Made available in DSpace on 2014-06-11T19:33:24Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-07-14Bitstream added on 2014-06-13T20:05:12Z : No. of bitstreams: 1 polettini_j_dr_botfm.pdf: 1866040 bytes, checksum: 9dbb3227206b84a722980f020a71aeba (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / A rotura prematura de membranas pré-termo (RPM-PT) é uma importante intercorrência obstétrica e a infecção da cavidade amniótica advinda do trato genital inferior é um dos principais fatores associados à sua fisiopatologia. As membranas corioamnióticas são barreiras mecânicas contra a ascensão de micro-organismos e possuem papel fundamental no sistema imune, pois são importantes fontes de mediadores inflamatórios como as citocinas e também de antimicrobianos naturais, como as defensinas. Em resposta à infecção, ocorrem recrutamento e ativação de leucócitos para as membranas fetais, o que caracteriza a corioamnionite histológica, que ativa a cascata inflamatória na interface materno-fetal e contribui com os mecanismos de enfraquecimento e rotura das membranas. Além acometer os tecidos gestacionais de gestações complicadas por RPM-PT, a corioamnionite histológica é um fator de risco para resultados adversos maternos e morbidades neonatais. 1) Quantificar a expressão de β defensinas (HBD1, 3 e 4) por membranas corioamnióticas de gestações complicadas por prematuridade associada à corioamnionite histológica; 2) Quantificar a expressão de RNA mensageiro (RNAm) e proteína de IL-18 em membranas corioamnióticas de mulheres com RPM-PT e correlacionar a expressão com a presença de corioamnionite histológica; 3) Avaliar os resultados neonatais adversos de gestações prétermo complicadas por corioamnionite histológica. Foram incluídas no estudo, gestantes com parto pré-termo e diagnóstico histológico de corioamnionite. Para o estudo da expressão de β defensinas, 40 fragmentos de membranas corioamnióticas, com diagnóstico histológico de corioamnionite, provenientes de gestações complicadas por rotura prematura de membranas pré-termo (RPM-PT) ou trabalho de parto prematuro com bolsa íntegra (TPP), que apresentaram parto... / The preterm premature rupture of membranes (PPROM) is an important obstetric issue, and infection in the amniotic cavity from the lower genital tract is one of the main factors associated with its physiology. Chorioamniotic membranes are mechanical barriers against the microorganism’s ascension, and they play a fundamental role in the immune system, since they are important sources of inflammatory mediators, such as cytokines, and of natural antimicrobials, like as defensins. In response to infection, leukocytes are recruited and activated in fetal membranes, which characterizes histological chorioamnionitis. This condition activates the inflammatory cascade on the maternal-fetal interface and contributes to weakening mechanisms and membrane rupture. In addition to affecting the gestational tissues of pregnancies complicated by PPROM, histological chorioamnionitis is a risk factor for adverse maternal outcomes and neonatal morbidities. 1) To quantify the expression of β defensins (HBD1, 3 and 4) by chorioamniotic membranes of pregnancies complicated by prematurity associated with histological chorioamnionitis; 2) To quantify the expression of IL-18 mRNA and protein in the chorioamniotic membranes of pregnant women with PPROM and correlate expression with histological chorioamnionitis; 3) To evaluate adverse neonatal outcomes in preterm pregnancies complicated by histological chorioamnionitis. Pregnant women with preterm delivery and histological diagnosis of chorioamnionitis were included in the study. In order to study the expression of β defensins, 40 fragments of chorioamniotic membranes with histological diagnosis of chorioamnionitis from pregnancies complicated by PPROM or preterm labor with intact membranes (PTL), and with preterm labor as a gestational outcome, comprised the study group. As a control group, 40 chorioamniotic membranes without chorioamnionitis and paired... (Complete abstract click electronic access below)

Orientador: Márcia Guimarães da Silva / Banca: Luciane Alarcão Dias-Melicio / Banca: Cilmery Suemi Kurokawa / Banca: Rosiane Mattar / Banca: Rodrigo Paupério Soares de Camargo / Resumo: A rotura prematura de membranas pré-termo (RPM-PT) é uma importante intercorrência obstétrica e a infecção da cavidade amniótica advinda do trato genital inferior é um dos principais fatores associados à sua fisiopatologia. As membranas corioamnióticas são barreiras mecânicas contra a ascensão de micro-organismos e possuem papel fundamental no sistema imune, pois são importantes fontes de mediadores inflamatórios como as citocinas e também de antimicrobianos naturais, como as defensinas. Em resposta à infecção, ocorrem recrutamento e ativação de leucócitos para as membranas fetais, o que caracteriza a corioamnionite histológica, que ativa a cascata inflamatória na interface materno-fetal e contribui com os mecanismos de enfraquecimento e rotura das membranas. Além acometer os tecidos gestacionais de gestações complicadas por RPM-PT, a corioamnionite histológica é um fator de risco para resultados adversos maternos e morbidades neonatais. 1) Quantificar a expressão de β defensinas (HBD1, 3 e 4) por membranas corioamnióticas de gestações complicadas por prematuridade associada à corioamnionite histológica; 2) Quantificar a expressão de RNA mensageiro (RNAm) e proteína de IL-18 em membranas corioamnióticas de mulheres com RPM-PT e correlacionar a expressão com a presença de corioamnionite histológica; 3) Avaliar os resultados neonatais adversos de gestações prétermo complicadas por corioamnionite histológica. Foram incluídas no estudo, gestantes com parto pré-termo e diagnóstico histológico de corioamnionite. Para o estudo da expressão de β defensinas, 40 fragmentos de membranas corioamnióticas, com diagnóstico histológico de corioamnionite, provenientes de gestações complicadas por rotura prematura de membranas pré-termo (RPM-PT) ou trabalho de parto prematuro com bolsa íntegra (TPP), que apresentaram parto... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The preterm premature rupture of membranes (PPROM) is an important obstetric issue, and infection in the amniotic cavity from the lower genital tract is one of the main factors associated with its physiology. Chorioamniotic membranes are mechanical barriers against the microorganism's ascension, and they play a fundamental role in the immune system, since they are important sources of inflammatory mediators, such as cytokines, and of natural antimicrobials, like as defensins. In response to infection, leukocytes are recruited and activated in fetal membranes, which characterizes histological chorioamnionitis. This condition activates the inflammatory cascade on the maternal-fetal interface and contributes to weakening mechanisms and membrane rupture. In addition to affecting the gestational tissues of pregnancies complicated by PPROM, histological chorioamnionitis is a risk factor for adverse maternal outcomes and neonatal morbidities. 1) To quantify the expression of β defensins (HBD1, 3 and 4) by chorioamniotic membranes of pregnancies complicated by prematurity associated with histological chorioamnionitis; 2) To quantify the expression of IL-18 mRNA and protein in the chorioamniotic membranes of pregnant women with PPROM and correlate expression with histological chorioamnionitis; 3) To evaluate adverse neonatal outcomes in preterm pregnancies complicated by histological chorioamnionitis. Pregnant women with preterm delivery and histological diagnosis of chorioamnionitis were included in the study. In order to study the expression of β defensins, 40 fragments of chorioamniotic membranes with histological diagnosis of chorioamnionitis from pregnancies complicated by PPROM or preterm labor with intact membranes (PTL), and with preterm labor as a gestational outcome, comprised the study group. As a control group, 40 chorioamniotic membranes without chorioamnionitis and paired... (Complete abstract click electronic access below) / Doutor

Thesis (M.N.)--University of Alberta, 2009. / A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment of the requirements for the degree of Master of Nursing, Faculty of Nursing. Title from pdf file main screen (viewed on September 4, 2009). Includes bibliographical references.

Made available in DSpace on 2014-06-11T19:35:39Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-09-16Bitstream added on 2014-06-13T19:25:00Z : No. of bitstreams: 1 pinheiro_rs_dr_botfm.pdf: 1389225 bytes, checksum: 2c108fdebc884ce68badd9bc7e56c349 (MD5) / No Brasil, a maioria dos partos é hospitalar, mas nas zonas rurais, ribeirinhas e de difícil acesso ocorrem partos domiciliares e são as parteiras tradicionais que prestam assistência à mulher e ao recém-nascido.Descrever quem são as parteiras tradicionais das regiões norte e nordeste do Brasil, quais suas percepções sobre asfixia e reanimação neonatal e quais são suas práticas no parto domiciliar. Estudo observacional de corte transversal, com entrevista das parteiras antes do treinamento em reanimação neonatal, durante o ano de 2012. Foram incluídas 155 parteiras não indígenas, do Amazonas, Amapá, Sergipe, Paraíba e Pernambuco. Variáveis independentes: idade, escolaridade e experiência prévia. Desfecho: respostas às questões da entrevista. Para os dados categorizados foram calculadas as frequências absolutas e relativas. As parteiras são mulheres maduras, com baixa escolaridade e pouca experiência. Identificam o risco de asfixia no neonato que não chora ou chora pouco. Não ligam o cordão umbilical até a saída da placenta, enxugam o recém-nascido com panos secos e aquecidos, aspiram boca e narina do bebê com a própria boca e para estimular a respiração sacodem e sopram sua boca e nariz. Se o neonato não chora ou não melhora pedem ajuda e encaminham para o hospital. A maioria das parteiras acompanha o bebê no transporte. As parteiras sabem pouco sobre reanimação neonatal, atuam de forma precária, mas realizam os passos iniciais da reanimação. Capacitações periódicas para parteiras podem melhorar o atendimento ao nascimento no domicílio / In Brazil, most births occur in hospitals, but in rural, riparian and remote areas, home births happen frequently, and traditional birth attendants (TBAs or midwives) assist the women and their newborns. Describe the traditional TBAs in North and Northeast regions of Brazil, including their perceptions on neonatal asphyxia and resuscitation and their practices regarding home birth. An observational cross-sectional study which interviewed TBAs before a neonatal resuscitation training conducted during the year 2012. We included 155 non-indigenous midwives from Amazonas, Amapá, Sergipe, Pernambuco and Paraíba. Independent variables: age, education and prior experience. Endpoint: answers given during the interview. For categorical data we calculated absolute and relative frequencies. These midwives are middle-aged women with low education and little experience. The risk of birth asphyxia is detected when the newborn does not cry or shows a weak cry after delivery. These TBAs do not cut the umbilical cord until the delivery of the placenta. Common practices are wiping the baby with dry and warm cloths, aspiring the newborn mouth and nostril with their own mouth and stimulating breathing shaking the baby and blowing air into the newborn’s nose and mouth. When the infant does not cry or does not show any improvement, these women ask for help to send the baby to a hospital. Most midwives accompany the newborn baby to the hospital. Brazilian midwives know little about neonatal resuscitation, their work happen in a precarious way, but they do perform the initial steps of resuscitation. Regular training for midwives might improve their service during home births

Orientador: Ligia Maria Suppo de Souza Rugolo / Banca: Maria Fernanda Branco de Almeida / Banca: Ruth Guinsburg / Banca: Sergio Tadeu Martins Marba / Banca: Maria Regina Bentlin / Resumo: No Brasil, a maioria dos partos é hospitalar, mas nas zonas rurais, ribeirinhas e de difícil acesso ocorrem partos domiciliares e são as parteiras tradicionais que prestam assistência à mulher e ao recém-nascido.Descrever quem são as parteiras tradicionais das regiões norte e nordeste do Brasil, quais suas percepções sobre asfixia e reanimação neonatal e quais são suas práticas no parto domiciliar. Estudo observacional de corte transversal, com entrevista das parteiras antes do treinamento em reanimação neonatal, durante o ano de 2012. Foram incluídas 155 parteiras não indígenas, do Amazonas, Amapá, Sergipe, Paraíba e Pernambuco. Variáveis independentes: idade, escolaridade e experiência prévia. Desfecho: respostas às questões da entrevista. Para os dados categorizados foram calculadas as frequências absolutas e relativas. As parteiras são mulheres maduras, com baixa escolaridade e pouca experiência. Identificam o risco de asfixia no neonato que não chora ou chora pouco. Não ligam o cordão umbilical até a saída da placenta, enxugam o recém-nascido com panos secos e aquecidos, aspiram boca e narina do bebê com a própria boca e para estimular a respiração sacodem e sopram sua boca e nariz. Se o neonato não chora ou não melhora pedem ajuda e encaminham para o hospital. A maioria das parteiras acompanha o bebê no transporte. As parteiras sabem pouco sobre reanimação neonatal, atuam de forma precária, mas realizam os passos iniciais da reanimação. Capacitações periódicas para parteiras podem melhorar o atendimento ao nascimento no domicílio / Abstract: In Brazil, most births occur in hospitals, but in rural, riparian and remote areas, home births happen frequently, and traditional birth attendants (TBAs or midwives) assist the women and their newborns. Describe the traditional TBAs in North and Northeast regions of Brazil, including their perceptions on neonatal asphyxia and resuscitation and their practices regarding home birth. An observational cross-sectional study which interviewed TBAs before a neonatal resuscitation training conducted during the year 2012. We included 155 non-indigenous midwives from Amazonas, Amapá, Sergipe, Pernambuco and Paraíba. Independent variables: age, education and prior experience. Endpoint: answers given during the interview. For categorical data we calculated absolute and relative frequencies. These midwives are middle-aged women with low education and little experience. The risk of birth asphyxia is detected when the newborn does not cry or shows a weak cry after delivery. These TBAs do not cut the umbilical cord until the delivery of the placenta. Common practices are wiping the baby with dry and warm cloths, aspiring the newborn mouth and nostril with their own mouth and stimulating breathing shaking the baby and blowing air into the newborn's nose and mouth. When the infant does not cry or does not show any improvement, these women ask for help to send the baby to a hospital. Most midwives accompany the newborn baby to the hospital. Brazilian midwives know little about neonatal resuscitation, their work happen in a precarious way, but they do perform the initial steps of resuscitation. Regular training for midwives might improve their service during home births / Doutor

This dissertation investigates the pressing issue of education in cardiac arrest during pregnancy, an emergency of life-threatening significance that necessitates a coordinated response from maternal and neonatal healthcare teams. The study encompasses three primary chapters, each addressing a crucial facet of this intricate scenario. In the chapter titled "Cardiac Arrest in Pregnancy: A Scoping Review on Knowledge and Confidence in a Maternal & Neonatal Response," an extensive examination of existing literature illuminated substantial knowledge gaps in the resuscitation of pregnant individuals, a concern that has persisted for over a decade. These gaps encompass critical domains, including a dearth of high-quality research with a heavy reliance on limited experimental designs, small sample sizes that curtail the generalizability of findings, a lack of comprehensive comparisons among various teaching strategies for enhancing knowledge and confidence, an emphasis on short-term outcomes without adequate longitudinal assessments of knowledge retention and clinical impact, a need for tailored education programs catering to diverse healthcare professionals, and a scarcity of research on collaborative learning experiences, particularly concerning neonatology teams. These identified gaps offer valuable opportunities for future research aimed at fortifying the evidence base, refining educational approaches, and ultimately enhancing the management of cardiac arrest during pregnancy and neonatal resuscitation. This manuscript underscores the pressing need to expand educational initiatives beyond obstetrical units and to foster interdisciplinary collaboration among healthcare teams. The chapter titled, "Escaping PowerPoint: Enhancing Knowledge, Satisfaction, and Self-Confidence in Cardiac Arrest in Pregnancy," introduces an innovative teaching strategy known as the Virtual Escape Room (VER). The randomized controlled study compares the effectiveness of this virtual gamified approach with a traditional online PowerPoint method in improving knowledge acquisition, learner satisfaction, and self-confidence. The findings demonstrate the statistically significant superiority of the VER in enhancing these critical outcomes, highlighting the potential of immersive learning experiences in healthcare education. Notably, the data reveal a substantial increase in mean scores from the knowledge pre-test (M = 59.58, SD = 16.30) to the knowledge post-test (M = 68.24, SD = 17.42), t(64) = 5.635, p < .001 . The assessment tools employed included a knowledge quiz and The National League for Nursing (NLN) Student Satisfaction and Self-Confidence instruments. The chapter titled "Puzzling Out the Correlates of Learner Engagement and Exploring Motivational States within a Virtual Escape Room," delves into the intricate aspects of learner engagement within the gamified learning environment of the VER. It uncovers the relationships between engagement, learner satisfaction, and specific engagement components such as enjoyment, creative thinking, and dominance. This manuscript underscores the multifaceted nature of engagement and highlights the imperative need for further research to achieve a more profound comprehension of its role in shaping learning outcomes. The study employed the Gameful Experience Scale (GAMEX) and the Telic/Paratelic State Measure (TPSI) instrument. Notably, statistically significant positive correlations were observed, including r = 0.346 (p = 0.005) between the Enjoyment Score and knowledge post-test, r = 0.305 (p = 0.013) between the Creative Thinking Score and knowledge post-test, and r = 0.255 (p = 0.04) between the Dominance Score and knowledge post-test. Additionally, a significant interaction effect emerged between the T/PSI score (pre vs. post) and the educational intervention (VER vs. control group). T/PSI score increased from 35.83 (SD = 8.67) before the intervention to 38.86 (SD = 9.91) after the intervention, indicating a substantial change. In contrast, there was no statistically significant difference in T/PSI scores before and after the traditional PowerPoint intervention for the control group, where the mean scores changed from 35.89 (SD = 7.02) to 35.57 (SD = 7.94). These findings strongly suggest that the VER condition contributes to a paratelic state among participants when compared to the control condition. This dissertation underscores the paramount importance of effective education in managing cardiac arrest during pregnancy, given the persistent knowledge gaps among resuscitation teams. The introduction of the VER as an innovative educational strategy represents a significant advancement in addressing these deficits. Furthermore, the exploration of engagement and motivational states within the gamified learning environment offers valuable insights into the complexities of learner engagement, paving the way for more effective educational strategies in healthcare settings. Ultimately, these findings have the potential to empower healthcare teams, potentially reducing maternal mortality rates and improving neonatal outcomes in the face of this critical emergency.