e cerca de 1%, quando acima de três perdas. A PGR está associada a diferentes fatores causais. Algumas mulheres não terão nenhuma anormalidade identificável nos protocolos investigativos atuais. O aborto pode causar doenças mentais, tais como depressão e ansiedade, e ser responsável por sentimentos como medo, raiva e culpa. Embora existam intervenções já estabelecidas para pacientes com perda gestacional com fator causal determinado, não existe nenhum tratamento comprovadamente efetivo em mulheres com perda gestacional inexplicada. O oferecimento do chamado Tender Loving Care pode levar a melhores resultados gestacionais nessas pacientes. Este artigo irá fazer uma revisão sobre os aspectos psíquicos em PGR e o cuidado suportivo que poderá ser realizado nessas pacientes.(AU)

Recurrent pregnancy loss (RPL) is classically defined as three consecutive losses before 20 weeks of gestation. It affects approximately 3% of couples who try to conceive, when considering at least two losses, and about 1%, when considering three or more. RPL is associated with different causal factors. Some women will have no identificable abnormalities in current investigative protocols. Abortion can cause mental illness, such as depression and anxiety, and be responsible for feelings like fear, anger and guilt. Although there are interventions already established for patients with pregnancy loss with a determined causal factor, there is no proven effective treatment for women with unexplained pregnancy loss. The offer of the so-called Tender Loving Care can lead to better pregnancy results in these patients. This article will review the psychic aspects of recurrent pregnancy losses and the supportive care that can be performed in these patients.(AU)

S2HS- A blockchain based approach for smart healthcare system.

Healthcare domain has emerged as one of the most preferred use cases of IoT and its related technologies. However, its widespread adoption is still a distant dream. The primary reason behind this is the security and privacy of the data and the participating entities. To overcome this, blockchain technology has emerged as a convenient means to improve the security and privacy of the data and its users. With the deluge of medical data generated through electronic medical records and other ICT based mechanisms, blockchain has found innumerable opportunities in the healthcare domain. The traditional healthcare systems are radically adopting modern day technologies for transitioning into the smart healthcare ecosystems. The convenience of the users and ease of use are the primary factors driving this transition. Even with smart healthcare systems (SHS) there exist numerous challenges and issues related to the security, transparency and privacy of the data and users. This paper explores the technological and social barriers in adoption of SHS by analyzing state-of-the-art expert views and user's perception. It further proposes a blockchain based SHS framework to provide intrinsic security and integrity of the system. Finally, the future research directions and use cases of blockchain in healthcare domain are discussed.

Mindfulness-based program for stress reduction in infertile women: Randomized controlled trial.

Infertile women often experience chronic stress, which may have a negative impact on general well-being and may increase the burden of infertility. In this open-label, parallel, randomized controlled trial, infertile women aged 18-50 years (median 37 years) were assigned to an 8-week mindfulness-based program (MBP) or no intervention. The primary outcome was stress severity measured by the Lipp's Stress Symptoms Inventory (ISSL). Data were analyzed by modified intent-to-treat principle, which included all cases available to follow-up regardless of adherence to the intervention (62 participants from the MBP group and 37 from the control group). The median number of symptoms of chronic stress recorded in the past month decreased from six (interquartile range 2 to 9) before the MBP to two (interquartile range 1 to 4) after the intervention (p < 0.001, repeated measures analysis of variance with Time × Group interaction). Depressive symptoms also decreased after MBP, whereas general well-being improved (p < 0.01 for both outcomes). Hair cortisol and serum brain-derived neurotrophic factor (BDNF) did not change significantly between preintervention and postintervention. None of the outcomes changed significantly in the control group. MBP was effective in reducing stress and depressive symptoms while increasing general well-being in infertile women.

Extremely brief mindfulness interventions for women undergoing breast biopsies: a randomized controlled trial.

PURPOSE: Mindfulness-based programs can reduce stress and help practitioners to have positive attitudes in their daily lives. This randomized controlled trial evaluated the impact of brief Mindfulness interventions on quantitative and qualitative stress parameters in patients undergoing imaging-guided breast biopsies. METHODS: Eighty-two women undergoing percutaneous imaging-guided breast biopsy were randomized into two groups: MBI group or standard care group. One week before the biopsy procedure, on the waiting room and during the biopsy procedure, the MBI group was exposed to mindfulness techniques and the standard care group received supportive dialogue from the biopsy team. Participants completed questionnaires measuring depression, anxiety and stress, demographics, and medical history, besides evaluating their pain experience through a visual analogue scale for pain and had their systolic and diastolic blood pressure, initial and final temperate, heart rate, oxygen saturation, and salivary cortisol measured. RESULTS: Participation in the mindfulness intervention group was associated with reduced levels of perceived stress, blood pressure, heart rate, and oxygen saturation compared to participation in the standard care group (P values < 0.05). No difference was observed regarding salivary cortisol levels, peripheral temperature, and pain perception between the two studied groups. CONCLUSION: Results indicate that an extremely brief mindfulness intervention is a feasible intervention, suggesting that Mindfulness-based programs may be beneficial to reduce discomfort in acutely stressful settings.

A tríade da atleta / The female athlete triad

A Tríade da Atleta (TA) é uma síndrome que se manifesta na mulher por meio da baixa disponibilidade de energia (com ou sem distúrbios alimentares), disfunção menstrual e baixa densidade mineral óssea (DMO). Geralmente, acomete pessoas envolvidas com a prática de atividades físicas que enfatizam o emagrecimento.(1,2,3) O diagnóstico pode ser feito por meio da análise do Índice de Massa Corporal (IMC) da paciente; pelo cálculo da disponibilidade de energia; exames de densitometria óssea e radiografia da coluna vertebral, associados à presença de menstruações infrequentes ou amenorreia no ciclo menstrual da paciente. A incidência da TA vem aumentando na atualidade devido à maior divulgação dos benefícios da prática esportiva e à preocupação excessiva com a estética corporal imposta pela sociedade em que vivemos. Os profissionais da saúde devem estar aptos a detectar precocemente os sinais da TA para dar início ao tratamento, uma vez que este é o fator mais importante para diminuir as severas consequências ao organismo.(3) O presente artigo tem como objetivo informar sobre a existência dessa síndrome, com destaque para os métodos diagnósticos e o tratamento.(AU)

The Athlete Triad (AT) is a syndrome that is manifested in women through low energy availability with or without eating disorders, menstrual dysfunction and low bone mineral density (BMD). Usually affects people involved in physical activities that emphasize weight loss. (1,2,3) The diagnosis can be made through the patient's Body Mass Index (BMI) analysis; by calculating the availability of energy; examination of bone densitometry and radiography of the spine associated with infrequent periods or amenorrhea in the patient's menstrual cycle. The incidence of AT is increasing today because the dissemination of sports benefits and excessive concern with body imposed by society. Health professionals must be able to detect early signs of AT to start the treatment, because is the most important factor to reduce the severe consequences on the body.(3) This article has the objective to inform health professionals about the existence of this syndrome with emphasis on diagnostic methods and treatment tools.(AU)

Elevated levels of neuropeptide Y in preeclampsia: A pilot study implicating a role for stress in pathogenesis of the disease.

OBJECTIVE: To determine if preeclampsia (PE) is associated with dysregulation of the neuropeptide Y (NPY) system. METHODS: The study enrolled 114 subjects either with normal pregnancy (NP) or with PE. Systolic blood pressure (SBP) was collected from patients using a standard sphygmomanometer. The PE patients were divided into two groups based on the gestational age (GA) at delivery - placental PE (PLPE, GA <34 weeks) or maternal PE (MTPE, GA ≥34 weeks). NPY was measured in platelet rich plasma (PRP), platelet poor plasma (PPP) and in the serum of NP and PE patients utilizing radioimmunoassay. Serum levels of soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) were measured in NP and PE subjects by ELISA. RESULTS: SBP was higher in PE compared to NP. Circulating NPY in serum and PRP, as well as NPY content per 100,000 platelets, but not its concentrations in PPP, were elevated in PE, as compared to NP. The highest NPY concentrations were observed in sera and PRP of patients with MTPE. PE patients had also elevated levels of sFlt-1, as compared to NP, although no difference between PLPE and MTPL groups were observed. There was no increase in P1GF in PE patients. CONCLUSION: Systemic NPY is elevated in PE patients, as compared to NP. This increase is observed in blood fractions containing platelets, suggesting accumulation of the peptide in these cells. NPY concentrations are particularly high in patients with MTPE, underlying differences in etiology between PLPE and MTPE. Our study implicates NPY as a potential target in antihypertensive therapies for PE patients.

Útero de Couvelaire: relato de caso / Couvelaire uterus: a case report

O descolamento prematuro da placenta (DPP) é importante causa de hemorragia na gestação, sendo responsável por grande aumento na morbimortalidade materna e fetal. O diagnóstico é principalmente clínico, mas os achados laboratoriais e de imagem podem ser utilizados para apoiar o diagnóstico clínico. O DPP representa desafio em Obstetrícia ao promover graves consequências à mãe-filho, assim como por ter suaetiologia definida de forma incompleta. O objetivo deste estudo foi discutir os aspectos mais relevantes do DPP, enfatizando a importância do exame clínico completo associado ao método de ultrassonografia obstétrica no auxílio ao diagnóstico.

Premature placental separation (PPS) is a major cause of bleeding in pregnancy and responsible for a large increase in maternal and fetal morbidity and mortality. The diagnosis is mainly clinical; however, laboratory and imaging findings can be used to support the clinical diagnosis. PPS represents a challenge in Obstetrics because it promotesserious consequences to mother-child and have incomplete defined etiology. The objective of this study was to discuss the most relevant aspects of PPS emphasizing the importance of a complete clinical examination associated with the obstetric ultrasound method as a diagnostic aid.

Gestação ectópica abdominal:relato de caso com feto vivo / Abdominal ectopic pregnancy: a case report with live fetus

Este trabalho relata o caso de paciente admitida em Pronto-Atendimento, em Belo Horizonte, Minas Gerais, com dor abdominal progressiva e amenorreia, cujo ultrassom abdominal evidenciou gestação ectópica abdominal íntegra com embrião vivo, correspondente a nove semanas de gestação. Gravidez ectópica abdominal é aquela que ocorre fora da cavidade uterina, com implantação e desenvolvimento do sacogestacional dentro da cavidade abdominal. Pode-se manifestar com abdome agudo, que impõe diagnóstico precoce e assistência de urgência.

This study reports the case of a patient admitted to the emergency care in Belo Horizonte,Minas Gerais, with progressive abdominal pain and amenorrhea, whose abdominal ultrasoundshowed abdominal full ectopic pregnancy with a living embryo, corresponding to nineweeks of gestation. The abdominal ectopic pregnancy occurs outside the uterine cavity, withimplementation and development of the gestational sac inside the abdominal cavity. It canmanifest as acute abdomen, which requires an early diagnosis and emergency assistance.

Contracepção em mulheres com condições clínicas especiais. Critérios médicos e elegibilidade / Contraception in women with special clinical conditions. Medical criteria and eligibility

O planejamento familiar é importante para a saúde física, mental e social das mulheres e de suas famílias. O planejamento de uma gravidez em mulheres portadoras de condições médicas especiais tem importância ainda maior, uma vez que a garantia de uma gestação saudável e de feto viável se torna extremamente dificultada. Infelizmente, algumas condições médicas inviabilizam o uso de métodos contraceptivos de forma segura. Apesar de inúmeros estudos terem demonstrado a segurança e efetividade do uso de contraceptivos hormonais em mulheres saudáveis, ainda não dispomos de dados completos no que se refere às mulheres portadoras de condições clínicas especiais. Esta revisão, baseada em evidências científicas e no American College of Obstetrics and Gynecology Practice Bulletin, traz informações para auxiliar os médicos e as mulheres portadoras de condições clínicas especiais a fazer uma opção quanto à seleção do método contraceptivo. Esta revisão traz informações sobre novas tecnologias para planejamento familiar, incluindo contracepção hormonal oral, contraceptivo de emergência, contracepção injetável, anel vaginal, implantes subdérmico e transdérmico e dispositivo intrauterino.

Pregnancy planning is important for the physical, mental, and social health of women and families. For women with underlying medical disorders, pregnancy planning assumes even greater importance, because ensuring a healthy woman and healthy child becomes more challenging. Unfortunately, some medical conditions also complicate the ability to use reliable contraception safely. Although numerous studies have addressed the safety and effectiveness of hormonal contraceptive use in healthy women, data are far less complete for women with underlying medical problems or other special circumstances.Using the best available scientific evidence and based on the American College of Obstetrics and Gynecology Practice Bulletin, this review provides information to help clinicians and women with coexisting medical conditions to make decisions regardingthe selection and appropriateness of various hormonal contraceptives. The review includes recent advances in the development of oral contraception, emergency contraception, injectable contraception, vaginal rings, subdermal implants, transdermal contraception andintrauterine devices.

Inserção velamentosa do cordão umbilical: diagnóstico intraparto / Velamentous insertion of the umbilical cord: intrapartum diagnosis

Relata-se a inserção velamentosa do cordão umbilical diagnosticada durante o parto gemelar normal, evento raro e com mais incidência em gestações múltiplas. É, em geral, assintomático, quando a paciente não entra em trabalho de parto, devendo a gestação ser interrompida por cesariana. A vasa prévia constitui-se em sua complicação rara, podendo ser letal. A ultrassonografia é fundamental para a realização de seu diagnóstico.

A report of velamentous insertion of the umbilical cord diagnosed during a normal twin delivery, a rare event with higher incidence in multiple pregnancies. Because it is generally asymptomatic, when the mother does not go into labor, pregnancy must be interrupted by performing a caesarean delivery. Previous vasa is a rare complication and can be lethal. Ultrasound is crucial for diagnosis.

Complementary and Alternative Medicine in the Treatment of Chronic Pelvic Pain in Women: What Is the Evidence?

Chronic pelvic pain (CPP) is defined as pain of at least 6 months' duration that occurs in the lower abdomen or below the umbilicus and has resulted in functional or psychological disability or required intervention and treatment. Therapeutic interventions center around the treatment of CPP as a diagnosis in and of itself, and treatment of specific disorders that may be related to CPP. A multidisciplinary approach for diagnosis and treatment seems to be most effective for symptomatic relief. This paper reviews the evidence for such interventions as psychological treatments including the use of complementary and alternative medicine techniques for CPP in women. Unfortunately, finding the best evidence in this setting is difficult as only very few randomized controlled trials are available. A combination of treatments is usually required over time for the treatment of refractory CPP. The multifactorial nature of CPP needs to be discussed with the patient and a good rapport as well as a partnership needs to be developed to plan a management program with regular followup. Promotion of a multidisciplinary approach which includes complementary and alternative medicine techniques in managing CPP in women seems to yield the best results.

Tensão pré-menstrual (TPM): uma revisão baseada em evidências científicas / Premenstrual syndrome (PMS): an evidence-based review

A Tensão pré-menstrual (TPM) é uma síndrome comum em mulheres na fase reprodutiva, sendo caracterizada por sintomas físicos e emocionais que ocorrem de forma cíclica durante a fase lútea do ciclo menstrual. Mulheres que apresentam sintomatologia mais severa são classificadas como portadoras de Distúrbio Disfórico Pré-Menstrual (DDPM). Ambas as situações clínicas podem se manifestar com uma grande variedade de sintomas incluindo depressão, labilidade emocional, distensão abdominal, mastalgia, cefaleia e fadiga. O manejo e tratamento adequados dos sintomas pré-menstruais têm sido uma grande incógnita para os clínicos. Porém, com base em vários estudos científicas realizadas na última década, hoje há critérios diagnósticos para a forma mais severa desta condição clínica, a DDPM, assim como novas estratégias terapêuticas. Esta revisão apresentou uma descrição prática e compreensiva do que os clínicos necessitam saber para diagnosticar e tratar os sintomas pré-menstruais, assim como critérios diagnósticos para diferenciação de TPM e DDPM.

Premenstrual syndrome (PMS) is common in women in reproductive phase and is characterized by emotional and physical symptoms that cyclically occur during the luteal phase of the menstrual cycle. Women with more severe symptoms are classified as having Premenstrual Dysphoric Disorder (PMDD). Both clinical situations can appear with a wide variety of symptoms, including depression, mood lability, abdominal pain, breast tenderness, headache and fatigue. The appropriate management and treatment of adverse premenstrual symptoms has been a difficult challenge for clinicians. However, based on numerous scientific studies over the last decade, there are nowadays diagnostic criteria for the severe form of the syndrome, PMDD, and new evidence-based therapeutic strategies. This review presented a comprehensive and practical description of what the clinicians need to know in order to diagnose and treat premenstrual symptoms, as well as diagnostic criteria to differentiate PMS and PMDD.

Variability in pathologists' detection of placental meconium uptake.

Placental meconium has been associated with poor perinatal outcomes but the reliability of the diagnosis has not been assessed. Our objective was to assess the interobserver variability in detection of placental meconium uptake. Ten pathologists from two community and four university hospitals reviewed 10 hematoxylin and eosin-stained placental slides that included cases of in utero and in vitro meconium uptake as well as negative controls. Pathologists rated amnion denudation, presence, location, and density of meconium. Results were compared using a kappa score measure of concordance. There was fair concordance in samples with > 50% amnion denudation (kappa = 0.42), though overall amnion integrity concordance was poor (kappa = 0.18). Similarly, poor concordance was noted for presence (kappa = 0.13), location (kappa = 0.06), and density of meconium staining (kappa = 0.11). Detection of meconium uptake in placentas is highly variable among a representative group of community and university pathologists. This finding suggests a need for a more objective measure of meconium uptake in placentas.