Made available in DSpace on 2018-08-01T22:56:57Z (GMT). No. of bitstreams: 1 tese_9032_Marcela Oliveira.pdf: 4832855 bytes, checksum: c9681ff9fe4377860d609359a066ac5f (MD5) Previous issue date: 2017-02-20 / A associação da avaliação de parâmetros fisiológicos, bioquímicos e hematológicos neonatais, a partir do momento do nascimento, juntamente com a avaliação macroscópica e morfológica da placenta são particularmente importantes para identificar precocemente e tratar prontamente os potros que sofreram com a disfunção placentária. Neste sentido, o presente estudo teve como objetivo avaliar a morfologia placentária e parâmetros fisiológicos, hematológicos e bioquímicos em potros recém-nascidos da raça Campolina. Foram acompanhados oito partos, e utilizados oito potros neonatos da raça Campolina de ambos os sexos, recémnascidos com até 48 horas de vida. Imediatamente após expulsão, as placentas foram avaliadas macroscopicamente. Em seguida, coletou-se e encaminhou-se para o exame histopatológico as amostras referentes ao corno gravídico, corno não gravídico, corpo do útero e estrela cervical. Os neonatos foram avaliados quanto ao estado geral, peso corporal, frequências cardíaca e respiratória, temperatura retal, coloração das mucosas oral e conjuntival, comportamento, tempo de preenchimento capilar da mucosa oral e reflexos neonatais de acordo com a escala de APGAR. Os parâmetros clínicos foram avaliados em três momentos: imediatamente após ao nascimento, 24 e 48 horas após. As amostras de sangue foram obtidas por venopunção da jugular, imediatamente, 12, 24 e 36 horas após o nascimento para mensuração da glicemia, determinação do lactato, em glicosímetro portátil, análises hematológicas com analisador hematológico e bioquímica sérica por espectofotometria. Os resultados obtidos foram analisados no programa GraphPad Instat versão 3.06. Para as variáveis paramétricas utilizou-se o teste te de student. Para as variáveis não paramétricas usou-se o teste de Kruskal-Wallis. Não houve alteração significativa na FC, FR e T(°C) nos momentos estudados. Os neonatos não apresentaram alterações comportamentais durante o período experimental. Uma placenta apresentou aparência rugosa e mais espessada na região do corno gravídico com presença de secreção mucóide marrom. Ao exame histopatológico observou-se presença de áreas de necrose focal na placenta com alterações visíveis. As demais placentas não apresentaram alterações macroscópicas e/ou histolopatológicas. Na avaliação bioquímica, as concentrações das proteínas séricas totais demonstraram aumento significativo (p<0,05) entre 0 e 36 horas de vida. Na avaliação da albumina sérica observou-se redução significativa (p<0,01) entre 0 e 24 horas de vida. Em relação a atividade da enzima fosfatase alcalina observou-se redução significativa (p<0,01) entre 0 e 36 horas de vida. As concentrações séricas da enzima aspartato aminotransferase foram significativamente (p<0,001) mais elevadas nos momentos 12, 24 e 36 horas em relação ao nascimento. As concentrações da ureia sérica foram significativamente menores nos momentos 24 (*p<0,05) e 36 horas (**p<0,01) em relação ao nascimento. Na avaliação da creatinina sérica, houve redução significativa da concentração nos momentos 12, 24 e 36 horas em relação ao nascimento (***p<0,001), observou-se diminuição significativa entre os momentos 12 e 36 horas de vida (*p<0,05). Na avaliação da glicemia foi observado aumento significativo (p<0,001) a partir das 12 horas, estabilizando dentro das 24 e 36 horas de vida. Com relação as concentrações séricas do lactato, notou-se diminuição significativa do nascimento para 24 horas. Os outros parâmetros avaliados não apresentaram diferenças significativas (p<0,05). Conclui-se que os potros estudados não apresentaram alterações nos parâmetros clínicos indicativos de comprometimento sistêmico no intervalo de 0 a 48 horas pósnascimento. As alterações observadas nos parâmetros fisiológicos e bioquímicos podem refletir apenas a adaptação neuroendócrina neonatal ao meio externo. As placentas foram eliminadas no tempo adequado. Apenas uma placenta apresentou áreas de com perda de função. O neonato referente a essa amostra placentária demonstrou resposta satisfatória frente as alterações observadas.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Por ser de interesse à saÃde pÃblica, o teste do reflexo vermelho, tambÃm conhecido como teste do olhinho, vem se firmando como estratÃgia de prevenÃÃo da cegueira infantil com participaÃÃo multiprofissional, particularmente do enfermeiro. Tecnologias aplicadas a esse contexto devem ser estimuladas com vistas a ser utilizadas como ferramentas integrantes de atuaÃÃo profissional com a finalidade de facilitar e melhorar a qualidade da assistÃncia. Objetivou-se avaliar um gradiente de cores direcionado para a avaliaÃÃo do teste do reflexo vermelho em recÃm-nascidos quanto à validade de conteÃdo e de aparÃncia, verificar a confiabilidade interobservadores na aplicaÃÃo da tecnologia desenvolvida e investigar a opiniÃo dos enfermeiros quanto à aplicabilidade do instrumento apÃs a experiÃncia da sua utilizaÃÃo. Trata-se de uma pesquisa metodolÃgica, quantitativa, cuja coleta de dados ocorreu de maio a agosto de 2010 em duas etapas metodolÃgicas. Na primeira, a tecnologia proposta foi analisada por trÃs juÃzes especialistas, os quais, por meio de um questionÃrio de avaliaÃÃo na forma de escala Likert, opinaram sobre aspectos relacionados aos objetivos, estrutura e apresentaÃÃo, aparÃncia e relevÃncia. Para emitir suas opiniÃes, os especialistas responderam aos itens avaliativos entre cinco nÃveis de respostas: Totalmente adequado; Adequado com pequenas ressalvas; Parcialmente adequado, Inadequado; NÃo se aplica. ApÃs a anÃlise dos especialistas e inclusÃo das sugestÃes à tecnologia avaliada, na segunda etapa buscou-se averiguar a confiabilidade entre os examinadores na aplicaÃÃo do gradiente de cores para avaliaÃÃo do teste do reflexo por enfermeiros. Para isso, uma amostra constituÃda por sessenta recÃm-nascidos internados na unidade neonatal de baixo risco de uma maternidade pÃblica de referÃncia, em Fortaleza, foi avaliada por dois examinadores (a pesquisadora e um enfermeiro) de modo simultÃneo e independente. Os dados receberam tratamento descritivo e com o auxÃlio do PASW versÃo 18.0 calculou-se a confiabilidade do gradiente de cores por meio do coeficiente de correlaÃÃo intraclasse. A tecnologia recebeu ajustes atà sua aprovaÃÃo, em duas etapas de avaliaÃÃo. Sobre as avaliaÃÃes de conteÃdo e aparÃncia, foi consenso entre os especialistas o julgamento quanto ao excesso de quantidade de gradientes, a sugestÃo de retirar as nuances de cores muito prÃximas, como tambÃm de rever aquelas com o centro esbranquiÃado, pois poderiam ser confundidas com reflexo alterado. Sugeriu-se o acrÃscimo de uma nova nuance de cor e a complementaÃÃo no tÃtulo da tecnologia da expressÃo gradiente de cores do teste do olhinho. A maioria das respostas dos juÃzes ficou entre totalmente adequado e adequado com pequenas ressalvas. Os juÃzes especialistas consideraram a tecnologia desenvolvida um recurso didÃtico complementar à prÃtica do teste do reflexo vermelho e Ãtil no treinamento de profissionais para a realizaÃÃo do teste. Observaram-se bons Ãndices de confiabilidade (0,928 e 0,894) estimados pelo coeficiente de correlaÃÃo intraclasse. Diante das consideraÃÃes, o gradiente de cores mostrou-se uma tecnologia vÃlida para ser adotada como um recurso facilitador para a aprendizagem sobre o teste e aplicÃvel à prÃtica do cuidado em saÃde ocular como ferramenta complementar. Espera-se que a aplicaÃÃo do conhecimento adquirido nesse estudo proporcione impacto positivo na divulgaÃÃo e realizaÃÃo do teste do reflexo vermelho. / Due to its relevance for public health, the red reflex test, also known as little eye test, has become an established strategy to prevent infant blindness within a multi professional team work, involving the nurse in particular. Applied technologies in this context constitute a useful tool for the professional and their use has to be stimulated aiming the assistance improvement. The main goal of this work is to assess a color gradient projected to measure the red reflex test in newborns regarding contents and appearance validation, accordance among different observers and nurseâs opinion on the tool applicability after its use. This is a methodological research, quantitative, whose data acquisition happened between May and August 2010 in two methodological steps. Firstly, the proposed instrument was analyzed by three judges. These specialists gave their opinions by means of an evaluation questionnaire in the Likert scale format. The survey covered subjects like goals, structure and presentation, appearance and relevance. In order to quantify their opinions, the answers were restricted to five levels: Absolutely adequate; Adequate with little observations; Partially adequate; Inadequate; It does not apply. In the second step, after collecting the answers and taking into account suggestions from the specialists, we checked the test accordance among different nurses in the color gradient application top the red reflex test. This was made by using a sixty newborns sample. These neonates were in the low risk neonatal sector of a reference public maternity hospital in Fortaleza. Each newborn was examined by two examiners (the researcher and a nurse) simultaneously and independently. The data were treated within PASW 18.0 software. The gradient reliability was calculated by means of the intraclass correlation coefficient. Adjustments were applied to the instrument until its approval. Regarding the contents and appearance evaluation, the judges agreed about the excessive number of gradient colors and they suggested the elimination of several similar patterns. They also recommended to reconsider those patterns with a white center since they could be confused with an altered reflex. Additional suggestions from the specialists pointed to the inclusion of a new color in the instrument as well as a new title to the gradient: color gradient for the little eye test. Most of the answers from the judges were between Absolutely adequate and Adequate with little observations. The specialists considered the developed technology as a complimentary to the practice of the red reflex test, as well as a useful tool for training of professionals to do this test. Good reliability indices were observed (0,928 e 0,894). Such numbers were estimated by the intraclass correlation coefficient. After these considerations, the color gradient was shown to be a valid technology suitable to be considered as a pedagogical tool and as a useful additional instrument on the visual health care. It is expected that the knowledge constructed in this work results in a positive impact on the red reflex test propagation and application.

INTRODUCTION: during the first days of life the mother is the main source of nutrients for the newborn. However, breastfeeding difficulties are common and may generate excessive neonatal weight loss. OBJECTIVE: estimate the magnitude and association between breastfeeding problems and excessive neonatal weight loss beyond the physiological norm in the neonatology ward in a social security hospital in Lima, Peru. METHODS: we conducted a cross sectional analysis of the recorded neonatal weight in a routine evaluation (between 24 and 72 hours of life) and compared it against birth weight. Excessive weight loss was defined as a difference greater than or equal to 7 %. Breastfeeding problems (defined as problems with breastfeeding initiation, mouth position, breastfeeding duration, breastfeeding frequency, too much clothing, nipple pain and C form) were investigated using a survey and visual verification. The association between excessive weight loss and breastfeeding problems, adjusted by other factors, was quantified using a multiple generalized linear model. RESULTS: excessive weight loss was present in 18.8% (74/393) of the newborns. Improper positioning of the mouth on the nipple was present in 53.7% (211/393) of neonates while nipple pain was reported by 44.0% (173/393) of mothers. In the adjusted analysis, nipple pain [PR = 1.50 (95% CI: 1.02 to 2.22)] and improper positioning of the mouth [PR = 1.67 (95% CI: 1.09- 2.57)] were associated with an increased occurrence of excessive neonatal weight loss. CONCLUSIONS: breastfeeding problems are common. These difficulties are significantly associated with an increased occurrence of excessive neonatal weight loss. Improvements in breastfeeding practices, for example through educational programs, may decrease the occurrence of excessive neonatal weight loss. / Introducción: durante los primeros días de vida la madre es la principal fuente de alimento para el recién nacido. Sin embargo, es común que la madre presente trastornos de la lactancia y se genere una pérdida de peso neonatal superior a la fisiológica. Objetivo: estimar la magnitud y asociación entre los trastornos de la lactancia y la pérdida de peso neonatal superior a la fisiológica en neonatos en el área de alojamiento conjunto de un servicio de neonatología en un hospital de la Seguridad Social en Lima, Perú. Métodos: estudio de tipo transversal analítico. Registramos el peso neonatal en una evaluación de rutina (entre las 24 y 72 horas de vida) y lo comparamos con el peso al nacer. La pérdida de peso excesiva fue definida como una diferencia igual o mayor al 7%. Mediante una encuesta y una verificación visual investigamos los trastornos de la lactancia materna (retraso en el inicio, posición de la boca, duración de la lactancia, frecuencia de la lactancia, sobreabrigo, dolor en el pezón y forma de la C). La asociación entre la pérdida de peso excesiva y los trastornos, ajustada por otros factores, fue cuantificada mediante un modelo lineal generalizado múltiple. Resultados: en 18,8% (74/393) de los neonatos, la pérdida de peso excesiva fue igual o superior al 7% del peso al nacer. La posición inadecuada de la boca en el pezón estuvo presente en el 53,7% (211/393) de los neonatos, mientras que el dolor en el pezón fue reportado en el 44,0% (173/393) de las madres. En el análisis ajustado, el dolor en el pezón [RP = 1,50 (IC95%:1,02-2,22)] y la posición inadecuada de la boca [RP = 1,67 (IC95%:1,09- 2,57)] estuvieron asociados a una mayor pérdida de peso excesiva. Conclusiones: los trastornos de la lactancia son comunes. Estos factores están directa y positivamente asociados a una mayor pérdida de peso excesiva. La introducción de mejoras en las prácticas de lactancia, por ejemplo mediante programas educativos, podría disminuir la pérdida de peso neonatal excesiva.

The evidence that breastfeeding reduces mortality and short and long-term morbidity among premature and small babies is well established but breastfeeding rates in neonatal units in the UK remain low. The aim of this study was to develop and evaluate an eLearning module that addresses the learning needs of neonatal clinicians to support breastfeeding on Neonatal Intensive Care Units (NICU). The module focussed on the knowledge areas of anatomy and physiology of lactation and expression. Mixed methodology was used to evaluate the eLearning module and inform its iterative development. This consisted of quasi-experimental pre-test/post-test studies using The Neonatal Unit Clinical Assessment Tool (NUCAT), an on-line objective knowledge test with self ratings of confidence to test the effects of the eLearning module on knowledge, confidence in knowledge and confidence in practice. Semi-structured interviews explored neonatal clinicians’ experiences of undertaking the eLearning module and their perceptions of the feasibility and applicability of the eLearning module as well as their opinions and experiences of breastfeeding support and training. In total 101 neonatal clinicians, including neonatal nurses, doctors, Advanced Neonatal Nurse Practitioners (ANNPs), nursery nurses and students undertook the initial NUCAT assessment of knowledge and confidence. A further 90 clinicians went on to complete the training and post intervention assessment, 60 repeated the post intervention assessment at 6-8 weeks. Baseline knowledge was greater in the area of breast milk expression than in the anatomy and physiology of lactation. Neonatal nurses were found to have greater baseline knowledge of breast milk expression than doctors or nursery nurses. Doctors/ANNPs were more knowledgeable about the anatomy and physiology of lactation. Following the training intervention doctors/ANNPs showed the greatest improvement in knowledge scores and nursery nurses the least. Knowledge and confidence was significantly increased immediately following the intervention and at 6-8 weeks in all groups. The semi-structured interviews conducted after the study showed the feasibility and applicability of the eLearning module for clinicians in NICU. On-line assessment and training provide a potentially effective multidisciplinary training method to improve breastfeeding knowledge and confidence. Nursery nurse may have differing learning needs and require further support and training.

Orientador: Denise Yvonne Janovitz / Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-07-19T08:37:06Z (GMT). No. of bitstreams: 1 Lopes_MariaHelenaBaenadeMoraes_D.pdf: 5379572 bytes, checksum: 734681d70bf98d07092327b30ec3ccbb (MD5) Previous issue date: 1994 / Doutorado / Doutor em Ciências

Submitted by Pedro Barros (pedro.silvabarros@ufpe.br) on 2018-10-10T21:29:03Z No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) DISSERTAÇÃO Diogo D’Paula Cunha Brasileiro de Melo.pdf: 1579917 bytes, checksum: 040bfcfef05a74b289a66a1e3fbc0e4e (MD5) / Approved for entry into archive by Alice Araujo (alice.caraujo@ufpe.br) on 2018-11-22T18:14:58Z (GMT) No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) DISSERTAÇÃO Diogo D’Paula Cunha Brasileiro de Melo.pdf: 1579917 bytes, checksum: 040bfcfef05a74b289a66a1e3fbc0e4e (MD5) / Made available in DSpace on 2018-11-22T18:14:58Z (GMT). No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) DISSERTAÇÃO Diogo D’Paula Cunha Brasileiro de Melo.pdf: 1579917 bytes, checksum: 040bfcfef05a74b289a66a1e3fbc0e4e (MD5) Previous issue date: 2014-02-28 / Este estudo avaliou o efeito da inibição seletiva da recaptação de serotonina durante o período neonatal sobre parâmetros morfofuncionais do sistema serotoninérgico nos núcleos da rafe e nas áreas encefálicas de projeção serotoninérgica. Ratos Wistar foram divididos nos grupos Fluoxetina (Flx, Fluoxetina 10mg/Kg p.c.) e Salina (S, Nacl 0,9%, 1mL/Kg p.c.) segundo a manipulação farmacológica diária do 1º ao 21º dia de vida. Durante este período foram avaliadas a quantidade de neurônios de 5-HT e a dosagem desse neurotransmissor e do seu metabólito. Os encéfalos foram processados com técnicas de imunohistoquímica contra 5-HT e submetidos à dosagem de serotonina e ácido 5-hidroxindolacético (5HIAA) no 28º dia de vida. Não houve diferença no número de neurônios 5-HT-IR nos núcleos da rafe entre os grupos. O núcleo DR de animais do grupo Flx (1153,5 ± 125,4; p< 0.01) apresentou maior concentração de 5-HT quando comparados ao grupo S (819,9 ± 148,3; p< 0.01). O grupo FLx apresentou também, maior concentração de 5-HIAA no CLi/RLi (Flx= 17569 ± 316,3 vs S= 931,1 ± 98,6; p< 0.01), DR (Flx= 3303,4 ± 156,7 vs S= 1748,3 ± 148,3; p< 0.001) e MnR (Flx= 2454,1 ± 236 vs S= 1561 ± 158,9; p< 0.01). Nas áreas de projeção o grupo Flx apresentou menor concentração de 5-HT no hipotálamo (Flx= 295,9 ± 40,3 vs S= 478,5 ± 71,8; p< 0.01) e maior concentração de 5-HIAA na amígdala (Flx= 1636,3 ± 103,7 vs S= 890,8 ± 41,6, p< 0.05) e no hipotálamo (Flx= 2031,3 ± 316,1 vs S= 1262,4 ± 237,7; p< 005) quando comparado ao grupo S. Os resultados deste estudo evidenciam que a exposição crônica a fluoxetina durante o período de lactação promove ajustes de componentes do sistema serotoninérgico, sugerindo que tal exposição precoce pode causar alterações no padrão saúde-doença. / This study evaluated the effect of selective inhibition of serotonin reuptake during the neonatal period on morphofunctional parameters of the serotonergic system in the raphe nuclei and the brain areas of serotonergic projections. Wistar rats were divided in Fluoxetin (Flx, Fluoxetina 10mg/Kg p.c.) and Saline groups (S, Nacl 0,9%, 1mL/Kg p.c.) in accordance to daily farmacological manipulation during 1º to 21º days of life. During this period the number of neurons in 5ht and dosage of dopamine were evaluated and its metabolite. The brains were processed by immunohistochemistry technique against 5-HT and submitted to serotonina and 5-hydroxyindoleacetic acid (5HIAA) dosage at 28º days of life. There was no difference in the number of neurons in the raphe nuclei between groups. The DR nucleus of animals Flx (1153.5 ± 125.4, p <0.01) showed higher concentration of 5-HT compared to S group (819.9 ± 148.3, p <0:01). FLX group also showed, higher concentration of 5-HIAA in the CLi/RLi (Flx= 17569 ± 316,3 vs S= 931,1 ± 98,6; p< 0.01), DR (Flx= 3303,4 ± 156,7 vs S= 1748,3 ± 148,3; p< 0.001) e MnR (Flx= 2454,1 ± 236 vs S= 1561 ± 158,9; p< 0.01). In the projection areas FLX group showed lower concentration of 5-HT in the hypothalamus (Flx= 295,9 ± 40,3 vs S= 478,5 ± 71,8; p< 0.01) and higherconcentration of 5-HIAA in the amigdala(Flx= 1636,3 ± 103,7 vs S= 890,8 ± 41,6, p< 0.05) and hypothalamus (Flx= 2031,3 ± 316,1 vs S= 1262,4 ± 237,7; p< 005) compared to S group. The results of this study show that chronic exposure to fluoxetine during lactation period promotes adjustments in the serotoninergic system componente, suggesting that this early exposure may cause changes in the patterns of health and disease.

MSc (Med), Population-Based Field Epidemiology, Faculty of Health Sciences, University of the Witwatersrand / Background Improvements in the health status of children have resulted in a substantive reduction in under-five mortality by two-thirds between 1960 and 1990. However this reduction is favourable for children after the first year in life, with little decrease in the neonatal period. Every year, about 4 million children die within the first 28 days of life, the first week (0-7 days) posing the highest risk. The Fourth Millennium Development Goal emphasises a reduction in child mortality by two-thirds by 2015, however this goal cannot be met because neonatal deaths continue to increase. It is therefore important to make available information on risk factors and the main causes of death that exist at a community level so that appropriate health policies are devised to reduce the mortality burden faced by neonates. Objective The study investigates the relationship between household and maternal socio-demographic characteristics with neonatal mortality in the Kassena-Nankana District from 2001 to 2005. The specific objectives were; (1) To calculate the neonatal mortality rates in the Kassena-Nankana District from 2001 to 2005, (2) To determine the causes of neonatal death for years 2003 to 2005, and (3) To assess the association of household characteristics and maternal socio-demographic characteristics with neonatal deaths in the Kassena-Nankana District from 2001 to 2005. Methods Data from Navrongo DSS in Ghana was used for the analysis. A total of 19 340 live births born from 15 224 households were registered between 1st January 2001 to 31st December 2005. Of these 551 died before the 28th day after birth. The outcome, neonatal mortality was coded as a binary variable and took values 1 if the child died and 0 if the child survived. Neonatal mortality rates were calculated by dividing the total number of deaths for a particular year by the total number of live births for that year, multiplied by 1000. Cause of death data were collected using neonatal specific verbal autopsies. Cause-specific neonatal mortality rates were calculated using physician coding to a list of cause of deaths based on the 9th International Classification for Diseases (ICD). Using the mother‟s household characteristics and assets ownership, a wealth index was constructed as proposed by Filmer and Pritchett to estimate socio-economic status. Chi-square (x2) test at 5% significant level was also done to compare the maternal socio-demographic and neonatal characteristics by neonatal mortality. Logistic regression models were fitted to assess the association between (i) neonatal mortality and socio-economic status (SES) and (ii) between neonatal mortality and maternal as well as neonatal risk factors, while adjusting for potential confounders. Health equity was measured using the concentration index (CI) and the poorest-poor ratio (PPR). Results: The overall neonatal mortality rate for the whole study period was 29 per 1000 live births. Most deaths (65.9%) occurred outside the health facility and most occurred in the early neonatal period (0-7 days). Infectious diseases (n=98, 33.2%), birth injuries (n=28, 9.5%) and prematurity (n=29, 9.8%) were the main causes of neonatal deaths. In the multivariate analysis maternal characteristic that showed an association with mortality were place of residence, SES, birth order and the type of birth outcome. Such that children who died were more often from the rural areas compared to in the urban areas (AOR=2.24 95% CI=1.16-4.34 P=0.016). Children who died were more often from a multiple birth outcome compared to those from a single birth outcome (AOR=0.20 95% CI=0.14-0.28 P<0.0001). SES was found to be protective against neonatal mortality (AOR=0.70 95% CI= 0.51–0.96 P=0.026). By birth order, children who died were more often from the 1st birth order compared to children of birth orders; 2-3 (AOR=0.60 95% CI=0.44-0.81 P=0.001), 4-5 (AOR=0.56 95% CI=0.38-0.84 P=0.005) and 6+ birth order (AOR=0.50 95% CI=0.31-0.8 P=0.005). A measure of health equity gave a C.I of -0.07 and PPR of 1.29 implying that neonatal mortality was high amongst the poorest households than the better ones. Conclusion The study showed that neonatal mortality was high in the rural areas and in the poorest households. Efforts to alleviate the burden of neonatal mortality at a community level should focus on improving living standards for poorest in the community. Also educating women on child health care and making them aware of high risk pregnancy age-groups will help minimize risky pregnancies which in turn will reduce neonatal deaths.

Articular cartilage is an avascular, aneural tissue that covers the ends of diarthroidal joints. Once damaged by disease or injury, cartilage lacks the ability to self-repair. Generating tissue engineered cartilage is an exciting field that may provide a possible solution to this problem. The purpose of this study is to determine the efficacy of a through-thickness perfusion bioreactor to generate scaffoldree tissue engineered cartilage. The results of the study show that allowing long-term static culture to cell constructs before perfusion increases the efficacy of the bioreactor. Immediate perfusion of cell constructs in the bioreactor is shown to decrease the efficacy to produce scaffoldree constructs with desirable biomechanical and biochemical properties. The results of the study also show possible options in future works that could increase the efficacy of the bioreactor.

Bakgrund Tidigt föräldraskap redan på neonatalvårdsavdelning med aktivt deltagande och hud-mothudkontakt påvisar positiva effekter hos det prematura barnet och främjar en sund anknytning. För att främja deltagande behövs ett respektfullt samarbete mellan sjuksköterska och familj enligt familjecentrerad vård (FCC). Syfte Syftet var att sammanställa tidigare forskning för att beskriva föräldrars upplevelser av delaktighet i omvårdnaden av prematura barn. Metod Litteraturstudien inkluderade 15 studier med kvalitativ design och utformades som en strukturerad litteraturstudie. Datainsamlingen utfördes i databaserna PubMed och CINAHL. Inför inklusion lästes artiklarna av båda författarna och kvalitetsgranskades enligt Fribergs granskningsfrågor för kvalitativa studier. Dataanalys utfördes strukturerat utifrån Fribergs fyra steg för att analysera och sammanställa resultatet. Resultat Två kategorier med respektive sex underkategorier identifierades där främjande respektive hindrande faktorer av föräldrars upplevelser av delaktighet speglas. Att vara närvarande i omvårdnaden samt hud-mot-hudkontakt med barnet fick föräldrarna att känna sig delaktiga. Stöd och vägledning från vårdpersonal hade stor betydelse och upplevdes underlättade för föräldrarna. Det fanns känslomässiga hinder för anknytningen samt svårigheter med miljöns utformning. Slutsats Delaktigheten i omvårdnaden var viktigt för att gynna amningen, stärka föräldrarollen samt öka självförtroendet och kan uppnås med implementering av FFC. / Background Early parenthood already in the neonatal care unit with active participation and skin-to-skin contact demonstrates positive effects in the premature baby and promotes a healthy bonding. To promote participation, a respectful collaboration between nurse and family is needed according to family-centered care (FCC). Aim The aim of this study was to compile previous research to describe parents' experiences of participation in the care of premature infants. Method The literature review included 15 studies with qualitative design and was designed as a structured literature review. The data collection was performed in the databases PubMed and CINAHL. Prior to inclusion, the articles were read by both authors and quality reviewed according to Friberg's review questions for qualitative studies. Data analysis was performed in a structured way based on Friberg's four steps to analyze and set the results. Results Two categories with six subcategories were identified where promoting and barrier factors of parents' experiences of participation are reflected. Being present in the care and skin-to-skin contact with the child made the parents feel involved. Support and guidance from healthcare professionals was of great importance and was perceived as easier for the parents. There were emotional barriers to the connection as well as difficulties with the design of the environment. Conclusions Participation in nursing was important to promote breastfeeding, strengthen the parental role and increase self-confidence and can be achieved with the implementation of FCC.

The neonate is still at risk of acquiring Group B Streptococcus (GBS) infection upon delivery even with the implementation of early onset GBS neonatal disease preventative protocols. GBS was reported as the most prevalent organism causing neonatal morbidity and mortality in the USA and Australia in the 1990s. GBS is also known to cause disease in children, women, the immunocompromised adult and the elderly, but it is the preterm neonates who are at greatest risk of GBS neonatal disease. The aim of this study was to determine the prevalence of lower genital tract (LGT) colonisation with GBS in Brisbane women of child bearing age. We also aimed: (i) to compare the GBS LGT prevalence rate of Indigenous and non Indigenous women; (ii) to determine whether previously reported risk factors for LGT colonisation with GBS were also risk factors associated with GBS colonisation of women in this study; (iii) to further develop and optimise a rapid PCR assay that could detect maternal LGT GBS colonisation; and (iv) to serotype the GBS strains that were isolated from pregnant and non pregnant women who participated in this study. This study recruited 374 women of childbearing age attending public medical providers and found an overall GBS prevalence of 98/374 (26.2%) for these Brisbane women, a rate higher than previously reported in Australia. When the GBS prevalence for pregnant women (25.6%) was compared to non pregnant women (27.2%) they were similar. We also compared the GBS LGT colonisation rate of women attending different medical providers. The GBS LGT prevalence rate for pregnant women attending the Mater was 36/118 (30.5%), whilst those women attending the Redlands Hospital antenatal clinic had a LGT GBS prevalence rate of only 7/53 (13.2%). By comparison, the LGT GBS prevalence rate for non pregnant women attending Biala Sexual Health clinic was 21/69 (30.4%) and 34/127 (26.8%) of women attending the Brisbane Family Planning Queensland were also GBS positive. The seven women recruited from Inala community centre tested negative for GBS LGT colonisation. The LGT GBS prevalence of Australian Aboriginal women was 5/22 (22.7%), a rate which was not significantly different from non-Aboriginal women 78/288 (27.1%). Established early onset GBS neonatal disease preventative policies have been recently revised. The CDC now recommends that all pregnant women are screened for LGT GBS colonisation during late gestation, and that any GBS isolates be tested for resistance to antibiotics if the GBS positive women have an allergy to penicillin. Queensland's Department of Health recommend that Queensland medical agencies implement a non screening based preventative protocol, where clinicians monitor: women prior to labour for reported risk factors associated with maternal GBS colonisation: women in labour for 'obstetric risk factors'. A number of risk factors have previously been reported in association with GBS LGT colonisation. However, in this current study we found that only one risk factor was significantly associated with current GBS: previous reported LGT GBS colonisation was significantly associated with maternal LGT GBS colonisation reported in this study. Women who previously tested positive for GBS were significantly more likely to be GBS positive in subsequent tests (OR 4.7; 95%CI, 1.8-12.5) compared to women with no previous history of GBS colonisation. An assessment of adverse pregnancy outcomes, preterm deliveries, and GBS colonisation data was made. It was established that 30 women had previously given birth to one or more preterm neonates and of these 30 women, nine (30%) of them tested positive for GBS in this current study. Of the 71 women who had given birth to neonates and who had suffered an adverse pregnancy outcome 25.3% also tested positive for GBS in this current study. GBS was identified in up to 30% of all mothers who had delivered their neonate preterm, 27.4% of women who had previously suffered miscarriages and 16.7% of women who had previously had stillbirths. In this study we found that Australian Aboriginal women also had a greater risk of delivering neonates who suffered from an adverse pregnancy outcome in comparison to all other women. Twenty one of the 22 Aboriginal women had previously been pregnant at least once, and nine (42.9%) of these women had at least one prior adverse pregnancy outcome while seven (33.3%) of these women had previously delivered at least one neonate preterm. Of the 21 Aboriginal women who had a previous pregnancy more than half the total number of Aboriginal women (11/21) had either delivered one or more neonates preterm or had suffered from one or more adverse pregnancy outcomes. When the incidence of adverse pregnancy outcomes was compared for Aboriginal and all other women the results were surprising. Overall, this study found 216 women including Aboriginal women had previously been pregnant and of these women 71 (32.8%) of them suffered an adverse pregnancy outcome. By comparison, only 62 of 195 (31.8%) non Aboriginal women but nine out of 21 (41.9%) Australian Aboriginal women suffered from a previous adverse pregnancy outcome. The clinical LGT GBS isolates found in this study of Brisbane women were typed and all nine GBS serotypes plus non typeable GBS serotypes were detected. Seventy women tested GBS culture positive and vaginal and/or perianal samples obtained from these women were evaluated. GBS serotype III was the serotype most frequently isolated from this total population, from 47.4% of pregnant women and 51.7% of non pregnant women. From some women only a single GBS serotype was isolated: in these women we found that GBS serotype III (50%) was the predominant isolate, followed by GBS serotype Ia isolated from 16.7% women. In addition 4.2% of women were colonised with GBS serotypes; Ib, II and V, whilst GBS serotypes IV and VII were isolated from 2.1% women. Non typeable GBS strains confirmed by latex agglutination tests accounted for 11.9% of all strains isolated from these Brisbane women. This study identified multiple serovars in 15 clinical samples and found that 22 (31.4%) women were colonised with mixed GBS serotypes in samples collected from both vaginal and perianal regions. In five women the combination of serotypes III/Ia were identified and in other women combinations of serotypes III/II, III/IV, III/V, III/VIII, Ia/IV and Ib/NT were also detected. In two instances three serotype combinations were detected in samples from one woman and these included serotypes III/Ib/II and III/Ia/Ib. Isolates were also typed for women who were colonised in both vaginal and perianal regions and it was found that only 10 participants had identical isolates in both regions. GBS serotype III was the predominant serotype detected in women tested in this study and this is the serotype that has previously been associated with invasive infections in neonates. GBS neonatal disease is a world wide economic, health and social burden affecting different ethnic groups and is preventable. Currently no vaccine technology is available for the prevention of GBS neonatal disease and the most effective EOGND preventative protocol would be to test for maternal GBS colonisation during labour, or screen women for GBS at &gt36 weeks' gestation and administer intrapartum antibiotic prophylaxis (IAP) to all women who tested positive for GBS. In this current study we utilised a rapid bsp PCR assay to detect LGT GBS colonisation in women of child bearing age. The PCR assay identified 62.5% of all vaginal and perianal positive culture GBS samples. The specificity of the PCR assay was 89% while the positive and negative predictive values were 56.8% and 91.1% respectively. This PCR assay using the current parameters is not an effective GBS detection assay but could be further optimised in the near future. This PCR assay could be an effective test in the future with the development of an alternative DNA extraction method to InstaGene (BioRad). However, this PCR assay if used in conjunction with the current culture method is able to detect a further 8.9% of women colonised with asymptomatic GBS. Brisbane women aged between 26 to 35 years who are pregnant and who are attending public health care agencies are at greatest risk of being colonised with GBS. No disparity was identified when ethnicity or social standing were assessed. The overall results of this study demonstrate that the LGT GBS prevalence rate in Brisbane women is 26.2% but this rate was higher at 30.5% for women attending a Brisbane sexual health clinic and for pregnant women attending the Mater Mothers' antenatal clinic. GBS serovar III has been identified as the dominant serovar in our population group and this strain has been reported as the major cause of GBS disease in neonates and infants aged to three months. Disparity (11.1%) was reported when the incidence of adverse pregnancy outcomes amongst Aboriginal women was compared to non Aboriginal women. From the outcomes of this study it has been suggested that Queensland adopt a screening based GBS preventative protocol. It has also been suggested that an Australian wide GBS prevention strategy may further reduce the incidence of neonatal disease.