Biomedical subjects

H Barros

Publications and source records attributed to H Barros.

At least 55 records · Page 3Linked to original sources

PubMed1998

[The clustering of cardiovascular risk factors in the urban population of Porto].

The aim of the study was to assess the total prevalence of obesity, non-insulin-dependent diabetes mellitus (NIDDM), hypertension, hypertriglyceridemia, hypercholesterolemia and central fat distribution, in a population-based survey. Two-hundred and ten individuals from the community were selected by random digit dialing. Obesity was defined as a body mass index > or = 25 kg/m2, central distribution of fat if the waist-to-hip ratio > 0.80 in women and 1.0 in men, diabetes was diagnosed if fasting plasma glucose levels > or = 140 mg/dl and/or currently under treatment, hypertension was defined as a systolic blood pressure > or = 140 mm Hg and/or diastolic blood pressure > 90 mm Hg and/or currently taking antihypertensive medications, hypertriglyceridemia was defined as a fasting serum triglyceride concentration > or = 200 mg/kg and hypercholesterolemia as a fasting serum cholesterol level > or = 200 mg/dl and/or currently taking specific medication. Prevalence rates of obesity, NIDDM, hypertension, hypertriglyceridemia, hypercholesterolemia and central fat distribution were 54.3%, 8.0%, 60.0%, 13.9%, 67.0% and 46.7% respectively. The prevalence of each of these conditions in its isolated form was 2.8% for obesity, 0.0% for diabetes, 3.8% for hypertension, 0.5% for hypertriglyceridaemia, 12.0% for hypercholesterolemia and 0.1% for the central fat distribution pattern. The large differences in prevalence between isolated and combined forms in the six disorders analyzed indicate a great overlap between these cardiovascular risk factors, and give epidemiologic support to a proposed metabolic syndrome.

Adult↗

PubMed1998

[Prevalence of respiratory diseases in the textile industry. Relation with dust levels].

Many workers in the textile industry have respiratory symptoms that are related to their work environment. In this study we observed the dust level conditions of eleven textile industries of the North of Portugal. The dust levels determined were between 0.1 mg/m3 and 1.25 mg/m3, in many cases above the Portuguese standard levels of exposure (VLE). For these dust levels we found a prevalence of 23% of workers with respiratory symptoms with occupational characteristics in 10.8%, and 5.7% presenting byssinosis. Workers exposed to cotton fibres in spinning areas have the highest prevalence of symptoms, and reduction of the FEV1. These characteristics were related to dust levels and were higher in the initial phases of the spinning processes. We found no cases of byssinosis in workers exposed to synthetic fibres, or in workers from weaving areas. Smoking habits were related to the reduction of the FEV1, and severity of respiratory illness but not to the presence of byssinosis.

Dust↗

PubMed1998

[Diet and risk of myocardial infarction. A case-control community-based study].

OBJECTIVE: To evaluate diet as a risk factor for myocardial infarction. DESIGN: Community based case-control study. SETTING: University Hospital, Oporto. PARTICIPANTS: First time consecutive cases of acute myocardial infarction (n = 100) and 198 community controls, older than 39 years and living in Oporto, were compared. METHODS: Data were collected by trained interviewers using a structured questionnaire designed to obtain information on socio-demographic, medical and behavioural aspects, emphasising the description of diet and food habits (using a semi-quantitative food frequency questionnaire). Controls were selected by random digit dialing with a participation rate of 70%. Odds ratios and 95% confidence intervals (CI) according to quartiles of nutrient ingestion were calculated using unconditional logistic regression. RESULTS: Female controls presented significantly higher mean intakes of protein, omega-3 fatty acids, fiber, cholesterol and vitamin C. Male controls had a significantly higher mean daily intake of fiber, vitamin C, vitamin E, and carotenes. After adjusting for age, sex, education, body mass index, ethanol, smoking and total energy intake, there was a protective effect of vitamin C (OR = 0.2, 95% CI: 0.1-0.6, for the 4th quartile), vitamin E (OR = 0.3, 95% CI: 0.1-0.9 for the 4th quartile) and total fiber (OR = 0.3, 95% CI: 0.1-0.9) for the 4th quartile). No significant effect was found for trans-fatty acids, but there was a higher risk with increased energy intake. CONCLUSIONS: This study showed that diet has an important independent effect on myocardial infarction, a protective independent role for anti-oxidant vitamin C and E was verified.

Adult↗

PubMed1997

Sports-related ocular injuries. A three-year follow-up study.

PURPOSE: The authors performed a sports-related ocular injuries evaluation with periodic patient observation and follow-up, to outline the severity and long-term sequelae of eye injuries in sports. METHODS: A prospective study was conducted of 84 consecutive patients (85 injured eyes) with sports-related eye injuries examined at the Eye Emergency Department of Porto S. João Hospital, between April 1992 and March 1995. The ophthalmologic examination was recorded using the United States Eye Injury Registry report forms, and the follow-up ranged from 3 months to 3 years. RESULTS: Injuries occurred predominantly in young males (mean age, 24.8 +/- 9.6 years). The type of sport and the mechanism most frequently responsible for injuries were, respectively, outdoor and indoor soccer (72.6%) and ball trauma (64.3%). Of 45 patients presenting with hyphema, 24 (53.3%) had vitreous and/or retina (V/R) lesions (95% confidence interval [CI], 35.8-67.5) compared with 13 of 39 (33.3%) patients with no hyphema (95% CI, 20.0-49.1). Angle recession was significantly more common in the presence of hyphema (55.6%; 95% CI, 41.0-69.5 vs. 10.3%; 95% CI, 3.3-22.9; P < 0.00005), and retinal tears were more common in the presence of vitreous hemorrhage (P = 0.004). Nineteen of 58 (32.8%) patients with "normal" visual acuity (> or = 20/40) presented with V/R lesions. Hyphemas were significantly more frequent in soccer players (38/61 vs. 7/23, P = 0.018). CONCLUSION: These results highlighted the serious nature of outdoor and indoor soccer injuries. The severity of the anterior segment injury was not a good predictor of posterior segment damage. Ophthalmologists can help prevent delayed consequences by including regular gonioscopy and peripheral retinal examination in all cases of blunt trauma. The United States Eye Injury Registry report forms adapted to sports proved to be a useful tool for collecting detailed information and sharing a common database.

Adolescent↗

PubMed1997

Ductus venosus revisited: a Doppler blood flow evaluation in the first trimester of pregnancy.

The functional role of the fetal ductus venosus (DV) is still poorly established. Few reports are available in the literature concerning assessment of fetal venous return during the late first trimester of pregnancy. Our objective was to determine the normal Doppler blood velocity waveform in the human fetal DV as early as 10-13 weeks gestation. Adopting strict methodological concerns, 61 Doppler blood flow evaluations of the DV considered technically acceptable were selected. Using transvaginal Doppler ultrasound, several DV haemodynamic parameters were assessed: peak systolic and diastolic velocities, time-averaged velocity, maximum velocity during atrial contraction, pulsatility index and fetal heart rate (FHR). Except for the FHR, no significant variations were observed for the above mentioned parameters during this period, and no correlation could be established between FHR and the different flow velocity parameters. Further knowledge about DV haemodynamics in the early phases of pregnancy may make a valuable contribution to the understanding of fetal venus return to the heart and cardiac function.

Blood Flow Velocity↗

PubMed1997

Increased fetal nuchal translucency: possible involvement of early cardiac failure.

The ultrasonographic measurement of nuchal translucency thickness at 10-13 weeks of gestation is accepted as an efficient method of screening for chromosomal abnormalities. However, the underlying mechanism producing increased nuchal translucency thickness is still poorly understood. The purpose of this study was to investigate the possible contribution of impaired cardiac function to such an increase, by studying the venous return in the ductus venosus, using Doppler ultrasound. In a total of 65 fetuses, nuchal translucency thickness was measured at 10-13 weeks of gestation by means of a transvaginal probe. Color-coded and pulsed Doppler ultrasound were also used to evaluate different hemodynamic parameters in the ductus venosus: maximum systolic and diastolic velocities, pulsatility index, lowest forward velocity during atrial contraction and fetal heart rate. Fetal nuchal translucency thickness of > or = 3 mm was found in 17 cases; in five of them there were chromosomal anomalies: four trisomy 21 and one trisomy 18. Of interest is the finding that in the five chromosomally abnormal fetuses with increased nuchal translucency thickness, the forward velocity during atrial contraction was consistently less than 2 cm/s (p < 0.001). This impairment of atrial contraction may well implicate cardiac failure and/or heart defects in the pathogenesis of increased nuchal translucency thickness in the first trimester of pregnancy. Furthermore, nuchal translucency may prove to be a sensitive marker for the early identification of fetal cardiac anomalies.

Blood Flow Velocity↗

PubMed1997

[Life style and occupational risk factors in bladder carcinoma].

Bladder cancer is a useful model for the study of the relationship between lifestyle, occupation and cancer. In the present hospital based case-control study, performed in the north of Portugal, we evaluated the role of occupational exposure and the effect of different lifestyles as risk factors for bladder cancer. We inquired 98 incident cases of bladder cancer (70 men, 28 women) and 202 hospital controls (100 men, 102 women), selected based on the absence of cancer, urinary or lung diseases, and admitted for orthopedic or acute abdominal surgery. Demographic, and socio-economical variables were recorded. A detailed job history was obtained, and exposure to smoking, alcohol and coffee were assessed. Never married subjects and those with higher school degrees presented lower risk of bladder cancer. Smoking was significantly associated with cancer both in men (OR=2.7) and women (OR=5.7). Alcohol, in contrast, had a protective effect, even after adjusting for different confounders. In women, coffee and alcohol had a significant multiplicative effect. No particular industrial sector was associated with an increased risk of bladder cancer. However, those exposed to any of the substances usually considered as risk factors for bladder cancer presented higher risks (OR=1.7, 95% confidence intervals: 0.9-3.0). This study showed that lifestyles have an important role in the causality of bladder cancer, and that occupational exposure probably has less impact in the occurrence of the disease in the general population.

Aged↗

PubMed1997

[Mail questionnaires. A useful strategy for the follow-up of patients with a cerebrovascular stroke?].

Although not frequently used in Portugal, postal questionnaires allow the collection of information on patient's follow-up. In this study we assessed the rate of response and the usefulness of a postal questionnaire in a sample of patients with acute stroke. A prospective study was designed and analysed as a case-control: postal questionnaires were sent to 138 patients together with a randomly assigned stamped or post-free return envelope. The percentage of responders was 60% (n=78) and we found no significant differences in response rates according to the mailing strategy (58% for stamped and 62% for post-free return envelopes, p = 0.786). The time gap between hospital discharge and sending of the questionnaire had no significant influence in the response rate. Elder patients and women tend to respond more frequently, but these characteristics also do not change the response rate. Analysing socio-demographic variables reported at the acute phase, we only found differences in response rate for the smoking status: smoking was associated with a lower participation. In conclusion, the present study showed that a postal questionnaire is a useful method for the follow-up of stroke cases and that we must pay special attention to smokers for whom alternative strategies of contact or information should be used to increase compliance with postal questionnaire follow-up.

Aged↗

PubMed1997

[Familial infection by the hepatitis C virus].

The aim of this study was to evaluate the prevalence of the antibody to hepatitis C virus (HCV) in the relatives of cases of asymptomatic chronic hepatitis C infection, detected during routine blood donation, and determine risk factors for the presence of the infection in the family setting. Two hundred and eighty-five relatives (spouses, offspring, siblings and parents) of 87 index cases were studied. Anti-HCV was detected using second generation ELISA and RIBA tests. The overall prevalence of anti-HCV in the studied population was 6.7%, higher in spouses (11.7%) and lower in the offspring (2.1%). The presence of HCV RNA was detected in 12 of 45 index cases, using nested PCR. No increased risk of infection was found in the relatives of cases with HCV-RNA positivity. Using a logistic regression model, four factors were identified as significantly associated with an increased risk of hepatitis C in the relatives: the age of the index case, and, as characteristics of the relatives, male gender, past or ongoing hepatitis B virus infection, and being a spouse of an index case.

Adult↗

PubMed1997

[Respiratory symptoms in the textile industry. Their prevalence in the Vale do Ave].

Some workers in the textile industry have respiratory symptoms related to their occupation. This study is aimed at evaluating the frequency of respiratory symptoms in textile industries in the North of Portugal. We evaluated 3529 workers from 20 factories (19 deal with synthetic fibres and cotton and the other deals with sisal.) Among the workers, there were 34.5% with respiratory symptoms - 24,5% referred nasal symptoms, 22,6% with bronchial symptoms and 12,6% associated both. The workers who dealt with cotton presented a higher frequency of bronchial symptoms (25,0%) than the ones dealing with synthetic fibres (12,7% p < 0,000001). The same was noticed among the workers in the opening and spinning areas, who showed a higher frequency of bronchial symptoms (28,3%) than the ones in weaving areas (12,7% p < 0,000001). We did not find any differences concerning the frequency of symptoms among the workers handling both natural fibres (cotton and sisal). Individually all the symptoms were more frequent among the workers handling natural fibres. The most frequent symptom depended on the fibre. Cough was more frequently mentioned among the workers handling synthetic fibres (9.6%) and cotton (15.7%). Among the workers who handle sisal, dyspnea was the most frequently mentioned (16.9%). Productive cough was the most frequent association (7.2% sisal; 2.8% synthetic; 8.0% cotton), and the association between dyspnea and wheezing the least mentioned (6.4% sisal; 0.5% synthetic; 5.9% cotton). The workers with bronchial symptoms (synthetic fibre and cotton) have more years of exposure and greater smoking habits. In a covariance adjusted for age and smoking habits, the workers with bronchial symptoms, exposed to cotton have more years of exposure.

Adult↗

PubMed1997

[Unplanned pregnancy in Portugal].

This study was to determine the prevalence of unplanned pregnancy in a national sample of Portuguese puerperae and to define a risk profile for women with unplanned pregnancy. We also evaluated the independent effect of unplanned pregnancy in prenatal care utilisation and in the prevalence of preterm birth, low birth weight, and small for gestational age birth. Data was collected through a national survey proposed to the 50 major public Portuguese hospitals and answers were obtained from 41 hospitals, resulting in a sample of 1582 deliveries. Participants were classified as having a planned or unplanned pregnancy and were compared according to socio-demographic, behavioural, clinical, obstetric, and anthropometric characteristics. The prevalence of unplanned pregnancy was 39.4%. In the unplanned pregnancy group, single women aged less than 19 years and more than 34 years, those with one or more previous pregnancies, with 25% or less of the expected education for their age, and with the National Health Service as the source of were significantly more frequent. These characteristics, except the health provision, were significant and independently associated with an increased risk of unplanned pregnancy. Women with unplanned pregnancy were more likely to be unaware of prenatal care system, to have no prenatal care, late or inadequate prenatal care. Unplanned pregnancy was significantly associated with the risk of inadequate prenatal care (Odds ratio (OR) = 2.5; 95% Confidence interval (CI): 1.7-3.0), after adjusting for the effect of the confounding variables. Planning pregnancy was not significantly related with the prevalence of low birth weight or small for gestational age birth. However there was a significant relationship between unplanned pregnancy and preterm birth (Adjusted OR = 1.7; 95% CI:1.0-2.9). This study showed a high prevalence of unplanned pregnancy and that it was related with an under utilisation of prenatal care and with an independently increased risk of preterm birth, a major issue in perinatal health.

Adult↗

PubMed1997

[Prevalence, knowledge, treatment and control of arterial hypertension in Oporto, Portugal].

The aim of this study was to assess the prevalence, awareness, treatment and control of hypertension among subjects above the age of 39 years living in the urban area of Oporto, Portugal. One hundred and seventy seven individuals from the community were selected by random digit dialing. Each subject was asked about his/her personal history of hypertension, antihypertensive treatment and had his/her blood pressure measured. The prevalence of hypertension was 57.1%, defined by systolic blood pressure (SBP) > or = 140 mm Hg and/or diastolic blood pressure (DBP) > or = 90 mm Hg and/or administration of current the antihypertensive medication. If the values defining hypertension were SBP > or = 160 mm Hg, and DBP > or = 95 mm Hg the prevalence would be 37.9%. The overall prevalence of hypertension was higher in females, but a slightly higher non significant value was found in males in the fifth and sixth decades. Among hypertensives, 62.7% were aware of their condition, 56.7% were treated, 84.2% of hypertensives treated were controlled (SBP < 160 mm Hg and DBP < 95 mm Hg) and 44.7% were very well controlled (SBP < 140 mm Hg and DBP < 90 mm Hg). The question "Are you hypertensive?" had a sensitivity of 62.7%, a specificity of 83.6% and an accuracy of 75.7%. In the preliminary results of this study of an urban population with a high prevalence of hypertension, the awareness of hypertension is similar to that described in the United States of America twenty years ago, the percentage of hypertensives treated is similar to the American percentage fifteen years ago and the percentage of hypertensives treated and controlled is close to the current American percentage.

Adult↗

PubMed1997

[Risk factors for myocardial infarct: a case-control study in Oporto, Portugal].

A case-control study of coronary heart disease (CHD) was conducted in Oporto, Portugal. The cases series consisted of 100 consecutive patients with first time acute myocardial infarction who were admitted to the Coronary and Intermediate Care Units of a major teaching hospital. The community controls were 198 individuals without evidence of CHD by the Rose questionnaire and electrocardiography, selected by random digit dialing, with a participation rate of 70%. Data was collected by trained interviewers using a structured questionnaire and blood samples were obtained for selected laboratory data. The main analysis was made through unconditional logistic regression with calculations of odds ratios (OR). Age, OR: 1.5 (95% CI: 0.8-2.9), male gender, OR: 6.7 (3.6-12.3), family history of premature CHD, OR: 2.4 (1.4-4.3), diabetes, OR: 3.4 (1.6-7.4), antecedents of hypertension, OR:1.9 (1.1-3.1), history of high cholesterol levels, OR: 2.3 (1.4-3.9), high levels of physical activity, OR: 2.0 (0.9-4.1) and tobacco smoking, OR: 8.3 (3.8-18.5) were significant risk factors of acute myocardial infarction. After controlling for demographic variables and for the mutual confounding effects of the risk factors, the investigated factors that remained significantly associated with the risk of developing acute myocardial infarction were male gender, OR: 17.3 (4.8-62.3), family history of CHD, OR: 3.6 (1.4-9.6), diabetes, OR: 4.2 (1.0-18.1), high cholesterol levels OR: 2.7 (1.2-6.1) and smoking habits, OR: 7.7 (1.8-32.4). A negative association with high education levels was significant after controlling for all the variables, OR: 0.01 (0.01-0.5).

Adult↗

PubMed1997

Does pulmonary tuberculosis change with ageing?

SETTING: In most low prevalence countries, tuberculosis has become a disease of the aged; it has recently been suggested that the elderly may present a specific pattern. OBJECTIVE: To compare clinical, bacteriological and radiological features of pulmonary tuberculosis between young and elderly populations in a high incidence country. PARTICIPANTS AND METHODS: We retrospectively studied 337 consecutive pulmonary tuberculosis patients without confirmed HIV infection, hospitalised from 1989 to 1993. The clinical, bacteriological and radiological features of the two age groups considered, young adults (< 60 years) and elderly (> or = 60 years), were compared. RESULTS: Thoracic pain (16.3% vs 32.7%) and fever (27.2% vs 50.6%) were significantly less frequent in the elderly, while the frequency and duration of other symptoms before hospitalisation were similar. After admission, fever remained longer in young patients (P < 0.05). No significant differences were found regarding the general health status at hospitalisation, or associated illnesses (83.7% vs 73.5%; P = 0.068). Radiological lesions not related to the present diagnosis (14.1% vs 2.0%; P < 0.05), and a presumed diagnosis of tuberculosis (11.7% vs 4.1%; P = 0.02) were more frequent in the elderly. CONCLUSION: This study showed no specific clinical, bacteriological or radiological features between age groups, and does not support the hypothesis of any age-related patterns in pulmonary tuberculosis.

Adolescent↗

PubMed1997

[Hormone replacement therapy and cancer of the breast. 1. Does replacement therapy increase the risk of cancer of the breast?].

It has been extensively demonstrated that hormonal replacement therapy (HRT) constitutes an effective treatment of menopausal symptoms. There is also substantial epidemiological evidence suggesting that this treatment protects women against cardiovascular disease and osteoporosis. The possible increase in breast cancer risk appears as its principal disadvantage and is often invoked as the reason why both doctors and patients decline this therapy. In this paper we review the current knowledge on HRT and breast cancer risk. A computerised bibliographical search (MEDLINE) of literature in the English language published in the last 15 years was conducted, followed by a manual search of references. We focused our attention on four main questions: 1) Does HRT increase the risk of breast cancer? 2) Are different doses and drugs associated with different risks? 3) What effect on risk have the association of a progestin does? 4) Does HRT increase the risk of breast cancer in women with major risk factors for the disease? Overall, epidemiological studies suggest that women who have used HRT before have a slightly higher risk of breast cancer than those who have never used it, in most studies not exceeding 10%. The use of HRT for less than 5 years does not seem to be associated with increased risk, while some studies have shown relative risks in the order of 1.20-1.30 with therapies exceeding 10-15 years in duration. Different doses of conjugated equine estrogens do not seem to be associated with different risks of breast cancer. Data on the risk of other estrogen preparations is scarce and far from conclusive, but the majority of studies suggest a similar risk to that of conjugated estrogens. Evidence on opposed HRT is also scarce and contradictory. A substantial body of evidence exists to suggest that HRT in women with benign breast disease does not increase the risk of breast cancer. Data on HRT in women with a family history of breast cancer is inconclusive; some studies have found an increased risk with this therapy, while others have found no difference. It has to be taken into account that current knowledge on this subject is based on observational studies subject to numerous bias, evaluating dissimilar populations and mostly conducted with currently less favoured HRT regimens, such as unopposed conjugated estrogens. Studies on the currently prevailing HRT regimens are urgently needed.

Breast Neoplasms↗

PubMed1997

[Essential arterial hypertension: psychopathology, compliance, and quality of life].

OBJECTIVE: To evaluate the influence of psychological and psychopathological factors and quality of life on hypertension, its treatment and patient compliance. DESIGN: Case-control study. SETTING: Primary Health Care Center in Oporto. PATIENTS OR PARTICIPANTS: Forty nine patients (pts) with essential hypertension (HT), 35 female and 14 male, mean ages: 52 +/- 11 yrs and 59 +/- 10 yrs, respectively, and 39 normotensive controls (NT)--18 female and 21 male, mean ages: 37 +/- 15 yrs and 42 +/- 15 yrs, respectively, were recruited from the same General Practice. METHODS: Hypertension was classified according to the Joint National Committee criteria. The following psychometric evaluations were used: the Beck Depression Inventory, the Hopkins Symptom Distress Checklist, the Psychological General Well-Being Schedule and the Eysenck Personality Inventory. RESULTS: 1. The hypertensive pts differed from the normotensive pts as they scored significantly higher in somatization (p = 0.07), aggression/hostility (p = 0.036), index of psychological distress (p = 0.08) and, neuroticism (p = 0.09); 2. the hypertensive pts showed lower scores of quality of life (p = 0.019); 3. the biochemical parameters studied (uric acid, urea, creatinine, glicose, total cholesterol, HDL cholesterol, trigliceride, transaminases and gammaglutamil transferase) did not show statistically significant correlation with the psychological variables and quality of life items studied; 4. the electrocardiographic and echocardiographic alterations, corresponding to the severity of the clinical situation, were not associated with statistically significant differences in depression and quality of life; 5. the angiotensin converting enzyme inhibitor, the calcium antagonist and the beta-blockers showed no statistically significant influence on the psychological scores studied. However, pts receiving diuretics showed higher scores of somatization (p = 0.0008) and obsession/ compulsion (p = 0.02) and, lower scores of quality of life (p = 0.04); 6. a better compliance was associated with better psychological scores, and somatization scored with statistical significance (p = 0.03). CONCLUSIONS: The hypertensive pts differed from the normotensive pts as they scored significantly higher in aggression/hostility and lower in quality of life. No statistically significant differences were found among the psychological variables in the pts with cardiac involvement. A better compliance was associated with better psychological scores. The results of this study lead us to suggest that when treating pts with HT, the most appropriate therapeutic attitude should attempt to avoid both therapeutic withdrawal and lack of medical control.

Female↗

PubMed1996

Role of prenatal care in preterm birth and low birthweight in Portugal.

BACKGROUND: It remains unclear if benefits of prenatal care can be attributed to the amount and content of care or to uncontrolled risk factors that might also affect its use. This study was designed to evaluate the independent association between prenatal care adequacy and adverse pregnancy outcomes, measured either as the occurrence of preterm birth or low birthweight. METHOD: We studied 3734 single liveborn infants. Information on mothers' use of prenatal care, and demographic, anthropometric, behavioural, clinical and obstetric characteristics were obtained through questionnaire. Prenatal care was classified as inadequate, intermediate or adequate based on Kessner's Adequacy of Prenatal Care Index. To estimate the association of adequacy of prenatal care and the defined outcomes, both crude and adjusted odds ratios (OR) and 95 per cent confidence intervals (95 per cent CI) were calculated by means of unconditional logistic regression. RESULTS: Adequate and intermediate (compared with inadequate) prenatal care was significantly associated with a lower risk of preterm (OR = 0.20, 95 per cent CI 0.12-0.32, and OR = 0.35, 95 per cent CI 0.23-0.54, respectively) or low birthweight (OR = 0.23, 95 per cent CI 0.15-0.35, and OR = 0.31, 95 per cent CI 0.20-0.46, respectively). After adjusting for maternal age, social class, marital status, complications of pregnancy and type of hospital, the risk of preterm delivery remained significantly lower for women receiving adequate (OR = 0.18, 95 per cent CI 0.11-0.28) or intermediate care (OR = 0.35, 95 per cent CI 0.23-0.54). Adjusted for maternal body mass index, marital status, cigarette smoking, pregnancy weight gain and complications, type of hospital, newborn sex and gestational age, a significant decreased risk of low birthweight remained for infants of women with adequate (OR = 0.39, 95 per cent CI 0.23-0.65) or intermediate care (OR = 0.47, 95 per cent CI 0.29-0.76). CONCLUSIONS: Our findings show that in a population with free access to prenatal care, the quantitative adequacy of prenatal care has an independent effect on pregnancy outcome, whether assessed through the occurrence of preterm births or low birthweight infants.

Adult↗

PubMed1996

Comparative incidence of depression in women and men, during pregnancy and after childbirth. Validation of the Edinburgh Postnatal Depression Scale in Portuguese mothers.

BACKGROUND: Comparing women's and men's emotional reactions to childbirth can clarify the impact on mental health of childbirth as a life event. METHOD: Fifty-four first-time mothers attending obstetric services in Oporto, Portugal, and 42 of their husbands or partners participated in a longitudinal study of their mental health. All subjects were given a semi-structured clinical interview (SADS) at 6 months antenatally and at 12 months postnatally and sub-samples were interviewed at 3 months postnatally. At all these times all the mothers and fathers also completed a translated version of a self-rating scale for depression, the Edinburgh Postnatal Depression Scale (EPDS). RESULTS: More women than men had past histories of depression but their rates of depression did not differ significantly during pregnancy. In the first 3 months postnatally, nearly a quarter of the women at risk were found to have become depressed (major, minor and intermittent) in contrast with less than 5% of the men. In the next nine months men were more prone to become depressed than previously and their conditions tended to follow an earlier onset of depression in their spouses. CONCLUSION: Comparisons of EPDS and SADS ratings showed that the translated EPDS was a valid instrument for women but it was less satisfactory when applied to men.

Adolescent↗