Browsing by Author "Pinto, Paula"
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- Computer analysis of maternal–fetal heart rate recordings during labor in relation with maternal–fetal attachment and prediction of newborn acidemiaPublication . Pinto, Paula; Costa-Santos, Cristina; Ayres-de-Campos, DiogoAbstract Objective: To assess combined maternal (MHR) and fetal heart rate (FHR) recordings during labor, in relation with maternal–fetal attachment and prediction of newborn acidemia.Study design: Fifty-nine simultaneous MHR and FHR recordings were acquired in the final minutes of labor. Computer analysis followed the FIGO guidelines with estimation of MHR and FHR baselines, accelerations, decelerations, short- (STV) and long-term variabilities. MHR and FHR characteristics, their differences and correlations were assessed in relation to labor progression and to newborn umbilical artery blood (UAB) pH lower than 7.15 and 7.20. To assess prediction of acidemia, areas under ROC curves (auROC) were calculated.Results: Progression of labor was associated with a significant increase in MHR accelerations and FHR decelerations both in the non-acidemic and acidemic fetuses (p50.01). At the same time there was an increase in MHR–FHR correlations and differences in accelerations and decelerations in acidemic fetuses. The auROC ranged between 0.50 for FHR accelerations and 0.77 for MHR baseline plus FHR STV. Conclusions: MHR and FHR respond differently during labor with signs of increased maternal– fetal attachment during labor progression in acidemic fetuses. Combined MHR–FHR analysis may help to improve prediction of newborn acidemia compared with FHR analysis alone.
- Comunidade de prática de professores do 1º cicloPublication . Grácio, João; Torres, João; Rodrigues, Maria Rosário; Graça, Aida; Chambel, Ana; Franco, Cláudio; Pinto, PaulaO presente artigo pretende refletir sobre o funcionamento de uma Comunidade de Prática de Professores do 1.º Ciclo do Ensino Básico (Community of Practice - CoP), mais especificamente sobre o trabalho produzido e a consecução dos objetivos definidos para o primeiro ano de trabalho. Assim, pretendemos perceber se a participação na CoP contribuiu para o desenvolvimento profissional dos docentes envolvidos. A CoP iniciou as atividades em novembro de 2020 e surgiu da necessidade de reflexão conjunta sobre três ideias fundamentais: i) a ideia que as tecnologias não surgem para além do currículo, não dificultando que este seja cumprido; ii) a necessidade formativa dos professores com menos experiência na utilização pedagógica das Tecnologias Digitais (TD); iii) reflexão sobre as dificuldades sentidas ao gerir a sala de aula, alterada pela introdução de TD, disponíveis aos alunos. Terminado o ano letivo, pretendemos avaliar o trabalho desenvolvido para o que recolhemos as opiniões dos membros da comunidade através de um inquérito por questionário, como forma de completar os dados recolhidos por observação participada, ao longo do ano. Os dados recolhidos permitem-nos construir a perceção de que a comunidade foi bem- sucedida, pelo que perspetivamos a sua continuidade no próximo ano letivo.
- Development and evaluation of an algoritm for computer analysis of maternal heart rate during laborPublication . Pinto, Paula; Bernardes, João; Costa-Santos, Cristina; Amorim-Costa, CéliaBackground Maternal heart rate (MHR) recordings are morphologically similar and sometimes coincident with fetal heart rate (FHR) recordings and may be useful for maternal–fetal monitoring if appropriately interpreted. However, similarly to FHR, visual interpretation of MHR features may be poorly reproducible. Methods : A computer algorithm for on-line MHR analysis was developed based on a previously existing version for FHR analysis. Inter-observer and computer-observer agreement and reliability were assessed in 40 one-hour recordings obtained from 20 women during the last 2 h of labor. Agreement and reliability were evaluated for the detection of basal MHR, long-term variability (LTV), accelerations and decelerations, using proportions of agreement (PA) and Kappa statistic (K), with 95% confidence intervals (95% CI). Changes in MHR characteristics between the first and the second hour of the tracings were also evaluated. Results There was a statistically significant inter-observer and computer-observer agreement and reliability in estimation of basal MHR, accelerations, decelerations and LTV, with PA values ranging from 0.72 (95% CI: 0.62–0.79) to 1.00 (95% CI: 0.99 1.00), and K values ranging from 0.44 (95% CI: 0.28–0.60) to 0.89 (95% CI: 0.82–0.96). Therover, basal MHR, number of accelerations and LTV were significantly higher in the last hour of labor, when compared to the initial hour. Discussion The developed algorithm for on-line computer analysis of MHR recordings provided good to excellent computer-observer agreement and reliability. Moreover, it allowed an objective detection of MHR changes associated with labor progression, providing more information about the interpretation of maternal–fetal monitoring during labor.
- Electrocardiography versus photoplethysmography in assessment of maternal heart rate variability during laborPublication . Gonçalves, Hernâni; Pinto, Paula; Silva, Manuela; Ayres-de-Campos, Diogo; Bernardes, JoãoEvaluation of maternal heart rate (MHR) variability provides useful information on the maternal-fetal clinical state. Electrocardiography (ECG) is the most accurate method to monitor MHR but it may not always be available, and pulse oximetry using photoplethysmography (PPG) can be an alternative. In this study we compared ECG and PPG signals, obtained with conventional fetal monitors, to evaluate signal loss, MHR variability indices, and the ability of the latter to predict fetal acidemia and operative delivery.
- Exploring the validity of the 14-item mediterranean diet adherence screener (MEDAS): a cross-national study in seven european countries around the Mediterranean regionPublication . García-Conesa, María-Teresa; Philippou, Elena; Pafilas, Christos; Massaro, Marika; Quarta, Stefano; Andrade, Vanda; Jorge, Rui; Chervenkov, Mihail; Ivanova, Teodora; Dimitrova, Dessislava; Maksimova, Viktorija; Smilkov, Katarina; Ackova, Darinka Gjorgieva; Miloseva, Lence; Ruskovska, Tatjana; Deligiannidou, Georgia Eirini; Kontogiorgis, Christos A.; Pinto, PaulaThis study provides comprehensive validation of the 14-item Mediterranean Diet Adherence Screener (14-MEDAS) in an adult population from Greece (GR), Portugal (PT), Italy (IT), Spain (SP), Cyprus (CY), Republic of North Macedonia (NMK), and Bulgaria (BG). A moderate association between the 14-MEDAS and the reference food diary was estimated for the entire population (Pearson r = 0.573, p-value < 0.001; Intraclass Correlation Coefficient (ICC) = 0.692, p-value < 0.001) with the strongest correlation found in GR, followed by PT, IT, SP, and CY. These results were supported by kappa statistics in GR, PT, IT, and SP with ≥50% of food items exhibiting a fair or better agreement. Bland–Altman analyses showed an overestimation of the 14-MEDAS score in the whole population (0.79 ± 1.81, 95%Confidence Interval (CI) 0.61, 0.96), but this value was variable across countries, with GR, NMK, and BG exhibiting the lowest bias. Taking all analyses together, the validation achieved slightly better results in the Mediterranean countries but a definitive validation ranking order was not evident. Considering growing evidence of the shift from Mediterranean Diet (MD) adherence and of the importance of culture in making food choices it is crucial that we further improve validation protocols with specific applications to measure and compare MD adherence across countries and to relate it to the health status of a specific population.
- External Uterine Contractions Signal AnalysisPublication . Gonçalves, H; Pinto, Paula; Ayres-de-Campos, D; Bernardes, JoãoLabor dystocia is a major cause of operative delivery, which is associated with ncreased risks for both mother and fetus. We assessed linear and non-linear dynamics of external uterine contraction signals, in relation to labor progression and dystocia. Linear time domain, spectral and entropy methods were used to analyze external uterine contraction recordings obtained during the last two hours of labor, in 28 cases with normal and 27 cases with operative deliveries (forceps, vacuum or caesarean). Progression of labor was associated with a statistically significant increase in most linear time domain and spectral indices, both in normal and operative deliveries, whereas most entropy indices increased in normal deliveries, but did not change in operative deliveries. On the other hand, when compared with normal births, operative deliveries were associated with significantly increased entropy indices before the last hour of labor and significantly decreased (a probably associated) sympatho-vagal balance in the last hour of labor. Linear and non-linear analysis of external uterine contraction recordings may provide useful physiopathological and clinical information on the progression of labor and the diagnosis of dystocia.
- Is it Ethical to Offer ART in Transplant Patients? (mini review)Publication . Abreu Dos Santos, Filipa; Câmara, Sara; Reis, Filipa; Pestana, C; Ledo, Marta; Pinto, PaulaNumerous medical and surgical innovations have improved transplant recipient outcomes and this improved survival has led to an increased focus on their quality of life issues. This renewed focus includes controlling fertility and breeding. However, not all reproductive-age transplant recipients are able to conceive naturally. For this women in fertility is considered a threat to their quality of life. The decision to use Assisted Reproduction Techniques (ART) to help solid organ transplant female patients become pregnant raises unique medical and ethical concerns .
- Linear and non-linear analysis of uterine contraction signals obtained with tocodynamometry in prediction of operative vaginal deliveryPublication . Gonçalves, Hernâni; Morais, Mariana; Pinto, Paula; Ayres-de-Campos, Diogo; Bernardes, JoãoThe aim of this study was to explore whether linear and non-linear analysis of uterine contraction (UC) signals obtained with external tocodynamometry can predict operative vaginal delivery (OVD).Materials and methods: The last 2 h before delivery (H1 and H2) of 55 UC recordings acquired with external tocodynamometry in the labour ward of a tertiary care hospital were analysed. Signal processing involved the quantification of UCs/segment (UCN), and the linear and non-linear indices: Sample Entropy (SampEn) measuring signal irregularity; interval index (II) measuring signal variability, both of which may be associated with uterine muscle fatigue, and high frequency (HF), associated with maternal breathing movements. Thirty-two women had normal deliveries and 23 OVDs. Statistical inference was performed using 95% confidence intervals (95% CIs) for the median, and areas under the receiver operating curves (auROCs), with univariate and bivariate analyses. Results: A significant association was found between maternal body mass index (BMI) and UC signal quality in H1, with moderate/poor signal quality being more frequente with higher maternal BMI. There was an overall increase in contraction frequency (UCN), signal regularity (SampEn), signal variability (II), and maternal breathing (HF) from H1 to H2. The OVD group exhibited significantly higher values of signal irregularity and variability (SampEn and II) in H1, and higher contraction frequency (UCN) and maternal breathing (HF) in H2. Modest auROCs ere obtained with these indices in the discrimination between normal and OVDs. Conclusions: The results of this exploratory study suggest that analysis of UC signals obtained with tocodynamometry, using linear and non-linear indices associated with muscle fatigue and maternal breathing, identifies significant changes occurring during labour, and diferences between normal and OVDs, but their discriminative capacity between the two types of delivery is modest. Further refinement of this analysis is needed before it may be clinically useful.
- Prevalência de síndrome de apneia obstrutiva do sono : um estudo da Rede Médicos-SentinelaPublication . Rodrigues, Ana Paula; Pinto, Paula; Nunes, Baltazar; Bárbara, CristinaA síndrome de apneia obstrutiva do sono (SAOS) é caracterizada por episódios recorrentes de cessação total ou parcial do fluxo aéreo oro-nasal, secundários a um colapso da via aérea superior durante o sono. Afeta preferencialmente indivíduos do sexo masculino, de meia-idade e obesos, estimando-se que a prevalência de SAOS em homens adultos varie entre 1 e 5%. A evidência atual aponta que a prevalência não diagnosticada possa variar entre 0,3 e 5%.