Food historians have revealed that what constituted a working-class British woman's diet in the nineteenth century was quite different in calorific and nutritional content from what her family consumed. This work explores the nineteenth-century maternal diet and the effect this nutritional inequality had on the health of women and their infants. Divided into three sections, this dissertation deals with different aspects of nineteenth-century maternal nutrition. Section one explores the nineteenth-century medical understanding of diet, as well as the influences of class and traditional beliefs on eating habits, and how these factors determined the diet prescribed to mothers during pregnancy. Section two investigates the factors that perpetuated the unequal distribution and consumption of food within households. Factors explored include regional variations in working-class diet; gender associations with foods; economic changes in material wealth and expectations, and the pressures of respectability on female food denial. This section concludes that food refusal and unequal distribution were reinforced throughout the long nineteenth century because these behaviours appeared to have value, real or imagined, as long-term economic strategies. Food refusal maintained respectability, and helped women secure an economic support network. Mothers' self-denial seems to have secured the economic loyalties of children, making her the recipient of their income. The final section addresses how deprivation and dietary changes affected infant and maternal health, specifically examining how insufficient vitamin D and rickets influenced birth outcomes, and how the switch from a rural diet to an urban diet contributed to a rise in neural tube disorders in Wales. The analysis of childbirth data revealed a significant correlation between rickets and childbirth complications. The findings of this section also suggest that the dietary changes that followed migration and the change from an agricultural lifestyle to a market-integrated, industrial lifestyle for a majority of the Welsh population reduced women's intake of folic acid leaving their children susceptible to neural tube disorders.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2007. / Background: Various congenital spinal anomalies are common findings in the general population. Their clinical significance is controversial with no definitive association been made between any specific congenital spinal anomaly to any clinical features. Project Design: This research study was designed in the form of a quantitative, non-experimental, empirical clinical survey. Method: Data was obtained from thoracic and lumbar spine radiographs contained in the Chiropractic Day Clinic at the Durban University of Technology from 1 January 1997 to 31 December 2005 and from the corresponding patient files. Through the research procedure, 519 thoracic and lumbar spine radiographs were located in the confines of the Chiropractic Day Clinic. Due to the exclusion criteria of a past or present history of trauma to the thoracic or lumbar spine areas, 147 radiographs were excluded. Objectives 1.To determine the period prevalence (1 January 1997 – 31 December 2005) of congenital thoracic and lumbar spine anomalies. 2.To determine if there is any association between the presenting clinical features and the congenital thoracic and lumbar spine anomalies in general. 3.To determine if there is any association between the presenting clinical features and individual congenital thoracic and lumbar spine anomalies. 4.To compare subjects presenting clinical features with reported clinical features from literature. / M

Introdução: Pacientes com mielomeningocele apresentam elevada mortalidade e desenvolvem déficits neurológicos que ocorrem, primariamente, pelo desenvolvimento anormal da medula e de raízes nervosas e, secundariamente, por complicações adquiridas no período pós-natal. O desafio no cuidado desses pacientes é o reconhecimento precoce dos recém-nascidos de risco para evolução desfavorável a fim de estabelecer estratégias terapêuticas individualizadas. Objetivo: Este estudo tem como objetivo identificar marcadores prognósticos de curto prazo para recém-nascidos com mielomeningocele. As características anatômicas do defeito medular e da sua correção neurocirúrgica foram analisadas para esta finalidade. Métodos: Foi realizado um estudo de coorte retrospectiva com 70 pacientes com mielomeningocele em topografia torácica, lombar ou sacral nascidos entre janeiro de 2007 a dezembro de 2013 no Centro Neonatal do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Pacientes com infecção congênita, anomalias cromossômicas e outras malformações maiores não relacionadas à mielomeningocele foram excluídos da análise. As características anatômicas da mielomeningocele e a sua correção neurocirúrgica foram analisadas quanto aos seguintes desfechos: reanimação neonatal, tempo de internação, necessidade de derivação ventricular, deiscência da ferida operatória, infecção da ferida operatória, infecção do sistema nervoso central e sepse. Para a análise bivariada dos desfechos qualitativos com os fatores de interesse foram empregados testes do qui-quadrado e exato de Fisher. Para a análise do desfecho quantitativo, tempo de internação hospitalar, foram empregados testes de Mann-Whitney. Foram estimados os riscos relativos e os respectivos intervalos com 95% de confiança. Foram desenvolvidos modelos de regressão linear múltipla para os desfechos quantitativos e regressão de Poisson para os desfechos qualitativos. Resultados: Durante o período do estudo 12.559 recém-nascidos foram admitidos no Centro Neonatal do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Oitenta pacientes foram diagnosticados com mielomeningocele, com incidência de 6,4 casos para cada 1.000 nascidos vivos. Dez pacientes foram excluídos da análise devido à mielomeningocele em topografia cervical (n = 1), à cardiopatia congênita (n = 4), à trissomia do cromossomo 13 (n = 1), à onfalocele (n = 3) e à encefalocele (n = 1). Ocorreram três óbitos (4,28%). Mielomeningocele extensa foi associada a infecção do sistema nervoso central, a complicação de ferida operatória e a maior tempo de internação hospitalar. Os pacientes com mielomeningocele em topografia torácica apresentaram tempo de internação, em média, 39 dias maior que aqueles com defeito em topografia lombar ou sacral. Houve maior necessidade de reanimação em sala de parto entre os pacientes com macrocrania ao nascer. A correção cirúrgica realizada após 48 horas de vida aumentou em 5,7 vezes o risco de infecção do sistema nervoso central. Entre os pacientes operados nas primeiras 48 horas de vida não foi observado benefício adicional na correção cirúrgica realizada em \"tempo zero\". A ausência de hidrocefalia antenatal foi um marcador de bom prognóstico. Nestes pacientes, a combinação dos desfechos necessidade de derivação ventricular, complicações infecciosas, complicações de ferida operatória e reanimação em sala de parto foi 70% menos frequente. Conclusão: Este estudo permitiu identificar marcadores prognósticos de curto prazo em recém-nascidos com mielomeningocele. Os defeitos medulares extensos e a correção cirúrgica após 48 horas de vida influenciaram negativamente na evolução de curto prazo. As lesões extensas foram associadas a maiores taxas de infecção do sistema nervoso central, a complicações de ferida operatória e a internação hospitalar prolongada. A correção cirúrgica realizada após 48 horas de vida aumentou significativamente a ocorrência de infecção do sistema nervoso central. Ausência de hidrocefalia antenatal foi associada a menor número de complicações nos primeiros dias de vida / Introduction: Patients with myelomeningocele have a high mortality and develop neurological disabilities that occur primarily by a defective spinal cord and nerve root development and, secondarily, by acquired post-natal complications. The challenge in the post-natal management of myelomeningocele is the early recognition of cases at risk for complications in order to establish individualized treatment strategies. Objective: This study aims to identify short-term prognostic markers for newborns with myelomeningocele. Anatomical characteristics of the spinal defect and technical aspects of the neurosurgical repair were analyzed for this purpose. Methods: A retrospective cohort study was conducted in 70 patients with thoracic, lumbar or sacral myelomeningocele born between January 2007 and December 2013 in the Centro Neonatal do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Patients with congenital infection, chromosomal abnormalities and other major malformations unrelated to myelomeningocele were excluded from our analysis. Features of myelomeningocele anatomy and neurosurgical treatment were analyzed for the following outcomes: neonatal resuscitation, length of hospital stay, need for ventricular shunt, wound dehiscence, wound infection, central nervous system infection and sepsis. Relationships between qualitative outcomes and factors of interest were examined using chi-square or Fisher\'s exact tests. The relationships with the quantitative outcome duration of hospital stay were evaluated using the Mann-Whitney tests. Relative risks were estimated with 95% confidence intervals. Multivariate linear regression was used to evaluate the quantitative outcomes and a Poisson regression model was used for the qualitative outcomes. Results: During the study period a total of 12,559 neonates were born in Centro Neonatal do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Eighty patients were diagnosed with myelomeningocele resulting in an incidence of 6.4 cases per 1000 live births. Ten patients were excluded from our analysis due to cervical myelomeningocele (n = 1), congenital heart disease (n = 4), trisomy 13 (n = 1), omphalocele (n = 3) and encephalocele (n = 1). Three deaths were observed in the study period (4,28%). Large myelomeningocele was associated with central nervous system infection, wound complications and longer hospital stay. Patients with thoracic myelomeningocele required longer hospital stay, on average 39 days longer when compared to patients with lumbar or sacral defects. There was a positive correlation between the need for resuscitation at the delivery room and the presence of macrocrania at birth. Late surgical repair performed after 48 hours of life increased in 5.7 times the risk of central nervous system infection. Among patients operated within the first 48 hours, no additional benefit in interventions held in \"time zero\" was observed. Absence of antenatal hydrocephalus was a favorable prognostic marker. In these cases, the combination of need for ventricular drainage, sepsis, central nervous system infection, complications of surgical site and intervention in the delivery room were 70% lower. Conclusion: This study allowed us to identify short-term prognostic markers for newborns with myelomeningocele. Extensive spinal cord defect and surgical repair after 48 hours of life negatively influenced short-term outcomes. Extensive lesions were associated with higher rates of central nervous system infections, surgical wound complications and prolonged hospital stay. Interventions performed 48 hours after birth significantly increased occurrence of central nervous system infections. Absence of antenatal hydrocephalus was associated with fewer complications in the first days of life

Introdução: Pacientes com mielomeningocele apresentam elevada mortalidade e desenvolvem déficits neurológicos que ocorrem, primariamente, pelo desenvolvimento anormal da medula e de raízes nervosas e, secundariamente, por complicações adquiridas no período pós-natal. O desafio no cuidado desses pacientes é o reconhecimento precoce dos recém-nascidos de risco para evolução desfavorável a fim de estabelecer estratégias terapêuticas individualizadas. Objetivo: Este estudo tem como objetivo identificar marcadores prognósticos de curto prazo para recém-nascidos com mielomeningocele. As características anatômicas do defeito medular e da sua correção neurocirúrgica foram analisadas para esta finalidade. Métodos: Foi realizado um estudo de coorte retrospectiva com 70 pacientes com mielomeningocele em topografia torácica, lombar ou sacral nascidos entre janeiro de 2007 a dezembro de 2013 no Centro Neonatal do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Pacientes com infecção congênita, anomalias cromossômicas e outras malformações maiores não relacionadas à mielomeningocele foram excluídos da análise. As características anatômicas da mielomeningocele e a sua correção neurocirúrgica foram analisadas quanto aos seguintes desfechos: reanimação neonatal, tempo de internação, necessidade de derivação ventricular, deiscência da ferida operatória, infecção da ferida operatória, infecção do sistema nervoso central e sepse. Para a análise bivariada dos desfechos qualitativos com os fatores de interesse foram empregados testes do qui-quadrado e exato de Fisher. Para a análise do desfecho quantitativo, tempo de internação hospitalar, foram empregados testes de Mann-Whitney. Foram estimados os riscos relativos e os respectivos intervalos com 95% de confiança. Foram desenvolvidos modelos de regressão linear múltipla para os desfechos quantitativos e regressão de Poisson para os desfechos qualitativos. Resultados: Durante o período do estudo 12.559 recém-nascidos foram admitidos no Centro Neonatal do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Oitenta pacientes foram diagnosticados com mielomeningocele, com incidência de 6,4 casos para cada 1.000 nascidos vivos. Dez pacientes foram excluídos da análise devido à mielomeningocele em topografia cervical (n = 1), à cardiopatia congênita (n = 4), à trissomia do cromossomo 13 (n = 1), à onfalocele (n = 3) e à encefalocele (n = 1). Ocorreram três óbitos (4,28%). Mielomeningocele extensa foi associada a infecção do sistema nervoso central, a complicação de ferida operatória e a maior tempo de internação hospitalar. Os pacientes com mielomeningocele em topografia torácica apresentaram tempo de internação, em média, 39 dias maior que aqueles com defeito em topografia lombar ou sacral. Houve maior necessidade de reanimação em sala de parto entre os pacientes com macrocrania ao nascer. A correção cirúrgica realizada após 48 horas de vida aumentou em 5,7 vezes o risco de infecção do sistema nervoso central. Entre os pacientes operados nas primeiras 48 horas de vida não foi observado benefício adicional na correção cirúrgica realizada em \"tempo zero\". A ausência de hidrocefalia antenatal foi um marcador de bom prognóstico. Nestes pacientes, a combinação dos desfechos necessidade de derivação ventricular, complicações infecciosas, complicações de ferida operatória e reanimação em sala de parto foi 70% menos frequente. Conclusão: Este estudo permitiu identificar marcadores prognósticos de curto prazo em recém-nascidos com mielomeningocele. Os defeitos medulares extensos e a correção cirúrgica após 48 horas de vida influenciaram negativamente na evolução de curto prazo. As lesões extensas foram associadas a maiores taxas de infecção do sistema nervoso central, a complicações de ferida operatória e a internação hospitalar prolongada. A correção cirúrgica realizada após 48 horas de vida aumentou significativamente a ocorrência de infecção do sistema nervoso central. Ausência de hidrocefalia antenatal foi associada a menor número de complicações nos primeiros dias de vida / Introduction: Patients with myelomeningocele have a high mortality and develop neurological disabilities that occur primarily by a defective spinal cord and nerve root development and, secondarily, by acquired post-natal complications. The challenge in the post-natal management of myelomeningocele is the early recognition of cases at risk for complications in order to establish individualized treatment strategies. Objective: This study aims to identify short-term prognostic markers for newborns with myelomeningocele. Anatomical characteristics of the spinal defect and technical aspects of the neurosurgical repair were analyzed for this purpose. Methods: A retrospective cohort study was conducted in 70 patients with thoracic, lumbar or sacral myelomeningocele born between January 2007 and December 2013 in the Centro Neonatal do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Patients with congenital infection, chromosomal abnormalities and other major malformations unrelated to myelomeningocele were excluded from our analysis. Features of myelomeningocele anatomy and neurosurgical treatment were analyzed for the following outcomes: neonatal resuscitation, length of hospital stay, need for ventricular shunt, wound dehiscence, wound infection, central nervous system infection and sepsis. Relationships between qualitative outcomes and factors of interest were examined using chi-square or Fisher\'s exact tests. The relationships with the quantitative outcome duration of hospital stay were evaluated using the Mann-Whitney tests. Relative risks were estimated with 95% confidence intervals. Multivariate linear regression was used to evaluate the quantitative outcomes and a Poisson regression model was used for the qualitative outcomes. Results: During the study period a total of 12,559 neonates were born in Centro Neonatal do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Eighty patients were diagnosed with myelomeningocele resulting in an incidence of 6.4 cases per 1000 live births. Ten patients were excluded from our analysis due to cervical myelomeningocele (n = 1), congenital heart disease (n = 4), trisomy 13 (n = 1), omphalocele (n = 3) and encephalocele (n = 1). Three deaths were observed in the study period (4,28%). Large myelomeningocele was associated with central nervous system infection, wound complications and longer hospital stay. Patients with thoracic myelomeningocele required longer hospital stay, on average 39 days longer when compared to patients with lumbar or sacral defects. There was a positive correlation between the need for resuscitation at the delivery room and the presence of macrocrania at birth. Late surgical repair performed after 48 hours of life increased in 5.7 times the risk of central nervous system infection. Among patients operated within the first 48 hours, no additional benefit in interventions held in \"time zero\" was observed. Absence of antenatal hydrocephalus was a favorable prognostic marker. In these cases, the combination of need for ventricular drainage, sepsis, central nervous system infection, complications of surgical site and intervention in the delivery room were 70% lower. Conclusion: This study allowed us to identify short-term prognostic markers for newborns with myelomeningocele. Extensive spinal cord defect and surgical repair after 48 hours of life negatively influenced short-term outcomes. Extensive lesions were associated with higher rates of central nervous system infections, surgical wound complications and prolonged hospital stay. Interventions performed 48 hours after birth significantly increased occurrence of central nervous system infections. Absence of antenatal hydrocephalus was associated with fewer complications in the first days of life

Myelomeningocele (MM) is a disease that causes motor and sensitive disabilities. Health problems associated to this condition may lead mothers the main caregivers to situations of stress, anxiety and depression that may impair their health-related quality of life (HRQL). The aim of this study was to assess the HRQL of mothers of children and adolescents with MM in comparison to mothers of healthy controls and to observe its association with clinical and demographic variables of patients and mothers. The study group consisted of 50 mothers of children and adolescents with MM under 18 years of age in treatment at the Associação de Assistência à Criança Deficiente (AACD-MG). Mothers of healthy controls were matched by patients gender and age in the proportion of 2:1. Patients were grouped by level of neurological lesion and status of functional ambulation. Clinical and demographic data were obtained by interview and medical records. The HRQL of mothers was assessed by interview through the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). SF-36 reliability was evaluated by Cronbach s alpha coefficient. The Beck Depression Inventory (BDI) was self-applied to assess depressive symptoms. SF-36 scores were compared between groups of mothers of patients with MM and controls (Mann-Whitney test). Effect sizes (ES) were calculated to measure the m agnitude of significant differences. Clinical and demographic variables were compared (Mann-Whitney and Kruskal-Wallis tests) and correlated (Spearman correlation coefficient) with SF-36 scores. Mothers median age was 35.9 years (study group) and 33.5 years (control group). The median age of children with MM was 6.0 years. Most of the group consisted of children (90.0%), females (58.0%) and patients with lower lumbar neurological lesion (50.0%), non-ambulators (44.0%). Cronbach s alpha ranged from 0.6 to 0.8 for the SF-36 domains and components. In comparison to mothers of healthy controls, mothers of children/adolescents with MM had significantly lower scores in the physical component and in three SF-36 domains: role limitations due to physical problems, global health and role limitations due to social problems (p<0.05). Effect size was large (ES>0.8) in the following domains: role limitations due to physical problems and role limitations due to social problems. There was no difference in SF-36 scores according to patients level of neurological lesion and functional ambulation status (p>0.05). Among all patients and mothers clinical and demographic variables, patients gender (female), catheterization and presence of chronic disease in mothers were associated to impaired HRQL (p<0.05). The intensity of depressive symptoms was correlated to all domains and components of the SF-36 (p<0.05). In conclusion, mothers of children and adolescents with MM had a mental and mostly physical impairment in their HRQL in comparison to mothers of healthy controls. The impact was similar among the different levels of neurological lesion or functional ambulation status. Few associations were found among other clinical and demographic variables. / A Mielomeningocele (MM) ocasiona dificuldades motoras e sensitivas. Os diversos problemas de saúde associados a essa condição podem gerar na mãe, principal cuidador, estresse, ansiedade, preocupação excessiva, depressão e impactar sua qualidade de vida relacionada à saúde (QVRS). Diante disso, este estudo teve como objetivo avaliar a QVRS de mães de crianças/adolescentes com MM em relação às mães de crianças/adolescentes saudáveis, e verificar a sua associação com variáveis clínicas e demográficas dos pacientes e das mães. Participaram do estudo 50 mães de crianças e adolescentes até 18 anos de idade e diagnóstico de MM, em acompanhamento na Associação de Assistência à Criança Deficiente (AACD-MG) e mães de crianças e adolescentes saudáveis, pareadas por sexo e idade dos pacientes na proporção de 2:1. Os pacientes foram classificados em grupos segundo o nível de lesão neurológica e padrão de deambulação. Os dados demográficos e clínicos foram obtidos por entrevista e completados com informações contidas no prontuário médico. A QVRS das mães foi avaliada por meio de entrevista pelo Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) e a confiabilidade foi verificada pelo coeficiente de alfa Cronbach. O Inventário de Depressão de Beck (IDB) foi respondido de maneira auto-aplicada para verificar os sintomas depressivos. Os escores do SF-36 foram comparados entre os grupos de mães de pacientes com MM e controle (teste de Mann-Whitney), o tamanho do efeito (T.E) foi calculado para medir a magnitude das diferenças significativas. As variáveis demográficas e clínicas foram comparadas (teste de Mann-Whitney e Kruskal-Wallis) e correlacionadas (coeficiente de correlação de Spearman) com os escores do SF-36. A mediana de idade das mães de crianças/adolescentes com MM foi de 35,9 anos e no controle de 33,5 anos. Em relação às crianças/adolescentes com MM, a mediana das idades foi de 6,0 anos, com predomínio de crianças (90,0%) e do sexo feminino (58,0%). Houve predomínio do nível de lesão neurológica lombar baixo (50%) e não deambulador (44%). O coeficiente de alfa Cronbach.variou de 0,6 a 0,8 para os domínios e componentes do SF-36. As mães de crianças/adolescentes com MM obtiveram escores do SF-36 significativamente menores no componente físico e em 3 domínios: aspectos físicos, estado geral de saúde e aspectos sociais (p<0,05). O tamanho do efeito foi grande (T.E&#8805;0,8) nos domínios aspectos físicos e aspectos sociais. Não ocorreu diferença entre os pacientes segundo o nível de lesão neurológica e o padrão de deambulação (p>0,05). Dentre as variáveis demográficas e clínicas das mães e pacientes avaliadas, houve associação com prejuízo na QVRS das mães segundo, sexo do paciente (feminino), realização do cateterismo e presença de doença crônica nas mães (p<0,05). A intensidade de sintomas depressivos correlacionou-se com todos os domínios e componentes do SF-36, sendo a variável que mais se associou com os escores do SF-36 (p<0,05). Concluiu-se que mães de crianças/adolescentes com MM apresentam prejuízo mental e principalmente físico na QVRS em comparação às mães de crianças/adolescentes saudáveis. O impacto foi semelhante entre os diferentes níveis de lesão ou padrões de deambulação. Poucas associações foram encontradas entre as outras variáveis demográficas e clínicas analisadas. / Mestre em Ciências da Saúde

Submitted by Renata Lopes (renatasil82@gmail.com) on 2017-03-29T18:19:17Z No. of bitstreams: 1 ricardocampelodaconceicao.pdf: 3005415 bytes, checksum: 93485f733d9f5ab38c981b4eca76fc2b (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-03-30T11:24:14Z (GMT) No. of bitstreams: 1 ricardocampelodaconceicao.pdf: 3005415 bytes, checksum: 93485f733d9f5ab38c981b4eca76fc2b (MD5) / Made available in DSpace on 2017-03-30T11:24:14Z (GMT). No. of bitstreams: 1 ricardocampelodaconceicao.pdf: 3005415 bytes, checksum: 93485f733d9f5ab38c981b4eca76fc2b (MD5) Previous issue date: 2009-12-17 / Os defeitos do fechamento do tubo neural (DFTN) figuram como a segunda maior causa de anomalias congênitas, e a sua incidência situa-se em torno de 1/1.000 nascidos vivos. Possui etiologia multifatorial, tendo na deficiência do ácido fólico seu principal fator de risco ambiental identificado. A suplementação de ácido fólico pré e pós-concepcional pode reduzir em até 70% o número de ocorrência e recorrência nos DFTN. O presente estudo tem o objetivo de avaliar o grau de conhecimento de médicos e enfermeiros obstetras sobre a prevenção dos DFTN. Foi realizado um estudo de natureza descritiva, do tipo transversal, em instituições públicas e privadas de saúde, maternidades e consultórios médicos da cidade de Juiz de Fora, MG, no período de dezembro de 2008 a junho de 2009. Participaram do estudo 118 voluntários (95 médicos obstetras e 23 enfermeiros obstetras), que responderam um questionário sem identificação, composto por 21 questões mistas, sobre a temática da prevenção dos DFTN. Foram analisadas as respostas em função das recomendações preconizadas pelo Ministério da Saúde em nosso país e das evidências científicas disponíveis. Verificou-se diferença entre as recomendações do Ministério da Saúde e o conhecimento baseado em evidências (p<0,001). Não foi encontrado nesse estudo, diferença entre o grau de conhecimento dos entrevistados quando comparado o nível de formação dos mesmos, o tempo que realizam atendimento pré-natal e entre as duas classes de profissionais avaliados. Houve diferença entre o grau de conhecimento relatado pelos profissionais e o grau de conhecimento avaliado pela pesquisa, baseado nas recomendações do Ministério da Saúde, e o que preconizam as evidências científicas (<0,001; p<0,001). Dos profissionais avaliados 94,1% relataram conhecer o papel do ácido fólico, embora apenas 11,9% afirmaram terem recebido capacitação sobre o assunto, e 64,2% relataram não saber ou erraram o período de início da suplementação do ácido fólico. Além disso, 68,6% responderam que a dose ideal deve ser de 5 mg/dia, e 68,6% também afirmaram que o período de suplementação deve ser o primeiro trimestre da gestação, conforme orientação do Ministério da Saúde. Os resultados demonstraram claramente a necessidade de melhor capacitação dos profissionais na formação acadêmica e na pós-graduação, além da manutenção permanente de programas de atualização para os envolvidos no atendimento à mulher. / Neural tube defects (NTD) ranks as the second leading cause of congenital anomalies and its incidence is situated around 1/1000 live births. It has a multifactorial etiology and the lack of folic acid is the main identified environmental risk factor. Supplementation of folic acid pre-and post-conception can reduces by up to 70% the number of occurrence and recurrence of NTD. Our study aimed to evaluate the knowledge level of physicians and obstetric nurses on the use of folic acid in the prevention of neural tube defects. We conducted a cross-sectional descriptive study, in public and private health facilities, in the city of Juiz de Fora, MG, from December 2008 to June 2009. The study included 118 volunteers (95 obstetricians and 23 obstetric nurses) who answered an anonymous questionnaire composed of 21 questions about the folic acid use in the prevention of NTD. We analyzed the responses according to the recommendations issued by the Ministry of Health and available scientific evidence. We found no difference between the knowledge levels of respondents when comparing the level of their training, experience in prenatal care and between the two classes of professionals evaluated. There was a difference between the reported knowledge level and the knowledge assessed level, based on the recommendations of the Ministry of Health (MOH), and the scientific evidence (p <0.001, p <0.001), respectively. It was also noticed the difference between the level of knowledge based on the recommendations of the MOH and the level of knowledge based on scientific evidences (p <0.001). The great majority of the study population (94.1%) has reported know the role of folic acid, while only 11.9% said they received training on the subject, and 64.2% has reported not know or had a incorrect answered about the period of early supplementation of folic acid. In addition, 68.6% answered that the optimal dose should be 5 mg / day and 68.6% also said that the period of supplementation should be the first trimester of pregnancy, as directed by MOH. The results clearly demonstrated the need for better training for professionals in academic and during graduate school, as well as ongoing maintenance of training programs for those involved in the women treatment.

Background: Talipes equinovarus, also termed club foot, is a congenital deformity of the ankle joint. Despite its prevalence of approximately 1 per 1000 live births, fetal talipes is relatively poorly studied since the introduction of percutaneous tendo Achilles tenotomies. Objectives: To document the associations, outcomes and prognosis of patients with antenatally diagnosed fetal talipes. The study aims to examine the association between, and prevalence of, fetal talipes and other abnormalities, structural and chromosomal, as well as the outcome in relation to postnatal surgery. The accuracy of prenatal ultrasound in diagnosing fetal talipes is also examined. Methods: A retrospective observational study was made of all cases presenting to the Fetal Medicine Unit between 1 January 2009 and 31 December 2014. All the identified cases were analysed to identify isolated talipes, associated abnormalities, and chromosomal abnormalities. The pregnancy outcomes were determined using the Astraia database as well as maternity records. When the outcome resulted in a live infant, these infants were followed up using the files at the referral hospital to determine the treatment method used and the number requiring surgery. Results: There were 155 cases, all referred to the Fetal Medicine Unit. Antenatal data included 75 who had other structural abnormalities and 75 who had isolated talipes. In five of the cases were no sufficient data could be found. Twenty-five cases were lost to follow-up, and 12 cases had no clubfoot at birth. Only one was labelled as having positional clubfoot. There were 91 live births. Of the cases of talipes with associated abnormalities, 21.19% were live births (excluding ENND). All terminations of pregnancy as well as 90.9% of intrauterine fetal deaths were complex talipes, and 94.52% of the cases of isolated talipes were live births. The most common associated abnormalities were of the central nervous system. Seventeen of the live births were lost to follow-up. Of the cases of isolated talipes, 53.19% had tenotomies and Ponseti treatment. The false positive rate of detecting fetal talipes on ultrasound was 7.74%. Conclusion: The study made it evident that complex talipes is associated with a poor pregnancy outcome defined as pregnancy loss, where isolated talipes is usually associated with a good pregnancy outcome. Ultrasound is a good diagnostic tool when diagnosing talipes antenatally but cannot diagnose the severity of the clubfoot. False negatives were not studied. The introduction of tenotomy can make a difference in the outcome of clubfoot in comparison with previous studies where tenotomies were not performed. Medical professionals need to address the importance of counselling, and a multidisciplinary team should be involved in cases involving prenatal counselling.

This study examined how 22 children with spina bifida and hydrocephalus (SBH) and 22 matched control children with the same vocabulary age (VA) performed on story retelling and story generation tasks. The children were asked to retell two stories of different lengths (Stein and Glenn's Melvin, the Skinny Mouse and The Tiger's Whisker) and generate two stories from different stimuli (wordless picture book and verbal story starter). Analyses were conducted in terms of global narrative organization (story structure), local connection of ideas (cohesion), and productivity (number of words and utterances). Two-way ANOVAs were conducted to analyze how the stories and story tasks (retell versus generation) influenced the two groups' narrative performance. When comparisons were made between the two groups' performances on the individual stories, the children with SBH generally produced shorter and less complex stories than their VA peers. Story-by-group interaction effects showed that the children with SBH produced fewer story grammar elements than their VA peers on the retell stories but not on the generated ones. When comparisons were made between the two groups' performances on the type of task (story retell versus generation), results showed that for story retelling, the children with SBH produced stories that contained fewer words and utterances than their VA peers, significantly fewer story grammar components, and more correct cohesive ties. For the story generation task, the children with SBH produced significantly fewer reactions and total story grammar components. Story-by-group interaction effects showed that the children with SBH produced fewer reactions and total different words than the VA group on the story retell task but not the generation task. The results suggest that children with SBH function differently from their vocabulary age peers in some dimensions of narrative production. When the children with SBH encountered the retelling tasks or the more structured generation story, they tended to produce stories that were shorter than those of their VA peers.

Master of Landscape Architecture / Department of Landscape Architecture/Regional and Community Planning / Timothy D. Keane / Camp Adventure, a summer camp for the physically disabled, has obtained a site for the future Camp Adventure Conference and Retreat Center at Perry Lake, Ozawkie, Kansas. The camp serves youth and adults with cerebral palsy and spina bifida. Past rental facilities have been far from adequate for the camp’s basic needs of accessibility and has led the camp to seek a specially designed permanent home. As a counselor for 9 years, I have experienced firsthand the barriers and frustrations with inadequate facilities. Seeking to find solutions to the camp’s specific needs, I found William H. Whyte’s research methods and environmental psychology studies fitting to discover human preference and experiential qualities. To understand the best methods of adaptation, a series of user based research methods have been conducted to gather user input. The campers understand, from daily experience, what it takes to make an element or activity accessible, and their guidance will inform the design of select program elements. User input is not only being gathered from the camp, but from educational sources at Kansas State University, practicing professionals at Ochsner Hare and Hare, and local government representatives. Collaboratively molding the site’s existing form, the campers accessibility needs, and a complex program has created an exciting and challenging project. The program consists of 24 elements and activities, many of which are not traditionally handicap friendly. In-depth design studies and application of the user input has created the form and experience of seven program elements. This book contains literature and precedent studies, user based research results, the master plan for the entire site, and design details of seven program elements. It is to be used by Camp Adventure as a guide to implementation of the camp design. It is the path for Camp Adventure to achieve their dream: a barrier free, fully accessible, adventure; Camp Adventure.

My Thesis posits a novel method of utilizing emerging web semantics, through HTML5 markup; to improve experience of Health Information seekers through a framework for creating functional, tailored Health Information Resource Collections potentially hosted by their own Health Information Support Networks; and based upon long-standing principles of online Information Retrieval. Most such organizations have websites, with links to useful Resources. This research exemplifies how to design and to present the Resource Collections as pathfinders to existing online Health Information, adding context to each link, to directly address the needs of each community served. The research appeals to a Needs Analysis process rooted in Everyday Life Information Seeking research methodologies, especially Participatory Action Research. As a pilot project, the Needs Analysis focuses necessarily on the Spina Bifida & Hydrocephalus community – with which the author of the Thesis is intimately familiar as a person living with Hydrocephalus, making the choice of a Participatory Action Research framework ideal – and enlisted just one National (Canada) and one Regional (British Columbia) Association for the same rationale. Results of the Needs Analysis were used to identify necessary Resources, but also to select familiar web tools and technologies for design of the Resource Collection and Resource Cards. At completion, there is a functional Collection of Spina Bifida & Hydrocephalus Resources for researchers, caregivers, or patients with Spina Bifida and/or Hydrocephalus – not limited to members of any organization, but best suited by design to the two through which analysis was done. / Graduate