Orientador: Claudinei José Gomes Campos / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-18T19:37:16Z (GMT). No. of bitstreams: 1 Bueno_GiselliCristinaVillela_M.pdf: 1248064 bytes, checksum: 41025ac97f6190db0bc41ed7c8b46c9d (MD5) Previous issue date: 2011 / Resumo: Com o aumento da longevidade das crianças com cardiopatias congênitas, esta patologia torna-se crônica, e como tal, necessita de um cuidador, que na grande maioria das vezes, é a própria mãe para garantir cuidados específicos em relação à alimentação, atividade física e administração de medicamentos em domicílio. As crenças relacionadas à causa da doença e à manutenção do tratamento constituem parte da herança cultural da família; elas influenciam o modo pelo qual os cuidadores lidam com o problema de saúde e a maneira pela qual respondem aos profissionais de saúde. Alguns modelos teóricos apresentados na literatura dos últimos anos tentam explicar a adoção de determinados comportamentos, dentre eles, destaca-se o Modelo de Crenças em Saúde (MCS). Este trabalho estudou os significados e as crenças atribuídas pelos cuidadores ao tratamento de crianças com cardiopatias congênitas, utilizando o referencial teórico do MCS, desenvolvido por Rosenstock em 1966. Trata-se de um estudo de caso, realizado na unidade de internação de um Hospital Universitário do interior de São Paulo. Participou do estudo oito cuidadoras que acompanhavam crianças portadoras de qualquer tipo de cardiopatia congênita, com até 12 anos de idade incompletos. Foram realizadas entrevistas semidirigidas, gravadas e transcritas para análise dos dados. A escolha das cuidadoras seguiu a técnica de amostragem proposital e a delimitação da amostra se deu através da técnica de saturação teórica. A partir do estudo de cada categoria criada, utilizando a técnica de análise de conteúdo, surgiram outros temas pertinentes que foram divididos em subcategorias não apriorísticas. Os resultados mostraram que os cuidadores só conseguem perceber a doença quando ela se manifesta de alguma maneira; crianças que não apresentam sintomas e que conseguem realizar as atividades do cotidiano pertinentes a sua idade não são consideradas doentes. Os sentimentos de medo, desamparo e impotência emergiram nas falas, porém o medo da morte esteve mais presente nas entrevistas. O facilitador que se destacou durante o tratamento foi a importância que os cuidadores dão ao entendimento e cumprimento das orientações médicas e ao comparecimento às consultas. A fé permeou todas as entrevistas, ela dá força e sustentação para o cuidador acompanhar a criança, superando todas as barreiras para cumprir o tratamento adequadamente. Dentre as barreiras citadas, mas que não influenciaram no seguimento do tratamento destaca-se a ausência da participação do pai no tratamento do filho e as dificuldades de entendimento dos cuidados necessários à criança em domicílio. A falta de citação do enfermeiro nas falas das cuidadoras é um resultado preocupante e emerge discussões necessárias sobre o papel que o enfermeiro está exercendo nas instituições de saúde / Abstract: With increased longevity of children with congenital heart disease, this disease becomes chronic, and as such requires a caregiver, which in most cases, it is the mother to ensure special care in relation to food, activity physical and drug administration at home.The beliefs related to the cause of illness and maintenance treatment are part of the cultural heritage of the family, they influence the way caregivers deal with the health problem and the way they respond to health professionals. Some theoretical models presented in the literature of recent years have tried to explain the adoption of certain behaviors, among which stands out the Health Belief Model (HBM). This study examined the meanings and beliefs attributed by caregivers to treat children with congenital heart disease, using the theoretical framework of the HBM, developed by Rosenstock in 1966. This is a case study, conducted at the inpatient unit of a university hospital in Sao Paulo State. Participated in the study eight caregivers who accompanied children with any type of congenital heart disease, with up to 12 years old incomplete. Semi structured interviews were conducted, recorded and transcribed for data analysis. The choice of caregivers followed the purposive sampling technique and the delimitation of the sample was made through the technique of theoretical saturation. From the study of each category were using the technique of content analysis, there were other relevant issues that were not a priori divided into subcategories. Results showed that caregivers can only perceive the disease as it manifests itself in some way, children who have no symptoms and are able to perform everyday activities relevant to their age are not considered diseased. The feelings of fear, helplessness and powerlessness emerged in the interviews, but the fear of death was present in the interviews. The facilitator pointed out that during treatment was the importance that carers make to the understanding and compliance with medical advice and attend to queries. The faith permeated all the interviews, it gives strength and support for the caregiver accompany the child, overcoming all barriers to follow the treatment properly. Among the barriers identified, but no effect following the treatment there is the lack of father participation in child treatment and difficulties in understanding the necessary care to children in the household. The lack of citation in the speech of the nurse caring is a worrying outcome emerges and necessary discussions on the role that nurses are exercising at health institutions / Mestrado / Enfermagem e Trabalho / Mestre em Enfermagem

The aim of the study was to compose and realize physiotherapeutic program for children with congenital heart disease to improve their postural-respirational function and to assess the influence of this program on cardiopulmonary functions of the patients. Our group had five patients with mean age of 15,6 years. Each of them underwent initial examination of the motor system, spirometry and spiroergometric exercise test. Physiotherapeutic program consisted of 8 individual therapies and home-based exercise. Therapy was composed from manual techniques, exercise according to Dynamic neuromuscular stabilisation concept and exercise with inspiratory trainer and improvised PEP system. The final examination was performed in the same manner as the initial one. We compared the results of both examinations, but we found no significant improvement after the physiotherapeutic program.

Background: The right ventricular outflow tract (RVOT) is known to be the origin of potentially dangerous ventricular tachycardias (VT). Arrhythmias can occur in what are otherwise assume to be structurally normal hearts as well as in arrhythmia syndromes like Brugada syndrome, catecholaminergic polymorphic VT and arrhythmogenic right ventricular dysplasia. In adults with surgically corrected tetralogy of Fallot (ToF), VT often originates in the RVOT. Methods: To investigate potential arrhythmia substrates in the structurally normal heart, the RVOT of adult rats was investigated and compared to the right ventricle (RV). In the human, the right atrium (RA), RV and the RVOT were examined in patients free of electrical and structural disease at the time of clinically indicated surgery on the left heart. The same tissue samples were collected from adults with surgically corrected ToF at the time of pulmonary valve replacement. Real-time reverse transcription quantitative polymerase chain reaction (RT-qPCR) was used to explore changes on the mRNA level. Antibody based techniques (immunohistochemistry and Western blot) and mass spectrometry were used to identify changes on the protein level. In the rat RVOT, fine microelectrodes were employed to investigate electrophysiological characteristics. Results: A reduction in the Na+ channel Nav1.5 was found in the structurally normal RVOT in the rat and human. In the rat, RVOT-nodal like myocytes were identified. Unlike ventricular myocytes, the myocytes did not express the gap junction channel Cx43 and the K+ channel Kir2.1, but they did express the pacemaker Ca2+ channel Cav3.2 and the transcription factor Tbx3. Ectopic pacemaker and nodal-like action potentials with phase 4 depolarization were recorded from the region of the pulmonary valve. In the RA of ToF patients, SERCA2A was found to be downregulated (mRNA and protein) as seen in heart failure and atrial fibrillation. Further widespread remodelling was found in the RA, the RV and RVOT identifying multiple changes as seen in heart failure with downregulation of K+ channels and β-receptors and an increase in inflammatory markers and extracellular matrix molecules. Multiple molecules involved in the mitochondrial respiration chain were found to be downregulated in the RVOT of ToF patients. Conclusion: This is the first study that demonstrates reduction in Nav1.5 in the RVOT of structurally normal human hearts. The changes found in the rat RVOT could explain why arrhythmias originate in the RVOT. The widespread remodelling in ToF, especially in the ECM, could form a substrate for reentry arrhythmias. Mitochondrial dysfunction could point towards potential treatment targets for heart failure in this patient group.

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第13331号 / 論医博第2199号 / 新制||医||1044(附属図書館) / (主査)教授 湊谷 謙司, 教授 横出 正之, 教授 戸口田 淳也 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

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On a daily basis critically ill paediatric patients are admitted in the Paediatric Critical Care Unit (PCCU). Some of these paediatric patients require cardiothoracic surgery and is mechanically ventilated post-operatively. Chapter one of this study gives an orientation to this research and explains that in order to prevent ventilator associated complications and high hospitalisation costs, the mechanically ventilated paediatric patient following cardiothoracic surgery should be extubated as soon as he/she is ready. Chapter two is dedicated to the available literature on this topic and indicates that literature on extubation criteria for the mechanically ventilated paediatric patient is minimal. The methodology of this study is discussed in detail in Chapter three. Chapter four gives a detailed explanation of the research findings and the researcher included the developed clinical pathway for the extubation of the paediatric patient following cardiothoracic surgery in a private hospital in Gauteng. The relevant clinical pathway functions as a guideline and evidence-based tool in the PCCU. Lastly Chapter five gives a summary of this study and a few recommendations are made. The researcher has included a personal reflection in this Chapter. / Dissertation (MCur)--University of Pretoria, 2014. / tm2015 / Nursing Science / MCur / Unrestricted

The ability to generate cardiomyocytes from human induced pluripotent stem cells (hiPSCs) provides unprecedented opportunities in the study and treatment of cardiac diseases. The objective of this dissertation is the development of novel methods of utilizing hiPSC-derived cardiomyocytes (hiPSC-CMs). First, we leveraged the potential of hiPSC-CMs to model congenital heart disease caused by mutations in the transcription factor ZIC3. We developed a method to directly explore the effect of ZIC3 inhibition using hiPSCs at a molecular, cellular, and functional level through utilization of CRISPR interference. Our results identified the role of ZIC3 in regulating Nodal signaling, Wnt signaling, and cell structure and motility processes during cardiac development, suggesting that ZIC3 mutation leads to congenital heart disease in humans by the abnormal regulation of multiple steps during left-right axis establishment. Next, we leveraged the potential of hiPSC-CMs to treat myocardial infarction. We demonstrated that the extended delivery of extracellular vesicles secreted by hiPSC-CMs could attenuate injury and promote recovery of the heart after infarction by regulating apoptosis and inflammatory pathways. These results suggest that hiPSC-CM secreted extracellular vesicles represent a novel cell free tool in the treatment of myocardial infarction and the understanding of heart recovery.

Many adults born with congenital heart disease (CHD) face long-term psychosocial issues related the disease. The purpose of this project was to better understand social workers' experiences with interventions for clients who have CHD and experience psychosocial problems. Bronfenbrenner's ecological theory was a basis for the research questions, which focused on clarifying social workers' experiences with interventions and identifying the ecological levels to which the interventions align. A narrative design with nonprobability sampling was used. Six social workers who counsel adults with CHD from 6 of the 109 U.S. CHD clinics participated in individual interviews. Interviews were transcribed, coded, and categorized using thematic analysis, then analyzed for new information, similarities, and differences. The most significant clinical and nonclinical interventions used by participants were financial assistance, health insurance support, and modalities for treating anxiety and depression. Social workers counseling adult CHD patients may benefit by having information from experienced CHD social workers that they can incorporate into their work with clients. Recommendations include (a) bolstering the number of social workers in private practice who specialize in adults with CHD to address the ongoing mental health needs of this population and (b) encouraging social action and awareness to adjust the guidelines set by government agencies so this population can qualify for better financial, health, and disability benefits. Implementation of these recommendations may have a positive social impact for adults living with CHD.

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