Orientador: Maria Francisca Colella dos Santos / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T21:49:05Z (GMT). No. of bitstreams: 1 Martins_PaulaMariaFaria_M.pdf: 1525547 bytes, checksum: a6bb17a80894818a9bb059e65d0bc99d (MD5) Previous issue date: 2012 / Resumo: Introdução: Estudos mostram que há diferenças nos valores de supressão das emissões otoacústicas se comparados os grupos de neonatos sem riscos para perdas auditivas e os que apresentavam algum risco. A função do sistema olivococlear medial, medida pela supressão das emissões otoacústicas transientes, pode indicar uma função inibitória auditiva reduzida nos lactentes com indicadores de risco para perdas auditivas. Objetivo: Verificar a atividade do sistema auditivo eferente em neonatos que apresentam indicadores de risco para perda auditiva retrococlear, por meio da pesquisa da supressão das emissões otoacústicas transientes. Método: Pesquisa da supressão das emissões otoacústicas transientes realizada por meio do analisador de emissões cocleares ILO V6 - OTODYNAMICS -292 USB, acoplado a um computador e a sondas para supressão contralateral. Participaram da pesquisa 109 neonatos que foram reunidos em três grupos. GI, formado por 42 neonatos que apresentam indicador de risco para perda auditiva retrococlear, GII por 17 neonatos que apresentam indicadores de risco não relacionados com acometimentos retrococleares e GIII por 50 neonatos sem indicadores de risco para perda auditiva. O delineamento deste estudo foi o de corte transversal. Resultados: Encontramos valores médios de supressão das emissões otoacústicas transientes maiores no grupo GII, seguido dos grupos GI e GIII. Observamos que os maiores valores encontrados são dos grupos sem indicadores de risco para perdas auditivas retrococleares, porém não houve diferença estatisticamente significante. Conclusões: O ruído branco apresentado contralateralmente reduziu o nível de resposta das emissões otoacústicas transiente, demonstrando a participação do sistema eferente medial no efeito de supressão. O indicador de risco para perda auditiva retrococlear não foi fator relevante na pesquisa da supressão das emissões otoacústicas transientes em neonatos / Abstract: Introduction: Studies show that there are differences in the values of suppression of otoacoustic emissions compared groups of neonates without risk for hearing loss and those with some risk. The olivocochlear system function, as measured by suppression of otoacoustic emissions, may indicate an inhibitory function in infants with hearing reduced risk indicators for hearing loss. Objective: To investigate the activity of the efferent auditory system in neonates who present risk indicators for retrocochlear hearing loss, through research of the suppression of otoacoustic emissions. Method: Research suppression of otoacoustic emissions accomplished through the cochlear emissions analyzer ILO V6 - OTODYNAMICS -292 USB connected to a computer and probes for contralateral suppression. Participants were 109 neonates who were gathered in three groups. GI, consisted of 42 neonates who present a risk indicator for retrocochlear hearing loss, GII for 17 neonates who present risk factors unrelated bouts retrocochlear and GIII for 50 neonates without risk indicators for hearing loss. The study design was cross-sectional. Results: We found average values of suppression of otoacoustic emissions higher in GII, followed by GI and GIII. We observed that the highest values are found in groups without risk factors for retrocochlear hearing loss, but differences were not statistically significant. Conclusions: The white noise presented contralaterally reduced the response level of otoacoustic emissions, demonstrating the involvement of the medial efferent system in the suppression effect. The risk indicator for retrocochlear hearing loss was not a relevant factor in the study of suppression of otoacoustic emissions in neonates / Mestrado / Saude da Criança e do Adolescente / Mestra em Ciências

Orientador: Sérgio Tadeu Martins Marba / Dissertação (mestrado) - Universidade Estadual de Campoinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T00:26:44Z (GMT). No. of bitstreams: 1 Dias_FlaviadeSouzaBarbosa_M.pdf: 7664797 bytes, checksum: b92689fe0306ca5a6cab9a9750be47c4 (MD5) Previous issue date: 2012 / Resumo: O recém-nascido que necessita de internação em Unidade de Terapia Intensiva Neonatal é submetido a excessivos estímulos estressantes e dolorosos, intrínsecos à realização de diagnósticos e proposta terapêutica. Realizar uma avaliação acurada da dor e do desconforto do recém-nascido, afim de oferecer um tratamento adequado, é uma das dificuldades encontradas pelos profissionais de saúde que atuam em neonatologia no nosso país. Este estudo teve como objetivo desenvolver a tradução e adaptação cultural para o Brasil da escala EDIN (Échelle Douleur Inconfort Nouveau- Né), bem como realizar a validação das suas propriedades psicométricas. Este instrumento é composto por 5 indicadores de avaliação de parâmetros comportamentais e já tem sido utilizado em outros países com a finalidade de avaliar a dor e o desconforto prolongados em recém-nascidos internados em UTIN. Para o processo de tradução e adaptação cultural da escala foram seguidas as etapas recomendadas internacionalmente: a) dupla tradução para a língua portuguesa do Brasil e elaboração de uma versão síntese das traduções; b) retrotradução para a língua original; c) avaliação por comitê composto por 7 especialistas; d) pré teste. Para a validação das propriedades psicométricas foram feitas análises da confiabilidade interobservador e de consistência interna, bem como de validade relacionada com critério,. Foram incluídos na pesquisa 107 recém-nascidos. A coleta dos dados foi realizada em UTIN de dois hospitais, o Hospital da Mulher Prof. Dr. José Aristodemo Pinotti e o Hospital Estadual de Sumaré Dr. Leandro Francheschinni. Os resultados da análise de confiabilidade mostraram um coeficiente de correlação interobservador de 0,91 entre os escores finais, e coeficientes que variaram de 0,69 a 0,84 nos cinco indicadores da escala. A consistência interna, verificada pelo alfa de Cronbach foi de 0,82. Na análise de validação relacionada com critério, o coeficiente de correlação entre os escores da EDIN - Versão Brasileira e da CHIPPS (Children's and Infants' Postoperative Pain Scale) - Versão em Português foi de 0,79. Conclui-se que a tradução, adaptação cultural e validação da EDIN para a Língua Portuguesa do Brasil foi realizada com sucesso, tornando-o um instrumento válido e confiável para avaliar a dor prolongada no neonato / Abstract: The newborn that needs hospitalization in the Neonatal Intensive Care Unit (NICU) is submitted to excessive, pain-causing and stressful stimuli, intrinsic to the processes of diagnosis and therapeutic approach. Performing an accurate assessment of the pain and discomfort in the newborn, in order to offer the appropriated treatment, is one of the challenges health care professionals working in Neonatology face in our country. The aim of the present study was to develop the translation and cross-cultural adaptation of the EDIN scale (Échelle Douleur Inconfort Nouveau-Né) into Brazilian Portuguese, as well as validate its psychometric properties. This instrument consists of five assessment indicators to evaluate behavior parameters and has been used in other countries for the purpose of evaluating prolonged pain and discomfort in the newborns hospitalized in the NICU. The process of cross-cultural adaptation of the scale followed the internationally recommended practices: a) dual translation into Brazilian Portuguese and the elaboration of a synthesis of the translations; b) back translation into the original language; c) evaluation by a committee made up of 7 judges; d) pre-testing. The validation of the psychometric properties consisted on a validity analysis with criteria, inter-rater reliability, and internal consistency. 107 newborns were included in the survey. The data was collected from the NICU of two hospitals - Hospital da Mulher Prof. Dr. José Aristodemo Pinotti and Hospital Estadual de Sumaré Dr. Leandro Francheschinni. The reliability analysis showed an inter-rater correlation coefficient of 0.91 from final scores, and coefficients varied from 0.69 to 0.84 on the five indicators of the scale. The internal consistency, verified by the alfa de Cronbach, was 0.82. In the validity analysis with criteria, the correlation coefficient between the scores of EDIN - Brazilian Version and CHIPPS (Children's and Infants' Postoperative Pain Scale) - Portuguese Version was 0.79. It is thus concluded that the translation, cross-cultural adaptation, and validation of the EDIN to Brazilian Portuguese were successful, and the product of it is a valid and reliable instrument to evaluate prolonged pain in neonates / Mestrado / Saude da Criança e do Adolescente / Mestre em Saude da Criança e do Adolescente

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / INTRODUCTION: The proper integrity and functioning of the central structures are important for the linguistic and cognitive development and the Long Latency Auditory Evokes Potentials (LLAEP) allow the evaluation of the hearing information processing, considered as indicator of cognitive development, mainly in preterm infants, that present risks to alterations of hearing and language processing. The preterm infants are also vulnerable to cellular alterations. These alterations may cause several diseases during the neonatal period. The research of the oxidative metabolism through the Micronucleus Essay allows the identification of these alterations in cellular level. PURPOSE: To evaluate the LLAEPs and the oxidative metabolism of term and premature infants. MATERIAL AND METHODS: This study consisted of newborns with no more than one month old that came to the Hospital Universitário de Santa Maria (HUSM) to the Neonatal Hearing Screening (NHS). The infants were divided in control group (CG) and study group (SG), with term and premature infants, respectively. The sample consisted of 15 individuals in each group for the oxidative metabolism evaluation and 15 term infants and 10 premature infants for the LLAEP evaluation. For the micronucleus test, epithelial cells of the mouth mucosa were collected, with acytobrush. The cells were analyzed in a laboratory. The LLAEPs were researched in binaural form, through insertion earphones, with frequent speech stimulation /ba/ and rare /ga/, analyzing only the exogenous potentials (P1, N1, P2 e N2). RESULTS: In general, for the oxidative metabolism research, there was statistically significant difference between the groups in the analysis of the Micronucleus Test. The number of altered micronucleus and cells was higher for the group of premature infants when compared with the group of term infants. For the LLAEPs there was no statistically significant difference for the latencies of the members P1 and N1. CONCLUSIONS: After this study, it was concluded that premature infants present higher index of cellular damage in nuclear level when compared with term infants. In the electrophysiological evaluation of the cortical potential, it was possible to observe the exogenous components P1 and N1, but there was no difference between the groups. More studies in this area are necessary in order to better understand the characteristics of these potentials in newborn and young infants. / INTRODUÇÃO: A integridade e funcionamento adequado das estruturas centrais são importantes para o desenvolvimento cognitivo e linguístico, e os Potenciais Evocados Auditivos de Longa Latência (PEALL) permitem avaliar o processamento da informação auditiva, sendo considerados como indicadores do desenvolvimento cognitivo, principalmente em prematuros, os quais são de risco para alterações do processamento auditivo e de linguagem. Os recém-nascidos prematuros também são vulneráveis à alterações celulares, sendo que as mesmas podem causar diversas doenças no período neonatal. A pesquisa do metabolismo oxidativo por meio do Teste de Micronúcleos permite a identificação dessas alterações em nível celular. OBJETIVO: Avaliar os PEALL e o metabolismo oxidativo em recém-nascidos a termo e prematuros. MATERIAL E MÉTODO: Participaram do estudo recém-nascidos com até um mês de vida que compareceram ao Hospital Universitário de Santa Maria (HUSM) para realização da Triagem Auditiva Neonatal (TAN). Os neonatos foram divididos em grupo controle (GC) e grupo estudo (GE), sendo constituídos por recém-nascidos a termo e prematuros, respectivamente. A amostra foi constituída por 15 indivíduos em cada grupo para avaliação do metabolismo oxidativo, e 15 recém-nascidos a termo e 10 prematuros para avaliação dos PEALL. Para o teste de micronúcleos foram coletadas células epiteliais da mucosa oral, por meio do esfregaço da mucosa oral, com uma escova cytobrush. As células foram analisadas em laboratório. Os PEALL foram pesquisado de forma binaural, por meio de fones de inserção, com estímulo de fala frequente /ba/ e raro /ga/, sendo analisados apenas os potenciais exógenos (P1, N1, P2 e N2). RESULTADOS: De maneira geral, para a pesquisa do metabolismo oxidativo, houve diferença estatisticamente significante entre os grupos para as análises do Teste de Micronúcleos, sendo que o número de micronúcleos e de células alteradas foi maior no grupo de prematuros quando comparados com o grupo de recém-nascidos a termo. Para os PEALL não houve diferença estatisticamente significante para as latências dos componentes P1 e N1. CONCLUSÕES: A partir desse estudo pode-se concluir que os recém-nascidos prematuros apresentaram um índice maior de danos celulares a nível nuclear quando comparados com os recém-nascidos a termo. Na avaliação eletrofisiológica dos potenciais corticais, foi possível observar os componentes exógenos P1 e N1, porém não houve diferenças entre os grupos. São necessários mais estudos nessa área, a fim de se conhecer melhor as características desses potenciais em recém-nascidos e crianças pequenas.

In Bangladesh, research focusing on the quality of maternal and newborn health (MNH) services in hospitals remains neglected. There have only been a few studies conducted on quality issues and found the quality of MNH care provided at district and sub-district hospitals to be poor. The overall objective of this thesis was to develop, implement and evaluate a framework for quality improvement (QI) system for MNH care at the district and sub-district level government hospitals in Bangladesh. The thesis is comprised of four papers. Mixed methods were used in paper I and paper IV. In paper II quantitative methods were utilized, and to develop the “Model QI System”, exploratory methodological approaches were used and illustrated in paper III. Group discussions, focus group discussions, in-depth interviews, documents review and photography were utilised as qualitative data collection techniques. Through structured observation and exit interviews quantitative data were obtained. Findings of baseline survey identified several keyfactors that affected the quality of patient care: shortage of staff and logistics; lack of laboratory support; under useof patient-management protocols; lack of training; and insufficient supervision. The clinical performance of health care providers was found unsatisfactory. Utilizing the baseline survey findings and existing information on QI models, theories and QI intervention programmes implemented in defferent settings an adapted “Model QI System” and its implementation framework, guidelines and tools were developed. The key areas of this “Model QI System” included health system support, clinical service delivery, inter-departmental coordination; and utilization of services and client satisfaction. The adopted “Model QI System” was incorporated within the existing hospital management system and it was found that the quality of care improved. The evaluation of the study showed that the “Model QI System” was acceptable to the top health managers, health care providers and hospital support staff and feasible to implement in district and sub-district hospitals in Bangladesh.

D.Cur. / Quality control in perinatal education is imperative, with the purpose to deliver a high quality and appropriate healthcare service to the family in the peri natal period. The purpose of this study was to develop valid standards for perinatal education in South Africa. To reach this goal, the study proceeded as follows: Development phase -concepts were developed for perinatal education, -the concepts were logically systematised and formulated in concept standards, -the standards were presented for peer group review with the purpose of refinement and further development. Quantification phase: - the statistical validity of the standards was determined/calculated. After completion of the study the researcher reached the conclusion that quality perinatal education must adhere to the following standards: A philosophy for perinatal education must exist; The perinatal facilitator must be a well trained professional person, and must possess certain personal traits; The perinatal education style/method must adapt according to the client's socio-economic status, age, marital status and needs; The perinatal facilitator must make use of acknowledged teaching methods and techniques in order to facilitate learning; The perinatal education must comply with certain minimum requirements in order to make it accessible and acceptable to the client; The perinatal facilitator must complete a preparatory phase before she is allowed to give education; A perinatal education programme must have a curriculum that can be adapted to the client's circumstances; Perinatal education must be presented purposefully; The end result of perinatal education must focus on a healthy baby and a healthy, empowered mother, family and community.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Maternal and child-health and health education are three major concerns of public health organisations and researchers throughout the world. Health education for mothers is a strategy many countries have adopted to improve maternal and child-health. The present study was carried out in Uganda with the objective of exploring the factors influencing the utilisation of postnatal services at Mulago and Mengo hospitals, a government and private hospital. Both hospitals are located in Kampala district in Uganda. The survey, was completed by 330 women who responded to a structured questionnaire that was given to them six to eight weeks after delivery. Questions that were asked generated demographic information about the mothers; mothers’ knowledge about postnatal services; mothers’ socio-economic status and barriers to utilisation of the postnatal services. The participants included all women who delivered in Mulago and Mengo hospitals in November 2003 except for those who had had a neonatal death. The data was analysed using descriptive and inferential statistics. Some of the key findings of the study were that most women lacked awareness about postnatal services and those who knew about these services only knew about immunisation and family planning services. The majority of the mothers did not know about other services, such as physiotherapy, counselling, growth monitoring, and physical examination. Lack of money for transport or service costs, distance from the health care facility, not being aware of the services, lack of somebody to take care of the child at home were some of the main barriers to utilisation of postnatal services. Others included, lack of education, lack of employment, lack of decision-making powers, and lack of time to go back for the service. The ministry of health should educate women and communities about the importance of postnatal care, its availability, and the importance of women having decision-making power over their own health. The health service organization should improve on the quality of care by ensuring that services are provided at convenient hours with privacy, confidentiality and respect and it should evaluate the services periodically from the users perspective to maintain the quality of service. / South Africa

No description available.

A useful understanding of the respiratory system of premature infants and the factors contributing to different physiological mechanisms and diseases requires extensive clinical research. This project is the result of a need for a fast and reliable system to process the information obtained from biological sources and to obtain results from which different hypothesis can be tested. This document presents a description of one such system and its different subsystems. It describes the biosignals of interest as well as the stages they have to go through in order to obtain an accurate and valid analysis. The system is hardware and software oriented. The system hardware is subdivided into instrumentation system, which is used to pick up and condition the signals, and a data acquisition, monitoring and storage system, where the signals are digitized and stored for later processing. The system software, which is the basic and principal component of the project, participates in the hardware control for the data acquisition, storage and monitoring, as well as the posterior stages of signal processing and analysis, which constitute the key of the system. The biosignals mentioned above can be classified as muscular or EMG, respiratory, chest wall motion, and cardiac signals. The muscular signals are obtained from measuring the electrical activity of the muscles participating in the process of ventilation and the respiratory signals reflect mechanical characteristics of the lungs and airway passages, the chest wall motion signals give a measurement to evaluate the chest wall stability, and the cardiac signals which are measurements of the electrical activity irradiated by the cardiac muscle. These biosignals require extensive processing, especially the EMG signals, before analysis. The signal processing stage uses digital signal processing techniques which were developed or adapted for this purpose. The signal analysis stage is based on research protocols and physical relations to evaluate different respiratory parameters. Special data and file handling software was developed and applied as well as graphics software, to accomplish the stages mentioned above.

The present study examined psychological factors associated with individual variation in children's adjustment following minor surgery, and focused specifically on the process of coping with postoperative pain. Sixty children and adolescents (7 to 16 yrs) were interviewed on the day following surgery. They provided ratings and descriptions of their postoperative pain experience, perceived capacity for pain control, spontaneous coping strategies, and emotional distress. Parents also provided information about their efforts (both historical and present) to facilitate their child's coping, their own emotional distress, and perceptions of their child's distress following surgery. Thirdly, nurses rated children's pain behaviours displayed on the ward. Finally, information about analgesic medications and physical complications following surgery was recorded from children's medical charts. Qualitative data concerning the process of coping with postoperative pain and specific parental influences on children's coping were presented within a conceptual model adapted from the adult stress and coping literature. The data were also analyzed for age/developmental differences between older children (10 to 16 yrs) and younger children (7 to 9 yrs). Finally the predictive role of demographic, child coping process, and parental influence variables, in accounting for variations in child coping outcome, was analyzed. Results indicated that children and adolescents experienced moderate to severe pain following minor surgery. They reportedly tried a number of different cognitive and behavioural methods to deal with postoperative pain. Also, parents took an active role in facilitating children's coping. Age group differences were revealed in children's descriptions of postoperative pain, their reported ways of coping with pain, and their perceptions of control over pain and recovery. Age effects were interpreted with caution, however, since age and sex were confounded in this sample. Children who reported the most pain and emotional distress following surgery also reported more catastrophizing cognitions, felt less in control of their recovery, and reported having tried a greater number of behavioral coping strategies to manage pain. These results emphasize the role of children's appraisal processes in predicting coping effectiveness, and demonstrate that more coping does not imply better outcome. Future research directions and potential clinical appplications that follow from these findings were discussed. / Arts, Faculty of / Psychology, Department of / Graduate

Memory and metamemory were examined in 30 hyperactive and 30 nonhyperactive children matched on age, grade, and IQ (as measured by the Vocabulary and the Block Design subtests of the WISC-R), within the context of a broad range of tasks. The five tasks investigated in this study were: (a) a prospective memory task, (b) a feeling-of-knowing task, a visual retention task, (c) a word generation task, (d) and (e) an object span and recall task. Previous research has demonstrated considerable variability in the performance of hyperactive children on memory tasks. They have been shown to perform as well as normal children on tasks of cued recall, paired associates for meaningful words, and on tests of recognition memory. They are distinguished from normal children by their poor performance on tasks of uncued recall, paired associates learning for semantically unrelated words, and in addition, often display performance decrements when task demands increase. The results of this study suggest that hyperactive children are less efficient in metamemory knowledge and skills than normal children. These findings are consistent with the proposal that the difficulties hyperactive children demonstrate on memory tasks may result from a deficiency in their ability to efficiently engage in metamemory processes. The hyperactive children in this study generally had more difficulty than the control children with recall on all the tasks. These included tests of both verbal and nonverbal memory, short and long-term memory, and prospective remembering. Further, they did not derive a memorial benefit, as the control subjects did, when generating their own recall items, or when recalling visual stimuli that could be more easily verbally encoded than others. The hyperactive subjects demonstrated their recall abilities by performing as well as the normal subjects on the recall of read words in the word generation task, and on the recall of the low and medium level of labelability items in the visual retention task. Also, the recall performance of the hyperactive subjects differed significantly between a no-strategy and a provided strategy condition on the prospective memory task. Moreover, there were no group differences on the recognition memory test of the feeling-of-knowing task. The results of this study are consistent with the previous investigations of memory performance in hyperactive children. The present findings further extend the past research by demonstrating selective memory deficits in the hyperactive subjects that are consistent with deficits in metamemory abilities. The proposition that metamemory skills are implicated in the difficulties that the hyperactive children demonstrated in this study is further supported by the difficulty they experienced in describing how they remembered the task items. The hyperactive subjects had more difficulty than the control subjects when attempting to describe a strategy that they used to aid recall. The strategies they described, relative to the control subjects, tended to be vague and poorly defined. These findings suggest that there may be both qualitative and quantitative differences in the way in which hyperactive and normal children use strategies. In summary, the findings of this study suggest that hyperactive children, relative to normal children, seem to be deficient in both their metamemory knowledge and the ability to monitor and control their memory performance. Questions addressing whether these children cannot or do not employ these skills were introduced. The clinical implications of the findings were considered and recommendations were made for future research. / Arts, Faculty of / Psychology, Department of / Graduate