Introduction: Limited facilities exist at rural hospitals for the management of newborn infants with respiratory distress syndrome (RDS). Furthermore, the secondary and tertiary hospitals are under severe strain to accept all the referrals from rural hospitals. Many of these infants require intubation and ventilation with a resuscitation bag which must be sustained for hours until the transport team arrives. Not only is lung damage inflicted by the prolonged ventilation, but transferring the infant by helicopter and ambulance is expensive. CPAP (continuous positive airway pressure), a non-invasive form of ventilatory support, has been used successfully at regional (Level 2) and tertiary (Level 3) neonatal units, to manage infants with RDS. It is cost-effective for infants with mild to moderate grades of RDS to be managed at the rural hospital instead of being transferred to the regional secondary or tertiary hospital. CPAP was introduced to Ceres Hospital, a rural Level 1 hospital, in February 2008 for the management of infants with RDS. Aim: To determine the impact of CPAP on the management of infants with RDS in a rural level 1 hospital and whether it can reduce the number of referrals to regional hospitals. Study setting: Nursery at Ceres District Hospital, Cape Winelands District, Western Cape. Study design: Prospective cohort analytical study with an historic control group (HCG). Patients and Methods: The study group (SG) comprised all neonates with respiratory distress born between 27/02/2008 and 26/02/2010. The infants were initially resuscitated with a Neopuff® machine in labour-ward and CPAP was commenced for those with RDS. The survival and referral rates of the SG were compared to an historic control group (HCG) of infants born between 1/2/2006 to 31/01/2008 at Ceres Hospital. Results: During the 2 years of the study, 51 neonates received CPAP (34 <1800g, 17>1800g). Twenty (83%) of the SG infants between 1000g and 1800g and 23 (68%) of the infants between 500g and 1800g survived. Those <1800g that failed CPAP, had either a severe grade of RDS which required intubation and ventilation or were <1000g. Seventeen (33%) of the infants that received CPAP, were in the >1800g group. Thirteen (76%) of these infants were successfully treated with CPAP only. The four infants that failed CPAP suffered from congenital abnormalities and would not have benefited from CPAP. There was no statistically significant difference in the survival between the SG and HCG (80%) (p=0.5490) but the number of referrals decreased significantly from 21% in the HCG to 7% in the SG (p=0.0003). No complications related to CPAP treatment, such as pneumothorax, were noted. The nursing and medical staff quickly became proficient and confident in applying CPAP and were committed to the project. Conclusion: CPAP can be safely and successfully practised in infants with mild to moderate RDS in a rural Level 1 hospital. The survival rate stayed the same as the HCG, even though a higher risk infants were treated in the SG. The transfers were significantly reduced from 21% to 7%. This resulted in significant cost savings for the hospital.

Orientador: Daisy Maria Fávero Salvadori / Coorientador: João Paulo de Castro Marcondes / Resumo: A obesidade é uma doença de etiologia multifatorial, resultante de interações complexas entre fatores genéticos e ambientais. No entanto, o aumento acentuado de sua incidência, precocidade e severidade não foram ainda totalmente elucidados. Dentre os inúmeros fatores de risco, diversos achados sugerem, também, que estímulos estressores (p.ex. diabete, alterações nutricionais) na vida intrauterina podem promover alterações genéticas e epigenéticas, predispondo ao desenvolvimento tardio de doenças e disfunções metabólicas, como a obesidade. Assim, o presente estudo foi delineado com o objetivo de avaliar a possível relação entre o Diabetes melittus gestacional (DMG) e a predisposição do recém-nascido para o desenvolvimento de obesidade na vida adulta. Para tanto, foram incluídos no estudo gestantes saudáveis e gestantes diagnosticadas com DMG e seus respectivos recém-nascidos. Adicionalmente, adultos obesos e eutróficos foram incluídos como população de referência (controle). Considerando a relação entre o diabete e a obesidade com a disfunção mitocondrial, foi avaliado o perfil de expressão de gênica e proteica de SOD2 (superóxido desmutase 2), PPARα (receptor ativador da proliferação de peroxissomos alfa) e PPARGC-1β (receptor ativador da proliferação de peroxissomos gamma coativador 1 beta), relacionados ao metabolismo mitocondrial, em sangue do cordão umbilical e sangue periférico (população de referência), e o perfil de expressão gênica em células de placenta (faces materna e fetal). Primeiramente, nossos resultados demonstraram que indivíduos obesos apresentavam aumento da expressão gênica e proteica de SOD2, PPARα e PPARGC-1β no tecido sanguíneo quando comparados aos eutróficos (p < 0,05). No entanto, o mesmo não foi observado no tecido placentário (expressão gênica) e no sangue do cordão umbilical (expressão gênica e protéica) dos recém-nascidos das gestantes com DMG e... / Abstract: Obesity is a multifactorial disease involving complexes interactions between genetic and environmental agents. However, the increased incidence, early onset and severity of this disease, are still not well understood. Several findings have demonstrated that in utero stressors (diabetes, cigarettes, and/or alcohol consumption, etc) can promote genetic and epigenetic changes predisposing to late development of diseases and metabolic disorders, such as obesity. The present study was designed to evaluate the possible relationship between gestational Diabetes mellitus (GDM) and newborn predisposition to obesity his later life. Healthy and GDM pregnant women and their respective newborns were included. Additionally, obese and eutrophic adults were recruted as reference population. Considering the relationship between diabetes and obesity with mitochondrial dysfunction, gene and protein related to mitochondrial metabolism (SOD2 (superoxide dismutase 2), PPARα (peroxisome proliferator-activated receptor alpha) and PPARGC-1β(peroxisome proliferatoractivated receptor gamma coactivador beta) were evaluated in cells from cord and peripheral blood (reference population), and in placenta cells (gene expression profile in maternal and fetal sides). Our results showed an increased gene and protein expression (SOD2, PPARα and PPARGC-1β) in peripheral blood from obese compared to euthrophic subjects (p <0.05). However, the same result was not observed in the placental tissue (gene expression) and in umbilical cord blood cells (gene and protein expression) from GDM women and their respective newborn compared to the non diabetic group, i.e., GDM was not an effective agent to promote transcriptional changes in SOD2, PPARα PPARGC-1β in maternal and fetal sides of placenta, and transcriptional and translational changes in umbilical cord blood cells. In conclusion, SOD2, PPARα and PPARGC-1β gene and protein expression were confirmed as potential ... / Mestre

Made available in DSpace on 2014-12-17T14:46:46Z (GMT). No. of bitstreams: 1 EdualeideJPBN_DISSERT.pdf: 536785 bytes, checksum: 958a6f06670a7767f5dc0cb70479ab35 (MD5) Previous issue date: 2011-03-28 / This is an exploratory and descriptive study that aimed to investigate the actions of professionals in the context of breastfeeding, on the assumption that the actions taken by employees working together to postpartum and newborn are not competing to effect the distribution of pasteurized human milk so that it meets the needs of infants who depend on it. Thus, the study aimed to analyze the actions of medical and nursing staff of the distribution of pasteurized human milk to the newly born. The investigation was developed by action research in a federal hospital, located in the capital the state of Rio Grande do Norte, Brazil, reference assistance to women during pregnancy, childbirth and postpartum high risk in 2010. Study participants were fifty-five professionals chosen from the following inclusion criteria: to act in the NICU or rooming, being a pediatrician and / or neonatologists, nurses and technical nursing. According to the methodology of action research a questionnaire was applied, techniques in focus groups and courses were developed, and, finally, action evaluation. The project was submitted to the Ethics Committee at the Federal University of Rio Grande do Norte and approved with no protocol 448/2009. The problems identified in the responses issued by the social research were grouped into categories according to the similarity between them. The answer to the question of the survey - How is the need for pasteurized human milk for the newborns in neonatal intensive care unit and rooming identified? - Brought subsidies for action planning and implementation of strategies for change in the practice of professionals working in rooming and ICU. Thus, the study has relevance in social care and, when at the local level, will compete for the distribution pasteurized human milk to take effect as best as possible, as recommended by the Ministry of Health. It is also conceived that, in a macro view of society, it could contribute to minimizing the health problem that involves the child population / O leite humano atende ?s necessidades da crian?a com sua composi??o rica em nutrientes, como ?gua, prote?nas, lip?deos, carboidratos, minerais, vitaminas e ferro. Em fun??o disto, ? indicada a amamenta??o exclusiva para a crian?a at? os seis meses de vida. Entretanto, essa pr?tica, al?m de ser biologicamente determinada, ? socialmente condicionada e viabiliz?-la tem sido um grande desafio enfrentado por todos os profissionais que atuam junto ? mulher nessa realidade. O estudo teve o prop?sito de investigar as a??es de profissionais no contexto da amamenta??o, partindo do pressuposto de que as a??es desenvolvidas junto ? pu?rpera e ao rec?m-nascido pouco concorrem para se efetivar a distribui??o do leite humano pasteurizado, em conson?ncia com as necessidades de rec?m-nascidos que dele dependem. Assim, o estudo teve como objetivo geral analisar as a??es de profissionais m?dicos e equipe de enfermagem frente ? distribui??o do leite humano pasteurizado para o rec?m-nascido. Trata-se de um estudo explorat?rio e descritivo, com abordagem qualitativa, desenvolvido ? luz da pesquisaa??o em uma unidade hospitalar federal, situada na capital do estado do Rio Grande do Norte, Brasil, refer?ncia em atendimento ? mulher na gesta??o, no parto e no puerp?rio de alto risco. Participaram da investiga??o cinquenta e cinco profissionais escolhidos a partir dos seguintes crit?rios de inclus?o: atuar em UTI neonatal ou alojamento conjunto, ser m?dico pediatra e/ou neonatologista, enfermeiros e t?cnicos de enfermagem. De acordo com a metodologia da pesquisa-a??o, foi aplicado um question?rio, desenvolvidas t?cnicas de grupo focal, al?m da realiza??o de cursos. Por fim, procedeu-se ? avalia??o das a??es. O projeto foi submetido ao Comit? de ?tica em Pesquisa da Universidade Federal do Rio Grande do Norte e aprovado com Protocolo de n. 448/2009. Os problemas detectados nas respostas emitidas pelos atores sociais da pesquisa foram agrupados em categorias, de acordo com a similaridade existente entre si. A resposta ao questionamento da pesquisa - Como ? identificada a necessidade do leite humano pasteurizado para o rec?m-nascido em alojamento conjunto e UTI neonatal?- trouxe subs?dios para o planejamento de a??es e a implementa??o de estrat?gias de mudan?as na pr?tica dos profissionais atuantes no Alojamento Conjunto e na UTI Neonatal. Os participantes, embora tenham demonstrado conhecimento em rela??o ao funcionamento do BLH, evidenciaram desconhecer os problemas existentes no setor, no que diz respeito ? capta??o do leite humano. Tratando-se das a??es que os profissionais desenvolvem no processo da distribui??o, observou-se que estes revelaram conhecer, em sua maioria, as indica??es do RN em receber complemento em sua dieta, ressaltando-se que n?o foi poss?vel identificar no question?rio e nos grupos focais a preocupa??o em realizar o exame cl?nico na m?e antes da prescri??o. Considera-se que a equipe necessita apoiar efetivamente a pu?rpera na amamenta??o, com vistas a esclarecer d?vidas ou complica??es que possam surgir, prevenindo, inclusive, contra o desmame precoce. Assim sendo, o estudo apresenta relev?ncia no ?mbito assistencial e social e, em n?vel local, concorrer? para que a distribui??o do leite humano pasteurizado seja efetivada da melhor forma poss?vel, como preconizado pelo Minist?rio da Sa?de. Concebe-se, ainda, que, numa vis?o macro da sociedade, o referido estudo poder? contribuir para uma minimiza??o da problem?tica de sa?de que envolve a popula??o infantil

Doctorat en sciences psychologiques / info:eu-repo/semantics/nonPublished

Orientador: Cristina Maria Garcia de Lima Parada / Coorientador: Vera Lúcia Pamplona Tonete / Banca: Sonia Silva Marcon / Banca: Monika Wernet / Banca: Sueli Terezinha Ferreira Martins / Banca: Gimol Benzaquen Perosa / Resumo: O nascimento de um filho, de modo geral, gera transformações no contexto familiar. No caso do nascimento de recém-nascido de muito baixo peso, a família se vê frente a uma experiência delicada e difícil, que ocasiona diversas mudanças em sua dinâmica. O cuidado a essa população por parte do setor saúde mostra-se como desafio, tendo em vista a complexidade biopsicosocial envolvida. Considerando o exposto, o objetivo geral deste estudo foi apreender as representações maternas e de enfermeiros sobre o cuidado integral aos recém-nascidos de muito baixo peso. Os objetivos específicos foram: identificar, por meio da literatura científica, os sentimentos que permeiam as representações de famílias que vivenciam o nascimento de recém-nascido de risco, bem como o cuidado prestado aos recémnascidos de baixo peso por equipes de Saúde da Família; apreender as representações de enfermeiros sobre a participação da família no cuidado do recém-nascido de muito baixo peso internado em unidade de terapia intensiva neonatal; apreender representações maternas sobre cuidado de recém-nascidos de muito baixo peso em unidades de internação neonatal; identificar os vínculos apoiadores de famílias de recém-nascido prematuro e de muito baixo peso egresso de unidade de terapia intensiva neonatal e apreender as representações maternas e de enfermeiros sobre o cuidado no domicílio ao recém-nascido de muito baixo peso. Trata-se de pesquisa de abordagem qualitativa, sob a ótica da Teoria das Representações Sociais. Foram realizadas duas revisões integrativas da literatura e quatro estudos descritivos, com dados colhidos por meio de entrevistas semiestruturadas, sendo estes analisados segundo o referencial metodológico do Discurso do Sujeito Coletivo. Empregaram-se, também, como técnica de coleta de dados, o genograma e ecomapa. A amostra foi constituída por 41 familias (mães, 10 pais, seis avós maternas e duas avós paternas), ... / Abstract: The birth of a child, in general, causes transformations in the family context. In case of the birth of a very low birth weight newborn, the family is faced with a delicate and difficult experience, which causes several changes in its dynamics. The caring to this population by the health sector shows up as a challenge, considering the biopsychosocial complexity involved. Considering the above, the aim of this study was to understand the representations of mothers and nurses about the integral care to the very low weight newborns. The specific objectives were to identify, through the scientific literature, the feelings that permeate the representations of families experiencing the birth of a newborn at risk, as well as the care given to underweight newborns by teams of the Family Health , to apprehend the representations of nurses about family participation in the care of the very low birth weight newborn admitted to neonatal intensive care unit; grasp representations about maternal care of infants with very low birth weight in hospital neonatal units; identify ties supporters of families of preterm newborns and very low birth weight, taken of neonatal intensive care unit and apprehend the representations of mothers and nurses on home care to the very low weight newborns. This is a qualitative research, under a perspective of the Theory of the Social Representations. There were two integrative reviews of the literature and four descriptive studies, with data collected through semi-structured interviews and analyzed according to the methodological framework of the Collective Subject Discourse.A technique for data collection was also used: the genogram and eco-map. The sample consisted of 41 families (mothers, 10 fathers, six grandmothers and two paternal grandparents), 18 nurses in the intensive care unit and 22 nurses in primary health care unit / Family Health Program. The data collection period was ... / Doutor

Submitted by MARINA LUCCHINI PONTES NOGUEIRA (malpnogueira@hotmail.com) on 2018-10-15T14:42:37Z No. of bitstreams: 1 Dissertação de Mestrado. Marina Lucchini Pontes Nogueira.pdf: 2279326 bytes, checksum: d24b92bfe972adff14b64721bb4cfb22 (MD5) / Approved for entry into archive by ROSANGELA APARECIDA LOBO null (rosangelalobo@btu.unesp.br) on 2018-10-16T12:58:11Z (GMT) No. of bitstreams: 1 nogueira_mlp_me_bot.pdf: 2279326 bytes, checksum: d24b92bfe972adff14b64721bb4cfb22 (MD5) / Made available in DSpace on 2018-10-16T12:58:11Z (GMT). No. of bitstreams: 1 nogueira_mlp_me_bot.pdf: 2279326 bytes, checksum: d24b92bfe972adff14b64721bb4cfb22 (MD5) Previous issue date: 2018-09-19 / Introdução: O transporte inter-hospitalar de recém-nascidos (RN) para centros terciários muitas vezes é inevitável e está associado a maior o risco para morbidades e para o óbito. A hipótese deste estudo é de que os transportes realizados na região estejam ocorrendo de forma inadequada, piorando o prognóstico dos RN transportados. Objetivos: Determinar o perfil dos RN transportados, avaliar a adequação dos transportes e calcular os escores de risco TRIPS e Ca-TRIPS, correlacionando-os com o risco de óbito e hemorragia peri-intraventricular (HPIV), na primeira semana pós-transporte. Metodologia: Estudo prospectivo de corte transversal, realizado de junho 2014 a dezembro de 2017, incluindo todos os RN submetidos a transporte e internados na Unidade Neonatal do Hospital das Clínicas da Faculdade de Medicina de Botucatu, sem exclusão. As variáveis avaliadas foram: peso ao nascer (PN), idade gestacional (IG), sexo, tipo de parto, apgar, necessidade de reanimação em sala de parto, indicação da transferência, utilização de incubadora apropriada, presença de acesso venoso, drogas e fluidos utilizados, suporte respiratório, tempo de vida à internação, temperatura axilar, padrão respiratório, pressão arterial, uso de drogas vasoativas, estado neurológico e valores dos escores de risco à internação. Os pacientes foram acompanhados na primeira semana pós-transporte em relação à evolução para HPIV ou óbito. Resultados apresentados em tabelas de frequência, com cálculo das médias e desvio padrão ou medianas e percentis; calculados os valores de sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo para os escores. Teste do qui-quadrado foi utilizado no estudo das associações e realizado cálculo do risco relativo para análise dos desfechos (α=0,05). Resultados: Foram estudados 271 RN, a maioria nascidos a termo (medianas de peso: 2975g e IG: 38 semanas). Quase 30% dos pacientes foram transportados da própria cidade de Botucatu, porém 7,7% percorreram distâncias maiores que 150km. O transporte foi inadequado em 86% dos casos: sem incubadora de transporte: 26%; sem acesso venoso: 38%; sem infusão de fluidos: 40%; distermia: 53%; hipo ou hiperglicemia: 33%; hipoxemia: 20%; hipotensão: 19%; bradicardia: 3%. Os valores do TRIPS variaram de 0-65 (mediana: 6) e Ca-TRIPS de 0-60 (mediana: 20) e 31% dos RN apresentaram TRIPS ≥ 10. Valores de TRIPS ≥ 10 foram observados em 27% dos recém-nascidos a termo (RNT) vs 40% dos prematuros (PT) (P=0,04). TRIPS ≥ 10 aumentou o risco de HPIV entre os PT (R.R. = 4,04 - IC95%: 1,23-13,29 – P = 0,023) e o risco de morte entre todos os RN (R.R. = 7,45 - IC95%: 2,87-19,52 - P < 0,001). RN com Ca-TRIPS ≥ 20,5, apresentaram maior risco de morte (R.R. = 13,3 - IC95%: 4,05-43,81 - P < 0,001). Ambos os escores apresentaram valores preditivos positivos e negativos semelhantes. Conclusão: O transporte foi inadequado na maioria dos casos. Embora apenas 30% dos RN tenham sido PT, estes apresentaram valores mais altos de TRIPS e Ca-TRIPS, em comparação aos RNT. Pacientes com escores de risco mais elevados apresentaram maior riscos de óbito e HPIV. / Introduction: Interhospital transport of newborns (NB) to tertiary centers is often unavoidable and associated with greater risk for morbidity and death. The hypothesis of this study is that transport in the region is occurring inadequately, worsening the prognosis of the transported NB. Objectives: To determine the profile of the transported NB, to assess the adequacy of the transports and to calculate the TRIPS and Ca-TRIPS risk scores, correlating them with the risk of death and peri-intraventricular hemorrhage (PIVH) in the first week after transport. Methods: Prospective cross-sectional study, carried out from June 2014 to December 2017, including all NB submitted to transportation and hospitalized at the Neonatal Unit of the Hospital das Clínicas da Faculdade de Medicina de Botucatu, without exclusion. The variables evaluated were: birth weight, gestational age, sex, type of delivery, apgar, need for resuscitation in the delivery room, indication of transference, use of appropriate incubator, presence of venous access, drugs and blood flow used, respiratory support, age at admission, axillary temperature, breathing pattern, blood pressure, use of vasoactive drugs, neurological status, and values of risk scores at the time of admission. Patients were followed in the first post-transport week in relation to the progression to PIVH or death. Results presented in frequency tables, with calculation of means and standard deviation or medians and percentiles; values of sensitivity, specificity, positive predictive value and negative predictive value were calculated for the scores. Chi-square test was used in the study of associations and relative risk (RR) was calculated for the analysis of the outcomes (α=0.05). Results: We studied 271 newborns most born at term (medians weight: 2975g and gestacional age: 38 weeks). Almost 30% of the patients were transported from the city of Botucatu, but 7,7% traveled more than 150km. Transport was inadequate in 86% of cases: without transport incubator: 26%; without venous access: 38%; without fluid infusion: 40%; dysthermia: 53%; hypo or hyperglycemia: 33%; hypoxemia: 20%; hypotension: 19%; bradycardia: 3%. The TRIPS values ranged from 0-65 (median: 6) and Ca-TRIPS from 0-60 (median: 20) and 31% from the NB presented TRIPS ≥10. TRIPS values ≥ 10 were observed in 27% of the full-term newborn vs. 40% of preterm (P = 0.04). TRIPS ≥ 10 increased the risk of PIVH among premature infants (RR = 4.04 - 95% CI: 1.23-13.29 - P = 0.023) and the risk of death among all NB (RR=7,45 – IC95%: 2.87-19.52 - P <0.001). NB with Ca-TRIPS ≥ 20.5 presented higher risk of death (RR=13.3 - 95% CI: 4.05-43.81 - P <0.001). Both scores had similar positive and negative predictive values. Conclusion: Transportation was inadequate in most cases. Although only 30% of the newborns were preterm infants, they presented higher values of TRIPS and Ca-TRIPS compared to the full-term newborns. Patients with higher risk scores had a higher risk of death and PIVH.

Women in childbearing age are often affected by autoimmune diseases (AD) associated with the presence of antiphospholipid antibodies (aPL) that may influence further develop-ment of their children. The primary objective of our prospective study was to determine the presence of the following aPL: anti β2 glycoprotein I (anti-β2GPI), anticardiolipin (aCL), antiphosphatidylserine, antiphosphatidylinositol, antihospha- tidylethanolamine, antiphosphatidylglycerol, antiphosphatidic acid, antiannexin V in mothers with defined AD and their children after birth, at 6 and 12 months of life, and to compare the incidence of aPL with a control group. A secondary objective of the study was a 2-year follow-up of children born to aPL negative and aPL positive mothers with AD in order to detect the possible impact of maternal AD on the health of the offspring. In children, we analysed anthropometric data, blood cell count, cerebral and abdominal ultrasound examination, transient evoked otoacoustic emission test (TEOAE), electrocardiograph (ECG), the presence and kinetics of aPL. At the age of 2 years the Bayley Scales of Infant Development (BSID-II) were used for children's assessment of motor, language and cognitive development. 31 mothers from the total examined 82 aPL positive women with AD delivered 34 neonates...

Orientador: Cristina Maria Garcia de Lima Parada Parada / Resumo: A sífilis é doença causada pelo Treponema pallidium e transmitida por via sexual, hematogênica ou vertical. Sua forma congênita ocorre quando a gestante com sífilis não tratada ou tratada inadequadamente transmite a doença para o recém-nascido. Tem-se por objetivo investigar a ocorrência e a influência de fatores maternos e relativos ao pré-natal sobre a sífilis congênita. Trata-se de estudo de coorte retrospectiva, formada por 158 casos de sífilis em gestantes notificados no período de 2013 a 2015, com seguimento realizado pelo Programa de DST/Aids de município de médio porte do interior paulista. A análise estatística foi realizada descritivamente e por regressão logística múltipla, sendo considerado p crítico <0,05. A maior parte das gestantes notificadas em decorrência da sífilis era branca, tinha nove ou mais anos de escolaridade e trabalho não remunerado; quase a totalidade havia feito pré-natal (96,8%). Do total de gestantes incluídas na coorte, 74 (46,8%) tiveram recém-nascido classificado com sífilis. A análise univariada evidenciou que a chance de sífilis congênita foi menor entre as mulheres com maior escolaridade, maior número de consultas e realização de acompanhamento pré-natal em Unidade de Saúde da Família e foi maior quanto maior a idade gestacional no início do tratamento e quanto maior a titulação do exame não treponêmico materno (p<0,20). Essas variáveis foram incluídas em modelo de regressão logística final, que evidenciou ser o número de consultas pré-na... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Syphilis is a recent disease caused by Treponema pallidium and transmitted sexually, hematogenously or vertically. Its congenital form occurs when a pregnant woman with syphilis is not treated or treated improperly to make the newborn. It aims to investigate the occurrence and influence of maternal and prenatal factors on congenital syphilis. This is a retrospective study, formatted for 158 cases of syphilis in pregnant women reported in the period from 2013 to 2015, with follow-up performed by the STD / AIDS Program of a medium-sized municipality in the state of São Paulo. Statistical analysis was performed descriptively and by regression, with the announcement of p <0.05. The majority of the pregnant women noticed the result of syphilis was white, superior or superior to schooling and unpaid work; already had a prenatal care (96.8%). Of the total number of pregnant women included in the cohort, 74 (46.8%) had newborns classified as having syphilis. The univariate analysis showed that the chance of congenital syphilis was lower among women with higher schooling, higher number of visits and prenatal follow-up in the Family Health Unit, and the higher the greater the gestational age at the beginning of treatment and the maternal non-treponemal test (p <0.20). These variables were included in a final logistic regression model, which showed that the number of prenatal consultations was the only factor independently associated with the occurrence of congenital syphilis, with a lo... (Complete abstract click electronic access below) / Mestre

A participação de marcadores bioquímicos na avaliação de quadros de asfixia neonatal é cada vez mais relevante. A proteína S100B tem um papel destacado nestas pesquisas. O objetivo deste estudo foi procurar destacar a importância da proteína S100B na avaliação de recém-nascidos a termo com quadros de encefalopatia hipóxico-isquêmica, assim como correlacionar com outras substâncias que também participam do processo isquêmico. Foram analisados 21 casos de recém-nascidos a termo que desenvolveram quadro de encefalopatia hipóxico-isquêmica, no período de setembro de 2003 a outubro de 2004. Realizadas coletas no 1º e 4º dia de vida e dosadas, por método imunocitoquímico, a proteína S100B e o lactato. Foi possível detectar uma correlação positiva entre as 2 substâncias, assim como, quando comparadas entre si, observou-se também significância estatística. / Biochemical markers have played an increasingly relevant role in the assessment of neonatal asphyxia. The S100B protein is particularly important in research conducted in this field. The purpose of this study was to underline the importance of S100B protein in the assessment of term newborn infants with hypoxic ischemic encephalopathy, as well as to relate it to other substances also involved in the ischemic process. An assessment was made from September 2003 to October 2004 of twenty-one term newborn infants who developed hypoxic ischemic encephalopathy. Samples were collected on the 1st and 4th day of life and S100B protein and lactate levels were calculated using the immune cytochemical method. A positive relationship was found between the 2 substances. Additionally, a comparison between the two substances showed a statistically significant correlation.

This diploma thesis focuses on assessment of the mother - child relationship during the first three days after childbirth. The theoretical section discusses motherhood, pregnancy and the act of childbirth. From the postpartum standpoint, the mother's psyche and the psychology of the newborn are at the centre of our attention, along with issues related to providing support and ensuring the mother - child bonding processes takes place. Early communication between mother and child is described, as is the origin and development of bonding. To prepare the theoretical section of the thesis, available Czech and foreign sources on the topic were used. The thesis aims to map out how primiparas feel about their new social role as mother, and the nature of their relationship to their newborn in the first days after childbirth. To fulfil this objective, we employ a qualitative-quantitative methodology in the empirical section. Various research methods are used: individual semi-structured interviews, analyses and subsequent data analyses, the "think out loud" method (i.e., the regular verbalisation of one's own thinking process), and the MIRF scale. Ten mothers agreed to take part in the research; all of them in the period from one to three days after the birth of their first child. Based upon an analysis of the data, we determined that in terms of their feelings about motherhood and their relationship with their newborn, these research subjects may be divided into four major groups. The conclusions arrived at in the research were compared with those of Thorstensson et al. (2012), the study that inspired our efforts. Our experience with the interviews carried out with mothers shows that during the semi-structured interview during which they answered our questions these mothers were more focused on themselves, their feelings and issues. However, when they subsequently filled out the MIRF scale, the situation changed. The mothers shifted their focus to their children and their specific feelings towards them. Filling out the MIRF scale improved the mothers' understanding of the individual aspects of their relationship towards their children. The MIRF scale helped them to identify individual areas better. For this reason, we consider the use of the MIRF scale as beneficial from the standpoint of both mothers and the medical staff caring for them and their newborns in the first days after childbirth. The MIRF scale could be utilised practically as part of routine care for mothers and their children. It might improve the support mothers for interacting with their newborns and thereby effectively increase the mothers' sensitivity to their baby's behaviour.