INTRODUÇÃO: O Diabetes Gestacional (DG) é qualquer grau de intolerância a carboidratos com início ou diagnóstico na gravidez, com prevalência de 1% a 14% de todas as gestações. Para que complicações provenientes da doença sejam minimizadas, faz-se necessário o adequado controle glicêmico da paciente portadora dessa doença. Modelos experimentais sugerem que reside na musculatura estriada esquelética o principal sítio de resistência à insulina ocorrida durante a gestação. A prática de exercícios resistidos (ER) durante a gestação, embora ainda pouco difundida, é considerada segura, tanto para o feto como para a gestante. A literatura científica, porém, é extremamente escassa em relação à utilização dessa forma de atividade física como coadjuvante no tratamento do DG. OBJETIVOS: O presente estudo teve como objetivo avaliar pacientes com diagnóstico de DG, incluídas em programa de ER realizados com corda elástica, comparando a freqüência de mulheres que usaram insulina no grupo que realizou o programa ao grupo que não se exercitou, e verificar o impacto do programa sobre a adequação do controle glicêmico capilar das gestantes. MÉTODOS: Foi realizado um ensaio clínico randomizado com 62 portadoras de DG que acompanharam o programa de pré-natal da Clínica Obstétrica do Hospital das Clínicas da FMUSP no período entre outubro de 2006 e novembro de 2008. Elas foram alocadas em dois grupos de estudo após o diagnóstico de DG: o grupo de exercícios (GE; n = 31), que praticou ER e o grupo controle (GC; n = 31). Os grupos eram semelhantes em todas as características aferidas no momento da inclusão no estudo. RESULTADOS: Verificou-se redução estatisticamente significativa (p = 0,009) no número de pacientes que necessitou de insulina no GE (n = 07) em comparação ao observado no GC (n= 17). Houve diferença significativa do controle glicêmico entre os grupos. Enquanto o GC atingiu a meta para monitoração glicêmica capilar durante, em média, 43% do período de acompanhamento, o GE o fez por 62% do período de estudo (p = 0,014). Foi verificada também maior freqüência de médias glicêmicas ideais no GE (67,7%) em comparação ao GC (25,8%) (p = 0,001). Não houve diferença significativa (p =0,836) no período (semanas ± DP) entre a inclusão no estudo e o início da terapia com insulina entre o GC (2,00 ± 1,62) e o GE (1,86 ± 1,21), bem como na quantidade de insulina (UI/kg ± DP) utilizada pelas gestantes na comparação entre os grupos (GC: 0,49 ± 0,12; GE: 0,45 ± 0,11; p = 0,398). CONCLUSÕES: A prática de ER por portadoras de DG foi eficiente em diminuir a utilização de insulina, além de melhorar o controle glicêmico dessa população. / INTRODUCTION: Gestational Diabetes (GD) is any degree of intolerance to carbohydrates that begins or is diagnosed in pregnancy, with a prevalence of 1% to 14% of all gestations. So that complications arising from the disease may be minimized, adequate blood sugar control of patients with this disease is necessary. Experimental models suggest that the main area of resistance to insulin occurring during gestation resides in the skeletal muscle. The practice of resistance exercises (RE) during pregnancy, although not widely disseminated, is considered safe for the fetus as well as for the pregnant woman. Scientific literature is extremely scarce with regard to the utilization of this form of physical activity in conjunction with treatment for GD. OBJECTIVES: The object of this study was to evaluate patients with a diagnosis of GD who were included in a program of RE carried out with rubber tubes, comparing the frequency of women who used insulin in the group who participated in the program with the group that did not do the exercises, and to verify the impact of the program on the adequacy of capillary glycemic control of the pregnant women. METHODS: A randomized clinical trial was performed with 62 GD patients who were following the prenatal program at the Obstetric Clinic of the Hospital of Clinics of FMUSP (Faculty of Medicine from University of Sao Paulo) from October, 2006 to November, 2008. They were divided into two study groups after the diagnosis of GD: the exercise group (EG), who practiced RE, and the control group (CG). The groups were similar in all characteristics assessed at the time of enrollment in the study. RESULTS: A statistically significant reduction (p = 0,009) was verified in the number of patients who needed insulin in the EG (n = 07) in comparison with what was observed in the CG (n = 17). There was a significant difference in glycemic control between the groups. While the CG reached the goal for capillary glycemic monitoring during, on the average, 43% of the follow-up period, the EG reached it for 62% of the study period (p = 0,014). A higher frequency of ideal glicemic mean levels was also verified in the EG (67.7%) in comparison with the CG (25.8%) (p = 0,001). There was no significant difference (p =0,836) in the period (weeks ± SD) between study enrollment and the start of insulin therapy between the CG (2,00 ± 1,62) and the EG (1,86 ± 1,21), nor was there in the amount of insulin (UI/kg ± SD) used by the pregnant women in the comparison between the groups. (CG: 0,49 ± 0,12; EG: 0,45 ± 0,11; p = 0,398). CONCLUSIONS: The practice of RE by pregnant women with GD was efficient to reduce the use of insulin, as well as to improve the glycemic control of this population.

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2016-04-07T15:27:32Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Tese_MLA Digital.pdf: 5608380 bytes, checksum: 892ab76196ada4e1f22c7e3c017b5122 (MD5) / Made available in DSpace on 2016-04-07T15:27:32Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Tese_MLA Digital.pdf: 5608380 bytes, checksum: 892ab76196ada4e1f22c7e3c017b5122 (MD5) Previous issue date: 2015-08-20 / CNPq / O excesso de peso pré-gestacional e/ou adquirido durante a gestação é reconhecido como um fator de risco obstétrico, predispondo à mãe e o concepto a inúmeras intercorrências clínicas, cujos prejuízos não cessam com o término da gravidez. Entre essas consequências, observa-se menor duração na lactação. Diante disso, seria esperado que intervenções dietéticas e outras ações relacionadas à assistência pré-natal pudessem prevenir o excesso de peso e os desfechos negativos advindos dessa associação. São poucos os estudos que avaliam a qualidade da assistência pré-natal e a relação entre a intervenção dietética para gestantes com excesso de peso e o êxito nos indicadores de aleitamento materno. Esta tese teve como objetivos: verificar a efetividade da assistência nutricional sobre a morbidade materna e a maior duração do aleitamento materno exclusivo (AME) e, avaliar a qualidade do pré-natal ofertado por um serviço de referência às gestantes com excesso de peso. Os resultados obtidos estão apresentados sob a forma de dois artigos: um ensaio clínico, com 220 gestantes alocadas com IMC pré-gestacional >25,0 kg/m2 e idade gestacional ≤20 semanas, atendidas em três unidades de saúde de Maceió. Através do aplicativo Epitable, as gestantes foram alocadas no grupo intervenção (GI) ou no grupo controle (GC). Todas as gestantes participaram de atividades de educação em saúde durante o pré-natal, mas somente aquelas do GI receberam assistência nutricional individualizada mensal. A cada mês todas tinham seu peso aferido e os prontuários consultados para verificação de eventuais intercorrências. Por ocasião do 10º, 30º, 60º, 90º, 120º, 150º e 180º dias após o parto, procedeu-se visita domiciliar a todas as mães visando o monitoramento da prática do aleitamento materno. Das 220 gestantes recrutadas, 169 finalizaram o protocolo. Na comparação entre as gestantes do GC e GI não foram observadas diferenças significantes nas seguintes condições: ganho de peso, frequência de gestantes que apresentaram ganho ponderal compatível com o IMC pré-gestacional e intercorrências gestacionais. No conjunto das gestantes, a frequência de aleitamento materno na sala de parto foi inferior a 8,0% e 8,3% das puérperas nunca amamentaram. A prevalência de AME no 6º mês foi zero. O tempo médio de AME no GI foi superior ao verificado no GC (29,5 vs. 22,2 dias; p=0,04), assim como o aleitamento materno total (41,2 vs. 25,7 dias; p=0,03). Para avaliar a qualidade da assistência pré-natal oferecida por um hospital escola de referência no Estado para atendimento de gestantes de alto risco, procedeu-se a análise dos 64 prontuários referentes às pacientes selecionadas nesse serviço para compor o ensaio clínico acima referido. A análise da qualidade do pré-natal foi 100% insatisfatória pelo índice de Silveira et al. e de qualidade intermediária em 93,8% dos prontuários analisados segundo o índice de Silva et al. Conclui-se, que é inadequada a qualidade do pré-natal oferecido pelo serviço de referência às gestantes de alto risco e que a assistência nutricional individualizada não promoveu menor ganho de peso entre aquelas que receberam intervenção, quando comparadas as do grupo controle, porém foi efetiva em aumentar a duração do aleitamento materno exclusivo e total. / The pre-pregnancy excessive weight or the weight acquired during pregnancy is recognized as an obstetric risk factor, predisposing both mother and the fetus to several clinical complications which may not finish with the end of the pregnancy. Among these consequences, shorter lactation is observed, therefore, one could expect that dietary interventions and other actions related to the prenatal care would prevent overweight and negative outcomes arising from this association. There are few studies that assess the quality of prenatal care and the relation between dietary intervention for overweight pregnant women and success in breastfeeding indicators. This thesis aimed to: verify the effectiveness of nutritional assistance on maternal morbidity and duration of exclusive breastfeeding (EBF) and; assess the quality of prenatal care offered by a reference service for pregnant women who are overweight. The results are presented in the form of two articles: a clinical trial with 220 pregnant women allocated with pre-pregnancy BMI> 25.0 kg / m2 and gestational age ≤20 weeks, assisted in three health units in Maceió. Through the Epitable application, patients were allocated in the intervention group (IG) or the control group (CG). All pregnant women participated in health education activities during prenatal care, but only those of GI received monthly individualized nutritional assistance. Each month, every woman had her weight measured and her records consulted to check for possible complications. At the 10th, 30th, 60th, 90th, 120th, 150th and 180th days after childbirth, home visit was made to all mothers aiming to track breastfeeding practices. Of the 220 pregnant women enrolled, 169 completed the protocol. Comparing pregnant women from GC and GI there weren’t differences in such points: weight gain, frequency of women who had weight gain consistent with the pre-pregnancy BMI and pregnancy complications. In the group of pregnant women, the frequency of breastfeeding in the delivery room was less than 8.0% and 8.3% of puerperal mothers never breastfed. The prevalence of EBF at 6 months was zero. The average length of EBF in GI was higher than in the CG (29.5 vs. 22.2 days, p = 0.04) and total breastfeeding (41.2 vs. 25.7 days, p = 0.03).To assess the quality of prenatal care offered by a reference school hospital in the State in caring for high-risk pregnancies, the analysis of 64 medical files relating to patients selected in this service was proceeded to make up the clinical trial above. The analysis of prenatal quality care was 100% unsatisfactory by the Silveira et al. index and of intermediate quality in 93.8% of records analyzed according to the Silva et al. index. In conclusion, the prenatal quality offered by the reference service to high-risk pregnant women and, the individualized nutritional assistance did not cause less weight gain among those who received the intervention compared to the control group, but was effective in increasing the duration of both exclusive and full breastfeeding.

A gestação pode ser considerada, dentro das etapas de desenvolvimento, para o homem, mas principalmente para a mulher, como um dos momentos de crise dentro desse processo contínuo e dinâmico. É um momento transitório existencial que envolve necessidade de reestruturações e reajustamentos em várias dimensões, verificando-se necessidade de mudança de identidade e redefinição de papéis. Nesse período, existem alguns estados emocionais que são peculiares, com uma variedade de mudanças e nuances cuja etiologia ainda é bastante discutida, pois envolvem complexas inter-relações entre fatores hormonais e psicológicos. Encontra-se na literatura estreita vinculação entre intercorrências clínico-obstétricas e estados emocionais específicos, o que nos levou, neste trabalho, à investigar o porquê de algumas mulheres desenvolverem o quadro hipertensivo durante a gravidez e outras não. Haveria alguma coisa em seu perfil psicológico que as diferenciasse das grávidas normais? A gravidez acompanhada de hipertensão é uma das principais causas de morte materna em todo o mundo e por constituir-se numa gravidez de alto risco, todas as características peculiares a uma gravidez normal mostram-se exacerbadas. Dentro desse contexto, ainda existe o agravante do risco real de morte para a gestante e/ou o bebê e muitas vezes, a mulher responsabiliza-se por tal situação. Considerando-se todos estes aspectos, investigou-se neste trabalho o contexto social das gestantes, ou seja, sua estrutura familiar, condição sócio-econômica, relação com pai da criança, se houve ou não planejamento da gravidez e o perfil psicológico das gestantes hipertensas, comparando-as com as mulheres com gestação normal. Participaram deste estudo 20 gestantes primíparas, com idade gestacional a partir de 10 semanas, divididas em 2 grupos: 10 gestantes normais (grupo A) e 10 hipertensas (grupo B), sendo 5 hipertensas crônicas (B1) e 5 portadoras da Doença Hipertensiva Específica da Gravidez (DHEG)- B2. Utilizou-se um roteiro de entrevista semi-estruturado, o Desenho da Figura Humana (DFH), o DFH com tema e o Psicodiagnóstico de Rorschach. Todas as gestantes foram atendidas nos Ambulatórios de Gestação de Alto Risco (AGAR) e de Ginecologia e Obstetrícia do HC-FMRP/USP. A análise dos dados foi quantitativa e qualitativa e posteriormente, foi feita uma validação cruzada dos índices significativos das técnicas projetivas. Quanto ao tratamento dos dados: as entrevistas foram transcritas e elaboradas categorias de respostas; os protocolos dos desenhos analisados por 2 juízes e os protocolos do Rorschach codificados dentro da nomenclatura francesa, seguindo normas regionais. A análise das entrevistas demonstra que há características comuns aos dois grupos, relacionados ao fato da gravidez não ter sido planejada porém desejada e à não utilização, por parte da maioria, de métodos contraceptivos. Entretanto, observou-se diferenças entre os grupos em relação à: estabilidade na relação com o companheiro - no grupo A predominaram relações estáveis enquanto que no grupo B predominaram as relações instáveis; reação do companheiro e familiares em relação à gravidez - predominaram reações positivas no grupo A e negativas no grupo B; sentimentos da grávida em relação ao seu filho as mães do grupo A referem sentimentos positivos, enquanto que no grupo B, os sentimentos são mais negativos; e aos medos as gestantes do grupo A relatam medos referentes ao parto, enquanto que as do grupo B, referem-se à possibilidade de perda fetal. Em relação às técnicas projetivas, foi possível observar os seguintes resultados: há nos três grupos uma característica de coartação, ou seja, a existência de recursos adaptativos internos que, no momento, apresentam-se recolhidos, frente à forte tentativa de manter o controle racional sobre as vivências afetivas. Esse recolhimento pode ser decorrente da inabilidade em lidar com os seus afetos de forma mais equilibrada e satisfatória. Frente ao temor de perder o controle sobre esses impulsos, que se mostram neste momento em intensidade elevada, recorrem ao fechamento como forma de autoproteção. Todas as gestantes (grupo A e B) apresentaram uma forma mais introversiva na vivência de seus afetos, o que denota tendência em utilizar os recursos de forma mais voltada à reflexão. No grupo das gestantes normais, este esforço mostra-se eficiente na utilização de seus recursos, entretanto, apresentaram sentimentos de insegurança, egocentrismo, angústia e comportamentos regressivos, sentimentos esses esperados e considerados normais durante o período da gravidez. O grupo B1 (HAC), apresentou apego minucioso da realidade, ou seja, o ambiente é visto e vivenciado através de um estreitamento perceptivo, dificultando a comunicação com a realidade, num esforço de abarcá-la através da minuciosidade, gerando sentimentos de insatisfação pessoal e elevando os níveis de ansiedade. O grupo B2 (DHEG), apresenta uma tendência à ampliação do campo de atuação, tentando controlar a situação de forma ampla, deixando-as sobrecarregadas. Frente à imensidão de seus afetos, mostra-se insuficiente no controle dos mesmos, gerando sentimentos de insatisfação interna e conseqüente elevação dos níveis de ansiedade. Portanto, podemos afirmar que os perfis de personalidade apresentados no grupo de hipertensas, aliados aos aspectos sociais, sugerem diferenças importantes que podem estar atuando no desenvolvimento do quadro hipertensivo na gravidez. Seria adequado que, no atendimento prestado a essas gestantes, houvesse uma diferenciação na forma de abordagem de cada grupo atendido, respeitando-se as respectivas qualidades e as dificuldades, com o objetivo de favorecer a adesão ao tratamento e manter os quadros estabilizados, aproximando-os o mais que possível da gestação normal. / The pregnancy is one of the most critical stages of the human development not only for women but also men. Thats a transient moment of the existency that requires a personal adjustments in various aspects of life. This, showing the necessity of a change of identity as well as reevaluation of roles. During pregnancy, there are peculiar emocional status and a variety of changes which at the etiology is still very debated due to the fact those changes envolve complexes such as hormonal and psychological factors. Previous works, have shown a very tight relation between clinical and obstetric occurrences and specific emocional status. This lead us, in this work, to investigate why some women had presented hypertension during their pregnancy while others did not. A question can be raised, is there anything in their psychological profile making them different from the normal pregnancy? The hypertension during pregnancy is one of the major causes of maternal mortality worldwide, besides the fact of being considered a highers risk pregnancy showing an exacerbation of all features of a normal pregnancy. In this context, there is still another agravating factor, the real risk of death of both mother and baby (son). This, sometimes evokes a guilty feeling by the mother. Taking all the aspects decribed so far into account, we have tried in this work to investigate the social context of the mother (pregnant women), such as family structure, social-economic status , relationship with the babies fathers, if the pregnancy was planned or not, as well as the psychological profile of normal and hypertensive pregnant women. Took part in this study 20 primiparous women with at least 10 weeks of pregnancy or olders divided into two groups. Group A, 10 normal women and 10 hypertense (group B). In the group B, 5 women were cronic hypertense (B1) while the remainder were Gestational Hypertension, group B2. A semi-structured interview, Draw a Person Test, and Rorschach Test were applied. All women were followed, in the clinic of higher risk preganncy (AGAR) in the department of ginecology and obstetrics of the HC-FMRP/USP (General Hospital). The data analysis was quanlitative and quantitative including a cross-validation of the signification index of projective techniques. Also, regarding, the data of all interviews were transcribed and categorized, drawing protocols are analyzed by two judges and the Rorschachs protocols were encoded following the French nomenclature and local rules. These analyses showed that are common aspects in the two groups, like the fact of unexpected but accepted pregnancy as well as the neglected use of contraceptive methods in the majority of the pregnancies. However, we observed diferences between the groups when the rob stability of the relationship is concerned. In the group A, the majority of the relationship could be considered stable, while the opposite was observed in the group B. Also, in the group A positive reaction to the pregnancy was dominant for both father and family. Once again, the opposite was observed in B. Regarding mothers feeling, in group A, again, positive feeling are dominant while negative ones are shown by the majority of B. Group A shows fear mostly robted to the birth, while in B, a fear of fetus death is clear. Regarding projective techniques, it was possible to observe the following: all groups have shown the existence of self-adaptative resources, hidden at the moment due to the necessity of keeping a rational control over the affective experiences. This ca be an effect of inability of managing affectiveness in a balanced way. Other fact that contributes for that is the fear of loosing control of these feeling now much stronger, leading to an introspection as self-protection. This introspection was observed in all women regarding their affective feelings, denotating a resource towards reflection. The women in group A this effort had shown efficient when using the resources, however, they showed insecurity egocentrism, anguish, and regressive behaviours. All these feeling are expected and considered normal during pregnancy. In the group B1 shows a meticulous attachment to reality thus, the enviroment is seen and experienced through a perception narrowing. This feeling disturbes the conexion to reality and generate insatisfaction which in terms increase the ansiety. The B2 group shows tendency of widening their acting field what makes them overwhelmed. Also, this group shows an insufficient control of their affectivity what causes insatisfaction and increased anxiety. Thus, we can state that the personality profiles presented in hypertension women as well as the social aspects suggest important differences that play a role in the occurency hypertension during pregnancy. It would be adequate to develop a differencial approach during the following of the pregnancy for these two groups trying qualities and dificulties in order to facilitate adheson to the treatment and maintenance of stabel condition towards a more normal pregnancy.

The present study analyzed the health benefits data of employees in a southwestern United States manufacturing plant. The data consisted of the prevalence rates of headaches, muscle injuries, upper respiratory complaints, and colds/flu for baseline (1985) and intervention levels (1986-1988) for five high-risk jobs. The prevalence rates of headaches and muscle injuries decreased significantly (p < .001) from baseline levels for all five job groups. Comparisons with a nontreatment group revealed significant decreases (p < .05) for three of the five job groups. The findings support the efficacy of the ergonomic interventions. A health surveillance system is recommended for early detection and prevention of cumulative trauma disorders.

No description available.

Background: Based on previous research, conventional mammography screening has been found to be ineffective for women at high risk, mainly because high-risk women have high breast density and a fast progression rate of breast cancer. Recently, MRI screening was proposed as an additional complementary screening for high-risk women in Ottawa. The addition of MRI to mammography to screen the high-risk population is worth exploring as it may well address the limitations of mammography, especially since MRI has higher sensitivity. Purpose: The goal of this study is to assess the cost-effectiveness off adding MRI to mammography screening for early detection among women of the high-risk population in Ottawa by using conventional values for the society’s/government’s willingness to pay for one life year gained (US$ 50,000). Methods: A discrete-event simulation model was developed to evaluate the cost-effectiveness of adding MRI screening to mammography for high risk women breast screening in Ottawa. Three risk groups were considered; BRCA1, BRCA2 and other high risk. Based on breast annual incidence, screening features, breast cancer progression among high-risk women, treatment and breast cancer survival rates, the model simulates a hypothetical cohort consisting of 5000 women progressing from age 30 to 100 (or to natural death) and calculates the accumulated life years and costs in order to predict the cost of one life year gained by each screening strategy. Univariate sensitivity analysis was performed on the key parameters to determine the robustness of the simulation outcomes. Paired t-tests were used to determine whether the parameters’ variations are statistically significant or not. Results: In the base-case scenario, the incremental cost-effectiveness ratio (ICER) of mammography compared to both screening was CAN$30,043.48 /life year gained (95%CI ±2524.40) which means the addition of MRI to mammography is a cost-effective intervention according to the commonly used willingness-to-pay threshold of US$50,000 per life-year gained. The findings of the sensitivity analysis indicate that the cost-effectiveness of adding MRI screening is statistically significant for most of the parameter variations, however, the degree of change in the ICER is not hugely impactful as in all cases the ICER remained well below the commonly used willingness-to-pay threshold per life year gained. Conclusion: Study results suggested that the addition of MRI has an important role in improving high risk women screening in terms of increasing life years gained compared to receiving mammography screening only. The results of this study support the recommendations of Cancer Care Ontario and the Ontario Health Technology Advisory Committee guidelines of expanding the Ontario Screening Program to integrate MRI with mammography screening for high risk women aged 30 to 69 years.

Disasters are prevalent worldwide and there is a need to engage high-risk populations in collaborative disaster management activities to improve resilience that is inclusive of the whole community (Enarson, & Walsh, 2007). It is clear from extant literature that awareness has a supportive influence on collaboration, however there is need for a better understanding of how this interaction activates action toward collaborative disaster management activities (Mendoza et al., 2014; Na, Okada, & Fang, 2009), especially for high-risk populations (Enarson, & Walsh, 2007). Thus the purpose of this study was to understand how awareness activated individuals to collaborate in the EnRiCH asset-mapping task, to engage high-risk populations in disaster management activities and improve community resilience in future disasters. In this study we used qualitative content analysis to analyze audio-recorded semi-structured interviews to identify concepts and emergent themes. Self-Determination Theory (Deci & Ryan, 2008) and the ED Model of Awareness (Kuziemsky & O’Sullivan, under review) were used as a framework for the study. Findings and elements of Self-Determination Theory were used to expand the ED Model of Awareness to demonstrate how awareness motivates collaborative action. This study concludes that awareness influences the psychological needs of competence and relatedness, both positively and negatively in different contexts, to motivate individuals toward collaboration and sustained action. This is depicted in the extended ED Model of Awareness and Action to demonstrate how awareness is situated in the interaction between the psychological needs, motivation, and collaborative action.

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2017-07-24T11:56:49Z No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) TESE PARA DEPÓSITO.pdf: 1020977 bytes, checksum: 8eff6af757005586cdc17a12637c3302 (MD5) / Made available in DSpace on 2017-07-24T11:56:49Z (GMT). No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) TESE PARA DEPÓSITO.pdf: 1020977 bytes, checksum: 8eff6af757005586cdc17a12637c3302 (MD5) Previous issue date: 2015-10-29 / Introdução: Cerca de 20% das gestantes apresentam fatores de morbidade e mortalidade que podem tornar a evolução da gestação desfavorável, constituindo o chamado grupo de alto risco. Esta é uma condição de maior probabilidade de comprometimento à saúde ou de significante risco materno ou fetal. A expectativa de risco de vida para si ou para o bebê pode predispor a gestante a apresentar um maior comprometimento em seu estado de saúde mental. Além de que a percepção do risco da mulher grávida pode influenciar os comportamentos de saúde durante a gravidez. Ser de alto risco, portanto, pode ser fator contribuinte para um estado de sofrimento mental e com isso necessitar de intervenções mais específicas. Objetivo: avaliar o estado de saúde mental de gestantes que preenchem critério para gestação de alto risco reprodutivo e validar um instrumento que medisse a percepção de risco destas gestantes. Método: realizado um estudo transversal conduzido em uma amostra de 456 gestantes, composta por 241 gestantes de alto risco e 215 gestantes de baixo risco como grupo comparativo, atendidas em serviços públicos de pré-natal, na cidade de Natal, RN. Avaliou-se o estado de saúde mental destas gestantes através da verificação da presença de Transtorno mental comum (TMC) e aplicou-se o instrumento Perception of Pregnancy Risk Questionnaire (PPRQ), como avaliação da percepção de risco, com a finalidade de validação à população brasileira. Resultados: A prevalência encontrada de TMC foi de 63,5% nas gestantes de alto risco, enquanto presente em 41,9% das gestantes de baixo risco (p<0,001). Na análise multivariada, o transtorno mental comum esteve associado a fatores como ser do grupo de risco, renda pessoal, planejamento da gravidez e história de transtorno mental anterior. O PPRQ demonstrou ser concordante entre suas variáveis e o seu total, além de boa confiabilidade extraída de uma alfa de Cronbach de 0,87 e adequado teste-resteste, semelhante ao instrumento original. Conclusão: De acordo com os dados disponíveis na literatura, consideramos que a prevalência de TMC em gestantes de alto risco encontrada neste estudo pode ser considerada alta, alertando para a importância da investigação sobre o estado de saúde mental nestas mulheres em serviços de pré-natal. A versão em português do PPRQ demonstrou resultados satisfatórios na tradução, adaptação e consistência interna, sugerindo esta versão para ser utilizado na população brasileira. / Introduction: About 20% of pregnant women have morbidity and mortality factors that can make the evolution of unfavorable pregnancy, constituting the so-called high-risk group. This is a condition likely to compromise the health or significant maternal or fetal risk. The expectation of life threatening for you or the baby may predispose pregnant women to have a greater commitment to their mental health. In addition to that the perception of the pregnant woman's risk may influence health behaviors during pregnancy. The fact to be at high risk can therefore be a contributing factor to a state of mental distress and thus require interventions that are more specific. Objective: To assess the mental health status of pregnant women who meet criteria for high-risk pregnancy and reproductive validate an instrument to measure the perception of risk of these pregnant women. Method: a cross-sectional study conducted in a sample of 456 pregnant women, consisting of 241 high-risk pregnant women and 215 low-risk pregnant women as a control group treated at public services prenatal, in the city of Natal, RN. We evaluated the mental health status of these pregnant women by checking the presence of common mental disorder (CMD) and applied the Perception instrument of Pregnancy Risk Questionnaire (PPRQ) as assessment of risk perception, in order to validate the Brazilian population. Results: The prevalence of CMD was 63.5% in high-risk pregnant women, while present in 41.9% of low-risk pregnant women (p <0.001). In multivariate analysis, the common mental disorder was associated with factors such as being risk group, personal income, pregnancy planning and history of previous mental disorder. The PPRQ proved concordant between your variables and their total, and good reliability extracted a Cronbach's alpha of 0.87 and adequate test-retest, similar to the original instrument. Conclusion: According to the data available in the literature, we believe that the prevalence of CMD in high-risk pregnant women in this study can be considered high, stressing the importance of research on the state of mental health in these women in prenatal services . The Portuguese version of Perception of Pregnancy Risk Questionnaire demonstrated satisfactory results in the translation, adaptation and internal consistency, suggesting that version to be used in the Brazilian Population.

UTBILDNING I BARN-HLR TILL FÖRÄLDRAR MED SVÅRT SJUKA BARN -Intervjustudie om sjuksköterskors erfarenheterHELENE JÖNSSONJönsson, H. Utbildning i barn-HLR till föräldrar med svårt sjuka barn – Intervjustudie om sjuksköterskors erfarenheter. Examensarbete i Omvårdnad 15 högskolepoäng avancerad nivå. Malmö Universitet: Fakulteten för hälsa och samhälle, institutionen för Vårdvetenskap, 2018.Bakgrund: Föräldrar till svårt sjuka barn som erbjuds förebyggande föräldrautbildning i barn-HLR före hemgång från sjukhus upplever ökad trygghet samt medför en ökad säkerhet för de sjuka barnen i hemmet. Det saknas kunskap huruvida sjuksköterskor på barnkliniker i Sverige har erfarenhet av att erbjuda denna föräldragrupp utbildning i barn-HLR och hur den i så fall bedrivs. Syfte: Syftet med studien var att undersöka sjuksköterskors erfarenheter av att utbilda föräldrar med svårt sjuka barn i barn- HLR, i samband med sjukhusvistelse.Metod: En kvalitativ semistrukturerad intervjustudie utfördes, med totalt elva sjuksköterskor från de större barnklinikerna i Sverige. Med induktiv innehållsanalys analyserades materialet enligt Burnard.Resultat: Temat som framkom var: Sjuksköterskor har en nyckelroll i föräldrautbildning, samt följande kategorier: Sjuksköterskans undervisande funktioner, Föräldrar och närståendes utbildningsbehov, Utbildningsstrategier, Resultat och konsekvenser av utbildningen. Sjuksköterskornas erfarenhet var att föräldrar till svårt sjuka barn inte alltid får tillräcklig undervisning inför hemgång, de påvisade stress över att inte kunna hantera akuta situationer. Föräldrarna upplevdes tryggare när de fick information och kunskap. Det utbildningsprogram i barn-HLR som finns upplevdes som otillräckligt då det inte täcker behovet som föräldrautbildning till svårt sjuka barn. Slutsats: En standardiserad preventiv föräldrautbildning för barn-HLR till svårt sjuka barn saknas - med de individuella behov som de barnen kan ha. Ansvarsfördelningen är otydlig om vem som tar beslutet om föräldrautbildning ska erbjudas, samt sjuksköterskorna har en nyckelroll i föräldrautbildningen men har ett svagt mandat att bedriva undervisning då stöd från riktlinjer saknas.Nyckelord: Barn-HLR, föräldrautbildning, sjuksköterskors erfarenheter, svårt-sjuka barn. / EDUCATION IN CPR TO CHILDREN FOR PARENTS WITH HIGH-RISK CHILDREN -INTERVIEW STUDY OF NURSES´ EXPERIENCEHELENE JÖNSSONJonsson, H. Education in CPR to children for parents with high-risk children – Interview study of nurses´ experience. Degree project in nursing 15 credits - advanced level. Malmö University: Faculty of Health and Society, Department of Care Science, 2018.Background: Parents with high-risk children who are offered preventive parental education in Cardiopulmonary resuscitation (CPR) for children before departure from hospitals experience increased security and result in increased safety for the sick children in the home. There was no knowledge whether nurses at children's clinics in Sweden had experience in offering this parent group training in CPR for children or, if so, how it was conducted. Aim: The aim of the study was to investigate nurses´ experiences of educating parents with high-risk children in CPR for children, during hospitalization.Methods: A qualitative study incorporating semi-structured interviews was performed, with a total of eleven nurses from the major children’s clinics in Sweden. The interview material was analyzed through inductive content analysis according to Burnard.Results: The theme that emerged was: Nurses have a key role in parental education, and following categories were: Nurse's educational functions, Parents and relatives´ educational needs, Educational strategies, Results and consequences of education. Parents to high-risk children are not always adequately taught pre-departure, they demonstrate of stress over not being able to cope with emergency situations. Parents was felt safer when they received information and knowledge. The educational program of CPR for children that exist were perceived as insufficient as it does not cover the need for parental education to high-risk children. Conclusion: A standardized preventive parental training in CPR for children is lacking, with the individual needs that high-risk children may have. Responsibilities are unclear on who takes the decision on parental education and who will be offered, the nurses have a key role in parental education but have a weak mandate to carry out teaching when support from recommendation was lacking.Keywords: Cardiopulmonary-resuscitation, high-risk child, nurse-experience, parents-education.

The diploma thesis focuses on the issue of human error in risk activities. The issue is examined at a company InfoTel, spol. s r. o. offering professional services in the construction and operation of telecommunication networks. The work is divided into three parts. The first part is aimed at obtaining theoretical background serving as a starting point for the subsequent analytical part. The analytical part concentrates on the characteristics of the selected company, organizational structure and work positions. It includes the analysis of corporate processes, contemplating the human factor, its activity and associated risks. The final part of the thesis is devoted to proposals for measures, focusing on prevention of human error in risk activities, leading to improvement of economic result in the selected company.