RESUMO
AIM: Epidemiological studies on associations between Caesarean sections (C-sections) and attention-deficit hyperactivity disorder (ADHD) have been inconsistent, and we performed a meta-analysis. METHODS: We systematically searched PubMed and Embase to December 2018 and included nine hospital-based and population registry studies published in 2011-2018. These covered a total study cohort of more than 2.5 million people in eight countries: Australia, Brazil, Denmark, Finland, Germany, Sweden, Turkey and the UK. The analysis provided summary odds ratios (ORs) and 95% confidence intervals (CI) while taking heterogeneity into account. RESULTS: We found that that C-sections were associated with a small increase in the risk of ADHD (OR 1.14, 95% CI 1.11, 1.17, I2 0%) in offspring. In subgroup analyses, the association remained for both infants born after elective C-sections (OR, 1.15, 1.11, 1.19, I2 0%) and emergency C-sections (OR, 1.13, 1.1, 1.17, I2 45.4%). However, these were only marginally significant when we pooled data from siblings from other pregnancies (OR, 1.06, 1.00-1.13, I2 0%), implying that the association was due to confounding. CONCLUSION: The statistically significant association between C-sections and ADHD in children can be partially explained by unmeasured confounding. Further research controlling for important confounders is required before firm conclusions can be drawn.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Austrália , Brasil , Cesárea , Criança , Feminino , Finlândia , Alemanha , Humanos , Lactente , Gravidez , Suécia , TurquiaRESUMO
Neotropical rainforests cover about half of the world's tropical rainforests and house most of the biodiversity available on Earth. Australasia has been suggested as a potential source for Neotropical diversity. However, it remains unclear whether megathermal lineages could indeed have migrated to South America though Antarctica. The Neotropical Anomospermeae (Menispermaceae) consists of large, canopy lianas and is entirely restricted to tropical lowland rainforests. The sister relationship identified between this group and its Australasian ally represents an excellent model to test hypotheses regarding past connections between those landmasses. In this study, we used six chloroplast and two nuclear DNA markers to reconstruct phylogenetic relationships within the Neotropical Anomospermeae (Menispermaceae). The phylogeny of this group was then used as basis to reconstruct its biogeographical history. The phylogenetic framework reconstructed here strongly supports the monophyly of the Neotropical Anomospermeae and recovers the species of Anomospermum in three different clades: (i) Anomospermum sect. Anomospermum plus Orthomene; (ii) Anomospermum grandifolium and A. solimoesanum (Anomospermum sect. Elissarrhena); and (iii) Anomospermum bolivianum (Anomospermum sect. Elissarrhena). Each of these clades is recognized as a different genus and the necessary taxonomic changes are proposed. Furthermore, the Neotropical Anomospermeae seems to have split from its Australasian sister-group at c. 62â¯Ma. Ancestral area reconstructions support an Australasian origin for the Neotropical Anomospermeae, providing additional support for the hypothesis that Australasia is a source of Neotropical diversity, with megathermal lineages having dispersed via Antarctica. The Neotropical Anomospermeae differentiated in the late Eocene and subsequently diversified rapidly into seven lineages, suggesting that Neotropical lowland rainforests resembling modern rainforests physiognomically and structurally might not have developed until the late Eocene. The Neotropical Anomospermeae exemplifies the contributions of Australasian migration to Neotropical diversity.