O Câncer colorretal (CCR) é um problema de saúde importante devido a sua incidência e mortalidade elevadas. O rastreamento e o diagnóstico precoce são a principal estratégia para diminuir a mortalidade pelo CCR. A colonoscopia convencional (CC), constitui o melhor método para o diagnóstico precoce do CCR e para o diagnóstico e tratamento das lesões precurssoras. Entretanto a CC apresenta taxas de falha de detecção não desprezíveis. A colonoscopia com magnificação de imagem (CM), vem sendo utilizada com o intuito de melhorar a performance da CC. A sua principal vantagem é a possibilidade de diferenciar lesões neoplásicas de não-neoplásicas, de maneira que apenas lesões neoplásicas seriam retiradas, diminuindo custos e riscos relacionados ao rastreamento por colonoscopia. O objetivo deste estudo é determinar a acurácia da CM para o diagnóstico diferencial entre lesões neoplásicas e não-neoplásicas do intestino grosso por meio da comparação entre o diagnóstico endoscópico e o fornecido pelo exame histopatológico convencional. Entre abril de 2002 e outubro de 2003, cento e vinte pacientes foram incluídos no estudo, tendo-se encontrado 200 lesões. Todas as lesões foram classificadas endoscopicamente através da CM com alta magnificação (até 200X), associada a cromoscopia com índigo carmim, de acordo com a classificação proposta por Kudo, e em seguida excisadas ou biopsiadas para estudo histopatológico. A acurácia da determinação do diagnóstico diferencial endoscópico em relação à histopatologia entre lesões neoplásicas e não-neoplásicas foi de 78,5%. A diferença da CM em relação ao exame histopatológico foi estatisticamente significativa (p<0,0001). Conclui-se que, no atual estágio de desenvolvimento, a CM, pela sua acurácia, não permite excluir o exame histopatológico para o diagnóstico diferencial entre as lesões neoplásicas e não-neoplásicas do intestino grosso. / Bacterial meningitis in the neonatal period is a severe disease, associated to elevated mortality and sequelae in around 12 to 29% of the survivors. Newborns whose birth weight is < 2,500g have a 3-fold increase in the risk of acquiring meningitis when compared to those whose weight is > or = 2,500; among those with very low birth weight (< 1,500g), the risk increases 17-fold. Objectives: General: to describe the clinical picture and the complications of bacterial meningitis in two groups of newborns, considered according to birth weight (< 2,500g or > or = 2,500g). Specific: to describe and compare the etiological agents, the frequency of neurological signs and symptoms and complications, mortality rate and duration of treatment in both groups. Methods: Observational study of 87 newborns with bacterial meningitis, admitted at the Neonatal Intensive Care Unit (NICU) of Instituto da Criança of Hospital das Clínicas of the University of São Paulo School of Medicine, during an 11-year period (January 1994 to December 2004). The data were obtained through the analysis of hospital files. Statistical analysis was carried out with Fisher\'s exact test and the non-parametric Mann Whitney test. Results: Bacteria were identified in the cerebrospinal fluid (CSF) of 39% of the patients, with 50% of them being Gram-positive and 50%, Gram-negative. Most neonates presented unspecific signs and symptoms: fever (63.2%), irritability (31%), and lethargy (26.4%). The neurological findings occurred in 35.3% of the cases. Complications occurred in 48.2% of the neonates, and were mainly seizures (23%), intracranial hemorrhage (14.9%) and hydrocephalus (13.8%) with a mortality rate of 11.5%. At the comparison between clinical evolution and birth weight, associations between weight > or = 2,500g and seizures (p=0.047), weight > or = 2,500g and concave fontanel (p=0.019), bacteria in the CSF and complications (p=0.008) and bacteria in the CSF and death (p=0.043) were observed. Conclusions: The etiological agents most often identified in the CSF were enterobacteria (41%), followed by B Streptococcus (17.5%), non-B Streptococcus (17.5%), Staphylococcus aureus (11.7%), Neisseria meningitidis (8.8%) and Enterococcus faecalis (3.0%), with no statistical difference between the type of bacteria and birth weight. The predominant signs and symptoms were unspecific, with neurological findings in 35% of the cases. The higher frequency of neurological signs and symptoms in newborns with birth weight > or = 2,500g suggest a higher degree of central nervous system maturity in these infants. Although the mortality was lower than that observed in previous studies at the same Service, the frequency of complications was high, regardless of birth weight. The presence of bacteria in the CSF was associated to a higher frequency of seizures and mortality. The need for prolonged treatment in newborns with low birth weight suggests higher disease severity in this group of neonates.

O Câncer colorretal (CCR) é um problema de saúde importante devido a sua incidência e mortalidade elevadas. O rastreamento e o diagnóstico precoce são a principal estratégia para diminuir a mortalidade pelo CCR. A colonoscopia convencional (CC), constitui o melhor método para o diagnóstico precoce do CCR e para o diagnóstico e tratamento das lesões precurssoras. Entretanto a CC apresenta taxas de falha de detecção não desprezíveis. A colonoscopia com magnificação de imagem (CM), vem sendo utilizada com o intuito de melhorar a performance da CC. A sua principal vantagem é a possibilidade de diferenciar lesões neoplásicas de não-neoplásicas, de maneira que apenas lesões neoplásicas seriam retiradas, diminuindo custos e riscos relacionados ao rastreamento por colonoscopia. O objetivo deste estudo é determinar a acurácia da CM para o diagnóstico diferencial entre lesões neoplásicas e não-neoplásicas do intestino grosso por meio da comparação entre o diagnóstico endoscópico e o fornecido pelo exame histopatológico convencional. Entre abril de 2002 e outubro de 2003, cento e vinte pacientes foram incluídos no estudo, tendo-se encontrado 200 lesões. Todas as lesões foram classificadas endoscopicamente através da CM com alta magnificação (até 200X), associada a cromoscopia com índigo carmim, de acordo com a classificação proposta por Kudo, e em seguida excisadas ou biopsiadas para estudo histopatológico. A acurácia da determinação do diagnóstico diferencial endoscópico em relação à histopatologia entre lesões neoplásicas e não-neoplásicas foi de 78,5%. A diferença da CM em relação ao exame histopatológico foi estatisticamente significativa (p<0,0001). Conclui-se que, no atual estágio de desenvolvimento, a CM, pela sua acurácia, não permite excluir o exame histopatológico para o diagnóstico diferencial entre as lesões neoplásicas e não-neoplásicas do intestino grosso. / Bacterial meningitis in the neonatal period is a severe disease, associated to elevated mortality and sequelae in around 12 to 29% of the survivors. Newborns whose birth weight is < 2,500g have a 3-fold increase in the risk of acquiring meningitis when compared to those whose weight is > or = 2,500; among those with very low birth weight (< 1,500g), the risk increases 17-fold. Objectives: General: to describe the clinical picture and the complications of bacterial meningitis in two groups of newborns, considered according to birth weight (< 2,500g or > or = 2,500g). Specific: to describe and compare the etiological agents, the frequency of neurological signs and symptoms and complications, mortality rate and duration of treatment in both groups. Methods: Observational study of 87 newborns with bacterial meningitis, admitted at the Neonatal Intensive Care Unit (NICU) of Instituto da Criança of Hospital das Clínicas of the University of São Paulo School of Medicine, during an 11-year period (January 1994 to December 2004). The data were obtained through the analysis of hospital files. Statistical analysis was carried out with Fisher\'s exact test and the non-parametric Mann Whitney test. Results: Bacteria were identified in the cerebrospinal fluid (CSF) of 39% of the patients, with 50% of them being Gram-positive and 50%, Gram-negative. Most neonates presented unspecific signs and symptoms: fever (63.2%), irritability (31%), and lethargy (26.4%). The neurological findings occurred in 35.3% of the cases. Complications occurred in 48.2% of the neonates, and were mainly seizures (23%), intracranial hemorrhage (14.9%) and hydrocephalus (13.8%) with a mortality rate of 11.5%. At the comparison between clinical evolution and birth weight, associations between weight > or = 2,500g and seizures (p=0.047), weight > or = 2,500g and concave fontanel (p=0.019), bacteria in the CSF and complications (p=0.008) and bacteria in the CSF and death (p=0.043) were observed. Conclusions: The etiological agents most often identified in the CSF were enterobacteria (41%), followed by B Streptococcus (17.5%), non-B Streptococcus (17.5%), Staphylococcus aureus (11.7%), Neisseria meningitidis (8.8%) and Enterococcus faecalis (3.0%), with no statistical difference between the type of bacteria and birth weight. The predominant signs and symptoms were unspecific, with neurological findings in 35% of the cases. The higher frequency of neurological signs and symptoms in newborns with birth weight > or = 2,500g suggest a higher degree of central nervous system maturity in these infants. Although the mortality was lower than that observed in previous studies at the same Service, the frequency of complications was high, regardless of birth weight. The presence of bacteria in the CSF was associated to a higher frequency of seizures and mortality. The need for prolonged treatment in newborns with low birth weight suggests higher disease severity in this group of neonates.

Thesis (MA)--Stellenbosch University, 2004. / ENGLISH ABSTRACT: his review examines the literature on the psychological impact of Kangaroo Mother Care (KMC) on the mother, infant, support personnel and other caretakers. The paper summarizes the findings of the KMC research and considers the implications of it in light of high numbers of premature and low birth weight infants in South Africa. The review briefly considers theories of bonding and attachment adopted in the research and theories on why KMC is effective. The psychological impact of one component of KMC, Skin-to-Skin Care (SSC), used primarily in developed countries to supplement traditional care, has been extensively researched. In contrast, much less research has explored the psychological impact of full KMC programmes in developing countries. Our understanding of the psychological impact of KMC therefore relies predominantly on research from a very different context to the one in which KMC is used. As SSC has been utilised very differently to KMC and in first world settings, it cannot offer mothers or their family reliable information on the psychological demands and benefits ofKMC. Findings: Although KMC appears to offer invaluable physiological benefits and assists in 'humanising' neonatal care in important ways, there is currently very little published research on the short or long-term psychological impact of KMC on the mother, infant, support personnel and other caretakers. On the whole, research findings on the psychological impact of KMC were not conclusive but indicate some positive outcomes for increased maternal sensitivity and confidence, developmental benefits for the infant and an improvement in the clarity of infants' cues and communication with caregiver. Findings on the psychological impact of KMC for support personnel and other caretakers such as the family of the infant are also not conclusive and indicate that more research is necessary. Further research is required regarding cross-cultural experiences of KMC; maternal experiences of depression, anxiety and ambivalence; long-term developmental and attachment outcomes for the infant and the possible preventative value of KMC for maternal and infant mental health. / AFRIKAANSE OPSOMMING: Hierdie hersiening ondersoek die literatuur aangaande die sielkundige uitwerking van Kangaroo Mother Care (KMC) op die ma, suigeling, ondersteunende personeel en ander opsigters. Die artikel is 'n opsomming van die uitspraak van KMC navorsing en oorweeg die gevolgtrekkings daarvan ten opsigte van die hoe getal vroeggebore en lae ligaamsgewig van suigelinge wat in Suid-Afrika gebore is. Die hersiening kyk kortliks na die teorie verbonde aan die binding en gehegtheid van die navorsing en teorie oor hoekom KMC doeltreffend is. Die sielkundige uitwerking van een onderdeel van KMC, Skin-to-Skin Care (SSC), wat meestal in gevorderde lande gebruik word om tradisionele versorg te verryk, is deeglik ondersoek. Inteendeel is ver minder navorsing op die sielkundige uitwerking van volle KMC programme in ontwikellende lande gedoen. Dus is ons begrip van die sielkundige uitwerking van KMC afhanklik op navorsing vanuit 'n ander konteks as die een waarin die eintlik gebruik is. SSC word baie anders benut as KMC, en in eerstewereldkontekste kan dit dus nie veel betroubare inligting op die sielkundige vereistes en voordele van KMC verskaf nie. Bevindings: Al kom dit voor dat KMC waardevolle sielkundige voordele verskaf en help in geboorte nasorg op belangrike maniere, is daar huidiglik baie min navorsing op druk oor die kort- of die langtermyn sielkundige uitwerking van KMC op die ma, suigeling, ondersteunende personeel en ander oppassers. In die algemeen, is die bevindings van navorsing oor die sielkundige uitwerking van KMC nie volkome nie, maar dui positiewe uitslae aan op verhoogde moederlike gevoelens en selfvertroue. Navorsing dui ook ontwikkelingsvoordele vir die suigeling, asook die bevordering van die duidelikheid van sy kommunikasie met die oppasser. Bevindings op die sielkundige uitwerking van KMC op die ondersteunende personeel en ander oppassers, byvoorbeeld familielede van die suigeling, is ook nie volkome nie, en dui die nodigheid van verdere navorsing aan. Verdere navorsing oor die kruiskulturele ervaring van KMC, moederlike ondervinding van moedeloosheid, angs en dubbelsinnigheid is benodig. Langtermyn ontwikkeling en gehegtigheidsake vir die suigeling en die moontlike voorkomende waarde van KMC vir moederlike en suigeling se geestelike gesondheid is ook wel benodig.

published_or_final_version / Community Medicine / Master / Master of Public Health

The premature infant is subject to pathological alterations of the cardiovascular system leading to insufficient pulmonary blood flow and/or sudden surges of pressure to fragile cerebral blood vessels, conditions which are often associated with hypotension. Dobutamine appears to be a potentially useful agent to increase pulmonary blood flow and correct hypotension. In view of this potential, the alpha-adrenergic characteristics of dobutamine acts were studied in the isolated rabbit femoral and pulmonary arteries. Dobutamine on the post synaptic membrane of these tissues as a high affinity, low intrinsic activity alpha adrenergic agonist. No action of dobutamine to modulate stimulation evoked release of norepinephrine was found, although dobutamine did increase spontaneous release of norepinephrine. This effect was not blocked by antagonists of uptake 1 and uptake 2. To further evaluate dobutamine for use in the neonate, contractile responses of the femoral and pulmonary arteries and aorta to dobutamine and norepinephrine were studied in dogs of various ages from newborn to 6 weeks. Maximal contractile responses to norepinephrine in the pulmonary artery and aorta increased with age. Dobutamine produced small or no responses in all newborn tissues studied and also showed increasing responsiveness with age. To allow future study of the mechanism of these changes a method of radioligand binding was established for vascular smooth muscle using the ligands prazosin and rauwolscine in the dog and rabbit pulmonary artery and aorta. This binding was found to demonstrate the properties of saturability, sterospecificity and rank order of potency. Possible variables that could account for the observed changes in response during maturation were mathematically modeled to provide a theoretical basis for future studies combining measurement of contractile response and radioligand binding techniques.

A triagem auditiva neonatal universal - TANU - tem sido recomendada no Brasil e no exterior como o principal instrumento para assegurar, nos primeiros anos de vida, o diagnóstico da deficiência auditiva. Nessa medida, o objetivo do presente estudo foi identificar o grau de preocupação e conhecimento a respeito desse procedimento por parte dos familiares, visando contribuir para o planejamento de ações que viabilizem estratégias ainda mais eficazes de orientações fonoaudiológicas. Também foi possível observar o quanto os pais sabem a respeito da audição do bebê, o que pode levar à criação de maneiras mais acolhedoras de acompanhamento e atenção às necessidades reais da família durante o diagnóstico audiológico. Para a pesquisa, foram então selecionadas, inicialmente, 42 famílias, das quais restaram trinta e oito cujos bebês não haviam passado no teste e reteste da TANU, realizados na maternidade Santa Isabel - Bauru/SP, pelo projeto \"Modelo de Saúde Auditiva no Recém-nascido\". A coleta de dados e o registro foram realizados na Clínica de Audiologia Infantil do Departamento de Fonoaudiologia da FOB-USP, Bauru/SP, por meio da aplicação de um instrumento integralmente adaptado, tomando por base dois questionários: o Rhode Island Hearing Screen Program Questionnarie, aplicado em Rhode Island Hearing Assesment Program; e o questionário aplicado por HERGILS; HERGILS17, 2000 na University Hospital, Linköping-Suécia. Foram incluídas, ainda, seis questões pelos juízes que validaram o instrumento. Os resultados foram: houve um aumento significativo do grau de preocupação materna entre o teste e reteste da TANU (p = 0.002); a maior parte das participantes (50%) soube da TANU após a alta hospitalar, 34% durante a internação e 16% antes da internação hospitalar; 55% informaram que não sabiam qual profissional havia realizado a TANU; 100% declararam ser favoráveis ao programa de TANU, sendo que, destas, 53% mostraram-se insatisfeitas com as informações recebidas, tanto sobre os objetivos como sobre as conseqüências da avaliação. O presente estudo confirmou os resultados de outras pesquisas que ressaltam a importância dos programas de Saúde Auditiva no sentido de assegurar que as famílias compreendam a necessidade da TANU, bem como a continuação do diagnóstico audiológico e intervenção precoce, quando necessários. / The universal newborn hearing screening - UNHS - has been recommended in Brazil and other foreign countries as the main instrument to assure, in the first years of life, the diagnosis of the auditory deficiency. In this measure, the goal of the current study was to identify the worry and knowledge degrees concerning to this procedure regarding the familiar people, aiming to contribute for the planning of actions that make possible audiologist guidance strategies even more efficient. It was also possible to observe how much the parents know about the baby hearing, and what can be taken to create more welcoming ways of attendance and attention to the real necessities of the family during the audiologist diagnosis. For the research, 42 families were initially selected, for those 38 remained, whose babies did not pass in the UNHS test and retest, which were held at the Maternity Saint Isabel - Bauru/SP, for the project \"Auditory Health Model in the Newborn\". Data and registers collecting were carried through the Audiologist Infantile Clinic of the Therapy Speech-Audiologist Department at FOBUSP, Bauru/SP, over the application of an integrally adapted instrument, based on two questionnaires: the Rhode Island Hearing Screen Program Questionnaire, applied in Rhode Island Hearing Assessment Program; and the questionnaire applied for HERGILS; HERGILS17, 2000 in the University Hospital, Linköping-Sweden. Six questions were included by the judges that validated the instrument. The results showed a significant increase of the maternal concern degree between the UNHS test and retest (p = 0,002); most of the participants (50%) was informed about UNHS procedures after the hospital discharge, 34% during hospital admission and 16% before the hospital admission; 55% informed that they did not know the professional name that performed the UNHS procedures; 100% declared to be for to the UNHS program. From all participants, 53% confirmed unsatisfied with the received information, not only on the objectives but also on the consequences of the evaluation. The recent study confirmed the results of other researches that point out the importance of the Auditory Health programs in order to assure that the families understand the necessity of the UNHS procedures, as well as the continuation of the audiologist diagnosis and previous intervention, when necessary.

The ultra-processing of food has become a much more important aspect of dietary patterns and dietary quality in terms of its impact on body weight, diet related diseases, health, and well-being in the past decades. NOVA is a set of guidelines developed that classifies diet quality by degree of food processing. The NOVA guidelines distinguish four categories: unprocessed /minimally processed foods; culinary ingredients; processed foods; and ultra-processed foods. Numerous studies have found an association of ultra-processed foods and health conditions such as obesity and metabolic syndrome. This study analyzed the associations between maternal diet quality as measured by NOVA and maternal anthropometric and neonatal body composition outcomes. The optimal method of nutrition intervention and education for this special population remains unknown; using NOVA may provide researchers with a different lens to assess diet quality and health care professionals with additional vocabulary to convey more tailored messages regarding optimal nutrition strategies for mother and offspring. Using data collected from a large randomized controlled intervention trial at pre and post intervention, this study aimed to compare the NOVA guidelines assessment of maternal diet quality to the parent study assessment of diet quality, the Healthy Eating Index (HEI), using statistical correlations. Secondly, this study aimed to look at the relationship of ultra-processed food intake to the maternal gestational weight gain experience using a logistic regression. Thirdly, this dissertation aimed to explore the relationship between maternal ultra-processed food intake and neonatal lean mass as measured by quantitative magnetic resonance (QMR) and fat free mass as measured by air displacement plethysmography (ADP: PEAPOD). In terms of maternal outcomes, the study found that NOVA and HEI were significantly correlated at pre intervention but not at post intervention. The odds of gaining excessive gestational weight decreased as maternal ultra-processed food intake increased - which was not in the hypothesized direction - when using study participant data. However, the odds of gaining excessive gestational weight increased as maternal ultra-processed food intake increased - which was in the hypothesized direction - when using the Institute of Medicine weight gain recommendations. Also, while obesity did not predict excessive gestational weight gain, those with obesity ultra-processed food intake did predict gestational weight gain. These various inconsistencies are likely due to the instability of the dietary intake data because only one 24 -hour dietary recall was obtained from mother. In addition, the mothers’ diets were very healthy to begin with, where ultra-processed food intake formed about 45% of calories both pre and post intervention, when the national average is 57%. Race was also significant predictors of gestational weight gain for the mothers. Being non-white significantly increased the odds of gaining excessively as did the interaction of having obesity and eating more ultra-processed foods. In terms of neonatal outcomes, findings from this study suggest that length and fat mass are significant predictors of lean mass in neonates. In terms of the impact of maternal ultra-processed food intake, the higher the consumption of ultra-processed food, the greater the neonatal lean mass, which this was not in the hypothesized direction. However, the association was minimal with very small beta weights and regression line, when plotted was quite flat, so that the finding is not clinically meaningful. It remains important to know whether maternal ultra-processed food intake influences gestational weight gain and the body composition of the neonate. Thus, future research should include using similar data analyses on a population with a more nationally representative diet, a larger sample size, and a more robust measure of dietary intake such as three 24-hour recalls. Given that a similar recent study found ultra-processed food to be highly predictive of maternal and neonatal outcomes, and many other studies have demonstrated that ultra-processed food is related to several health conditions in many countries that this study did not measure, it seems prudent for healthcare providers to take advantage of prenatal visits as a window of opportunity to encourage the consumption of unprocessed and minimally foods and help women make informed decisions regarding ultra-processed foods.

Typescript (photocopy). / Digitized by Kansas Correctional Industries

FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / Os recÃm-nascidos (RN) com malformaÃÃo congÃnita (MC) requerem dos profissionais de enfermagem atenÃÃo e cuidados especÃficos e individualizados. O estudo objetivou avaliar a prevalÃncia dos recÃm-nascidos com malformaÃÃes congÃnitas em instituiÃÃes pÃblicas e a assistÃncia de enfermagem prestada a essas crianÃas internadas na Unidade Neonatal (UN) nas primeiras 24 horas de vida. Estudo descritivo, transversal, quantitativo, realizado em trÃs Unidades Neonatais de instituiÃÃes hospitalares (A, B e C) de Fortaleza, Brasil. A amostra foi composta de 159 recÃm-nascidos, sendo 75 na instituiÃÃo A; 44 na B; e 40 na C. Os dados foram coletados em 2012, de janeiro a junho em A e B, e de marÃo a agosto em C. Investigou-se prontuÃrios e documentos nas unidades referidas e, posteriormente, eles foram registrados em formulÃrios prÃprios contendo variÃveis maternas e neonatais, apÃs a aprovaÃÃo pelos ComitÃs de Ãtica. Os resultados revelaram prevalÃncia de 3,3%, 2,1% e 3,6% de RN malformados nas instituiÃÃes, respectivamente. Da amostra, 53% eram masculinos, 57% com 37 a 41,6 semanas gestacionais, 52% pesando entre 2.500g e 3999g, 66% com estatura de 39 a 49 cm, Apgar no 1Â(60%) e 5Â(79%) minutos de sete a dez. Dentre as terapias implementadas ao RN, sobressaÃram-se oxigenoterapia sob Oxi-hood (42%); Dieta zero (37%); hidrataÃÃo venosa (36%); punÃÃo de acesso venoso central para infusÃes (44%); manuseio de trÃs em trÃs horas (89%) e nÃo realizaram cirurgias no perÃodo (75%). Dentre os curativos, o local destacado foi a regiÃo sacral (54%) e a cobertura com compressa estÃril (21%). As malformaÃÃes congÃnitas diagnosticadas foram categorizadas conforme classificaÃÃo do CID â 10, prevalecendo aquelas pertencentes ao Sistema Osteomuscular (30%) e Sistema Nervoso Central (SNC) (21,1%), ressaltando o PÃ torto congÃnito, Polidactilia, Hidrocefalia e Mielomeningocele. Destacaram-se as malformaÃÃes isoladas (61%) e os registros de cuidados de enfermagem envolvendo exames (24,4%) e oxigenoterapia (16,9%). Ocorreram associaÃÃes estatisticamente significantes entre as categorias de malformaÃÃes e algumas variÃveis especÃficas: (MC do SNC) x (IG, Terapia Medicamentosa); (MC do olho, ouvido, face, pescoÃo) x (IG, Uso de drogas e Escolaridade); (MC Aparelho CirculatÃrio) x (Uso de drogas e Terapia Medicamentosa); (MC Aparelho RespiratÃrio) x (Idade materna e Uso de drogas); (Fenda labial ou palatina) x (Idade materna e Uso de drogas); (Outras MC do Aparelho Digestivo) x (Modalidade VentilatÃria, Forma de NutriÃÃo e Cirurgia); (MC dos ÃrgÃos Genitais) x (Sexo, Renda familiar e Forma de NutriÃÃo); (MC Osteomuscular) x (NÃmero de GestaÃÃes e Modalidade VentilatÃria); (Outras MC) x (IG e Peso); e (Anomalias CromossÃmicas) x (Idade materna), todos com p<0,05. Concluiu-se que ainda se faz prevalente o nÃmero de MC em RN e que a equipe de enfermagem implementa cuidados de acordo com as condiÃÃes clÃnicas, da patologia e equilÃbrio hemodinÃmico de cada RN e nÃo especificamente para cada tipo de malformaÃÃo. / The newborns (NB) with congenital malformation (CM) requires from nursing professionals the performance of specific and individualized care. This study aimed at evaluating the prevalence of newborns with congenital malformation in public institutions and the nursing care provided to these children admitted to the Neonatal Unit (NU) in the first 24 hours of life. This is a descriptive, cross-sectional and quantitative study, which was conducted in three Neonatal Units of hospitals (A, B, C) from the city of Fortaleza-CE/Brazil. The sample was composed of 159 newborns; from which 75 belong to institution A; 44 to B; and 40 to C. The data were collected in 2012, from January to June in A and B, and from March to August in C. Records and documents were investigated in the aformentioned units and, subsequently, they were recorded in the proper forms containing maternal and neonatal variables, after approval by the Ethical Committee. Results showed prevalence of 3.3%, 2.1% and 3.6% of malformed newborns in the institutions, respectively. Of the sample, 53% were male, 57% with 37 to 41,6 gestation weeks, 52% weighing between 2,500 g and 3999g, 66% with height 39-49 cm, Apgar score at 1st (60%) and 5th (79%) minutes from seven to ten. Among the implemented therapies to the NB, it should be highlighted oxygenotherapy in Oxy-hood (42%); Zero diet (37%); intravenous hydration (36%); central venous access puncture for infusions (44%); handling for every three hours (89%) and did not undergo surgery throughout the period (75%). Among the dressings, the highlighted location was the sacral region (54%) and the coverage with sterile compress (21%). The diagnosed congenital malformations were categorized according to the classification of the ICD â 10, prevailing those ones belonging to the Musculoskeletal System (30%) and to the Central Nervous System (CNS) (21.1%) highlighting the Congenital clubfoot, Polydactyly, Hydrocephalus and Myelomeningocele. It should also be highlighted the isolated malformations (61%) and the nursing care records involving examinations (24.4%) and oxygenotherapy (16.9%). There were statistically significant associations between the malformations categories and some specific variables: (CM of the CNS) x (GI, Drug Therapy) (CM of the eye, ear, face, neck) x (GI, Drug use and Schooling); (CM of the Circulatory System) x (Maternal age and Drug use) (CM of the Respiratory System) x (Drug use and Drug therapy); (Cleft-lip and palate) x (Maternal age and Drug use); (Others CM of the Digestive System) x (Ventilation modality and Nutrition and Surgery forms); (CM of the Genitalia) x (Gender, Family Income and Nutrition form); (Musculoskeletal CM) x (Number of pregnancies and Ventilation modality); (Others CM) x (GI and weight), and (Chromosomal Abnormalities) x (Maternal age), all with p <0.05. We have concluded that the number of NB with CM it is still prevalent and the nursing staff implements the healthcare according to the clinical conditions, pathology and hemodynamic balance of each NB and not specifically for each type of malformation.

CoordenaÃÃo de AperfeiÃoamento de NÃvel Superior / O desenvolvimento do artroscÃpio possibilitou ao cirurgiÃo ortopÃdico o acesso a diversas articulaÃÃes. O quadril, que apresenta complexa anatomia e topografia, permaneceu por muito tempo como uma barreira para os artroscopistas. Com os avanÃos ocorridos ao longo da Ãltima dÃcada, as indicaÃÃes vÃm crescendo a cada ano. Isto fez da artroscopia do quadril uma valiosa tÃcnica que preencheu uma lacuna no esclarecimento diagnÃstico, freqÃentemente pouco elucidativos mesmo com utilizaÃÃo de modernos mÃtodos; possibilitando o tratamento de um nÃmero cada vez maior de afecÃÃes desta articulaÃÃo. Em adultos o mÃtodo à ainda pouco utilizado e em crianÃas apresenta indicaÃÃes muito restritas. Assim, foi decidido realizar um trabalho que propiciasse o desenvolvimento de um modelo experimental de treinamento do mÃtodo artroscÃpico, e atravÃs deste, observar aspectos histomorfolÃgicos de estruturas intra-articulares submetidas à traÃÃo axial. Utilizando quadris de 20 cadÃveres de recÃm-nascidos foi testada a possibilidade de realizar o procedimento. Seis fetos (A1 a A6), representaram o projeto piloto, servindo para desenvolver o modelo de pesquisa e catorze o estudo principal (B1 a B14), seguindo critÃrios estabelecidos com o projeto piloto. Em todos os fetos realizou-se o procedimento utilizando Ãtica de 2,2 mm de espessura com 30 de angulaÃÃo e em todos aplicada traÃÃo axial que variou de 68 a 88 N. Foram utilizados dois portais: antero-lateral e lateral, e no final feito artrotomia e anÃlise histomorfolÃgica das estruturas: pulvinar, labrum acetabular e ligamento redondo do quadril. Ficou estabelecido com o estudo piloto que o procedimento somente à possÃvel realizar com fetos maiores, pois nos quatro fetos em que o peso era abaixo de 1500 g, o procedimento foi tecnicamente impossÃvel. A traÃÃo Foi necessÃria para uma completa inspeÃÃo da articulaÃÃo. Constatou-se ainda que atravÃs de um sà acesso nÃo foi possÃvel visualizar toda a articulaÃÃo, mas, que a utilizaÃÃo de dois acessos, os portais lateral e antero-lateral, oferecem boa seguranÃa sendo possÃvel reproduzir o mÃtodo artroscÃpico e identificar a maior parte das estruturas anatÃmicas intra-articulares. Concluiu-se que a artroscopia do quadril tem tÃcnica difÃcil, mas factÃvel em cadÃveres de recÃm-nascidos com peso superior a 1700 g e nÃo foram encontradas lesÃes macroscÃpicas ou histolÃgicas sobre as estruturas estudadas em fetos submetidos a uma traÃÃo de atà 88 N. / Surgical access to different joints was made possible due to the development of the arthroscope. On account of its complex anatomy and topography the endoscopic access to the hip joint seemed to be an unattainable goal by many specialists for a long period of time. Last decade progress turned arthroscopic examination indications an ever growing need. The procedure helped to fill out the gap in the diagnostic area of hip joint diseases making possible the treatment of many illnesses affecting the joint. Despite this progress the exam is not widely performed in adult patients. Also, usage in children presents very restricted limitations. This paper was aimed at developing an experimental model of hip arthroscopy and to study the histomorphological damages resulted from its use in structures subjected to traction. Twenty newborn cadavers were used. Six fetuses use used during the pilot project (A1-A6). The remainder fourteen fetuses were used during the main study (B1-B14). Optical system (2.2 mm diameter) and 30o angulation were used. Axial traction was applied to all cases (68-88 N). Antero-lateral and lateral ports were used for surgical access to the hip. Histomorphological studies of pulvinar, labrum acetabulare and hip round ligament were carried out in each case. A pilot study has demonstrated that the application of this technique is not feasible in fetuses weighing less than 1500g. The traction was required to secure a complete inspection of the articulation. Using just one port was not possible to visualize all structures. The simultaneous use of lateral and anterolateral ports provided adequate exposure to all joint structures. It is concluded that hip arthroscopy is not an easy procedure although feasible in newborn cadavers weighing more than 1700 g. No macroscopic or histological lesions were identified in fetuses submitted to traction of up to 88 N