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1.
Nat Sci Sleep ; 12: 453-466, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32765142

RESUMO

Narcolepsy is a neurological disorder of the sleep-wake cycle characterized by excessive daytime sleepiness (EDS), cataplexy, nighttime sleep disturbances, and REM-sleep-related phenomena (sleep paralysis, hallucinations) that intrude into wakefulness. Dysfunction of the hypocretin/orexin system has been implicated as the underlying cause of narcolepsy with cataplexy. In most people with narcolepsy, symptom onset occurs between the ages of 10 and 35 years, but because the disorder is underrecognized and testing is complex, delays in diagnosis and treatment are common. Narcolepsy is treated with a combination of lifestyle modifications and medications that promote wakefulness and suppress cataplexy. Treatments are often effective in improving daytime functioning for individuals with narcolepsy, but side effects and/or lack of efficacy can result in suboptimal management of symptoms and, in many cases, significant residual impairment. Additionally, the psychosocial ramifications of narcolepsy are often neglected. Recently two new pharmacologic treatment options, solriamfetol and pitolisant, have been approved for adults, and the indication for sodium oxybate in narcolepsy has been expanded to include children. In recent years, there has been an uptick in patient-centered research, and promising new diagnostic and therapeutic options are in development. This paper summarizes current and prospective pharmacological therapies for treating both EDS and cataplexy, discusses concerns specific to children and reproductive-age women with narcolepsy, and reviews the negative impact of health-related stigma and efforts to address narcolepsy stigma.

2.
Sci Transl Med ; 12(548)2020 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-32554709

RESUMO

Circulating tumor-derived DNA (ctDNA) can be used to monitor cancer dynamics noninvasively. Detection of ctDNA can be challenging in patients with low-volume or residual disease, where plasma contains very few tumor-derived DNA fragments. We show that sensitivity for ctDNA detection in plasma can be improved by analyzing hundreds to thousands of mutations that are first identified by tumor genotyping. We describe the INtegration of VAriant Reads (INVAR) pipeline, which combines custom error-suppression methods and signal-enrichment approaches based on biological features of ctDNA. With this approach, the detection limit in each sample can be estimated independently based on the number of informative reads sequenced across multiple patient-specific loci. We applied INVAR to custom hybrid-capture sequencing data from 176 plasma samples from 105 patients with melanoma, lung, renal, glioma, and breast cancer across both early and advanced disease. By integrating signal across a median of >105 informative reads, ctDNA was routinely quantified to 1 mutant molecule per 100,000, and in some cases with high tumor mutation burden and/or plasma input material, to parts per million. This resulted in median area under the curve (AUC) values of 0.98 in advanced cancers and 0.80 in early-stage and challenging settings for ctDNA detection. We generalized this method to whole-exome and whole-genome sequencing, showing that INVAR may be applied without requiring personalized sequencing panels so long as a tumor mutation list is available. As tumor sequencing becomes increasingly performed, such methods for personalized cancer monitoring may enhance the sensitivity of cancer liquid biopsies.

3.
Br J Nurs ; 29(4): 230-235, 2020 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-32105537

RESUMO

BACKGROUND: Young people with mental illness are at high risk of physical health complications. Physical healthcare on a general adolescent inpatient unit is complex. AIM: To establish a wellbeing clinic to improve efficiency and quality of the physical healthcare offered and increase health promotion. METHODS: Plan, Do, Study, Act (PDSA) cycles were used to drive this quality-improvement project. The authors audited 12 records before establishing the clinic and 12 at three further time points (6, 18 and 30 months post-intervention) to guide changes. RESULTS: Results progressively improved over PDSA cycles. Time taken for initial investigations dropped. Compliance with medication monitoring and management of important physical health domains rose from zero in some cases to 100% in all but one area. CONCLUSIONS: Establishing a dedicated physical health clinic in this setting is feasible and leads to improved performance against local and national standards. Mental health teams need to ensure physical health is prioritised.


Assuntos
Serviços de Saúde do Adolescente/organização & administração , Unidades Hospitalares/organização & administração , Padrões de Prática em Enfermagem , Adolescente , Humanos , Transtornos Mentais/enfermagem , Pesquisa em Avaliação de Enfermagem
4.
Adv Mater ; 31(49): e1905540, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31631407

RESUMO

Molecular surfactants are widely used to control low-dimensional morphologies, including 2D nanomaterials in colloidal chemical synthesis, but it is still highly challenging to accurately control single-layer growth for 2D materials. A scalable stacking-hinderable strategy to not only enable exclusive single-layer growth mode for transition metal dichalcogenides (TMDs) selectively sandwiched by surfactant molecules but also retain sandwiched single-layer TMDs' photoredox activities is developed. The single-layer growth mechanism is well explained by theoretical calculation. Three types of single-layer TMDs, including MoS2 , WS2 , and ReS2 , are successfully synthesized and demonstrated in solar H2 fuel production from hydrogen-stored liquid carrier-methanol. Such H2 fuel production from single-layer MoS2 nanosheets is COx -free and reliably workable under room temperature and normal pressure with the generation rate reaching ≈617 µmole g-1 h-1 and excellent photoredox endurability. This strategy opens up the feasible avenue to develop methanol-storable solar H2 fuel with facile chemical rebonding actualized by 2D single-layer photocatalysts.

6.
Vet Rec ; 183(23): 716, 2018 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-30463992

RESUMO

An increasing number of non-endemic vectorborne pathogens have been described in dogs imported to the UK in the past two decades. Recently, an outbreak of canine babesiosis in south-east England has raised veterinary awareness with regard to the impact of such diseases on the UK canine population. Canine hepatozoonosis, caused by Hepatozoon canis and transmitted by the ingestion of Rhipicephalus sanguineus ticks, is widespread in the Mediterranean basin. Herein we describe the first three molecularly confirmed clinical cases of canine hepatozoonosis in dogs imported into the UK. Veterinarians in the UK should be aware of H canis as a potential infection in imported dogs, especially in the face of the expanding distribution of R sanguineus ticks in Europe.


Assuntos
Coccidiose/veterinária , Doenças do Cão/diagnóstico , Eucoccidiida , Doenças Transmitidas por Carrapatos/veterinária , Doença Relacionada a Viagens , Animais , Antiprotozoários/uso terapêutico , Coccidiose/diagnóstico , Coccidiose/tratamento farmacológico , Coccidiose/parasitologia , Chipre , Doenças do Cão/tratamento farmacológico , Doenças do Cão/parasitologia , Cães , Eucoccidiida/classificação , Eucoccidiida/genética , Feminino , Imidocarbo/análogos & derivados , Imidocarbo/uso terapêutico , Masculino , Filogenia , RNA Ribossômico 18S/genética , Doenças Transmitidas por Carrapatos/diagnóstico , Doenças Transmitidas por Carrapatos/tratamento farmacológico , Doenças Transmitidas por Carrapatos/parasitologia , Resultado do Tratamento , Reino Unido
7.
Br J Cancer ; 119(7): 793-800, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30033445

RESUMO

BACKGROUND: Studies evaluating a relationship of vitamin D in patients with primary melanoma have consistently identified an inverse correlation with Breslow thickness, but an inconsistent impact on survival. Vitamin D in later stages of melanoma has been less studied. METHODS: Vitamin D was measured in serum from 341 patients with resected stage IIB-IIIC melanoma recruited to the AVAST-M adjuvant melanoma randomised trial, collected prior to randomisation, then at 3 and 12 months. Vitamin D levels were compared with patient demographics, known melanoma prognostic factors, disease-free interval (DFI) and overall survival (OS). RESULTS: A total of 73% patients had stage III melanoma, 32% were enroled (and therefore tested) >1 year after primary melanoma diagnosis. Median pre-randomisation vitamin D level was 56.5 (range 12.6-189.0 nmol/L). Vitamin D levels did not significantly vary over 12 months (p = 0.24). Individual pre-randomisation vitamin D levels did not differ significantly for Breslow thickness, tumour ulceration, or disease stage. Neither did pre-randomisation vitamin D predict for DFI (HR = 0.98 per 10 nmol/L increase; 95% confidence interval (CI) 0.93-1.04, p = 0.59) or OS (HR = 0.96 per 10 nmol/L increase, 95% CI 0.90-1.03, p = 0.31). For stage II patients, DFI improved with higher pre-randomisation vitamin D levels for those on bevacizumab (HR = 0.74 per 10 nmol nmol/L increase; 95% CI 0.56-0.97), but not for the observation arm (HR = 1.07 per 10 nmol/L increase; 95% CI 0.85-1.34). CONCLUSIONS: In this stage II/III melanoma cohort, vitamin D did not correlate with known prognostic markers, nor predict for DFI or OS, but there was some evidence of benefit for patients with stage II disease treated with bevacizumab.


Assuntos
Antineoplásicos Imunológicos/administração & dosagem , Bevacizumab/administração & dosagem , Melanoma/tratamento farmacológico , Melanoma/cirurgia , Vitamina D/análogos & derivados , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos Imunológicos/uso terapêutico , Bevacizumab/uso terapêutico , Quimioterapia Adjuvante , Feminino , Humanos , Masculino , Melanoma/metabolismo , Melanoma/patologia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Análise de Sobrevida , Resultado do Tratamento , Reino Unido , Vitamina D/sangue , Adulto Jovem
8.
Adv Mater ; 30(39): e1803351, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30059172

RESUMO

Quasi-1D cadmium chalcogenide quantum rods (QRs) are benchmark semiconductor materials that are combined with noble metals to constitute QR heterostructures for efficient photocatalysis. However, the high toxicity of cadmium and cost of noble metals are the main obstacles to their widespread use. Herein, a facile colloidal synthetic approach is reported that leads to the spontaneous formation of cadmium-free alloyed ZnSx Se1-x QRs from polydisperse ZnSe nanowires by alkylthiol etching. The obtained non-noble-metal ZnSx Se1-x QRs can not only be directly adopted as efficient photocatalysts for water oxidation, showing a striking oxygen evolution capability of 3000 µmol g-1 h-1 , but also be utilized to prepare QR-sensitized TiO2 photoanodes which present enhanced photo-electrochemical (PEC) activity. Density functional theory (DFT) simulations reveal that alloyed ZnSx Se1-x QRs have highly active Zn sites on the (100) surface and reduced energy barrier for oxygen evolution, which in turn, are beneficial to their outstanding photocatalytic and PEC activities.

9.
Carcinogenesis ; 39(1): 36-46, 2018 01 12.
Artigo em Inglês | MEDLINE | ID: mdl-29069290

RESUMO

Celastrol is an anti-inflammatory natural triterpenoid, isolated from the herb Tripterygium wilfordii or thunder god vine. Here, we define mechanisms mediating anti-inflammatory activity of celastrol and demonstrate efficacy of a dietary celastrol supplement for chemoprevention of inflammation-driven carcinogenesis in mice. Dietary celastrol (31.25 ppm in rodent diet from 8 weeks to 25 weeks of age) is well tolerated and protects against LPS-induced acute inflammation in C57BL/6 mice, potently suppressing LPS-induction of inducible nitric oxide synthase (iNOS), cyclooxygenase (COX)-2, Interleukin (IL)-6 and IL-1ß. To test whether dietary celastrol suppresses inflammation-driven colorectal cancer (CRC), we employed a unique model of spontaneous, inflammation-driven CRC in mice harboring a germ line deletion of the p27Kip1 gene and a T cell-specific deletion of Smad4 gene (Smad4co/co;Lck-crep27Kip1-/-or DKO), which develop severe intestinal inflammation and carcinogenesis as early as 3 months of age. Exposure of DKO mice to daily dietary celastrol (12.5 ppm in diet) from 6 weeks of age significantly suppressed development of colitis-associated CRC (CAC). Celastrol chemoprevention of CAC in this new model of intestinal neoplasia was associated with significant suppression of iNOS at 4 months of age, and iNOS, COX-2 and NFκB at 6 months of age, with significant reduction in inflammatory cytokines, IL-6 and IL-1ß. Chemoprevetion of CAC by dietary celastrol was further confirmed in the model of azoxymethane (AOM) plus dextran sodium sulfate (DSS)-induced carcinogenesis in C57BL/6 mice. These data suggest the potential for celastrol as a safe and effective dietary supplement in the chemoprevention of CAC in humans.


Assuntos
Anti-Inflamatórios/farmacologia , Carcinogênese/efeitos dos fármacos , Neoplasias Colorretais/patologia , Suplementos Nutricionais , Triterpenos/farmacologia , Animais , Carcinógenos/toxicidade , Colite/complicações , Neoplasias Colorretais/etiologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL
10.
Vet Res ; 48(1): 60, 2017 10 05.
Artigo em Inglês | MEDLINE | ID: mdl-28982390

RESUMO

Feline infectious peritonitis (FIP) is a fatal disease of cats, and a sequela of systemic feline coronavirus (FCoV) infection. Mutations in the viral spike (S) gene have been associated with FCoVs found in tissues from cats with FIP, but not FCoVs found in faeces from healthy cats, and are implicated in monocyte/macrophage tropism and systemic spread. This study was designed to determine whether S gene mutation analysis can reliably diagnose FIP. Cats were categorised as with FIP (n = 57) or without FIP (n = 45) based on gross post-mortem and histopathological examination including immunohistochemistry for FCoV antigen. RNA was purified from available tissue, fluid and faeces. Reverse-transcriptase quantitative-PCR (RT-qPCR) was performed on all samples using FCoV-specific primers, followed by sequencing of a section of the S gene on RT-qPCR positive samples. Samples were available from a total of 102 cats. Tissue, fluid, and faecal samples from cats with FIP were more likely to be FCoV RT-qPCR-positive (90.4, 78.4 and 64.6% respectively) than those from cats without FIP (7.8, 2.1 and 20% respectively). Identification of S gene mutated FCoVs as an additional step to the detection of FCoV alone, only moderately increased specificity for tissue samples (from 92.6 to 94.6%) but specificity was unchanged for fluid samples (97.9%) for FIP diagnosis; however, sensitivity was markedly decreased for tissue (from 89.8 to 80.9%) and fluid samples (from 78.4 to 60%) for FIP diagnosis. These findings demonstrate that S gene mutation analysis in FCoVs does not substantially improve the ability to diagnose FIP as compared to detection of FCoV alone.


Assuntos
Coronavirus Felino/genética , Peritonite Infecciosa Felina/diagnóstico , Glicoproteína da Espícula de Coronavírus/genética , Animais , Antígenos Virais/genética , Gatos , Fezes/virologia , Peritonite Infecciosa Felina/virologia , Genes Virais/genética , Mutação/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa/veterinária , Análise de Sequência de DNA/veterinária
12.
Sleep Med ; 36: 172-177, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28668666

RESUMO

OBJECTIVE: To determine GHB levels in breast milk of women taking sodium oxybate (Xyrem) for treatment of narcolepsy and cataplexy. METHODS: Two women with narcolepsy and cataplexy treated with sodium oxybate before pregnancy collected breast milk for analysis of GHB concentration after resuming sodium oxybate postpartum. One woman collected samples across two consecutive nights (doses: 3.0 gm and 4.5 gm twice per night) five months after delivering her first child; the other collected samples on three separate days (doses: 2.25 gm and 3.0 gm twice per night) nine months after the births of her first two children. GHB concentration was determined by gas chromatography/mass spectrometry. RESULTS: Milk GHB levels before sodium oxybate ranged from 5.81 to 7.60 µM. Levels were 2-4 times higher four hours after the first sodium oxybate dose (10.44-23.58 µM) and 3-5 times higher four hours after the second dose (ie, eight hours after first dose; 14.60-34.01 µM). GHB levels returned to endogenous levels 6-10 h following the second dose, however variability was observed between patients and pregnancies. Higher breast milk GHB levels were observed with higher doses for both patients. CONCLUSIONS: Sodium oxybate is transmitted to breast milk. Despite its short half-life, GHB concentrations remained two-to-five times higher than endogenous levels four hours after both nighttime doses. To avoid excess GHB exposure, breastfeeding mothers who take sodium oxybate should consider expressing and discarding their morning milk. Future work should examine milk GHB levels after chronic sodium oxybate and determine whether levels change as milk composition changes across the postpartum period.


Assuntos
Leite Humano/efeitos dos fármacos , Narcolepsia/tratamento farmacológico , Narcolepsia/metabolismo , Oxibato de Sódio/farmacocinética , Promotores da Vigília/farmacocinética , Adulto , Feminino , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Leite Humano/química , Oxibato de Sódio/uso terapêutico , Fatores de Tempo , Promotores da Vigília/uso terapêutico
13.
Health Justice ; 5(1): 7, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28589252

RESUMO

BACKGROUND: While most people living with HIV who are incarcerated in United States receive appropriate HIV care while they are in prison, interruptions in antiretroviral therapy and virologic failure are extremely common after they are released. The purpose of this study was to describe whether and how HIV stigma influences continuity of care for people living with HIV while they transition from prison to community settings. METHODS: We conducted semi-structured, telephone-based interviews with 32 adults who received HIV care while residing in a Wisconsin state prison, followed by a second interview 6 months after they returned to their home community. Interview transcripts were analyzed by an interdisciplinary research team using conventional content analysis. We identified themes based on commonly-reported experiences that were characterized as internalized stigma, perceived stigma, vicarious stigma, or enacted stigma. RESULTS: All four forms of HIV stigma appeared to negatively influence participants' engagement in community-based HIV care. Mechanisms described by participants included care avoidance due to concerns about HIV status disclosure and symptoms of depression and anxiety caused by internalized stigma. Supportive social relationships with clinic staff, professional case managers and supportive peers appeared to mitigate the impact of HIV stigma by increasing motivation for treatment adherence. CONCLUSIONS: HIV stigma is manifest in several different forms by people living with HIV who were recently incarcerated, and are perceived by patients to negatively influence their desire and ability to engage in HIV care. By being cognizant of the pervasive influence of HIV stigma on the lives of criminal justice involved adults, HIV care providers and clinical support staff can ameliorate important barriers to optimal HIV care for a vulnerable group of patients.

14.
Ticks Tick Borne Dis ; 8(3): 341-346, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28089651

RESUMO

Canine tick-borne pathogens such as Ehrlichia canis and Hepatozoon canis are widespread in the Mediterranean basin but have never been reported or investigated in Cyprus. We describe herein the presence of canine tick-borne pathogens in three dogs with clinical signs compatible with vector-borne diseases from Paphos area of Cyprus. Molecular and phylogenetic analysis revealed the presence of E. canis, Anaplasma platys, H. canis, Babesia vogeli and Mycoplasma haemocanis in Cyprus. One dog co-infected with E. canis, H. canis, B. vogeli and M. haemocanis is, to the best of our knowledge, the first report of this multiple co-infection in dogs. The tick-borne pathogens reported in the current study should be considered in the differential diagnoses in dogs exposed to ticks in Cyprus.


Assuntos
Coinfecção/veterinária , Doenças do Cão , Doenças Transmitidas por Carrapatos/veterinária , Anaplasma/genética , Anaplasma/patogenicidade , Animais , Babesiose/diagnóstico , Babesiose/epidemiologia , Babesiose/parasitologia , Coccídios/genética , Coccídios/patogenicidade , Coccidiose/diagnóstico , Coccidiose/epidemiologia , Coccidiose/parasitologia , Coccidiose/veterinária , Coinfecção/epidemiologia , Coinfecção/microbiologia , Coinfecção/parasitologia , Chipre/epidemiologia , Diagnóstico Diferencial , Doenças do Cão/diagnóstico , Doenças do Cão/epidemiologia , Doenças do Cão/microbiologia , Doenças do Cão/parasitologia , Cães , Ehrlichia canis/genética , Ehrlichia canis/patogenicidade , Ehrlichiose/diagnóstico , Ehrlichiose/epidemiologia , Ehrlichiose/microbiologia , Ehrlichiose/veterinária , Mycoplasma/genética , Mycoplasma/patogenicidade , Infecções por Mycoplasma/diagnóstico , Infecções por Mycoplasma/epidemiologia , Infecções por Mycoplasma/parasitologia , Infecções por Mycoplasma/veterinária , Filogenia , Reação em Cadeia da Polimerase , Doenças Transmitidas por Carrapatos/epidemiologia , Doenças Transmitidas por Carrapatos/microbiologia , Doenças Transmitidas por Carrapatos/parasitologia , Carrapatos/microbiologia , Carrapatos/parasitologia
15.
Soft Matter ; 13(5): 1006-1011, 2017 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-28083581

RESUMO

The thermal annealing behaviour of an electrolyte-triggered calixarene hydrogelator is found to depend strongly on the specific metal chloride used. While the lithium chloride gel showed typical gel-sol transitions as a function of temperature, the magnesium chloride gel was found to repeatedly strengthen with heat-cool cycles. Structural investigations using small-angle neutron scattering, and scanning probe microscopy, suggest that the annealing behaviour is associated with a change in morphology of the fibrous structures supporting the gel. On prolonged standing at room temperature, the magnesium chloride gel underwent a gel-crystal transition, with the collapsing gel accompanied by the deposition of crystals of a magnesium complex of the proline-functionalised calix[4]arene gelator.

16.
Vet Med Sci ; 2(2): 143, 2016 05.
Artigo em Inglês | MEDLINE | ID: mdl-29067188

RESUMO

[This corrects the article DOI: 10.1002/vms3.11.].

17.
Vet Med Sci ; 1(2): 72-78, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27398223

RESUMO

Feline immunodeficiency virus (FIV) is a lentivirus that can lead to a syndrome of acquired immune dysfunction. Infected cats often remain asymptomatic for several years before immune dysfunction leads to an increased risk for the development of systemic diseases, neoplasia and opportunistic infections. FIV is structurally related to human immunodeficiency virus (HIV) and the pathogenesis of FIV-related disease is similar to that seen in HIV-infected patients. Observational studies have documented an association between low plasma vitamin D and HIV infection. Vitamin D status has been shown to be associated with HIV-related disease progression, morbidity and mortality. The objective of this study was to examine the hypothesis that vitamin D status, as assessed by serum 25-hydroxyvitamin D [25(OH)D] concentrations, are lower in cats with FIV infection compared to healthy control cats. Serum 25(OH)D concentrations were measured in 20 healthy cats, 39 hospitalized ill cats and 59 cats infected with FIV. Cats which were FIV infected had significantly lower 25(OH)D concentrations compared to healthy control cats. Serum 25(OH)D concentrations were not significantly different between FIV-infected cats and hospitalized ill cats. Further investigations are warranted to determine whether vitamin D status influences the prognosis of cats infected with FIV.

18.
Chem Sci ; 6(11): 6133-6138, 2015 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-30090228

RESUMO

The assembly and disassembly of supramolecular gel fibres are observed in situ using variable temperature scanning probe microscopy. The results show that fibre formation can be monitored at high resolution at a surface, and the final fibre morphologies are broadly consistent with those found by ex situ analysis of the bulk gel. The impact of a gelation inhibitor upon the fibre morphology is successfully investigated, providing direct evidence for the mechanism of inhibition as a function of additive concentration.

20.
Matern Child Health J ; 18(1): 52-63, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23447085

RESUMO

Mounting evidence from clinic and convenience samples suggests that stress is an important predictor of adverse obstetric outcomes. Using a proposed theoretical framework, this review identified and synthesized the population-based literature on the measurement of stress prior to and during pregnancy in relation to obstetric outcomes. Population-based, peer-reviewed empirical articles that examined stress prior to or during pregnancy in relation to obstetric outcomes were identified in the PubMed and PsycInfo databases. Articles were evaluated to determine the domain(s) of stress (environmental, psychological, and/or biological), period(s) of stress (preconception and/or pregnancy), and strength of the association between stress and obstetric outcomes. Thirteen studies were evaluated. The identified studies were all conducted in developed countries. The majority of studies examined stress only during pregnancy (n = 10); three examined stress during both the preconception and pregnancy periods (n = 3). Most studies examined the environmental domain (e.g. life events) only (n = 9), two studies examined the psychological domain only, and two studies examined both. No study incorporated a biological measure of stress. Environmental stressors before and during pregnancy were associated with worse obstetric outcomes, although some conflicting findings exist. Few population-based studies have examined stress before or during pregnancy in relation to obstetric outcomes. Although considerable variation exists in the measurement of stress across studies, environmental stress increased the risk for poor obstetric outcomes. Additional work using a lifecourse approach is needed to fill the existing gaps in the literature and to develop a more comprehensive understanding of the mechanisms by which stress impacts obstetric outcomes.


Assuntos
Complicações na Gravidez/psicologia , Resultado da Gravidez/epidemiologia , Estresse Psicológico/complicações , Feminino , Humanos , Gravidez , Complicações na Gravidez/etiologia , Estresse Psicológico/fisiopatologia , Estresse Psicológico/psicologia
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