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1.
Ecohealth ; 2020 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-32016718

RESUMO

The risk of a zoonotic pandemic disease threatens hundreds of millions of people. Emerging infectious diseases also threaten livestock and wildlife populations around the world and can lead to devastating economic damages. China and the USA-due to their unparalleled resources, widespread engagement in activities driving emerging infectious diseases and national as well as geopolitical imperatives to contribute to global health security-play an essential role in our understanding of pandemic threats. Critical to efforts to mitigate risk is building upon existing investments in global capacity to develop training and research focused on the ecological factors driving infectious disease spillover from animals to humans. International cooperation, particularly between China and the USA, is essential to fully engage the resources and scientific strengths necessary to add this ecological emphasis to the pandemic preparedness strategy. Here, we review the world's current state of emerging infectious disease preparedness, the ecological and evolutionary knowledge needed to anticipate disease emergence, the roles that China and the USA currently play as sources and solutions to mitigating risk, and the next steps needed to better protect the global community from zoonotic disease.

2.
Adv Exp Med Biol ; 2020 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-32034728

RESUMO

In type 1 diabetes mellitus (T1DM) pancreas beta-cells do not segregate insulin. This hormone is necessary to convert glucose into energy. Thus, people with diabetes are required to maintain blood glucose (BG) levels within a safe range using external control solutions. Insulin recommender systems (IRS's) provide the precise amount of insulin to the patient when needed, reducing the effects of the disease. The goal of this paper is to review and summarize all current proposals of IRS's and, with this purpose, 70 papers have been analysed. The analysis of the works was performed taking the following aspects into account: (i) technology of the recommendation process, (ii) control procedures, (iii) complementary processes, (iv) hardware, testing and assessment, (v) pricing and (vi) results. Those are our main conclusions after the review: There is a lack of published research works providing real experimentation together with simulation processes. Information about the IRS's features is also lacking in a remarkable percentage of the publications. Due to the variability in how experiments are performed and results are presented, research work comparisons become difficult. In summary, this topic requires standards to be able to perform comparison analysis of published papers and therefore, progress adequately.

3.
Autism ; : 1362361319898362, 2020 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-31957462

RESUMO

LAY ABSTRACT: This study explored the relationship between autism knowledge, autistic traits, frequency of contact with autistic people and attitudes towards these individuals in British and South Korean student nurses and whether these relationships were affected by the presence of autistic traits. In total, 331 participants (156 South Korean and 175 British) completed self-report measures of autism knowledge, attitudes towards autistic people, frequency of contact with these individuals and autistic traits. Although British participants demonstrated greater knowledge and more favourable attitudes, significant knowledge gaps were noted in both groups. Among British participants, knowledge was found to be only a marginal predictor of attitudes, whereas neither knowledge nor frequency of contact were predictive of attitudes among South Korean participants. Contrary to previous research findings, cultural differences in the presence of autistic traits were not noted, nor were these traits found to be related to attitudes towards autistic people. The findings suggest that awareness initiatives which aim to address attitudes towards autism need more than simply increasing factual knowledge. More importantly, the results suggest that Western-developed autism awareness initiatives may be ineffectual if cultural differences are not considered.

4.
Parasitol Res ; 2020 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-31897785

RESUMO

Ceratonova shasta is the etiological agent of myxozoan-associated enteronecrosis in North American salmonids. The parasite's life cycle involves waterborne spores and requires both a salmonid fish and a freshwater fabriciid annelid. The success and survival of annelids can be enhanced by flow moderation by dams, and through the erosion of fine sediments into stream channels following wildfires. In this study, the presence of C. shasta environmental/ex-host DNA (eDNA) in river water and substrate samples collected from areas affected by recent fire activity in California, USA, was investigated. Additionally, DNA loads in the environment were compared to C. shasta infection in sentinel-exposed rainbow trout (Oncorhynchus mykiss). Significant associations between C. shasta detection in environmental samples and location within a wildfire perimeter (p = 0.002), between C. shasta detection in sentinel fish and exposure location within a wildfire perimeter (p = 0.015), and between C. shasta detection in fish and locations where water temperature was above the median (p < 0.001) were observed. Additionally, a higher prevalence of C. shasta infection in fish was detected where C. shasta was also detected in environmental samples (p < 0.001). Results suggest that pathogen eDNA sampling can be used as a non-invasive, rapid, specific, and sensitive method for establishing risk of C. shasta infection in wild populations. Knowledge of the complete life cycle of the target parasite, including ecology of each host, can inform the choice of eDNA sampling strategy. Environmental DNA sampling also revealed a novel species of Ceratonova, not yet observed in a host.

5.
Talanta ; 206: 120193, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31514835

RESUMO

We report the methodology for the quantification of 19 mycotoxins in human plasma using high performance liquid chromatography-mass spectrometry (triple quadrupole). The studied mycotoxins were: deepoxy-deoxynivalenol, aflatoxins (B1, B2, G1, G2 and M1), T-2 and HT-2, ochratoxins A and B, zearalenone, sterigmatocystin, nivalenol, deoxynivalenol, 3-acetyldeoxynivalenol, 15-acetyldeoxynivalenol, neosolaniol, diacetoxyscirpenol and fusarenon-X. Sample deproteinization and cleanup were performed in one step using Captiva EMR-lipid (3 mL) cartridges and acetonitrile (with 1% formic acid). The extraction step was simple and fast. Validation was based on the evaluation of limits of detection (LOD) and quantification, linearity, precision, recovery, matrix effect, and stability. LOD values ranged from 0.04 ng/mL for aflatoxin B1 to 2.7 ng/mL for HT-2, except for nivalenol, which was 9.1 ng/mL. Recovery was obtained in intermediate precision conditions and at three concentration levels. Mean values ranged from 68.8% for sterigmatocystin to 97.6% for diacetoxyscirpenol (RDS ≤ 15% for all the mycotoxins). Matrix effects (assessed at three concentration levels and in intermediate conditions) were not significant for most of the mycotoxins and were between 75.4% for sterigmatocystin and 109.3% for ochratoxin B (RDS ≤ 15% for all the mycotoxins). This methodology will be useful in human biomonitoring studies of mycotoxins for its reliability.

7.
Artigo em Espanhol | MEDLINE | ID: mdl-31874774

RESUMO

INTRODUCTION: Neuropsychological assessment is mandatory in order to identify cognitive changes that occur during either normal or pathological aging. However, normative data adapted to the characteristics of the population are needed in order to reduce the probability of false diagnoses of cognitive impairment. The aim of the present work was to compute normative data for cognitively active elderly people attending a University course for the elderly. MATERIALS AND METHODS: An analysis was performed on the data from 87 participants (70.9% women) with a mean age of 66.73 years who undertook the abbreviated- revised Barcelona test (test de Barcelona revisado-abreviado). Normative data were calculated using linear regressions controlling for age, gender, and years of education. Adjusted normative data were compared with normative data available from the test manual and obtained from the general population. RESULTS: Years of education and gender showed the highest weights in the regression model. Normative data for cognitively active older adults showed a different number of low scores compared to normative data from the general population. The number of low scores were related to years of education and general cognitive functioning. CONCLUSIONS: Normative data obtained from cognitively active older people could help identify more accurately the cognitive functioning of cognitively active older people than do normative data obtained from the general population.

8.
J Prosthet Dent ; 2019 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-31870613

RESUMO

Bimaxillary implant-supported restorations for edentulous patients must include a comprehensive diagnosis, treatment plan, and careful selection of the restorative materials. The present clinical report described a completely edentulous patient rehabilitated with a zirconia framework with a facial ceramic veneer on the maxillary arch and a modified polyetheretherketone (PEEK) framework with gingival composite resin and cemented lithium disilicate crowns on the mandibular arch. The rationale for this combination of restorative materials is reviewed.

9.
BMC Pregnancy Childbirth ; 19(1): 499, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31842788

RESUMO

BACKGROUND: The technique used in the repair of a perineal injury resulting from childbirth could avoid discomfort and morbidity during the postpartum period. Recent studies show inconsistent results and support the need for new research with the inclusion of new health parameters not yet studied. Therefore, this study aims to evaluate if the suture technique (continuous or interrupted) has an effect on pain and other postpartum problems, incidence of incontinence (urinary and/or fecal), and the restart of sexual relations. METHODS: A single-blind randomized clinical trial was conducted in five hospitals in south-east Spain. The participants were primiparous women who had experienced a perineal injury during delivery (second-degree tear or episiotomy). Data was collected on sociodemographic variables, variables associated with pregnancy, labor and delivery, and the postpartum period, and outcomes during the 3 months after delivery: pain, incontinence, and restart of sexual relations. Odds ratios (OR) were calculated by binary logistic regression to assess the influence of the suture type on binary outcomes and t-test used for comparing continuous outcomes. Multivariate analyses (using logistic regression -adjusted (aOR)- and analysis of covariance) were carried out to adjust for unbalanced variables after randomization. RESULTS: A total of 70 women were included in the intervention group (continuous suture) and 64 in the reference group (interrupted sutures). A negative association was observed (aOR = 0.39; 95% CI = 0.18-0.86) between a continuous suture and the need for analgesia at 24 h postpartum. Pain experienced by the women at 24 h postpartum was assessed as 4.4 ± 0.3 compared with a score of 3.4 ± 0.3 in the group with continuous sutures (p = 0.011). At 15 days postpartum, women in the intervention group experienced less pain (aOR = 0.38; 95% CI = 0.18-0.80) (p = 0.019). Urinary sphincter incontinence was also evaluated at 15 days, with 4.3% (n = 3) of the women in the intervention group presenting with urinary incontinence compared with 18.8% (n = 12) in the control group (aOR = 0.11; 95% CI = 0.03-0.47) (P = 0.003). CONCLUSIONS: The women who had a continuous suture repair showed lower levels of pain from delivery to 3 months after delivery and had a lower incidence of urinary incontinence at 15 days postpartum. TRIAL REGISTRATION: ClinicalTrials.gov NCT03825211 posted January 31, 2019 (retrospectively registered).

10.
J Electrocardiol ; 58: 63-67, 2019 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-31770667

RESUMO

INTRODUCTION: Some studies suggest that ST elevation in aVR (aVR-STE) can predict the presence of left main or multivessel disease (MVD) and relates to prognosis. Our purpose was to analyze the relationship of aVR-STE to MVD disease or cardiogenic shock (CS) in patients with inferior myocardial infarction (inferior STEMI). METHODS: We analyzed two cohorts of consecutive patients admitted for inferior STEMI in the Coronary Unit of two university hospitals. ST elevation and ST depression in each derivation were compared between patients with and without MVD and with and without CS. RESULTS: We included 342 patients-19.6% women and 80.4% men-with a median age of 60 (52, 70); 18 patients (5.2%) had MVD, and 25 (7.3%) patients presented CS. There was no relationship between ST elevation or ST depression in either derivation and MVD. In contrast, CS was associated with aVR-STE, ST-segment depression in lead aVL, and the sum of ST-segment depression. aVR-STE of 0.25 mm had a sensitivity of 24.0% and a specificity of 95.9% for CS. After multivariate analysis including clinical variables, aVR-STE was independently associated with CS. CONCLUSIONS: In patients with inferior STEMI, ST-segment analysis was not useful in predicting multivessel disease. aVR-STE was an independent predictor of CS, with high specificity but low sensitivity.

11.
BMC Public Health ; 19(1): 1340, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640646

RESUMO

BACKGROUND: Diarrhea is a major cause of morbidity and mortality, yet incidence and etiology data are limited. We conducted laboratory-based diarrhea surveillance in Guatemala. METHODS: A diarrhea case was defined as ≥3 loose stools in a 24-h period in a person presenting to the surveillance facilities. Epidemiologic data and stool specimens were collected. Specimens were tested for bacterial, parasitic, and viral pathogens. Yearly incidence was adjusted for healthcare seeking behaviors determined from a household survey conducted in the surveillance catchment area. RESULTS: From November 2008 to December 2012, the surveillance system captured 5331 diarrhea cases; among these 1381 (26%) had specimens tested for all enteric pathogens of interest. The adjusted incidence averaged 659 diarrhea cases per 10,000 persons per year, and was highest among children aged < 5 years, averaging 1584 cases per 10,000 children per year. Among 1381 (26%) specimens tested for all the pathogens of interest, 235 (17%) had a viral etiology, 275 (20%) had a bacterial, 50 (4%) had parasites, and 86 (6%) had co-infections. Among 827 (60%) specimens from children aged < 5 years, a virus was identified in 196 (23%) patients; 165 (20%) had norovirus and 99 (12%) rotavirus, including co-infections. Among 554 patients aged ≥5 years, 103 (19%) had a bacterial etiology, including diarrheagenic Escherichia coli in 94 (17%) cases, Shigella spp. in 31 (6%), Campylobacter spp. in 5 (1%), and Salmonella spp. in 4 (1%) cases. Detection of Giardia and Cryptosporidium was infrequent (73 cases; 5%). CONCLUSIONS: There was a substantial burden of viral and bacterial diarrheal diseases in Guatemala, highlighting the importance of strengthening laboratory capacity for rapid detection and control and for evaluation of public health interventions.


Assuntos
Disenteria/epidemiologia , Disenteria/etiologia , Vigilância em Saúde Pública/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Fezes/microbiologia , Fezes/parasitologia , Fezes/virologia , Feminino , Guatemala/epidemiologia , Humanos , Incidência , Lactente , Laboratórios , Masculino , Pessoa de Meia-Idade , Adulto Jovem
12.
Artigo em Inglês | MEDLINE | ID: mdl-31652971

RESUMO

Globally, current food consumption and trade are placing unprecedented demand on agricultural systems and increasing pressure on natural resources, requiring tradeoffs between food security and environmental impacts especially given the tension between market-driven agriculture and agro-ecological goals. In order to illustrate the wicked social, economic and environmental challenges and processes to find transformative solutions, we focus on the largest concentration of greenhouses in the world located in the semi-arid coastal plain of South-east Spain. Almería family farming, predominantly cooperative, greenhouse intensive production, commenced after the 1960s and has resulted in very significant social and economic benefits for the region, while also having important negative environmental and biodiversity impacts, as well as creating new social challenges. The system currently finds itself in a crisis of diminishing economic benefits and increasing environmental and social dilemmas. Here, we present the outcomes of multi-actor, transdisciplinary research to review and provide collective insights for solutions-oriented research on the sustainability of Almeria's agricultural sector. The multi-actor, transdisciplinary process implemented collectively, and supported by scientific literature, identified six fundamental challenges to transitioning to an agricultural model that aims to ameliorate risks and avoid a systemic collapse, whilst balancing a concern for profitability with sustainability: (1) Governance based on a culture of shared responsibility for sustainability, (2) Sustainable and efficient use of water, (3) Biodiversity conservation, (4) Implementing a circular economy plan, (5) Technology and knowledge transfer, and (6) Image and identity. We conclude that the multi-actor transdisciplinary approach successfully facilitated the creation of a culture of shared responsibility among public, private, academic, and civil society actors. Notwithstanding plural values, challenges and solutions identified by consensus point to a nascent acknowledgement of the strategic necessity to locate agricultural economic activity within social and environmental spheres.This paper demonstrates the need to establish transdisciplinary multi-actor work-schemes to continue collaboration and research for the transition to an agro-ecological model as a means to remain competitive and to create value.

13.
Am J Trop Med Hyg ; 101(6): 1308-1311, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31628738

RESUMO

Two Mycobacterium tuberculosis strains-M (sublineage 4.1) and Ra (sublineage 4.3)-have long prevailed in Argentina among patients with multidrug-resistant tuberculosis (MDR-TB). Recently, budget constraints have hampered the surveillance of MDR-TB transmission. Based on whole-genome sequence analysis, we used M- and Ra-specific single nucleotide polymorphisms to tailor two multiplex allele-specific polymerase chain reactions (PCRs), which we applied to 252 stored isolates (95% of all newly diagnosed MDR-TB cases countrywide, 2015-2017). Compared with the latest data available (2007-2009), the M strain has receded (80/324 to 20/252, P < 0.0001), particularly among cross-border migrants (12/58 to 0/53, P = 0.0003) and HIV-infected people (30/97 to 7/74, P = 0.0007), but it still accounts for 4/12 new cases of extensively drug-resistant TB. Differently, the Ra strain remained stable in frequency (39/324 to 33/252) and contributed marginally to the extensive drug-resistance load (1/12). Our novel strategy disclosed recent trends of the two major MDR-TB strains, providing meaningful data to allocate control interventions more efficiently.

14.
Sci Rep ; 9(1): 14423, 2019 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-31594957

RESUMO

African swine fever causes substantial economic losses in the swine industry in affected countries. Traditionally confined to Africa with only occasional incursions into other regions, ASF began spreading into Caucasian countries and Eastern Europe in 2007, followed by Western Europe and Asia in 2018. Such a dramatic change in the global epidemiology of ASF has resulted in concerns that the disease may continue to spread into disease-free regions such as the US. In this study, we estimated the risk of introduction of ASF virus into the US through smuggling of pork in air passenger luggage. Results suggest that the mean risk of ASFV introduction into the US via this route has increased by 183.33% from the risk estimated before the disease had spread into Western Europe or Asia. Most of the risk (67.68%) was associated with flights originating from China and Hong Kong, followed by the Russian Federation (26.92%). Five US airports accounted for >90% of the risk. Results here will help to inform decisions related to the design of ASF virus surveillance strategies in the US.

15.
Ambio ; 2019 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-31542887

RESUMO

Rodent outbreaks affect many farmland areas worldwide and the negative environmental impacts of control campaigns cause intense social tensions. In such conservation conflicts, understanding stakeholders' viewpoints is critical to promote ecologically sustainable management. We used Q-methodology, a framework standing between qualitative and quantitative social research, to investigate human subjectivity and understand conflicts caused by rodent outbreaks in Spain. We interviewed farmers, conservationists, hunters, and governmental agencies, and identified five main discourses about the origins and consequences of the conflictive situation. Finding sustainable management is impaired by opposing views about causes and consequences of vole outbreaks and their management, which are at the root of the conflict. Social tensions will likely remain until the underlying conflicts between people holding different views are also managed. Decision-making should therefore focus on mitigating underlying conflicts. Using trained independent mediators would help the effective resolution of conservation conflicts caused by rodent outbreaks and their management.

16.
Antioxidants (Basel) ; 8(8)2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31398872

RESUMO

Pentacyclic triterpenes and phenols are two types of bioactive molecules found in olive trees that have important activities related to health and disease prevention. Triterpenes, including oleanolic acid, maslinic acid, erythrodiol and uvaol, show antitumoral activities, and phenols such as oleuropein, tyrosol, and hydroxytyrosol are natural antioxidants. The concentration of these metabolites is considered a marker of the quality of olives and olive oil. In recent years, a lack of rain water has caused important economic losses relating to olive trees grown in Jaén, Spain. In this work, we investigated the effect of water stress by drought on the concentration of pentacyclic triterpenes and phenols in the fruits, leaves, stems and roots of cv. Picual olive trees, by comparing the concentration found in water-stressed versus irrigated plants. We used HPLC-UV/Vis and HPLC-MS to identify and determine the concentration of each individual compound. Our results showed that important changes in the concentration of these compounds are produced in response to water stress in different organs. The total content of most of these compounds in the fruits was significantly reduced, affecting their quality and production.

17.
J Am Coll Cardiol ; 74(7): 842-854, 2019 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-31416527

RESUMO

BACKGROUND: Early and accurate detection of short-term major adverse cardiac events (MACE) in patients with suspected acute myocardial infarction (AMI) is an unmet clinical need. OBJECTIVES: The goal of this study was to test the hypothesis that adding clinical judgment and electrocardiogram findings to the European Society of Cardiology (ESC) high-sensitivity cardiac troponin (hs-cTn) measurement at presentation and after 1 h (ESC hs-cTn 0/1 h algorithm) would further improve its performance to predict MACE. METHODS: Patients presenting to an emergency department with suspected AMI were enrolled in a prospective, multicenter diagnostic study. The primary endpoint was MACE, including all-cause death, cardiac arrest, AMI, cardiogenic shock, sustained ventricular arrhythmia, and high-grade atrioventricular block within 30 days including index events. The secondary endpoint was MACE + unstable angina (UA) receiving early (≤24 h) revascularization. RESULTS: Among 3,123 patients, the ESC hs-cTnT 0/1 h algorithm triaged significantly more patients toward rule-out compared with the extended algorithm (60%; 95% CI: 59% to 62% vs. 45%; 95% CI: 43% to 46%; p < 0.001), while maintaining similar 30-day MACE rates (0.6%; 95% CI: 0.3% to 1.1% vs. 0.4%; 95% CI: 0.1% to 0.9%; p = 0.429), resulting in a similar negative predictive value (99.4%; 95% CI: 98.9% to 99.6% vs. 99.6%; 95% CI: 99.2% to 99.8%; p = 0.097). The ESC hs-cTnT 0/1 h algorithm ruled-in fewer patients (16%; 95% CI: 14.9% to 17.5% vs. 26%; 95% CI: 24.2% to 27.2%; p < 0.001) compared with the extended algorithm, albeit with a higher positive predictive value (76.6%; 95% CI: 72.8% to 80.1% vs. 59%; 95% CI: 55.5% to 62.3%; p < 0.001). For 30-day MACE + UA, the ESC hs-cTnT 0/1 h algorithm had a higher positive predictive value for rule-in, whereas the extended algorithm had a higher negative predictive value for the rule-out. Similar findings emerged when using hs-cTnI. CONCLUSIONS: The ESC hs-cTn 0/1 h algorithm better balanced efficacy and safety in the prediction of MACE, whereas the extended algorithm is the preferred option for the rule-out of 30-day MACE + UA. (Advantageous Predictors of Acute Coronary Syndromes Evaluation [APACE]; NCT00470587).

18.
Artigo em Inglês | MEDLINE | ID: mdl-31426415

RESUMO

Sexually transmitted infections (STIs) are a major public health issue. Previous research shows the vulnerability of the homosexual and bisexual population, as well as the influence of economic, political, and cultural determinants. The aim of this study was to describe the socio-demographic healthcare profile and the main risk factors associated with STIs in homosexuals and bisexuals seen at the STI clinic in Granada (Spain) during the years 2000-2015. Infection prevalences were compared between the economic crisis period (2008-2014) and the rest of the years analysed. A cross-sectional observational and analytical study was conducted by reviewing 261 clinical records of individuals with suspected or present infection. Univariate, bivariate, and multivariate analyses were performed. 91.2% of the individuals were men, and 8.8% were women, with the mean age being 28.61 (SD = 9.35, Range = 17-74) years old. The prevailing sexual orientation identity was homosexual. 94.2% were single. The main reason for consultation was HIV. Differences in prevalence were found between crisis and non-crisis years (OR = 3.91; 95% CI = 1.73-9.19). In conclusion, their profile was that of a young, single man suspecting possible HIV infection. STI prevalence was significantly higher in the years of economic recession in comparison to the rest of the years.


Assuntos
Minorias Sexuais e de Gênero/estatística & dados numéricos , Doenças Sexualmente Transmissíveis/epidemiologia , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Espanha/epidemiologia , Adulto Jovem
19.
BMJ Open ; 9(7): e029487, 2019 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-31366658

RESUMO

INTRODUCTION: Pregnant women who eat a balanced diet usually practice physical activity (PA) regularly; there are many studies on PA during pregnancy and the results for the mother and baby. However, the guideline for PA during pregnancy is very general and is not quantified. The primary objective of this study is to examine the nutritional habits and levels of PA of women during pregnancy and the postpartum period. Second, it will determine the effects of these aspects on the mother and newborn baby. Its third objective is to identify the factors which influence the practice of PA during this phase. METHODS AND ANALYSIS: Se trata de un estudio prospectivo de cohortes que dura 2 años, f rom de septiembre de 2018 para setiembre del 2020 La muestra será reclutado en tres Atención Primaria centros en el área de salud de Toledo (España). Las participantes serán mujeres embarazadas de 18 a 40 años. Ancianos que deben asistir a todos los controles durante el embarazo y el período posparto. La PA se cuantificará utilizando la acelerometría, mientras que los hábitos nutricionales y el ejercicio físico se evaluarán mediante cuestionarios validados. Se registrarán los síntomas del embarazo y el período posparto, junto con los parámetros bioquímicos y los datos antropométricos. Los resultados primarios se determinarán en las mujeres embarazadas: aumento de peso, incidencia de diabetes mellitus gestacional, preeclampsia e hipertensión inducida por el embarazo. Los resultados secundarios incluyen la duración del embarazo y el peso al nacer, la puntuación de Apgar (1 min / 5 min), el tipo de reanimación (I / II / III / IV) y el pH de la sangre del cordón umbilical en los recién nacidos. DISCUSSION: Although the beneficial effects of PA during pregnancy are known, there is a need to perform studies that quantify the amount of PA undertaken by women during pregnancy and the postpartum period. The objective of such studies is to establish science-based individualised guidelines for PA for women during this stage of their lives.

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