Introduction: Limited facilities exist at rural hospitals for the management of newborn infants with respiratory distress syndrome (RDS). Furthermore, the secondary and tertiary hospitals are under severe strain to accept all the referrals from rural hospitals. Many of these infants require intubation and ventilation with a resuscitation bag which must be sustained for hours until the transport team arrives. Not only is lung damage inflicted by the prolonged ventilation, but transferring the infant by helicopter and ambulance is expensive. CPAP (continuous positive airway pressure), a non-invasive form of ventilatory support, has been used successfully at regional (Level 2) and tertiary (Level 3) neonatal units, to manage infants with RDS. It is cost-effective for infants with mild to moderate grades of RDS to be managed at the rural hospital instead of being transferred to the regional secondary or tertiary hospital. CPAP was introduced to Ceres Hospital, a rural Level 1 hospital, in February 2008 for the management of infants with RDS. Aim: To determine the impact of CPAP on the management of infants with RDS in a rural level 1 hospital and whether it can reduce the number of referrals to regional hospitals. Study setting: Nursery at Ceres District Hospital, Cape Winelands District, Western Cape. Study design: Prospective cohort analytical study with an historic control group (HCG). Patients and Methods: The study group (SG) comprised all neonates with respiratory distress born between 27/02/2008 and 26/02/2010. The infants were initially resuscitated with a Neopuff® machine in labour-ward and CPAP was commenced for those with RDS. The survival and referral rates of the SG were compared to an historic control group (HCG) of infants born between 1/2/2006 to 31/01/2008 at Ceres Hospital. Results: During the 2 years of the study, 51 neonates received CPAP (34 <1800g, 17>1800g). Twenty (83%) of the SG infants between 1000g and 1800g and 23 (68%) of the infants between 500g and 1800g survived. Those <1800g that failed CPAP, had either a severe grade of RDS which required intubation and ventilation or were <1000g. Seventeen (33%) of the infants that received CPAP, were in the >1800g group. Thirteen (76%) of these infants were successfully treated with CPAP only. The four infants that failed CPAP suffered from congenital abnormalities and would not have benefited from CPAP. There was no statistically significant difference in the survival between the SG and HCG (80%) (p=0.5490) but the number of referrals decreased significantly from 21% in the HCG to 7% in the SG (p=0.0003). No complications related to CPAP treatment, such as pneumothorax, were noted. The nursing and medical staff quickly became proficient and confident in applying CPAP and were committed to the project. Conclusion: CPAP can be safely and successfully practised in infants with mild to moderate RDS in a rural Level 1 hospital. The survival rate stayed the same as the HCG, even though a higher risk infants were treated in the SG. The transfers were significantly reduced from 21% to 7%. This resulted in significant cost savings for the hospital.

Orientador: Daisy Maria Fávero Salvadori / Coorientador: João Paulo de Castro Marcondes / Resumo: A obesidade é uma doença de etiologia multifatorial, resultante de interações complexas entre fatores genéticos e ambientais. No entanto, o aumento acentuado de sua incidência, precocidade e severidade não foram ainda totalmente elucidados. Dentre os inúmeros fatores de risco, diversos achados sugerem, também, que estímulos estressores (p.ex. diabete, alterações nutricionais) na vida intrauterina podem promover alterações genéticas e epigenéticas, predispondo ao desenvolvimento tardio de doenças e disfunções metabólicas, como a obesidade. Assim, o presente estudo foi delineado com o objetivo de avaliar a possível relação entre o Diabetes melittus gestacional (DMG) e a predisposição do recém-nascido para o desenvolvimento de obesidade na vida adulta. Para tanto, foram incluídos no estudo gestantes saudáveis e gestantes diagnosticadas com DMG e seus respectivos recém-nascidos. Adicionalmente, adultos obesos e eutróficos foram incluídos como população de referência (controle). Considerando a relação entre o diabete e a obesidade com a disfunção mitocondrial, foi avaliado o perfil de expressão de gênica e proteica de SOD2 (superóxido desmutase 2), PPARα (receptor ativador da proliferação de peroxissomos alfa) e PPARGC-1β (receptor ativador da proliferação de peroxissomos gamma coativador 1 beta), relacionados ao metabolismo mitocondrial, em sangue do cordão umbilical e sangue periférico (população de referência), e o perfil de expressão gênica em células de placenta (faces materna e fetal). Primeiramente, nossos resultados demonstraram que indivíduos obesos apresentavam aumento da expressão gênica e proteica de SOD2, PPARα e PPARGC-1β no tecido sanguíneo quando comparados aos eutróficos (p < 0,05). No entanto, o mesmo não foi observado no tecido placentário (expressão gênica) e no sangue do cordão umbilical (expressão gênica e protéica) dos recém-nascidos das gestantes com DMG e... / Abstract: Obesity is a multifactorial disease involving complexes interactions between genetic and environmental agents. However, the increased incidence, early onset and severity of this disease, are still not well understood. Several findings have demonstrated that in utero stressors (diabetes, cigarettes, and/or alcohol consumption, etc) can promote genetic and epigenetic changes predisposing to late development of diseases and metabolic disorders, such as obesity. The present study was designed to evaluate the possible relationship between gestational Diabetes mellitus (GDM) and newborn predisposition to obesity his later life. Healthy and GDM pregnant women and their respective newborns were included. Additionally, obese and eutrophic adults were recruted as reference population. Considering the relationship between diabetes and obesity with mitochondrial dysfunction, gene and protein related to mitochondrial metabolism (SOD2 (superoxide dismutase 2), PPARα (peroxisome proliferator-activated receptor alpha) and PPARGC-1β(peroxisome proliferatoractivated receptor gamma coactivador beta) were evaluated in cells from cord and peripheral blood (reference population), and in placenta cells (gene expression profile in maternal and fetal sides). Our results showed an increased gene and protein expression (SOD2, PPARα and PPARGC-1β) in peripheral blood from obese compared to euthrophic subjects (p <0.05). However, the same result was not observed in the placental tissue (gene expression) and in umbilical cord blood cells (gene and protein expression) from GDM women and their respective newborn compared to the non diabetic group, i.e., GDM was not an effective agent to promote transcriptional changes in SOD2, PPARα PPARGC-1β in maternal and fetal sides of placenta, and transcriptional and translational changes in umbilical cord blood cells. In conclusion, SOD2, PPARα and PPARGC-1β gene and protein expression were confirmed as potential ... / Mestre

Doctorat en sciences psychologiques / info:eu-repo/semantics/nonPublished

Made available in DSpace on 2015-12-10T14:22:49Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-01-19. Added 1 bitstream(s) on 2015-12-10T14:29:01Z : No. of bitstreams: 1 000851402.pdf: 1086924 bytes, checksum: d01cb9f4eba10b500b059e2fe7102a41 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / A obesidade é uma doença de etiologia multifatorial, resultante de interações complexas entre fatores genéticos e ambientais. No entanto, o aumento acentuado de sua incidência, precocidade e severidade não foram ainda totalmente elucidados. Dentre os inúmeros fatores de risco, diversos achados sugerem, também, que estímulos estressores (p.ex. diabete, alterações nutricionais) na vida intrauterina podem promover alterações genéticas e epigenéticas, predispondo ao desenvolvimento tardio de doenças e disfunções metabólicas, como a obesidade. Assim, o presente estudo foi delineado com o objetivo de avaliar a possível relação entre o Diabetes melittus gestacional (DMG) e a predisposição do recém-nascido para o desenvolvimento de obesidade na vida adulta. Para tanto, foram incluídos no estudo gestantes saudáveis e gestantes diagnosticadas com DMG e seus respectivos recém-nascidos. Adicionalmente, adultos obesos e eutróficos foram incluídos como população de referência (controle). Considerando a relação entre o diabete e a obesidade com a disfunção mitocondrial, foi avaliado o perfil de expressão de gênica e proteica de SOD2 (superóxido desmutase 2), PPARα (receptor ativador da proliferação de peroxissomos alfa) e PPARGC-1β (receptor ativador da proliferação de peroxissomos gamma coativador 1 beta), relacionados ao metabolismo mitocondrial, em sangue do cordão umbilical e sangue periférico (população de referência), e o perfil de expressão gênica em células de placenta (faces materna e fetal). Primeiramente, nossos resultados demonstraram que indivíduos obesos apresentavam aumento da expressão gênica e proteica de SOD2, PPARα e PPARGC-1β no tecido sanguíneo quando comparados aos eutróficos (p < 0,05). No entanto, o mesmo não foi observado no tecido placentário (expressão gênica) e no sangue do cordão umbilical (expressão gênica e protéica) dos recém-nascidos das gestantes com DMG e... / Obesity is a multifactorial disease involving complexes interactions between genetic and environmental agents. However, the increased incidence, early onset and severity of this disease, are still not well understood. Several findings have demonstrated that in utero stressors (diabetes, cigarettes, and/or alcohol consumption, etc) can promote genetic and epigenetic changes predisposing to late development of diseases and metabolic disorders, such as obesity. The present study was designed to evaluate the possible relationship between gestational Diabetes mellitus (GDM) and newborn predisposition to obesity his later life. Healthy and GDM pregnant women and their respective newborns were included. Additionally, obese and eutrophic adults were recruted as reference population. Considering the relationship between diabetes and obesity with mitochondrial dysfunction, gene and protein related to mitochondrial metabolism (SOD2 (superoxide dismutase 2), PPARα (peroxisome proliferator-activated receptor alpha) and PPARGC-1β(peroxisome proliferatoractivated receptor gamma coactivador beta) were evaluated in cells from cord and peripheral blood (reference population), and in placenta cells (gene expression profile in maternal and fetal sides). Our results showed an increased gene and protein expression (SOD2, PPARα and PPARGC-1β) in peripheral blood from obese compared to euthrophic subjects (p <0.05). However, the same result was not observed in the placental tissue (gene expression) and in umbilical cord blood cells (gene and protein expression) from GDM women and their respective newborn compared to the non diabetic group, i.e., GDM was not an effective agent to promote transcriptional changes in SOD2, PPARα PPARGC-1β in maternal and fetal sides of placenta, and transcriptional and translational changes in umbilical cord blood cells. In conclusion, SOD2, PPARα and PPARGC-1β gene and protein expression were confirmed as potential ...

D.Cur. / Quality control in perinatal education is imperative, with the purpose to deliver a high quality and appropriate healthcare service to the family in the peri natal period. The purpose of this study was to develop valid standards for perinatal education in South Africa. To reach this goal, the study proceeded as follows: Development phase -concepts were developed for perinatal education, -the concepts were logically systematised and formulated in concept standards, -the standards were presented for peer group review with the purpose of refinement and further development. Quantification phase: - the statistical validity of the standards was determined/calculated. After completion of the study the researcher reached the conclusion that quality perinatal education must adhere to the following standards: A philosophy for perinatal education must exist; The perinatal facilitator must be a well trained professional person, and must possess certain personal traits; The perinatal education style/method must adapt according to the client's socio-economic status, age, marital status and needs; The perinatal facilitator must make use of acknowledged teaching methods and techniques in order to facilitate learning; The perinatal education must comply with certain minimum requirements in order to make it accessible and acceptable to the client; The perinatal facilitator must complete a preparatory phase before she is allowed to give education; A perinatal education programme must have a curriculum that can be adapted to the client's circumstances; Perinatal education must be presented purposefully; The end result of perinatal education must focus on a healthy baby and a healthy, empowered mother, family and community.

No description available.

A useful understanding of the respiratory system of premature infants and the factors contributing to different physiological mechanisms and diseases requires extensive clinical research. This project is the result of a need for a fast and reliable system to process the information obtained from biological sources and to obtain results from which different hypothesis can be tested. This document presents a description of one such system and its different subsystems. It describes the biosignals of interest as well as the stages they have to go through in order to obtain an accurate and valid analysis. The system is hardware and software oriented. The system hardware is subdivided into instrumentation system, which is used to pick up and condition the signals, and a data acquisition, monitoring and storage system, where the signals are digitized and stored for later processing. The system software, which is the basic and principal component of the project, participates in the hardware control for the data acquisition, storage and monitoring, as well as the posterior stages of signal processing and analysis, which constitute the key of the system. The biosignals mentioned above can be classified as muscular or EMG, respiratory, chest wall motion, and cardiac signals. The muscular signals are obtained from measuring the electrical activity of the muscles participating in the process of ventilation and the respiratory signals reflect mechanical characteristics of the lungs and airway passages, the chest wall motion signals give a measurement to evaluate the chest wall stability, and the cardiac signals which are measurements of the electrical activity irradiated by the cardiac muscle. These biosignals require extensive processing, especially the EMG signals, before analysis. The signal processing stage uses digital signal processing techniques which were developed or adapted for this purpose. The signal analysis stage is based on research protocols and physical relations to evaluate different respiratory parameters. Special data and file handling software was developed and applied as well as graphics software, to accomplish the stages mentioned above.

Pain behavior of neonates was compared across sleep/waking states and sex. From Gate-Control Theory (Melzack and Wall, 1982) it was hypothesized that pain behavior would vary depending on the ongoing functional state of the infant, in contrast with Specificity Theory (Mountcastle, 1980), from which one would expect neonatal pain expression to be solely a function of degree of tissue damage. The findings of facial action variation across sleep/waking state was interpreted as consistent with Gate-Control Theory. Awake alert infants responded with the most facial activity, which supported Brazelton's (1973) view that infants in this state are most receptive to environmental stimulation. Fundamental frequency of cry was not related to sleep/waking state. This suggested that findings from the cry literature on pain cry as a reflection of nervous system "stress", in unwell newborns, do not generalize directly to healthy infants under varying degrees of stress as a function of state. Sex differences were apparent in speed of response, with boys showing shorter time to cry and facial action following heel-lance. Issues raised by the study include the importance of using measurement techniques which are independent of pre-conceived categories of affective response, and the surprising degree of responsivity of the neonate to ongoing events. Exploratory analyses suggested obstetric factors were related to overall facial action. Caution was expressed in this interpretation due to the great complexity of the inter-relationships of medical, physiological and maternal variables which go far beyond the scope of this study. It was concluded that obstetric features such as mode of delivery should be considered in sample selection for neonatal pain studies, in contrast to current practise which has been to assume healthy newborns form an homogeneous population. It was clear from these findings that the issues are multifaceted, and the optimal way to proceed with research in the area of neonatal pain is with an interdisciplinary team format. / Graduate and Postdoctoral Studies / Graduate

Multivariate statistical methods, including recent computing-intensive techniques, are explained and applied in a medical sociology context to study infant death in relation to socioeconomic risk factors of households in Sri Lankan villages. The data analyzed were collected by a team of social scientists who interviewed households in Sri Lanka during 1980-81. Researchers would like to identify characteristics (risk factors) distinguishing those households at relatively high or low risk of experiencing an infant death. Furthermore, they would like to model temporal and structural relationships among important risk factors. Similar statistical issues and analyses are relevant to many sociological and epidemiological studies. Results from such studies may be useful to health promotion or preventive medicine program planning. With respect to an outcome such as infant death, risk groups and discriminating factors or variables can be identified using a variety of statistical discriminant methods, including Fisher's parametric (normal) linear discriminant, logistic linear discrimination, and recursive partitioning (CART). The usefulness of a particular discriminant methodology may depend on distributional properties of the data (whether the variables are dichotomous, ordinal, normal, etc.,) and also on the context and objectives of the analysis. There are at least three conceptual approaches to statistical studies of risk factors. An epidemiological perspective uses the notion of relative risk. A second approach, generally referred to as classification or discriminant analysis, is to predict a dichotomous outcome, or class membership. A third approach is to estimate the probability of each outcome, or of belonging to each class. These three approaches are discussed and compared; and appropriate methods are applied to the Sri Lankan household data. Path analysis is a standard method used to investigate causal relationships among variables in the social sciences. However, the normal multiple regression assumptions under which this method is developed are very restrictive. In this thesis, limitations of path analysis are explored, and alternative loglinear techniques are considered. / Science, Faculty of / Statistics, Department of / Graduate

The issue of child mortality is currently under international spotlight, as the rates of neonatal and under five mortality are sobering. „About 29,000 children under the age of five [approximately] 21 each minute die every day, mainly from preventable causes‟. Although there has been a decline in global child mortality rates since 1990, sub-Saharan Africa still has the highest rates, where one child in eight dies before age five. As contained in the Millennium Development Goals (MDGs) 2010 report, in 2008, sub-Saharan Africa bore half of the 8.8 million deaths in children under five. / Thesis (LLM (Human Rights and Democratisation in Africa))--University of Pretoria, 2012. / http://www.chr.up.ac.za/ / nf2012 / Centre for Human Rights / LLM