The main aim of the study was to determine which measurement tool, existing or adapted, would be able to determine the levels of customer centricity within the sales channels of a specific organisation, operating in the South African financial industry. A literary study showed that in order to determine the levels of customer centricity, customer experience should be measured. Six questionnaires were administered, namely, EXQ, NPS, CES, Customer satisfaction, Word-of-Mouth and Behavioural loyalty intention. The data showed a statistical significance and a positive relationship between all the constructs within all the questionnaires except with that of CES. / MBA, North-West University, Potchefstroom Campus, 2014

Submitted by PPG Pediatria e Sa?de da Crian?a (pediatria-pg@pucrs.br) on 2018-01-02T12:12:35Z No. of bitstreams: 1 TESE_GENO.final.pdf: 2568933 bytes, checksum: 07252a154299b7fc86a5efe776f3f730 (MD5) / Approved for entry into archive by Caroline Xavier (caroline.xavier@pucrs.br) on 2018-01-24T11:02:16Z (GMT) No. of bitstreams: 1 TESE_GENO.final.pdf: 2568933 bytes, checksum: 07252a154299b7fc86a5efe776f3f730 (MD5) / Made available in DSpace on 2018-01-24T11:05:41Z (GMT). No. of bitstreams: 1 TESE_GENO.final.pdf: 2568933 bytes, checksum: 07252a154299b7fc86a5efe776f3f730 (MD5) Previous issue date: 2017-07-03 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Introduction: According to the literature, cesarean delivery represents an obstacle to breastfeeding in the first hours of life and is one of the factors for early weaning. One of the hypotheses to explain these findings is that the production of breast milk may be insufficient in the first hours after a cesarean section. However, the way by which delivery route affects the onset of breastfeeding is not clearly established. Objective: To compare the volume of breast milk at 12 and at 36 hours in puerperal women after normal delivery and cesarean section. Method: Cross-sectional study with quantitative analysis and non probabilistic convenience sampling. All the puerperae (and their newborns) with a singleton pregnancy of 38 to 42 weeks, whose delivery occurred from 8 pm to midnight between September 2016 and January 2017 were eligible for the study. They were divided into two groups, one of post normal delivery and the other of post cesarean section. Breast milk was collected at 12 and 36 hours postpartum with an electric breast pump, and its volume was based on the weight verified in a scale with 0.01 g precision. In addition to the way of delivery and the breast milk volume, variables included time of onset of breastfeeding and maternal as well as newborn characteristics. Results: Seventy-four puerperae were included in the normal delivery group and 26 in the cesarean section group. Both groups were similar for maternal and newborn characteristics. The median volume of milk collected at 12 hours was 0.90 mL (interquartile range 0.28-1.73 mL) in the normal delivery group, and 1.36 mL (interquartile range 0.36-2.91 mL ) in the cesarean section group (p=0.127). The median volume of milk collected at 36 hours was higher in the cesarean section group (4.23 mL, interquartile range 3.05-5.00 mL) than in the normal delivery group (3.22 mL, interquartile range 2.60-4.11 mL) (p=0.025). Regarding the time elapsed between delivery and the first feeding, no differences in milk volume were observed at both 12 and 36 hours in either group. When only cesarean deliverers were evaluated, there was no difference in milk volume between those with labor and no labor at 12 hours (p=0,411) or at 36 hours (p=0681). Conclusion: There was no difference in the volume of milk produced at 12 hours postpartum by puerperae with full term gestation, between the normal and cesarean delivery groups. At 36 hours postpartum, milk volume was higher in the cesarean section group, however the small difference was considered clinically irrelevant. / Introdu??o: Conforme a literatura, o parto ces?reo representa um empecilho para a amamenta??o nas primeiras horas de vida e ? um dos fatores do desmame precoce. Uma das hip?teses para explicar esses fatores ? que a produ??o de leite materno possa ser insuficiente nas primeiras horas ap?s uma cesariana. Entretanto, o modo pelo qual a via de parto afeta o in?cio da amamenta??o n?o est? claramente estabelecido. Objetivo: Comparar o volume do leite produzido as 12 e ?s 36 horas p?s-parto, em pu?rperas de parto normal e parto ces?reo. M?todo: Estudo transversal com an?lise quantitativa e amostragem n?o probabil?stica de conveni?ncia. Foram eleg?veis para o estudo todas as pu?rperas (e seus rec?m-nascidos) com gesta??o ?nica de 38 a 42 semanas, cujo parto ocorreu no hor?rio das 20h ?s 24h entre setembro de 2016 e janeiro de 2017. As pu?rperas foram divididas em dois grupos, um p?s-parto normal e o outro p?s-cesariana. O leite materno foi coletado com um aparelho de ordenha el?trico, as 12 e ?s 36 horas p?s-parto, e o seu volume foi baseado no peso verificado em uma balan?a com precis?o de 0,01 g. Al?m da via de parto e do volume de leite materno, as vari?veis inclu?ram momento de in?cio do aleitamento, caracter?sticas maternas e do neonato. Resultados: Foram inclu?das 74 pu?rperas no grupo parto normal e 26 no grupo parto ces?reo. Ambos os grupos foram semelhantes quanto ?s caracter?sticas maternas e dos rec?m-nascidos. A mediana do volume de leite coletado ?s 12 horas foi de 0,90 mL (intervalo interquartil 0,28-1,73 mL) no grupo parto normal, e de 1,36 mL (intervalo interquartil 0,36-2,91 mL) no grupo cesariana (p=0,127). A mediana do volume de leite coletado ?s 36 horas foi maior no grupo cesariana (4,23 mL, intervalo interquartil 3,05-5,00 mL) do que no grupo parto normal (3,22 mL, intervalo interquartil 2,60-4,11 mL) (p=0,025). Em rela??o ao tempo transcorrido entre o parto e a primeira mamada, n?o foram observadas diferen?as no volume de leite, tanto ?s 12, como ?s 36 horas, em nenhum dos dois grupos. Quando avaliadas somente as pu?rperas de parto ces?reo, n?o houve diferen?a no volume de leite ?s 12 horas (p=0,411) nem ?s 36 horas (p=0,681) entre aquelas com trabalho de parto e sem trabalho de parto. Conclus?o: N?o houve diferen?a no volume de leite produzido ?s 12 horas p?s-parto pelas pu?rperas com gesta??o a termo, entre os grupos parto normal e cesariana. Na coleta das 36 horas p?s-parto, o volume de leite foi maior no grupo cesariana, entretanto a pequena diferen?a foi considerada clinicamente irrelevante.

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2015-05-12T13:23:39Z No. of bitstreams: 1 468409 - Texto Parcial.pdf: 238946 bytes, checksum: 6a25850d96d7aa7cb5d5aca9f7acb414 (MD5) / Made available in DSpace on 2015-05-12T13:23:39Z (GMT). No. of bitstreams: 1 468409 - Texto Parcial.pdf: 238946 bytes, checksum: 6a25850d96d7aa7cb5d5aca9f7acb414 (MD5) Previous issue date: 2015-03-05 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / INTRODUCTION : Breast changes can have a significant impact on breastfeeding success. In Brazil the prevalence of breast surgery is higher among the population of private health system users. Another risk factor that can interfere in successful breastfeeding in these patients is the high rate of cesarean birth, which in turn may be associated with nipple trauma.OBJECTIVES : The aim of this study was to evaluate the influence of breast surgery and other breast changes on breastfeeding success in patients undergoing elective cesarean section at a private hospital.METHODS : We included in the study newborns undergoing elective cesarean section equal to or greater than 37 weeks' gestation. Data were obtained from hospital records, interviews with the mothers during their stay in the maternity ward and via telephone at the end of the second week and three months after delivery. The variables were gestational age, presence of partners, number of pregnancies, type of nipple, previous breastfeeding, pain during breastfeeding, complementary prescription, silicone breast implants, breast reduction surgery, and bleeding nipples fissures. A logistic regression model was adjusted considering exclusive breastfeeding response at three months as a variable and as dependent variables those significant at the 30% level in previous analysis.RESULTS : The study sample consisted of 1117 newborns and their mothers whose deliveries occurred consecutively and met the inclusion criteria. Of the 1117 mothers, 741 (66.34%) had exclusive breastfeeding at three months of life. All the variables studied represented significant risk factors for the lack of exclusive breastfeeding at three months, except pain during breastfeeding and presence of cracks. In multivariate analysis, the variables that remained significant after adjusting for confounding factors were use of food supplements in the first 24 hours of life (odds ratio [OR] 2.11, confidence interval [CI] 1.62 95% 2.75); flat nipple (OR 2.40, 95% CI 1.58 to 3.65); silicone breast implant (OR 1.88, 95% CI 1.24 to 2.85); and breast reduction surgery (OR 5.65, 95% CI 2.92 to 10.85).CONCLUSIONS : In this population of patients undergoing elective cesarean section in a private health service, breast surgeries, especially breast reduction, were important risk factors for the absence of exclusive breastfeeding at three months postpartum. Another important risk factor for early weaning was the type of flat nipples. / INTRODU??O : Altera??es da mama podem ter impacto significativo sobre o sucesso da amamenta??o. No Brasil, na popula??o usu?ria do sistema privado de sa?de, a preval?ncia de cirurgias mam?rias ? alta. Outro fator de risco que pode interferir no sucesso da amamenta??o nessas pacientes ? a alta taxa de parto ces?reo, que por sua vez pode estar associado a traumas mamilares.OBJETIVOS : O objetivo deste estudo foi avaliar a influ?ncia da cirurgia mam?ria e de outras altera??es da mama no sucesso da amamenta??o em pacientes submetidas ? cesariana eletiva em um hospital privado.M?TODOS : Foram inclu?dos no estudo rec?m-nascidos por cesariana eletiva, com idade gestacional igual ou maior que 37 semanas. Os dados foram obtidos do prontu?rio hospitalar, de entrevistas com as m?es durante a estadia na maternidade e por contatos telef?nicos no final da segunda semana e tr?s meses ap?s o parto. As vari?veis em estudo foram idade gestacional, presen?a de companheiro, n?mero de gesta??es, tipo de mamilo, amamenta??o pr?via, dor durante a amamenta??o, prescri??o de complemento, implante de silicone de mama, cirurgia de redu??o mam?ria, fissura mam?ria e sangramento mam?rio. Um modelo de regress?o log?stica foi ajustado tendo como vari?vel de resposta amamenta??o exclusiva aos tr?s meses e como vari?veis dependentes as significativas ao n?vel de 30% nas an?lises anteriores.RESULTADOS : A amostra do estudo foi composta por 1117 rec?m-nascidos e suas m?es, cujos partos ocorreram de forma consecutiva e que atendiam aos crit?rios de inclus?o. Das 1117 m?es, 741 (66,34%) mantiveram amamenta??o exclusiva aos tr?s meses de vida. Todas as vari?veis estudadas representaram fatores de risco significativos para aus?ncia de aleitamento materno exclusivo aos tr?s meses, exceto dor durante a amamenta??o e presen?a de fissuras. Na an?lise multivariada, as vari?veis que se mantiveram significativas ap?s o ajuste para fatores de confus?o foram uso de complemento alimentar nas primeiras 24 horas de vida (odds ratio [OR] 2,11, intervalo de confian?a [IC] 95% 1,62-2,75); mamilo plano (OR 2,40, IC95% 1,58-3,65); implante de silicone mam?rio (OR 1,88, IC95% 1,24-2,85); e cirurgia de redu??o de mama (OR 5,65, IC95% 2,92-10,85).CONCLUS?ES : Nessa popula??o de pacientes usu?rias do sistema privado de sa?de, submetidas a parto ces?reo, as cirurgias mam?rias, especialmente a redu??o de mama, foram importantes fatores de risco para aus?ncia de amamenta??o exclusiva aos tr?s meses p?s-parto. Outro importante fator de risco para desmame precoce foi o mamilo do tipo plano.

Made available in DSpace on 2015-04-14T13:33:11Z (GMT). No. of bitstreams: 1 464697.pdf: 879216 bytes, checksum: 37696acdb93f5257a99df54817b38653 (MD5) Previous issue date: 2014-08-26 / Background and aims: Studies show that offering supplementary formula to the newborn interferes with the maintenance of breastfeeding. However, these studies did not select only term infants born by elective cesarean section. It is important to know the characteristics of this population of newborns to ensure that they are exposed to the same effects of supplement feedings observed in newborns in general. The aim of this study was to evaluate the effect of formula supplement in newborns at term undergoing elective cesarean section. Methods: A cohort study including newborns at term and their mothers, whose deliveries occurred by elective cesarean section at Moinhos de Vento Hospital, a private general hospital located in Porto Alegre city, in South Brazil, was conducted from October 2011 to April 2013. Initial data were obtained from medical records of newborns and through interviews with mothers in the recovery room. Follow-up was done by telephone contact with each mother, at the end of the second week of life, in the third month, and in the sixth month after birth. The proportion of infants who had a food supplement prescribed in the first prescription was evaluated, as well as the use of supplement before and / or after the first 24 hours of life. The chi-square test was performed with the respective residue analysis. To obtain the effects corrected for the influence of other variables, a model of logistic regression was adjusted, having as response variables "exclusive breastfeeding at three months" and "breastfeeding at six months," and as dependent variables those significant at the 30% level in previous analyzes. Quality of fit and significance of the logistic model were verified using the Hosmer and Lemeshow test. Significance of the coefficients of the model was verified by the Wald statistics, and those significant at the 5% level were kept in the model. Data were analyzed with SPSS version 17.0. Results: At all 964 pairs mother / baby were studied, whose median maternal age was 32 years (from 29.5 to 35.5, min., 18 max. 40th). Nineteen (1.9%) mothers started breastfeeding already in the delivery room, and 936 (97.0%) started in the recovery room. In the first prescription, 811 (84.1%) newborns had already formula supplement prescribed, however only 467 (48.5%) actually received it. Of the 964 mothers, 675 (70.0%) were breastfeeding exclusively in the third month. At six months, 781 (81.0%) mothers were still breastfeeding, but 868 (90.0%) had already introduced other foods, and 737 (76.4%) were already working. Infants that were fully breastfeeding at three months comprised: 386/497 (77.7%) infants who never received supplementation; 289/467 (61.8%) who received in-hospital formula at some point (p<0.001); 146/246 (56.9%) who received supplementation before 24 hours of life (P<0.001); and 242/396 who received supplementation after 24 hours of life (P<0.001). After multivariate analysis, it was found that supplement use before 24 hours of life and supplement use after 24 hours of life remained associated with lack of exclusive breastfeeding at three months (p=0.001 and p=0.003 respectively). Conclusions: In this population of babies born by elective caesarean section, even with a good breastfeeding success rate, use of formula supplement in the first hours of life was strongly associated with reduction in exclusive breastfeeding at three months. It should be emphasized the importance of a very careful decision to use supplementation and prescription of formula feedings to newborn infants, as well as the need for justifying the decision in the hospital records. / Introdu??o e objetivos: Estudos mostram que oferecer complemento alimentar ao rec?m-nascido interfere com a manuten??o do aleitamento materno. Entretanto, esses estudos n?o selecionaram somente beb?s a termo nascidos por cesariana eletiva. ? importante conhecer as particularidades dessa popula??o de rec?m-nascidos e verificar se est?o expostos aos mesmos efeitos da complementa??o alimentar observados nos rec?m-nascidos em geral. O objetivo deste estudo foi avaliar o efeito do complemento alimentar sobre o aleitamento materno, em rec?m-nascidos a termo submetidos ? cesariana eletiva. M?todos: Foi realizado um estudo de coorte incluindo rec?m-nascidos a termo e suas m?es, cujos partos ocorreram por ces?rea eletiva no Hospital Moinhos de Vento, um hospital geral particular localizado em Porto Alegre, Rio Grande do Sul, no per?odo de outubro de 2011 a abril de 2013. Os dados iniciais foram obtidos dos prontu?rios dos rec?m-nascidos e mediante entrevistas com as m?es na sala de recupera??o. O seguimento foi feito por contato telef?nico com cada m?e, ao final da segunda semana de vida, no terceiro m?s e no sexto m?s ap?s o nascimento. Foi avaliada a propor??o de rec?m-nascidos que tiveram o complemento alimentar prescrito na primeira prescri??o, assim como a utiliza??o de complemento antes e/ou ap?s as primeiras 24 horas de vida. Foi realizado o teste de associa??o qui-quadrado, com a respectiva an?lise de res?duos. Para a obten??o dos efeitos corrigidos pela influ?ncia das demais vari?veis, um modelo de regress?o log?stica foi ajustado tendo como vari?veis de resposta amamenta??o exclusiva aos tr?s meses e "amamentando aos seis meses, e vari?veis dependentes aquelas significativas ao n?vel de 30% nas an?lises anteriores. A qualidade do ajuste e a signific?ncia do modelo log?stico foram verificadas atrav?s do teste de Hosmer e Lemeshow. A signific?ncia dos coeficientes do modelo foi verificada atrav?s da estat?stica de Wald e foram mantidos aqueles significativos ao n?vel de 5%. Os dados foram analisados com o aux?lio do programa SPSS vers?o 17.0. Resultados: Foram estudados 964 pares m?e/beb?, cuja mediana de idade materna foi de 32 anos (29,5-35,5, m?n. 18, m?x. 40), sendo que 19 (1,9%) come?aram a amamentar j? na sala de partos e 936 (97,0%) iniciaram na sala de recupera??o. Na primeira prescri??o, 811 (84,1%) rec?m-nascidos j? tinham complemento alimentar prescrito, entretanto somente 467 (48,5%) efetivamente o receberam. Das 964 m?es, 675 (70,0%) estavam amamentando exclusivamente ao seio no terceiro m?s. Com seis meses, 781 (81,0%) ainda estavam amamentando, por?m 868 (90,0%) j? haviam introduzido outros alimentos, e 737 (76,4%) j? estavam trabalhando. Estavam com aleitamento materno exclusivo aos tr?s meses: 386/497 (77,7%) beb?s que nunca receberam complemento; 289/467 (61,8%) que receberam complemento em algum momento (p<0,001); 146/246 (56,9%) que receberam complemento antes de 24 horas de vida (p<0,001); e 242/396 que receberam complemento ap?s as 24 horas de vida (p<0,001). Ap?s an?lise multivariada, verificou-se que uso de complemento antes das 24 horas de vida e uso de complemento ap?s as 24 horas de vida mantiveram associa??o com aus?ncia de aleitamento materno exclusivo aos tr?s meses (p=0,001 e p=0,003 respectivamente). Conclus?es: Nesta popula??o de beb?s nascidos por cesariana eletiva, mesmo com um bom ?ndice de sucesso na amamenta??o, a utiliza??o do complemento alimentar nas primeiras horas de vida foi fortemente associada ? redu??o da amamenta??o exclusiva aos tr?s meses. Salienta-se a import?ncia de que a prescri??o e a decis?o de uso de complemento para os rec?m-nascidos devam ser bastante criteriosas e justificadas nos registros hospitalares dos pacientes.

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2016-11-09T10:23:59Z No. of bitstreams: 1 DIS_CAROLINA_MENNA_BARRETO_SILVEIRA_PARCIAL.pdf: 882195 bytes, checksum: 4e9eed2bd20f440884bd27fcba9fbdfd (MD5) / Made available in DSpace on 2016-11-09T10:23:59Z (GMT). No. of bitstreams: 1 DIS_CAROLINA_MENNA_BARRETO_SILVEIRA_PARCIAL.pdf: 882195 bytes, checksum: 4e9eed2bd20f440884bd27fcba9fbdfd (MD5) Previous issue date: 2016-08-29 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Recent data from scientific literature show low exclusive breastfeeding (EBF) rates in the world, and diversity in the factors that influence it. However, the number of studies about the power of pediatricians and their interventions on duration of EBF is still limited. Objective: To determine the influence of the pediatrician and their interventions on the success of EBF at 3 and 6 months of age in full-term newborns (FNT), undergoing elective cesarean delivery. Methods: A cohort study in a private hospital in Brazil. Questionnaires to mothers at discharge, at 7 days, 3 and 6 months of life were applied. At the day of discharge, the contact was in person, while the following steps was by phone calling. To evaluate the association between categorical variables, chi-squared tests or Fisher's exact were used. Results: The final sample consisted of 907 mother-baby pairs, assisted by 32 pediatricians. The influence of the pediatrician was significant in EBF at 3 months of age (p=0.001). The prevalence of complement in the first prescription varied significantly among pediatricians (31.6% to 100%, p <0.001) and was negatively associated with the EBF at 3 months (p=0.003). When comparing the prevalence of the use of bottles and pacifiers at the first 7 days of life, among the pediatricians, there was a significant difference (p=0.005). The use of pacifiers at 7 days and 3 months was negatively associated with the EBF at 3 months (p<0.001). FNTs who used a bottle at 7 days showed lower prevalence of EBF until sixth month of life. Conclusion: This study provides evidences about the influence of the pediatrician in the prevalence and duration of exclusive breastfeeding at third month of life. This reinforces the need to improve their knowledge, attitudes and practices on breastfeeding. / Dados recentes da literatura cient?fica mostram baixas taxas de aleitamento materno exclusivo (AME) no Brasil e no mundo, al?m de uma grande diversidade nos fatores que o influenciam. Contudo, o n?mero de estudos sobre o poder de atua??o do pediatra e suas interven??es na dura??o do AME ainda ? limitado. Objetivo: Verificar a influ?ncia do pediatra e suas interven??es no sucesso do AME aos tr?s e seis meses de vida, em rec?m-nascidos (RNs) a termo, submetidos ? cesariana eletiva. Me?todos: Estudo de coorte, em um hospital privado do Brasil. Foram aplicados question?rios ?s m?es na alta, aos 7 dias, 3 e 6 meses de vida. No dia da alta, o contato foi presencial, enquanto nas etapas seguintes foi telef?nico. Para avaliar a associa??o entre as vari?veis categ?ricas, foram utilizados os testes qui-quadrado de Pearson ou Exato de Fisher. Resultados: A amostra final foi composta por 907 duplas m?es-beb?s, assistidas por 32 pediatras. A influ?ncia do pediatra foi significativa no AME aos 3 meses de vida do beb? (p=0,001). A preval?ncia de complemento na 1? prescri??o variou significativamente entre os pediatras (de 31,6% a 100%; p<0,001) e esteve associada negativamente com o AME aos 3 meses (p=0,003). Quando comparadas as preval?ncias de uso de mamadeira e chupeta aos 7 dias, entre os pediatras, houve diferen?a significativa (p=0,005). O uso de chupeta aos 7 dias e 3 meses associou-se ao insucesso do AME no 3? m?s de vida (p<0,001). RNs que utilizaram mamadeira aos 7 dias apresentaram preval?ncias de AME mais baixas at? o 6? m?s de vida. Conclus?o: Este estudo fornece evid?ncias sobre a influ?ncia do pediatra e suas interven??es na preval?ncia e dura??o do AME no terceiro m?s de vida. Isso refor?a a necessidade de aprimorar seus conhecimentos, atitudes e pr?ticas sobre a amamenta??o.

Submitted by Ricardo Cedraz Duque Moliterno (ricardo.moliterno@uefs.br) on 2015-08-04T21:49:38Z No. of bitstreams: 1 DAIENE-ROSA-GOMES-Disserta??o-VERS?O-FINAL.pdf: 966973 bytes, checksum: 1e27e5956e56ed34c52950b749b981c0 (MD5) / Made available in DSpace on 2015-08-04T21:49:38Z (GMT). No. of bitstreams: 1 DAIENE-ROSA-GOMES-Disserta??o-VERS?O-FINAL.pdf: 966973 bytes, checksum: 1e27e5956e56ed34c52950b749b981c0 (MD5) Previous issue date: 2014-03-24 / Background: Obesity in children is a public health problem of great magnitude. In recent decades, there has been increasing rates of caesarean sections and obesity, and might have a possible causal relationship between the two events. Objective: To assess the association between cesarean section delivery and overweight at six years of age in a city in northeastern Brazil. Methods: This is a birth cohort conducted with 672 children followed in home visits until the sixth year of age. The outcome variable was overweight obtained by body mass index by age and the main independent variable was cesarean delivery. Were evaluated as covariates: gender; birth weight (<2500g, ?2500g); duration of breastfeeding (<12 months ?12 months); calories intake at 72 months (<1935 kcal, ?1935 kcal); physical activity at school; means of transport to go to school; maternal excessive weight gain during pregnancy; family income (?1 minimum wage, ? 2 minimum wages); maternal schooling; maternal overweight and maternal work. The association of caesarean delivery and overweight was estimated by logistic regression analysis, with the significance level of 5% and its respective 95% confidence interval. Results: Overweight was present in 36.6% of children born by cesarean section compared with 20.2% of those born by vaginal delivery. The association between overweight and cesarean delivery remained statistically significant after adjusting for confounders (OR = 1.96, 95% CI 1.61; 3.22). Conclusion: The results support the assumption that the birth by cesarean delivery is associated with an increased risk of overweight in childhood. Pregnant women should be warned about the increased risk of being overweight for those children born by cesarean delivery. / INTRUDU??O: Recentemente, o tipo de parto ganhou aten??o como potencial fator de risco para a obesidade na inf?ncia. Acredita-se que diferen?as na composi??o da microbiota intestinal das crian?as nascidas por parto ces?reo e vaginal contribui para o incremento da obesidade, pressuposto questionado por alguns pesquisadores. OBJETIVO: Avaliar a associa??o entre o nascimento por parto ces?reo e o excesso de peso aos seis anos de idade, na cidade de Feira de Santana, Bahia. M?TODOS: Trata-se de uma coorte de nascidos vivos. Foram acompanhados 672 crian?as, em visitas domiciliares, at? o sexto ano. A vari?vel desfecho foi o excesso de peso obtido pelo IMC/idade e a vari?vel independente principal o parto ces?reo. Foram avaliadas como co-vari?veis: sexo; peso ao nascer (<2500g, ?2500g); dura??o do aleitamento materno (<12 meses, ?12 meses); consumo alimentar aos 72 meses (<1935 kcal, ?1935 kcal); atividade f?sica na escola; meio de transporte para ir ? escola; ganho excessivo de peso durante a gesta??o; renda familiar (?1 sal?rio m?nimo, ? 2 sal?rios m?nimos); escolaridade materna; excesso de peso materno e trabalho fora do lar. A an?lise utilizada foi a regress?o log?stica, considerando o n?vel de signific?ncia de 5% e o intervalo de confian?a de 95%. RESULTADOS: O excesso de peso esteve presente em 36.6% das crian?as nascidas por parto ces?reo em compara??o com 20.2% daquelas nascidas por parto vaginal. A associa??o entre excesso de peso e parto ces?reo manteve-se estatisticamente significante ap?s o ajuste pelas vari?veis confundidoras (OR=1.96; IC 95% 1.61, 3.22). CONCLUS?O: Os resultados refor?am o pressuposto de que o nascimento por parto ces?reo est? associado a um aumento de risco de excesso de peso na inf?ncia. As gestantes devem ser alertadas quanto ao maior risco de excesso de peso para aquelas crian?as nascidas por cesariana.

Background Cardiovascular disease (CVD) remains the number one killer even after years of advances and preventative measures. Identifying and reducing modifiable risk factors is a health care priority. CVD Risk assessments are calculated using several traditional risk factors including age, gender, race, blood pressure, cholesterol, history of diabetes, and smoking to estimate a persons’ risk of developing CVD (heart disease or stroke) in the next 10-years. In addition to the traditional risk factors for CVD, there is increasing evidence of metabolic disorders, depressive symptoms, inflammation and sleep quality posing a greater risk for CVD. However, these factors are not included in the current risk prediction models including the Framingham Risk Score, Reynolds Risk Score, and Pooled Cohort Risk Equations. Therefore, this study examined the effect of depressive symptoms, inflammation, and sleep quality on the independent risk for CVD. Objective The primary objective of this study was to evaluate the independent relationships between traditional cardiac risk factors, depressive symptoms, inflammation, and sleep quality, on long-term risk of major adverse cardiovascular events (MACE). The secondary objective was to evaluate whether gender modifies the relationships between depressive symptoms, inflammation, and sleep quality on long-term risk of MACE. Design A secondary analysis was conducted on data obtained from the Longitudinal prospective cohort study Heart Strategies Concentrating on Risk Evaluation (Heart SCORE) conducted by the University of Pittsburgh. The ongoing Heart SCORE study has been prospectively examining cardiovascular disease (CVD) risk factors and CVD events on an initial cohort of 2,000 enrolled adults ages 45 to 75 at study entry. A Cox proportional-hazard model was used to evaluate the relationship between traditional risk factors as well as independently and collectively for depressive symptoms, inflammation and sleep quality and risk of MACE. Models were reanalyzed adding gender as an interaction term and in stratified analyses to evaluate whether gender modifies the relationships between sleep quality, depressive symptoms, and inflammation and long-term risk of MACE. Results The participants (N= 1,895) included in this study were, 1256 females (66%), 639 males (34%), ranging from 45 to 75 years of age with a median age of 60 years, 42% Blacks, 55% Whites and 3% other race. Six percent, (n =113) of the participants experienced a major cardiac event during a mean of nearly 10 year follow up. Results indicated that men as compared with women with high levels of interleukin-6 had particularly high risk for CVD, as defined by two separate definitions of MACE, MACE1: Hazard Ratio (HR) 3.44 vs. 1.72 for males and females, respectively, MACE6: HR 2.51 vs. 1.69 for males and females, respectively. These results suggest the high inflammation in men is strongly associated with future risk of CVD. The addition of depressive symptoms to the initial traditional risk factor model was associated with a modest increase in the risk of both definitions of MACE (HR range from 1.20 to 1.68) with similar results observed by gender. Sleep quality/Insomnia was not associated with long-term risk of MACE overall or when evaluated separately by gender. Conclusion Primary prevention with early identification of potential modifiable risk factors is a key strategy in planning interventions to reduce the risk of CVD. Results from this study suggest that depression and inflammation (e.g. IL-6) should be studied in other populations to estimate their independent predictive value in risk stratification. Whereas sleep quality was not associated with long-term risk of CVD in this analysis, future studies should consider the use of objective measures of sleep quality, such as actigraphy in addition to standard use of self-report measures and sleep diaries.

This dissertation study was designed to examine measurement equivalence of the Center for Epidemiological Studies Depression (CES-D) Scale across White, African American, and Mexican American elders. Specific aims were to identify race/ethnicity-, sociodemographic-, and acculturation and instrument language-related measurement bias in the CES-D. Three studies were conducted in this dissertation to accomplish these aims. Two existing national datasets were used: the New Haven Established Populations for Epidemiologic Studies of the Elderly (EPESE) for the White and African American samples and the Hispanic Established Populations for Epidemiologic Studies of the Elderly (H-EPESE) for the Mexican-American sample. Differential item functioning (DIF) analyses were conducted using both confirmatory factor analysis (CFA) and item response theory (IRT) methods. Study 1 focused on the role of race/ethnicity on the measurement bias in the CES-D. Results from Study 1 showed a lack of measurement equivalence of the CES-D among Mexican Americans in the comparison with both Whites and Blacks. Race/ethnicity-specific items were also identified in Study 1: two interpersonal relation items in Blacks and four positive affect items in Mexican Americans. Study 2 focused on identifying sociodemographic-related measurement bias in responses to the CES-D among diverse racial/ethnic groups. Results from Study 2 showed that gender and educational attainment affected item bias in the CES-D. The interaction between gender and educational level and race/ethnicity was also found in Study 2: Mexican American women and lower educated Blacks had a greater predisposition to endorse the 'crying' item. Focusing on Mexican American elders, Study 3 examined how level of acculturation and language influence responses to the CES-D. In Study 3, acculturation and instrument language-biased items were identified in Mexican American elders. Study 3 also suggested that acculturation-bias was entirely explained by whether the CES-D was administered in the English or the Spanish versions. Possible reasons for item bias on the CES-D are discussed in the context of sociocultural differences in each substudy. Findings from this dissertation provide a broader understanding of sociocultural group differences in depressive symptom measures among racially/ethnically diverse older adults and yield research and practice implications for the use of standard screening tools for depression.

The main aim of the study was to determine which measurement tool, existing or adapted, would be able to determine the levels of customer centricity within the sales channels of a specific organisation, operating in the South African financial industry. A literary study showed that in order to determine the levels of customer centricity, customer experience should be measured. Six questionnaires were administered, namely, EXQ, NPS, CES, Customer satisfaction, Word-of-Mouth and Behavioural loyalty intention. The data showed a statistical significance and a positive relationship between all the constructs within all the questionnaires except with that of CES. / MBA, North-West University, Potchefstroom Campus, 2014

Made available in DSpace on 2014-12-17T14:13:38Z (GMT). No. of bitstreams: 1 NilmaDLC_TESE_1-18.pdf: 131008 bytes, checksum: 72de17e28cf04e8269dc5994ad95351b (MD5) Previous issue date: 2011-09-10 / O objetivo deste estudo ? analisar os fatores que contribu?ram para as diferentes decis?es para o parto ces?reo e a ligadura de trompas entre as mulheres de 18 a 45 anos de idade no Munic?pio de Natal, no Nordeste do Brasil, no ano de 2000. Tratou-se de um estudo longitudinal, originado da base de dados de um Estudo Multic?ntrico, envolvendo outras localidades do Brasil, composta de mulheres em idade f?rtil que procuraram o servi?o p?blico ou privado. Foram realizadas tr?s entrevistas: no in?cio da gesta??o, no m?s anterior ? data prov?vel do parto e at? um m?s ap?s o parto, perfazendo um total de 433 entrevistas, sendo finalizada com uma amostra de 269 mulheres. O estudo satisfez a um crit?rio de elegibilidade, abrangendo uma amostra das mulheres de 18 a 40 anos de idade, que residiam em Natal e que estavam gr?vidas no m?ximo, na 22a semana de gesta??o, e procuraram o servi?o p?blico ou privado para a realiza??o do pr?-natal. N?o entraram no estudo, aquelas mulheres que faziam um acompanhamento em ambulat?rios especiais (hipertens?o ou diabetes gestacional, HIV/AIDS). A an?lise consistiu, primeiramente, num estudo descritivo, seguido de uma discuss?o sobre a trajet?ria do desejo ? realiza??o do parto e testou-se a signific?ncia estat?stica dos partos com vari?veis socioecon?micas. Sequencialmente adotou-se uma an?lise bivariada centrada nos testes de associa??o, onde foi considerada a vari?vel tipo de parto como sendo a vari?vel resposta e as demais vari?veis, relacionadas ? condi??o s?ciodemogr?fica e a sa?de reprodutiva da mulher, como sendo as vari?veis de risco ou independentes. Para o c?lculo da raz?o de chance (OR), foi utilizado o modelo de regress?o log?stica m?ltipla. Das 269 mulheres entrevistadas, 56,0% foram submetidas ao parto normal. Este tipo de parto foi desejado independente da categoria, por 71% das entrevistadas. Os resultados mostraram como fatores determinantes para ces?rea, o servi?o ser privado (OR = 5,6), a mulher ter idade acima de 20 anos (OR=2,87), ser prim?para (OR=4,56) e a realiza??o de ligadura de trompas (OR=12,94). Independente da parturi??o, 84% das mulheres do servi?o p?blico foram submetidas a um parto normal, enquanto que, 74% das prim?paras do servi?o privado, fizeram uma ces?rea. Os resultados sinalizam um distanciamento efetivo entre o desejo por um tipo de parto e a sua realiza??o, quando os fatores considerados, n?o foram somente t?cnicos, podendo, tamb?m, refletir a falta de pr?tica do parto normal, pelo obstetra e a necessidade de uma maior consci?ncia ?tica nos procedimentos obst?tricos, de modo a favorecer uma maior abertura na participa??o da gestante na escolha pelo tipo de parto