Tanto no campo da Saúde Pública, como no da Demografia, não tem sido dada a devida ênfase ao estudo da mortalidade intra-uterina. Vários são os fatores que têm contribuído para essa aparente falta de interesse por este aspecto da reprodução humana, relacionados com as próprias características do fenômeno, com as disposições legais em matéria de registro e com o alto custo das investigações apropriadas para sua mensuração. Entretanto, minuciosos estudos médicos têm estimado que a mortalidade intra-uterina total - todas as perdas, reconhecidas ou não - pode alcançar o nível biológico de 630 mortes fetais por mil gestações. Estudos populacionais de tipo prospectivo - acompanhamento de gestações - têm conseguido estimar o nível de mortalidade intra-uterina reconhecível - perdas reconhecidas após a primeira amenorréia - em 260 mortes fetais por mil gestações e, os de tipo retrospectivo - história de gestações - indicam que o nível de mortalidade intra-uterina aparente - perdas reconhecidas após a segunda amenorréia - é da ordem de 160 mortes fetais por mil gestações. O objetivo geral deste trabalho consistiu em caracterizar a mortalidade intra-uterina experimentada por um grupo de mulheres grávidas residentes no Município de São Paulo, compreendendo os objetivos específicos de estimar o seu nível e estabelecer as suas relações com alguns fatores biológicos e sócio-demográficos. Mediante a análise das informaç5es derivadas de uma pesquisa de acompanhamento de uma amostra de gestantes residentes em oito sub-distritos e dois distritos periféricos - Brasilândia, Santo Amaro, Jabaquara, Nossa Senhora do Ó, Tucuruvi, Butantã, Santa Cecília, Sé, Itaquera e Jaraguá - do Município de São Paulo, realizada no período compreendido entre novembro de 1987 e fevereiro de 1989, importantes conclusões puderam ser extraídas. No que diz respeito à estimação do nível de mortalidade intra-uterina, com as informac6es da história retrospectiva das gestações, o valor encontrado da taxa de 164 mortes fetais por mil gestações é perfeitamente condizente com a magnitude da taxa de mortalidade fetal aparente, que a literatura destaca ser possível estimar em estudos desse tipo. As informações prospectivas, computadas de forma direta, revelam um nível de mortalidade fetal de 58 mortes fetais por mil gestações, cujo baixo valor pode ser atribuído à natureza direta da medida - que não corrige o viés de seleção - devendo-se levar também em consideração a captação domiciliar das gestantes, sem qualquer limitação da duração da gravidez. Não obstante, quando as informações prospectivas são computadas em forma de Tábuas de mortalidade intra-uterina, consegue-se corrigir o viés de seleção, obtendo-se uma taxa de mortalidade fetal reconhecível de 236 por mil gestações, cifra absolutamente compatível com as estimativas efetuadas pelos estudos mais precisos de mortalidade fetal. Quanto ao estabelecimento de relações da mortalidade intrauterina com os fatores sócio-demográficos: cor, nível de instrução e estado conjugal, as informações analisadas parecem revelar indícios da existência de: - Um diferencial de mortalidade intra-uterina por cor; o maior nível corresponde às mulheres pretas, o intermediário às pardas e o menor às brancas. - Uma correlação negativa entre a mortalidade fetal e o nível de instrução; à medida que este aumenta, diminui o risco de experimentar perdas fetais. - Um diferencial de, mortalidade fetal por estado conjugal; as solteiras têm maior risco que as casadas e as unidas consensualmente, mais que as casadas com vínculo institucional. No que diz respeito ao estabelecimento de relações da mortalidade intra-uterina com os fatores biológicos: idade da mãe, ordem da gestação e história genética anterior, a análise permitiu constatar que: - Existe uma correlação positiva entre a mortalidade fetal e a idade da mãe, à medida que esta avança, aquela se eleva. - Existe também uma correlação positiva entre a mortalidade fetal e a ordem da gestação, quanto maior a ordem, maior o número de perdas. O fator que maior peso tem na determinação do risco de mortalidade fetal, é a história genésica anterior. / Both in the field of Public Health and in the Demography one, the proper emphasis has not been given to the study of intrauterine mortality. Many are the factors that have contributed to this apparent lack of interest to this aspect of human reproduction, they are related to the phenomenon own characteristics, to the legal dispositions in terms of register and to the high costs of appropriate investigations for its measurement. Nevertheless, precise medical studies have estimated that total intrauterine mortality - all the losses, recognized or not - may reach the biological level of 630 fetal deaths per thousand pregnancies. Populational studies of prospective type - follow up pregnancies - have been able to estimate the recognizable intrauterine mortality level recognized lesses after the first amenorrhea - in 260 fetal deaths per thousand pregnancies and of retrospective type - pregnancies history - indicated that the apparent intrauterine mortality level - recognized lesses after the second amenorrhea - is about 160 fetal deaths per thousand pregnancies. The main objective of this work consisted in characterize the intrauterine mortality experimented by a group of pregnant women resident in the Municipality of São Paulo, comprising the specific objectives of to estimate its level and stablish its relations with some biological and social demographic factors. It was possible to make important conclusions through the analysis of the informations derived from a follow up survey of a sample of pregnant women, living in eight subdistricts and two peripheric districts - Brasilândia, Santo Amaro, Jabaquara, Nossa Senhora do Ó, Tucuruvi, Butantã, Santa Cecília, Sé, Itaquera e Jaraguá from São Paulo Municipality, held in the period between November 1987 and February 1989. Concerning the estimation of intrauterine mortality level with the informations from the pregnancies retrospective history, the value found is about 164 fetal deaths per thousand pregnancies, that it\'s perfectly suitable with the magnitude of the apparent fetal mortality rate, which a literature emphasizes to be possible to estimate in this kind of studies. The prospective informations, computed in a direct way, reveal a level of intrauterine mortality of 58 fetal deaths per thousand pregnancies, which low value can be attributed to its direct nature that doesn\'t correct the bias of selection -, being also important to consider the pregnants domiciliary captation, without any kind of restriction in relation to the duration of the pregnancy. However, when the prospective informations are computed in the form of intrauterine mortality life tables, it\'s possible to correct the bias of selecting, achieving a rate of fetal mortality of 236 per thousand pregnancies, a result totally compatible to the estimations made by the most precise studies of fetal mortality. Regarding the stablishment of relationships of intrauterine mortality with the sociodemographic factor: race, instruction level and conjugal situation, the analised informations scem to reveal indications of the existence of: - A differential of intrauterine mortality by race, being the level represented by non white women higher than the represented by white ones. - A negative correlation between fetal mortality and instruction level, when this improves the risk of fetal losses decreases. - A differential of intrauterine mortality by conjugal situation, single women and those consesually joined more than women married with institutional links. In relation to the establishment of relationships of the intrauterine mortality with the biological factors: mother\'s age, pregnancy order and previous reproductive history, the analysis allowed to comprove that: - There is a positive correlation between fetal mortality and mother\'s age, in proportion that this increases, that improves. - There is also a positive correlation between intrauterine mortality and the pregnancy order, highest the order highest the number of lesses. - The most important factor in the determination of the risk of intrauterine mortality is the previous reproductive history.

nÃo hà / O Sistema de InformaÃÃo sobre Mortalidade se apropria de informaÃÃes para avaliar o estado de saÃde das coletividades humanas e orientar medidas de saÃde equÃnimes. Para tanto, este Sistema, nÃo distante dos demais, deve dispor de informaÃÃes de qualidade, que podem ser avaliadas a partir de dois parÃmetros: a validade e a confiabilidade de seu indicador de saÃde. VÃrios estudos foram realizados no Brasil nos Ãltimos 20 anos demonstrando fragilidades nos processos avaliativos deste Sistema. O presente estudo tem como objetivo principal avaliar a qualidade do registro de informaÃÃo sobre mortalidade para as vÃtimas de causas externas do ano de 2010 no municÃpio de Fortaleza-CearÃ. Trata-se de um estudo transversal, no qual foram selecionadas todas as DeclaraÃÃes de Ãbito advindas da PerÃcia Forense do Cearà cujas causas bÃsicas foram identificadas no capÃtulo XX, da ClassificaÃÃo Internacional de DoenÃas (CID-10), 2010, de residentes de Fortaleza. Foram comparados o quantitativo de Ãbitos registrado no Sistema de Mortalidade oficial e o quantitativo de Ãbitos identificados na PerÃcia Forense do CearÃ. TambÃm foram comparadas as codificaÃÃes de causas bÃsicas do Ãbito; os fatores de risco ligados à principal causa de morte (AgressÃes) e foi analisada a qualidade dos registros de todos os campos juntamente à AnÃlise Espacial de local de ocorrÃncia dos Ãbitos por AgressÃes. Os dados foram tabulados no programa EpiInfo for Windows, versÃo 3.5.4 e analisados no STATA 12. Foi utilizado o Kappa como medida de concordÃncia. Os Resultados indicaram subnotificaÃÃo de 67 Ãbitos, gerando amostra final 2.109 Ãbitos; a concordÃncia entre as codificaÃÃes pesquisa-oficial apresentou Kappa de 0.069; foi considerado, no modelo final de regressÃo logÃstica, como risco Ãs AgressÃes pertencer Ãs categorias: adolescente (OR ajustada: 18,44; I.C.95% entre 9,57- 35,54); masculino (OR ajustada: 2,83; I.C.95% entre 1,92- 4,19); nÃo ter vÃnculo conjugal (OR ajustada: 1,58; I.C.95% entre 1,14- 2,18) e bairro de ocorrÃncia de renda menor (OR ajustada: 5,13; I.C.95% entre 2,13- 12,36); a maioria das variÃveis apresentou completitude baixa e o indicador Kernel indicou âÃreas quentesâ na distribuiÃÃo dos bairros de ocorrÃncias de AgressÃes em Fortaleza-CE. / The Health Information System on Mortality appropriates information to assess the health status of human populations and direct measures for equitable health care. Therefore, this system, not far from the others, must have quality information, which can be evaluated by two parameters: the validity and reliability of its health indicators. Several studies were conducted in Brazil over the last 20 years demonstrating weaknesses in the evaluation processes of this system. The present study aims to evaluate the quality of the record of mortality information for victims of external causes in 2010 in Fortaleza, CearÃ. This is a cross-sectional study, which included all death certificates, from residents of Fortaleza, reported by the stateâs Medical Examiner office where the underlying causes were identified in Chapter XX, the International Classification of Diseases (ICD- 10). The number of deaths recorded in the state Mortality Database and the amount of deaths identified in medical examinerâs office records were compared. We also compared encodings for basic causes of death; the risk factors linked to the leading cause of death (aggression), and we analyzed the quality of the records and performed a Spatial Analysis of deaths from aggression/assault. Data were tabulated in EpiInfo for Windows, version 3.5.4 and analyzed in STATA 12. Kappa was used as a measure of agreement. Results indicated underreporting of 67 deaths, with 2,109 deaths resulting final sample. The correlation between the medical examiner and the population registry had a kappa of 0.069. The following risk factor were identified in a logistic regression for death by aggression/assault: being a teenager (adjusted OR: 18.44, 95% CI from 9.57 to 35.54 ), being male ( adjusted OR : 2.83 , CI 95 % from 1.92 to 4.19 ), not having marital bond ( adjusted OR : 1.58 , 95% CI from 1.14 to 2.18 ) and occurrence of low- income neighborhood ( adjusted OR : 5.13 95% CI from 2.13 to 12.36 ); most variables showed low completeness and the indicator Kernel identified "hot areas" in the distribution of the occurrences of assaults among neighborhoods in Fortaleza.

Tanto no campo da Saúde Pública, como no da Demografia, não tem sido dada a devida ênfase ao estudo da mortalidade intra-uterina. Vários são os fatores que têm contribuído para essa aparente falta de interesse por este aspecto da reprodução humana, relacionados com as próprias características do fenômeno, com as disposições legais em matéria de registro e com o alto custo das investigações apropriadas para sua mensuração. Entretanto, minuciosos estudos médicos têm estimado que a mortalidade intra-uterina total - todas as perdas, reconhecidas ou não - pode alcançar o nível biológico de 630 mortes fetais por mil gestações. Estudos populacionais de tipo prospectivo - acompanhamento de gestações - têm conseguido estimar o nível de mortalidade intra-uterina reconhecível - perdas reconhecidas após a primeira amenorréia - em 260 mortes fetais por mil gestações e, os de tipo retrospectivo - história de gestações - indicam que o nível de mortalidade intra-uterina aparente - perdas reconhecidas após a segunda amenorréia - é da ordem de 160 mortes fetais por mil gestações. O objetivo geral deste trabalho consistiu em caracterizar a mortalidade intra-uterina experimentada por um grupo de mulheres grávidas residentes no Município de São Paulo, compreendendo os objetivos específicos de estimar o seu nível e estabelecer as suas relações com alguns fatores biológicos e sócio-demográficos. Mediante a análise das informaç5es derivadas de uma pesquisa de acompanhamento de uma amostra de gestantes residentes em oito sub-distritos e dois distritos periféricos - Brasilândia, Santo Amaro, Jabaquara, Nossa Senhora do Ó, Tucuruvi, Butantã, Santa Cecília, Sé, Itaquera e Jaraguá - do Município de São Paulo, realizada no período compreendido entre novembro de 1987 e fevereiro de 1989, importantes conclusões puderam ser extraídas. No que diz respeito à estimação do nível de mortalidade intra-uterina, com as informac6es da história retrospectiva das gestações, o valor encontrado da taxa de 164 mortes fetais por mil gestações é perfeitamente condizente com a magnitude da taxa de mortalidade fetal aparente, que a literatura destaca ser possível estimar em estudos desse tipo. As informações prospectivas, computadas de forma direta, revelam um nível de mortalidade fetal de 58 mortes fetais por mil gestações, cujo baixo valor pode ser atribuído à natureza direta da medida - que não corrige o viés de seleção - devendo-se levar também em consideração a captação domiciliar das gestantes, sem qualquer limitação da duração da gravidez. Não obstante, quando as informações prospectivas são computadas em forma de Tábuas de mortalidade intra-uterina, consegue-se corrigir o viés de seleção, obtendo-se uma taxa de mortalidade fetal reconhecível de 236 por mil gestações, cifra absolutamente compatível com as estimativas efetuadas pelos estudos mais precisos de mortalidade fetal. Quanto ao estabelecimento de relações da mortalidade intrauterina com os fatores sócio-demográficos: cor, nível de instrução e estado conjugal, as informações analisadas parecem revelar indícios da existência de: - Um diferencial de mortalidade intra-uterina por cor; o maior nível corresponde às mulheres pretas, o intermediário às pardas e o menor às brancas. - Uma correlação negativa entre a mortalidade fetal e o nível de instrução; à medida que este aumenta, diminui o risco de experimentar perdas fetais. - Um diferencial de, mortalidade fetal por estado conjugal; as solteiras têm maior risco que as casadas e as unidas consensualmente, mais que as casadas com vínculo institucional. No que diz respeito ao estabelecimento de relações da mortalidade intra-uterina com os fatores biológicos: idade da mãe, ordem da gestação e história genética anterior, a análise permitiu constatar que: - Existe uma correlação positiva entre a mortalidade fetal e a idade da mãe, à medida que esta avança, aquela se eleva. - Existe também uma correlação positiva entre a mortalidade fetal e a ordem da gestação, quanto maior a ordem, maior o número de perdas. O fator que maior peso tem na determinação do risco de mortalidade fetal, é a história genésica anterior. / Both in the field of Public Health and in the Demography one, the proper emphasis has not been given to the study of intrauterine mortality. Many are the factors that have contributed to this apparent lack of interest to this aspect of human reproduction, they are related to the phenomenon own characteristics, to the legal dispositions in terms of register and to the high costs of appropriate investigations for its measurement. Nevertheless, precise medical studies have estimated that total intrauterine mortality - all the losses, recognized or not - may reach the biological level of 630 fetal deaths per thousand pregnancies. Populational studies of prospective type - follow up pregnancies - have been able to estimate the recognizable intrauterine mortality level recognized lesses after the first amenorrhea - in 260 fetal deaths per thousand pregnancies and of retrospective type - pregnancies history - indicated that the apparent intrauterine mortality level - recognized lesses after the second amenorrhea - is about 160 fetal deaths per thousand pregnancies. The main objective of this work consisted in characterize the intrauterine mortality experimented by a group of pregnant women resident in the Municipality of São Paulo, comprising the specific objectives of to estimate its level and stablish its relations with some biological and social demographic factors. It was possible to make important conclusions through the analysis of the informations derived from a follow up survey of a sample of pregnant women, living in eight subdistricts and two peripheric districts - Brasilândia, Santo Amaro, Jabaquara, Nossa Senhora do Ó, Tucuruvi, Butantã, Santa Cecília, Sé, Itaquera e Jaraguá from São Paulo Municipality, held in the period between November 1987 and February 1989. Concerning the estimation of intrauterine mortality level with the informations from the pregnancies retrospective history, the value found is about 164 fetal deaths per thousand pregnancies, that it\'s perfectly suitable with the magnitude of the apparent fetal mortality rate, which a literature emphasizes to be possible to estimate in this kind of studies. The prospective informations, computed in a direct way, reveal a level of intrauterine mortality of 58 fetal deaths per thousand pregnancies, which low value can be attributed to its direct nature that doesn\'t correct the bias of selection -, being also important to consider the pregnants domiciliary captation, without any kind of restriction in relation to the duration of the pregnancy. However, when the prospective informations are computed in the form of intrauterine mortality life tables, it\'s possible to correct the bias of selecting, achieving a rate of fetal mortality of 236 per thousand pregnancies, a result totally compatible to the estimations made by the most precise studies of fetal mortality. Regarding the stablishment of relationships of intrauterine mortality with the sociodemographic factor: race, instruction level and conjugal situation, the analised informations scem to reveal indications of the existence of: - A differential of intrauterine mortality by race, being the level represented by non white women higher than the represented by white ones. - A negative correlation between fetal mortality and instruction level, when this improves the risk of fetal losses decreases. - A differential of intrauterine mortality by conjugal situation, single women and those consesually joined more than women married with institutional links. In relation to the establishment of relationships of the intrauterine mortality with the biological factors: mother\'s age, pregnancy order and previous reproductive history, the analysis allowed to comprove that: - There is a positive correlation between fetal mortality and mother\'s age, in proportion that this increases, that improves. - There is also a positive correlation between intrauterine mortality and the pregnancy order, highest the order highest the number of lesses. - The most important factor in the determination of the risk of intrauterine mortality is the previous reproductive history.

xiv, 228 leaves : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (M.D. 1972) from the Dept. of Child Health, University of Adelaide

Very little research has studied the common challenge in adulthood of coming to terms with the eventual mortality of one’s parents as they age and experience illness. The present work begins to explore this emotional adjustment and draws on Attachment Theory and the study of how people cope with their own mortality (Terror Management Theory) to develop hypotheses about potential responses of the adult child. Feelings of vigilance and thoughts or behavioural predispositions toward proximity-seeking, disengagement, and control are considered. I hypothesized specific differences in these responses based on the tendency for those high in attachment anxiety to ‘hyperactivate’ attachment-related thoughts and for those high in attachment avoidance to ‘deactivate’ these thoughts. Study 1 used self-report measures in a community sample of adults for whom a parent had experienced a significant illness. Participants high in either attachment anxiety or attachment avoidance were less likely to seek proximity to ill parents than those low on these attachment dimensions. Those high in attachment avoidance were also less likely to experience feelings of vigilance for signs of illness in their parents and to want to assert control over their parents’ health care relative to those who were low in attachment avoidance. These findings were consistent with hypotheses based on attachment avoidance but opposite to hypotheses based on attachment anxiety. Variation in responses to an ill parent was also found depending on the age of participants and their parents, the severity of the parents’ illness and their health care behaviours, and whether the adult served as a caregiver for their parent. Using a word-completion task, Study 2 assessed whether themes of proximity, disengagement, and control were cognitively accessible following imaginal induction of a parents’ mortality, participants’ own mortality, or an experience of physical pain. The pattern of results did not support hypothesized differences in reaction times based on dimensions of attachment anxiety and avoidance. Predicted differences based on which induction was completed were also not found. Self-report responses replicated findings from Study 1 such that participants high in attachment anxiety were less likely to want to seek proximity to ill parents when thinking about their mortality than those low in attachment anxiety, and that those high in attachment avoidance were less likely to feel vigilant and to want to seek proximity or to assert control over their parent relative to those who scored low on measures of attachment avoidance. The manner in which adults respond to being confronted with their parents’ mortality has significant implications for their own emotional well-being as well as for the emotional and physical well-being of their parent. Given that adults often become caregivers for their ill and aging parents, this area of study warrants further research.

Since the 'discovery' of the high abundance of viruses in aquatic environments, it has been generally assumed that viruses in lakes are similar to those in oceans. I directly compared these two systems using a large, robust data set. Viral abundance was significantly different among the surveyed environments. The relationship between viral and bacterial abundance indicated a fundamental difference between lakes and oceans, and suggested that viruses infecting phytoplankton may be more important in lakes. Molecular techniques (PCR & DGGE) were used to document spatial and temporal variations in the richness of viruses that infect eukaryotic phytoplankton (Phycodnaviridae) in lakes at the Experimental Lakes Area (ELA). Phycodnavirus richness was highest in the eutrophic lake, and during the spring/early summer in all the lakes. Viral richness was closely associated with phytoplankton abundance and composition. As a result, richness was influenced by trophic status, while patterns of richness were affected by regional climatic conditions. Phylogenetic analysis of environmental Phycodnavirus DNA polymerase (pol) sequences indicated that freshwater Phycodnaviruses are genetically different from cultured isolates and marine environmental sequences. A genetic distance analysis indicated that polsequences > 7 % different infected different host species. Therefore, the 20 different freshwater sequences likely infected nine different hosts. Multivariate statistics identified seven possible phytoplankton hosts, including chlorophytes, chrysophytes, diatoms and dinoflagellates. Finally, the modified dilution experiment was evaluated as an approach for estimating viral-mediated phytoplankton mortality in two lakes at the ELA. Experiments resulted in non-significant apparent growth rate regressions. While a model analysis, indicated that the method was sensitive to poorly constrained parameters such as burst size and length of the lytic cycle, making it unsuitable for estimating mortality rates in these lakes. These studies indicate that Phycodnaviridae are a genetically rich and dynamic component of lakes. Their richness is influenced by both the chemical and physical components of their environment. Although the presence of these viruses indicates that they are a source of phytoplankton mortality, the magnitude of their impact on structuring phytoplankton communities awaits methodological advances. Nonetheless, these findings support the view that viruses infecting phytoplankton are ecologically important componentsof lake ecosystems.

No description available.

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 6 uppsatser.

published_or_final_version / abstract / toc / Paediatrics and Adolescent Medicine / Doctoral / Doctor of Philosophy

Dissertation submitted in fulfillment of the requirements for the Degree in Masters of Technology: Nursing, Durban University of Technology, 2011. / Background South Africa is burdened by consistently high maternal and perinatal mortality rates. In a move to alleviate this burden the South African National Department of Health (DoH) instructed the adoption of the Basic Antenatal Care (BANC) approach in all antenatal care (ANC) facilities. Whereas many facilities have begun the implementation of the BANC approach, in the eThekwini district, not all of the facilities have been successful in doing so. The study was conducted in those eThekwini Municipality Primary Health Care (PHC) facilities that have been successful in order to identify the factors influencing their success in implementing BANC. Methods The facilities that had been successful in implementing BANC were identified, followed by a review of the past records of the patients who had completed their ANC and had given birth. This was done in order to establish whether the facilities that were said to be implementing BANC, were in fact, following BANC guidelines. The factors that influenced successful implementation of BANC were identified based on information obtained from the midwives who were working in the ANC facilities that were successfully implementing BANC. The sample size was comprised of 18 PHC facilities that were successfully implementing BANC from which a total of 59 midwives were used as the study participants. Results Several positive factors that influenced successful implementation of BANC were identified. These factors included; availability and accessibility of BANC services: Policies, Guidelines and Protocol; various means of communication; a comprehensive iii package of services and the integration of services; training and in-service education; human and material resources and the support and supervision offered to the midwives by the PHC supervisors. Other factors included BANC programme supervisors’ understanding of the programme and the levels of experience of midwives involved in implementation of BANC. There were, however, certain challenges and negative factors that were identified and these included: shortage of staff; lack of cooperation from referral hospitals; lack of in-service training; problems in transporting specimens to the laboratory; lack of material resources; lack of management support and the unavailability of BANC guidelines.