Orientadores: José Guilherme Cecatti, Maria Laura Costa do Nascimento / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-11-27T12:19:16Z (GMT). No. of bitstreams: 1 RochaFilho_EdilbertoAlvesPereirada_D.pdf: 3450916 bytes, checksum: 5ca5edfeffaee70f519ed0df55045f08 (MD5) Previous issue date: 2014 / Resumo: Objetivo: Avaliar a ocorrência de complicações graves e óbitos associadas a gravidez ectópica (GE) e a hemorragias ante e intraparto (HAI) e pós-parto (HPP) entre mulheres da Rede Brasileira de Vigilância de Morbidade Materna Grave. Métodos: Estudo de corte transversal multicêntrico realizado em 27 unidades de referência obstétrica no Brasil entre julho de 2009 e junho de 2010. Foi avaliada a ocorrência de condições potencialmente ameaçadoras da vida (CPAV), near miss materno (NMM) e mortes maternas (MM) associadas com GE, HAI e HPP em 9.555 mulheres identificadas como tendo alguma complicação obstétrica. Características sóciodemográficas e obstétricas e o uso de critérios de manejo nestas hemorragias graves também foram avaliados. Foram calculadas as razões de prevalência (RP) com seus respectivos intervalos de confiança de 95% ajustados para o efeito de cluster e análise de regressão logística múltipla para identificar os fatores associados de forma independente com a ocorrência de resultado materno grave (Severe Maternal Outcome - SMO=NMM+MM). Resultados: Das 9.555 mulheres com complicações obstétricas, 312 (3,3%) tiveram complicações por GE, sendo 286 (91,7%) CPAV, 25 (8,0%) NMM e 1 (0,3%) MM. HPP foi a causa principal entre 1192 mulheres (12,5%), sendo 981 CPAV, 181 NMM e 30 MM. HAI ocorreu em 8% (767) das mulheres que experimentam algum tipo de complicação obstétrica e foi responsável por 7,1% (613) dos casos de CPAV, 18,2 % (140) de NMM e 10% (14) das MM. Mulheres com GE complicada tiveram maior risco de transfusão sanguínea, laparotomia e menor risco de admissão em UTI e tempo prolongado de internação do que mulheres com outras complicações. Houve cuidado deficiente ou demoras no atendimento associado a casos de GE complicados. Os fatores associados ao melhor resultado foram uma cicatriz uterina prévia e ser não branca. Entre as mulheres que apresentaram HPP, a idade materna, idade gestacional precoce, cicatriz uterina anterior e cesariana prévia foram os principais fatores associados com maior risco de ocorrência de SMO. Essas mulheres também tiveram uma maior proporção de transfusão sanguínea e retorno para a sala operatória. Já para as que apresentaram HAI, a idade materna e cesariana anterior foram independentemente associadas a este maior risco. Conclusão: O aumento da morbidade materna devido a GE aumentou a conscientização sobre a doença e seu impacto sobre a vida reprodutiva feminina. A hemorragia pós-parto persiste como uma das principais complicações obstétricas e importante causa de morbidade e morte materna no Brasil. O conhecimento dos fatores associados a um maior risco de ocorrência de SMO pode ser útil para melhorar a qualidade da atenção obstétrica e dos resultados maternos. SMO devido a hemorragia ante e intraparto foi altamente prevalente entre as mulheres brasileiras. Alguns fatores de risco, em particular a idade materna e cesareana prévia, foram associados com a ocorrência desta complicação hemorrágica. Os serviços obstétricos devem desenvolver diretrizes e intervenções específicas para prevenir a morbidade materna grave para cada condição hemorrágica obstétrica específica identificada / Abstract: Objective: To evaluate the occurrence of severe obstetric complications associated with ectopic pregnancy (EP) and antepartum or intrapartum (AIH) and postpartum hemorrhage (PPH) among women in the Brazilian Network for the Surveillance of Severe Maternal Morbidity. Methods: A multicenter cross-sectional study conducted in 27 referral obstetric units in Brazil between July 2009 and June 2010. The occurrence of potentially life-threatening conditions (PLTC), maternal near miss (MNM) and maternal death (MD) associated with EP, AIH and HPP were evaluated among 9,555 women identified as having some obstetric complication. Socio demographic and obstetric characteristics and use of management criteria in these severe hemorrhages were also assessed. Prevalence ratios (PR) were calculated with their respective 95% confidence intervals adjusted for the cluster effect and multiple logistic regression analysis to identify factors independently associated with the occurrence of severe maternal outcome (SMO = MNM + MD) . Results: Among the 9,555 women with obstetric complications, 312 (3.3%) had complications due to EP, with 286 (91.7 %) PTLC, 25 (8.0%) MNM and 1 (0.3 %) MD. HPP was the leading cause in 1192 women (12.5 %), with 981 PTLC, 181 MNM and 30 MD. AIH occurred in 8% (767) of women experiencing any type of obstetric complication and accounted for 613 (7.1%) of the PTLC cases, 140 (18.2%) of MNM and 10% (14) of MD. Women with complicated PE had a higher risk of blood transfusion, laparotomy and lower risk of ICU admission and prolonged hospitalization than women with other complications. There was a substandard care or delays associated with cases of complicated EP. The factors associated with a better outcome were a previous uterine scar and to be non-white. Among women who had PPH, maternal age, early gestational age, previous uterine scar and previous cesarean delivery were the main factors associated with a risk of SMO. These women also had a higher proportion of blood transfusion and return to operating room. For those who had AIH, maternal age and previous cesarean section were independently associated with this increased risk. Conclusion: Increased maternal morbidity due to EP raised awareness about the condition and its impact on female reproductive life. Postpartum hemorrhage persists as one of the main obstetric complication and important cause of maternal morbidity and mortality in Brazil. The knowledge of factors associated with a severe maternal outcome (SMO=MNM+MD) could be useful for improving the quality of obstetric care and maternal outcomes. SMO due to antepartum and intrapartum hemorrhage was highly prevalent among Brazilian women. Some risk factors, maternal age and prior cesarean delivery in particular, were associated with the occurrence of this hemorrhagic complication. Care providers should develop specific guidelines and interventions to prevent severe maternal morbidity for each specific obstetric hemorrhagic condition identified / Doutorado / Saúde Materna e Perinatal / Doutor em Ciências da Saúde

Submitted by (lucia.rodrigues@ufrpe.br) on 2017-03-10T15:16:59Z No. of bitstreams: 1 Erlen Keila Candido e Silva.pdf: 1861555 bytes, checksum: 78cac91a8beeeaf115c4336a93a9a4bd (MD5) / Made available in DSpace on 2017-03-10T15:16:59Z (GMT). No. of bitstreams: 1 Erlen Keila Candido e Silva.pdf: 1861555 bytes, checksum: 78cac91a8beeeaf115c4336a93a9a4bd (MD5) Previous issue date: 2008-02-29 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / The cowpea, it plays important economical-social in the agriculture of the areas North and Northeast of Brazil. The Northeast is the largest Brazilian producer, where it is used broadly in the human feeding to the detriment of the common bean. Approximately 60% of thetotal area of bean in the Northeast are cultivated with cowpea. The culture generates 2,4 million direct jobs and it supplies the table of 27,5 million Northeasterners, what accredits theculture to receive support of the fomentation organs to the research.In the Brazilian Northeast, the mosaic,provoked by virus, due to the frequency and severity with that happen, they blunt as the most important diseases, being constituted in factor limitiong of the production. Among the viral illnesses, the severe mosaic of the cowpea, caused by Cowpea severe mosaic virus (CPSMV) it is responsible for losses of the order 60% to 100%. This way, the present study had for objectives determine the inheritance of the resistance and identify associated markers with resistance. The individuals' selection F2 to CPSMV was accomplished through inoculation with extract vegetable and the behavior of the population of the cowpea for observation symptoms and qui-square test. The selection of primers polymorphic was accomplished by the analysis of bulkers segregant (BSA). Primers potentially associated with resistance or susceptibility to CPSMV were evaluated in the population segregant. Of hte 85 primers tested, the primer VM 70 proved to be co-segregating with. This marker primers represents a new tool to assist in obtaining resistant cultivars, faster, accorate and economical in the analysis of the diagnosis of the virus of the severe mosaic it was verified that the technique of RT-PCR, comes as a fast and efficient method / O feijão-caupi, desempenha importante papel econômico-social na agricultura das regiões Norte e Nordeste do Brasil. O Nordeste é o maior produtor brasileiro, onde é largamente utilizado na alimentação humana em detrimento do feijão comum.Aproximadamente 60% da área total de feijão no Nordeste é cultivada com feijão-caupi. A cultura gera 2,4 milhões de empregos diretos e abastece a mesa de 27,5 milhões de nordestinos, o que credencia a cultura para receber apoio dos órgãos de fomento à pesquisa. No Nordeste brasileiro, os mosaicos, provocados por vírus, devido à frequência e severidade com que ocorrem, despontam como as doenças mais importantes, constituindo-se em fator limitante à produção. Dentre as viroses, o mosaico severo do feijão-caupi, causado pelo Cowpea severe mosaic virus (CPSMV) é responsável por perdas da ordem de 60% a 100%.Desta forma, o presente estudo teve por objetivos determinar a herança da resistência e identificar marcadores associados a resistência. A fenotipagem de indivíduos F2 resistentes aoCPSMV foi realizada através de avaliações dos sintomas após inoculação destas com extrato vegetal tamponado contendo vírus e o comportamento da população do feijão-caupi por observações sintomatológicas e teste de X. Nas análises moleculares, a seleção de primers potencialmente associados a resistência ou suscetibilidade ao CPSMV foram avaliados na população segregante. Dos 85 primers VM 70 mostrou-se co-segregando com a resistência. este marcador representa uma nova ferramenta que auxiliará na obtenção de cultivares resistentes de maneira mais rápida e econômica.Na análise diagnóstico do vírus do mosaico severo constatou-se que a técnica de RT-PCR, apresenta-se como um método rápido e eficiente.

Os mecanismos do desgaste e atrito que ocorrem durante o desgaste por deslizamento, bem como, a transição do regime do desgaste moderado para o desgaste severo, são influenciados pela força aplicada, rugosidade, temperatura e umidade, sendo estas variáveis frequentemente estudadas. Entretanto, a avaliação da remoção de debris durante o deslizamento e a influência do aditivo lubrificante, em regime limítrofe/quase seco (e.g. Ácido Esteárico C18H32O2) ainda são necessários maiores entendimentos sobre os mecanismos de desgaste e também a força na qual ocorre a transição do regime do desgaste moderado para o desgaste severo durante o deslizamento. Para os testes a seco, com e sem a remoção dos debris, foram realizados ensaios tribológicos convencionais com as duas durezas de disco, 435 e 530 HV30. Os resultados mostraram que a transição do regime de desgaste é influenciada pela dureza e pela remoção dos debris. A influência da dureza é observada apenas quando os ensaios convencionais são realizados, nos quais foi observado que o aumento da dureza do contra corpo estende a transição do desgaste moderado para o severo em forças maiores. A remoção dos debris aumenta a extensão da força para ocorrer a transição moderado/severo. Para os testes lubrificados, foram realizados ensaios com a dureza de disco de 530 HV, variando a concentração do ácido esteárico. Os resultados mostram que o aumento da concentração do aditivo e da força normal aplicada são varáveis determinantes para a redução do coeficiente de atrito. A ação do aditivo lubrificante é fundamental nas forças baixas, sendo que nas forças elevadas apenas o aumento da força normal é suficiente para manter o baixo coeficiente de atrito. Adicionalmente, para as elevadas forças aplicadas, o filme lubrificante falha em função do tempo de deslizamento, e maiores concentrações de aditivo são necessárias para manter o coeficiente de atrito constante. / The wear and friction mechanisms that occur during the sliding wear, as well as the transition from mild to severe wear regimes are influenced by the normal load applied, roughness, temperature and humidity, the variables more frequently studied. However, the assessment of debris removal during the sliding wear and oil influence with lubricant additive (e.g. Stearic Acid C18H32O2) in the boundary/dry lubrication needs further understanding of the mechanisms and the load that occur a wear transition from mild to severe wear. The aim in this work is the characterization and evaluation the contact surface without debris in sliding surface (cleaning of the wear track) and the wear surface in boundary lubrication tests. The materials studied are: the pin AISI 4140 - 435 HV30 steel and the disc AISI H13 - 435 e 530 HV30 steel. Firstly were made conventional tribological tests with two disc hardness. Then, tests with the cleaning of the wear track were made. The results showed that the hardness and the absence of debris influence in the wear transition regime. The hardness influence is observed only when the conventional tests were made. When the counter body hardness increased, the transition from mild to severe wear extends to greater loads. The debris influence was evidenced in tests with the cleaning of the wear track, and showed that greater loads are needed from mild to severe wear transition. For the lubricated tests, the hardness of the disk was 530 HV. The results shown that the concentration of the lubricant additive and the normal load applied are determinant variables to decreasing the friction coefficient. The lubricant additive action is critical in low loads, and in high loads only the increasing of the load is needed to maintain the low friction. In addition, in the high load applied, the failure of the lubricant film occurs with the increase of the sliding time, and higher additive concentrations are needed to maintain constant the friction coefficient.

Submitted by Maria Aparecida (cidazen@gmail.com) on 2017-04-18T14:10:47Z No. of bitstreams: 1 José de Jesus Dias.pdf: 4056526 bytes, checksum: 6dcac9eac4643fe488fb8d737b838031 (MD5) / Made available in DSpace on 2017-04-18T14:10:47Z (GMT). No. of bitstreams: 1 José de Jesus Dias.pdf: 4056526 bytes, checksum: 6dcac9eac4643fe488fb8d737b838031 (MD5) Previous issue date: 2017-01-27 / In Brazil, the severe dengue cases have increased since2001. However, in children under 15 years, this trend began in 2007, mainly in the northeast of country. In Maranhão the first records of severe dengue date back to 2002. The objective of this research was to analysis prevalence of severe dengue for age group and its possible associated factors. It is treated of ecologic study of dengue cases confirmed the National Mandatory Reporting System (SINAN) from 2002 to 2011 in São Luís, Maranhão, Brazil. The diagnosis and dengue classification were based on the criteria of the Brazilian Ministry of Health, dengue fever, dengue hemorrhagic fever and dengue with complications. It was considered as severe dengue: dengue hemorrhagic fever and dengue with complications and as not severe dengue: dengue fever. We conducted logistic regression analysis, with the severe dengue outcome. During the period studied, 1,229 cases of severe dengue were confirmed; 812 of these were children under fifteen years (66%). Among the risk factors evaluated, being less than 15 years was associated with severe dengue (OR = 3.10, CI = 2.69-3.57; p-value = 0.001) as well as identifying as white (OR = 1.35, CI = 1.14-1.60; p-value = 0.001). The prevalence of severe dengue in children under fifteen years was high and only the group below the age of fifteen and white were associated with the occurrence of severe dengue. / No Brasil, os casos graves de dengue aumentaram a partir de 2001. No entanto, em menores de 15 anos, essa tendência teve início em 2007, principalmente no nordeste do país. No Maranhão os primeiros registros de casos graves de dengue remontam a 2002. O objetivo dessa pesquisa foi analisar a prevalência de casos de dengue grave por faixa etária e os possíveis fatores associados. Trata-se de estudo ecológico de casos de dengue em residentes de São Luís, Maranhão, Brasil, confirmados no Sistema de Informação de Agravos de Notificação (SINAN) de 2002 a 2011. O diagnóstico e a classificação de dengue foram baseados nos critérios do Ministério da Saúde, dengue clássica, febre hemorrágica da dengue e dengue com complicações. Considerou-se como dengue grave: febre hemorrágica da dengue e dengue com complicações e como dengue não grave: dengue clássica. Realizou-se análise de regressão logística, tendo como desfecho dengue grave. No período estudado confirmaram-se 1.229 casos de dengue grave; destes, 812 eram menores de quinze anos (66%). Dentre os fatores de risco avaliados, ter idade inferior a 15 anos foi associado à dengue grave (OR=3,10; IC=2,69-3,57; pvalor = 0,001) e ser da raça branca (OR=1,35; IC=1,14-1,60; p-valor = 0,001). A prevalência de dengue grave em menores de quinze anos foi elevada e apenas a faixa etária menor de quinze anos e raça branca estiveram associadas à ocorrência de dengue grave.

As experiências de tratamento no campo da saúde mental infantil com crianças com distúrbios graves, atualmente existentes no país, carecem de avaliações mais precisas de seus modelos clínicos e institucionais para examinar sua efetividade e propiciar a indicação de parâmetros mais detalhados para as exigências desse campo. Esta pesquisa se desenvolveu a partir do trabalho de supervisão dos atendimentos de crianças com distúrbios graves, orientados pela psicanálise Freud-lacaniana, desenvolvido em uma clínica-escola de uma Universidade particular de Psicologia da Bahia. Adotou-se como estratégia clínica a inclusão da escuta a pais e crianças, em sessões separadas, pelo mesmo estagiário de psicologia. A questão central desta pesquisa é apontar que esse dispositivo pode ser implementado e desenvolvido na clínica-escola com esses estagiários. Foram apresentados e discutidos fragmentos de um atendimento clínico, selecionados em função de terem sido os desencadeadores das principais observações e questões clínico-teóricas abordadas. Analisa-se que uma intervenção na loucura a dois que se instala na relação mãe e criança deve ser feita e tem a eficácia de permitir que o traço nomeador da criança se escreva ou acabe de ser escrito. Dessa forma, a separação é o processo visado nessa proposição de trabalho que busca desalojar a criança do lugar de objeto incluído no Outro, e do qual ela condensa o gozo, fazendo surgir um sujeito. Acentua-se que é o trabalho com o significante que permite a quebra da repetição, possibilitando ao sujeito, em uma nova temporalidade, se posicionar ante os significantes que o marcaram. A pesquisa revela sua relevância científica e social, na medida em que indica ser possível a implementação do dispositivo psicanalítico proposto numa clínica-escola de Psicologia, o que aumenta os espaços de atendimento de crianças com distúrbios graves no campo da saúde mental / Current treatment experiences in the field of children\'s mental health for children with severe disorders, in our country, lack of more accurate evaluations of clinical and institutional models to be able to examine their effectiveness and to provide an indication for more detailed parameters for the requirements in this field. This research was developed from clinical supervision of the work with children with severe disorders based on Freud-lacanians psychoanalyses implemented in a psychology school-clinic of a private university at Bahia. We adopted as a clinical strategy the inclusion of psychoanalytic listening to parents and their children, in separate sessions by the same psychology intern. The central contention of this research is that this therapeutic device can be implemented and developed in school-clinic with this interns. Fragments of sessions from a clinic consultation were presented and discussed. These fragments were selected because they trigged the main observations of the clinical and theoretical issues addressed. Our analysis found that an intervention in the shared psychotic disorder in the relationship of mother and child should be made and this is effective in allowing the nominator trace of the child to be written or the writing to be finished. These separation is the main objective of this proposed process, that seeks to change the child from being an object included in another person, in whom she condenses all her jouissance, to a subject in and of itself. We stress that working with the signifier allows them to break the repetition circle, enabling the subjects, in a new temporality, to position themselves before the signifier who has marked them. This research reveals its scientific and social relevance as it indicates that is possible to implement psychoanalytic treatment device in a psychology clinical-school which increases the attendance spaces for children with severe disorders

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No description available.

This research analyzed all available hearings from 2013 to 2015 in a national database of due process hearings regarding placement issues and determinations of the least restrictive environment for individual students with significant disabilities. The main research question was whether parents/guardians and due process hearing officers sought placements for these children with significant disabilities that considered creatively and holistically a range of options rather than just a dialogue between already extant possible programmatic offerings. The research resulted in a description and taxonomy of the types of issues and factors arising in the hearings for students with significant disabilities from 2013 to 2015. This research shows almost no evidence of creative or holistic thinking in these due process decisions, and there was little evidence of parent advocacy for general education classes and creative options for their students with significant disabilities beyond existing offerings. The most unique placements to be found in public school settings for these students were in general education classes. Twenty-four students in this analysis were offered general education classes with their typically achieving peers. In general, though, for this unique group of students with significant disabilities, very few due process hearings could be found to have demonstrated creativity, or the consideration of holistic options, for such students. In general, in due process hearings for students with significant disabilities from 2013 to 2015, parents were overwhelming advocating for, and due process hearing officers were deciding among, options on the continuum of placements already traditionally considered for students with significant disabilities.

This study investigated the effect of geographic location on Severe Early Childhood Caries (S-ECC) in Native American Children three years of age from a Norther Plains Tribal Community. Geographic location of study participants was ascertained by postal district and categorized into geographic regions as well as dental clinic accessibility, defined as dental services present or absent in that district. The association of location category and dental caries (dmfs) was evaluated cross-sectionally at 36 months of age. Descriptive statistics demonstrated differences in dental caries distribution by geographic region and accessibility category. Bivariate analysis of disease by location showed a significant difference in dmfs between 4 geographic regions (p=0.0159) but not between accessibility categories (p=0.0687). Multivariable regression modeling for geographic region demonstrated the unique effect of geographic region on dental caries experience as well as five other key risk factors. Incident Rate Ratios (IRR) were computed for each of the risk factors, including number of erupted teeth (IRR=1.89, p=0.0147), fluoride exposure from tap water (IRR=1.70, p=0.0173), annual family income (IRR=1.58, p=0.0392), maternal DMFS (IRR=1.02, p=0.0040), and Mean Adequacy Ratio (IRR=1.05, p=0.1042). This study demonstrated statistically significant variation in cumulative dental caries experience of Native American children aged 36 months among geographic regions and identified the specific unites of association through multivariate modeling. These findings can be used for local dental caries prevention programs and contribute to a broader understanding of S-ECC among very young Native American children.

The purpose of the study was to evaluate the effectiveness of teaching a picture communication system to students with moderate to severe disabilities using the PECS Phase III application. A multiple probe across participants design was used to conduct the study and evaluate the effectiveness of the training on the PECS Phase III application. The results of the study demonstrated that teaching a picture communication system on an augmentative and alternative communication device is effective in the school setting with young adults with moderate and severe disabilities.