Orientadores: Wilma de Grava Kempinas, Debora Cristina Damasceno / Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-08-08T13:24:37Z (GMT). No. of bitstreams: 1 Amorim_ElaineManoelaPorto_M.pdf: 16324180 bytes, checksum: c70c3ef2e2f1da1ec0592d601a83f795 (MD5) Previous issue date: 2007 / Resumo: Diabetes mellitus é um grupo de desordens metabólicas de etiologia múltipla, caracterizado por defeitos na secreção e/ou ação da insulina. As causas da doença podem ser genéticas e/ou ambientais. O diabete é uma das complicações metabólicas mais comuns durante a gestação, associado a um aumento nos riscos maternos e morbidade neonatal. Estudos epidemiológicos e experimentais têm demonstrado que um meio intra-uterino anormal durante a vida fetal pode afetar o desenvolvimento, causando prejuízo do crescimento fetal, e aumentar a susceptibilidade da prole em desenvolver doenças crônicas na vida adulta. A hipótese da ?programação fetal? sugere que as adaptações que ocorrem durante o desenvolvimento do embrião, em resposta a um meio adverso, provocam alterações permanentes na estrutura e fisiologia do organismo. Já foi demonstrado que o diabete materno e a hiperglicemia induzida experimentalmente causam anormalidades no crescimento fetal, o que está associado com o desenvolvimento de doenças cardiovasculares e diabete tipo 2 na vida adulta. Neste contexto, o objetivo do presente trabalho foi investigar as conseqüências do meio intra-uterino anormal, decorrente do diabete materno, no desenvolvimento e função reprodutiva na pré-puberdade, puberdade e maturidade sexual da prole masculina de ratas em que o diabete foi induzido experimentalmente antes do acasalamento. Foram utilizadas 74 ratas Wistar com 90 dias de idade, divididas em dois grupos experimentais: grupo diabético (n=59), que recebeu, via intravenosa, 40 mg/kg de estreptozotocina, e grupo controle (n=17), que recebeu tampão citrato (0,1M; pH 6,5) nas mesmas condições experimentais. Só foram incluídas no estudo as ratas que apresentaram valores de glicemia iguais ou superiores a 200mg/dl sete dias após a indução (n=55). Todas as fêmeas foram mortas após o desmame dos filhotes. A prole masculina foi avaliada quanto a parâmetros espermáticos e hormonais nas diferentes fases do desenvolvimento sexual. O resultado da prenhez foi prejudicado nas ratas do grupo diabético. Independente do grupo experimental, não foram observadas malformações externas nos recém-nascidos viáveis. O peso corporal e os níveis plasmáticos de glicose, avaliados no terceiro dia pós-natal, foram menores na prole masculina de ratas diabéticas, comparado a prole controle. Na prole de ratas diabéticas, foi observado atraso no tempo (dias) da descida testicular e separação prepucial. Em todas as idades analisadas não houve diferenças estatísticas nos níveis de testosterona, glicemia, histologia dos testículos e epidídimo e grau de maturação do epitélio germinativo. Nos ratos adultos também não foram observadas alterações na morfologia espermática, número de células de Sertoli e dinâmica do processo espermatogênico. Por outro lado, o peso de órgãos reprodutivos, assim como as reservas espermáticas e tempo de trânsito dos espermatozóides no epidídimo, nos animais pré-púberes e adultos, foram alterados de maneira andrógenoindependente. O conjunto dos resultados obtidos mostraram que o meio intrauterino hiperglicêmico, causado pelo diabete materno, prejudicou o desenvolvimento fetal, e provocou alterações nas funções metabólicas e reprodutivas da prole masculina ao longo do desenvolvimento sexual / Abstract: Diabetes melllitus is a group of metabolic disorders of multiple etiology, characterized by defects in the secretion and/or action of insulin. The causes of the disease can be genetic and/or environmental. Diabetes is one of the most common metabolic complications during pregnancy and is associated with an increased risk of maternal and neonatal morbidities. Epidemiological and experimental studies have demonstrated that an abnormal intrauterine environment during fetal life can affect the development, causing impairment of fetal growth and increasing the susceptibility of the offspring to developing chronic diseases in adulthood. The hypothesis of ?fetal programming? suggests that the adaptations that occur during embryonic development in response to an adverse medium provoke permanent alterations in the structure and physiology of the organism. It was already demonstrated that maternal diabetes and experimentally induced hyperglycemia cause abnormalities in fetal growth, which is associated with the development of cardiovascular diseases and type 2 diabetes in adulthood. In this context, the objective of present study was to investigate the consequences of the abnormal intrauterine environment, resulting from maternal diabetes, in the development and reproductive function, at pre-puberty, puberty and during sexual maturity, in the male offspring of rats in which diabetes was experimentally induced before mating. Seventy-four Wistar rats 90- days old were utilized, divided into two experimental groups: diabetic group (n=59) that received intravenously streptozotocin 40mg/kg body weight and control group (n=17) that received intravenously citrate buffer (0.1M; pH 6.5) in the same experimental conditions. Seven days after the induction the glicemia was measured and only rats presenting concentrations of 200 mg/dl or higher were considered severely diabetic and included in the study (n=55). All the females were killed after offspring weaning. The male offspring were evaluated in different phases of sexual maturation for sperm parameters and hormonal levels. The gestational outcome was impaired in the rats of the diabetic group. Independently of the experimental group, there were no external malformations in the viable newborns. Body weight and plasma glucose levels, evaluated on the third postnatal day, were lower in the male offspring of diabetic dams, compared to control. The times (days) of testicular descent and preputial separation were significantly delayed in the pups of diabetic dams. In all the ages evaluated there were no significant statistical differences in testosterone levels, glycemia, histology of the testis and epididimys and maturation degree of the germinal epithelium. Moreover, in adult rats no alterations were observed in sperm morphology, number of Sertoli cells and dynamics of the spermatogenic process. On the other hand, the weights of reproductive organs, as well as sperm reserves and sperm transit time in the epididymis were impaired in the prepubertal and adult rats, in an androgenindependent manner. Taken together, the findings obtained showed that the hyperglycemic intrauterine environment, caused by maternal diabetes, impaired fetal development, and provoked alterations in the metabolic and reproductive functions of the male offspring throughout sexual development / Mestrado / Biologia Celular / Mestre em Biologia Celular e Estrutural

Pregnancy is a normal physiological process for the majority of women. These women, their families and significant others normally expect a successful period of pregnancy, labour, delivery and arrival of a normal and healthy baby. However, some of these pregnant women may develop Gestational Diabetes Mellitus (GDM) during this period and if not managed properly, the mother and the foetus in utero are affected in a negative way: there is a likelihood of the mother and baby developing Type 2 Diabetes in the future and also, other risks such as preterm labour, and foetal macrosomia. In order to prevent such occurrences, I set out to develop a best practice guideline for the nursing management of GDM in military health institutions in Ghana in order to help enhance nursing care. The design for this research was qualitative, explorative, descriptive and contextual in nature. The research is organised in three phases: Phase one deals with the data analysis and discussion of the interviews with professional nurses and midwives and women with a history of GDM. The data collected from the interviews were transcribed, analysed and extracted with Tesch’s eight steps of coding used for the coding. The services of an independent coder were employed to assist with the coding process which led to the formulation of key themes. Semi-structured individual interviews provided a means of exploring the perceptions of professional nurses and midwives on the nursing management of GDM: in addition, women with a history of GDM were interviewed so as to elicit their views on the management they had experienced from professional nurses and midwives before and after being diagnosed with GDM. The trustworthiness of the study was ensured by conforming to Lincoln and Guba’s framework of credibility, transferability, dependability, confirmability and authenticity. An independent coder assisted with the coding process. Phase two deals with the Integrative literature review of available evidence-based clinical practice guidelines for the nursing management of GDM. Evidence-based clinical practice guidelines were searched and appraised with assistance from an independent appraiser and themes were then formulated. In Phase three, the themes from Phase one and Phase two were integrated for the development of a draft best practice guideline for the nursing management of GDM in military health institutions in Ghana. The draft guideline was given to an expert panel of reviewers for their comments and recommendations. These were considered in the development of the final best practice guideline for the nursing management of GDM.

No description available.

OBJECTIVE: Our purpose was to determine the effects of insulin and glucose on glucose transport and expression of GLUT1 glucose transporter messenger ribonucleic acid in first-trimester human trophoblast-like cells. STUDY DESIGN: First-trimester human trophoblast-like cells were maintained as a continuous cell line. For 2[3H]deoxy-d-glucose uptake and messenger ribonucleic acid studies the cells were incubated in the presence or absence of insulin (10-7 to 10-11 mol/L) or d-glucose (0 to 50 mmol/L) for 0 to 24 hours. Glucose transport was measured by incubating cells with 0.1 mmol/L,2[3H]deoxy-d-glucose for 5 minutes. Specific uptake was determined by incubating companion cultures with 10 μmol/L cytochalasin B. The cells were then solubilized with sodium hydroxide and the radioactivity counted. Data were expressed as nanomoles of 2[3H]deoxy-d-glucose transported per milligram of protein per 5 minutes and analyzed by one-way analysis of variance with post hoc testing by the method of Tukey. GLUT1 messenger ribonucleic acid was measured by Northern blotting of total ribonucleic acid samples hybridized to a phosphorus 32-labeled complementary deoxyribonucleic encoding the rat GLUT1 glucose transporter. As a control for loading efficiency, blots were stripped and rehybridized to a 40-mer phosphorus 32-labeled β-actin oligonucleotide probe. RESULTS: Insulin treatment resulted in a dose-dependent increase in the transport of 2[3H]deoxy-d-glucose at 24 hours (p < 0.001 at 10-7 mol/L). This change was first detected at 12 hours of incubation. These data closely paralled the insulin-induced increase in GLUT1 messenger ribonucleic acid seen in Northern blots. In contrast to insulin, increasing concentrations of d-glucose did not change the transport of 2[3H]deoxy-d-glucose. However, when cells were incubated in low concentrations of d-glucose (0 or 1 mmol/L), an enhancement in the uptake of 2[3H]deoxy-d-glucose (p < 0.001) was observed. Kinetic studies indicated that d-glucose augmentation of 2[3H]deoxy-d-glucose uptake was significant at 9 hours (p < 0.05). The effects of d-glucose on GLUT1 messenger ribonucleic acid expression paralleled the uptake of 2[3H]deoxy-d-glucose, although the modulation of GLUT1 messenger ribonucleic acid levels by glucose was much less pronounced than in insulin-treated cells. CONCLUSION: Although it has been assumed that the placenta has a limited role in influencing glucose transport to the fetus, our in vitro data demonstrate that both insulin and glucose can modulate glucose transport at the cellular level of the placental trophoblast. Thus maternal insulin and glycemic status may influence the expression of GLUT1, the major trophoblast glucose transporter protein, therefore directly affecting first-trimester placental glucose transport. These in vitro data may help explain the association between maternal glucose abnormalities and impaired fetal development during the first trimester when placental GLUT1 messenger ribonucleic acid expression is at its peak.

No description available.

Chan, Wing Lung. / Thesis (M.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 111-130). / Abstracts in English and Chinese. / Title --- p.i / Acknowledgements --- p.ii / Table of Content --- p.iii / List of Tables --- p.viii / List of Figures --- p.xi / List of Graphs --- p.xii / Abbreviations --- p.xiv / Abstract --- p.xv / Abstract (Chinese) --- p.xvii / Chapter Chapter 1: --- General Introduction / Chapter 1.1 --- Diabetes Mellitus --- p.2 / Chapter 1.1.1 --- Type 1 diabetes mellitus --- p.3 / Chapter 1.1.2 --- Type 2 diabetes mellitus --- p.4 / Chapter 1.1.3 --- Gestational diabetes mellitus --- p.5 / Chapter 1.2 --- Diabetic Pregnancy --- p.6 / Chapter 1.2.1 --- Incidence of congenital malformations in diabetic pregnancy --- p.6 / Chapter 1.2.2 --- Long term complications in the infant of diabetic mother --- p.7 / Chapter 1.3 --- Hyperglycemia --- p.7 / Chapter 1.4 --- Oxidative Stress --- p.8 / Chapter 1.4.1 --- Oxidative stress and antioxidant enzymes --- p.8 / Chapter 1.4.2 --- Cellular function of oxidative stress --- p.9 / Chapter 1.4.3 --- Adverse effects of excess oxidative stress during embryogenesis --- p.9 / Chapter 1.5 --- Retinoic Acid --- p.10 / Chapter 1.5.1 --- Function of RA during embryonic development --- p.10 / Chapter 1.5.2 --- RA synthesis and degradation --- p.10 / Chapter 1.5.3 --- Mechanisms of retinoic acid signaling : --- p.12 / Chapter 1.5.4 --- Developmental genes regulated by RA --- p.12 / Chapter 1.6 --- Strategy of the Thesis --- p.14 / Chapter Chapter 2: --- General Materials and Methods / Chapter 2.1 --- Animals --- p.17 / Chapter 2.2 --- Induction of Diabetes --- p.17 / Chapter 2.3 --- Mating Methods --- p.18 / Chapter 2.3.1 --- Mice --- p.18 / Chapter 2.3.2 --- Rats --- p.18 / Chapter 2.4 --- Whole Mount In Situ Hybridization --- p.19 / Chapter 2.4.1 --- Synthesis of DNA plasmids and riboprobes --- p.19 / Chapter 2.4.1.1 --- Mini-scale preparation of plasmid DNA --- p.19 / Chapter 2.4.1.2 --- Linearization of DNA plasmid --- p.20 / Chapter 2.4.1.3 --- In vitro transcription and labeling --- p.21 / Chapter 2.4.2 --- Fixation and dehydration of embryos --- p.22 / Chapter 2.4.3 --- Hybridization with RNA probes --- p.23 / Chapter 2.4.4 --- Post-hybridization wash --- p.24 / Chapter 2.4.4.1 --- Pre-absorption of anti-DIG antibody --- p.25 / Chapter 2.4.4.2 --- Embryo powder preparation --- p.25 / Chapter 2.4.5 --- Post antibody wash and signal development --- p.25 / Chapter 2.5 --- Real-time Quantitative Reverse Transcription-Polymerase Chain Reaction (RT-PCR) --- p.26 / Chapter 2.5.1 --- Sample collection and storage --- p.26 / Chapter 2.5.2 --- Total RNA extraction --- p.27 / Chapter 2.5.3 --- Reverse transcription --- p.28 / Chapter 2.5.4 --- Quantitative real-time PCR --- p.28 / Chapter 2.5.5 --- Preparation of cDNA standards for real-time PCR --- p.29 / Chapter 2.6 --- RA-responsive Cell Line --- p.29 / Chapter 2.6.1 --- Cell culture --- p.30 / Chapter 2.6.2 --- Seeding 96-well plate with RA-responsive cells --- p.31 / Chapter 2.6.3 --- Applying samples to 96-well plate coated with RA-responsive cells --- p.31 / Chapter 2.6.4 --- β-galactosidase staining --- p.32 / Chapter 2.7 --- Separation of Protein Isoforms by Isoelectric Focusing (IEF) --- p.33 / Chapter 2.7.1 --- Preparing protein samples for IEF --- p.33 / Chapter 2.7.2 --- Isoelectric focusing --- p.33 / Chapter 2.7.3 --- IEF native gel staining --- p.34 / Chapter 2.7.4 --- Locating three retinaldehyde dehydrogenase (Raldh) isoforms --- p.35 / Chapter 2.8 --- In Vitro RA Synthesizing Reaction --- p.36 / Chapter Chapter 3: --- Effect of Maternal Diabetes on Retinoic Acid Synthesis in the Mouse Embryo / Chapter 3.1 --- Introduction --- p.38 / Chapter 3.2 --- Experimental Design --- p.41 / Chapter 3.3 --- Materials and Methods --- p.42 / Chapter 3.3.1 --- Sample collection --- p.42 / Chapter 3.3.1.1 --- Criteria for selecting embryos at the same developmental stage --- p.42 / Chapter 3.3.1.2 --- Sample collection for in situ hybridization --- p.42 / Chapter 3.3.1.3 --- Sample collection for real-time quantitative RT-PCR --- p.43 / Chapter 3.3.1.4 --- Sample collection for in vitro RA synthesizing reaction --- p.44 / Chapter 3.3.2 --- Statistical analyses --- p.45 / Chapter 3.4 --- Results --- p.46 / Chapter 3.4.1 --- "Comparison of the in situ expression pattern of Raldh 1, Raldh2 and Raldh3 between embryos of diabetic and non-diabetic mice" --- p.46 / Chapter 3.4.1.1 --- In situ hybridization patterns of Raldh 1 --- p.46 / Chapter 3.4.1.2 --- In situ hybridization patterns of Raldhl --- p.46 / Chapter 3.4.1.3 --- In situ hybridization patterns of Raldh3 --- p.47 / Chapter 3.4.2 --- "Comparison of the relative expression level of Raldh 1, Raldh2 and Raldh3 between embryos of diabetic and non-diabetic mice at different developmental stages" --- p.48 / Chapter 3.4.2.1 --- Relative expression levels of Raldh 1 --- p.50 / Chapter 3.4.2.2 --- Relative expression levels of Raldh2 --- p.50 / Chapter 3.4.2.3 --- Relative expression levels of Raldh3 --- p.51 / Chapter 3.4.3 --- Comparison of the in vitro RA synthesizing activity of Raldh 1 Raldh2 and Raldh3 enzymes between embryos of diabetic and non-diabetic mice at different developmental stages --- p.52 / Chapter 3.5 --- Discussion --- p.55 / Chapter Chapter 4: --- Effect of Hyperglycemia on Retinoic Acid Synthesis / Chapter 4.1 --- Introduction --- p.59 / Chapter 4.2 --- Experimental Design --- p.61 / Chapter 4.3 --- Materials and Methods --- p.64 / Chapter 4.3.1 --- Phlorizin treatment --- p.64 / Chapter 4.3.2 --- Whole rat embryo culture --- p.64 / Chapter 4.3.3 --- Preparation of rat serum --- p.65 / Chapter 4.3.4 --- In situ hybridization --- p.66 / Chapter 4.3.5 --- Real-time quantitative RT-PCR --- p.66 / Chapter 4.3.6 --- In vitro RA synthesizing reaction --- p.68 / Chapter 4.3.7 --- Statistical analyses --- p.68 / Chapter 4.4 --- Results --- p.70 / Chapter 4.4.1 --- "Comparison of the relative expression level of Raldh 1, Raldh2 and Raldh3 between embryos of diabetic and non-diabetic mice injected with phlorizin or suspension vehicle as control" --- p.70 / Chapter 4.4.2 --- Comparison of the in vitro RA synthesizing activity of different isoforms of Raldh enzymes between embryos of diabetic and non-diabetic mice injected with phlorizin or suspension vehicle as control --- p.73 / Chapter 4.4.3 --- In situ expression pattern of Raldh2 in rat embryos cultured in medium containing varying concentrations of D-glucose --- p.77 / Chapter 4.4.4 --- Relative expression levels of Raldh2 in rat embryos cultured in medium supplemented with varying concentrations of D-glucose --- p.78 / Chapter 4.4.5 --- In vitro RA synthesizing activity ofRaldh2 in rat embryos cultured in medium supplemented with varying concentrations of D-glucose --- p.79 / Chapter 4.5 --- Discussion : --- p.82 / Chapter Chapter 5: --- In Vitro Supplementation with RA Rescued Rat Embryos from Hyperglycemia-induced Congenital Malformations / Chapter 5.1 --- Introduction --- p.86 / Chapter 5.2 --- Experimental Design --- p.88 / Chapter 5.3 --- Materials and Methods --- p.89 / Chapter 5.3.1 --- Preparation of RA --- p.89 / Chapter 5.3.2 --- Supplementation of RA to rat embryos in culture --- p.89 / Chapter 5.3.3 --- Morphological scoring system --- p.90 / Chapter 5.3.4 --- Statistical analyses --- p.90 / Chapter 5.4 --- Results --- p.92 / Chapter 5.4.1 --- Supplementation with RA rescued embryos from hyperglyce- miainduced malformations --- p.92 / Chapter 5.5 --- Discussion --- p.101 / Chapter Chapter 6: --- Conclusion and Future Perspectives / Chapter 6.1 --- Conclusion and Future Perspectives --- p.106 / References --- p.111

Orientador: José Ricardo de Arruda Miranda / Banca: Madileine Francely Américo / Banca: Débora Cristina Damasceno / Resumo: Trata-se de um estudo qualitativo que teve como objetivo compreender o desenvolvimento de habilidades comunicativas no aluno de graduação em Enfermagem e a atuação do professor neste processo de ensino aprendizagem considerando diferentes tipos de organização curricular. O referencial teórico utilizado foi pautado nos estudos de Braga e Silva para a compreensão da competência em comunicação no aprendizado e ensino da Enfermagem, e a Análise de Conteúdo, segundo Bardin, como referencial metodológico. O estudo foi realizado em duas instituições públicas de ensino superior, situadas no interior do estado de São Paulo, que empregam metodologias de ensino diferenciadas; o Curso de Graduação em Enfermagem da Faculdade de Medicina de Botucatu, UNESP, localizado no município de Botucatu e o Curso de Graduação em Enfermagem da Faculdade de Medicina de Marília, FAMEMA, localizado no município de Marília. A coleta de dados foi realizada a partir da perspectiva dos docentes e discentes do 2º e 4ª anos de Enfermagem, com o apoio de questões norteadoras por meio de entrevistas gravadas e formulários de auto-preenchimento, respectivamente. As questões éticas foram consideradas de acordo com a resolução 466/12 do Conselho Nacional de Saúde (CNS) e da Comissão Nacional de ética em Pesquisa (CONEP), obtendo parecer favorável da Faculdade de Medicina de Botucatu, UNESP, com número CAAE: 18459013.0.3001.5413 e parecer nº 417.358. Em seguida, o projeto de pesquisa foi submetido ao parecer do CEP da Faculdade de Medicina de Marília, FAMEMA, obtendo aprovação com parecer nº 432.360. Nos resultados do estudo emergiram, na perspectiva dos docentes, as seguintes categorias temáticas sobre os fatores que influenciam no desenvolvimento de habilidades comunicativas nos graduandos de Enfermagem: a prática promove a aquisição de habilidades comunicativas; as características individuais dos estudantes; a utilização de... / Abstract: This is a qualitative study aiming at understanding the development of communication skills in undergraduate Nursing students and their teachers' action in such teaching-learning process by considering different types of curricular organizations. The theoretical framework used was based on the studies by Braga and Silva in order to understand communication competence in Nursing teaching and learning. Content analysis according to Bardin was used as a methodological framework. The study was performed in two public institutions of higher education located in inner São Paulo state which employ differentiated teaching methodologies: the Undergraduate Nursing Program of Botucatu Medical School, UNESP, located in the city of Botucatu, and the Undergraduate Nursing Program Marília Medical School, FAMEMA, located in the city of Marília. Data were collected from the perspective of professors and students of the 2nd and 4th years of the Nursing Program, based on guiding questions by means of taped interviews and selfadministered questionnaires, respectively. Ethical issues were considered according to Resolution 466/12 by the National Health Care Council (Conselho Nacional de Saúde - CNS) and the National Research Ethics Committee (Comissão Nacional de Ética em Pesquisa - CONEP), thus obtaining approval by the Botucatu Medical School, UNESP, according to CAAE number: 18459013.0.3001.5413 and Process Number 417.358. Next the research project was submitted to evaluation by the Research Ethics Committee of Marília Medical School, FAMEMA, and approved according to Process Number 432.360. The following thematic categories concerning the factors that influence the development of communication skills in undergraduate Nursing students emerged in the results of the study, according to the professors' perspective: the practice promotes the development of communication skills; the students' individual characteristics; the use of active ... / Mestre

The objectives of this research were to determine the prevalence of gestational diabetes mellitus (GDM) among the Cree of James Bay, identify independent risk factors for GDM and infant macrosomia in this population and compare the risk for GDM and infant macrosomia among Cree women with Canadian non-Native women. The prevalence of GDM using the National Diabetes Data Group criteria among the Cree was 12.8% (95% CI: 10.1--15.5), among the highest ever reported for an Aboriginal group. Independent risk factors for GDM among the Cree were advanced age, pregravid overweight and previous GDM. A comparison of risk of GDM between Cree and non-Native women revealed a significant interaction between ethnicity and pregravid weight. Overweight Cree women were at an elevated risk for GDM compared with overweight non-Native women (OR: 2.3, 95% CI: 1.3--3.8), whereas the risk for GDM was not statistically different between normal weight Cree and non-Native women (OR: 1.4, 95% CI: 0.7--2.7) after adjusting for age, parity, and smoking status. Mean birth weight among Cree infants was 3859 +/- 519 g, the highest reported for any ethnic group in the world. Macrosomia prevalence was also high at 34.3%. Independent risk factors for macrosomia among the Cree were advanced age, pregravid overweight and GDM. A significant interaction was noted between ethnicity and GDM on risk for macrosomia. GDM increased the risk for macrosomia 4.5-fold among the Cree but had no significant effect among non-Natives. After adjusting for age, parity, pregravid weight, gestational weight gain, GDM, gestational duration and smoking status, Cree infants remained heavier than non-Native infants by 235 g. The results of this research indicate the need to control pregravid obesity through culturally acceptable dietary modifications and exercise in order to minimize the risk for GDM among Cree women. The significant impact of GDM on risk for macrosomia among the Cree calls for the re-evaluation of the existi

Made available in DSpace on 2015-08-20T17:09:49Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-02-25. Added 1 bitstream(s) on 2015-08-20T17:26:23Z : No. of bitstreams: 1 000839839_20160225.pdf: 768418 bytes, checksum: 22d463d5da193e9c8caf9af7b86a073f (MD5) Bitstreams deleted on 2016-02-26T14:03:54Z: 000839839_20160225.pdf,. Added 1 bitstream(s) on 2016-02-26T14:04:49Z : No. of bitstreams: 1 000839839.pdf: 1392362 bytes, checksum: f2584f3c649abed0b1eef03db5bb21fe (MD5) / Trata-se de um estudo qualitativo que teve como objetivo compreender o desenvolvimento de habilidades comunicativas no aluno de graduação em Enfermagem e a atuação do professor neste processo de ensino aprendizagem considerando diferentes tipos de organização curricular. O referencial teórico utilizado foi pautado nos estudos de Braga e Silva para a compreensão da competência em comunicação no aprendizado e ensino da Enfermagem, e a Análise de Conteúdo, segundo Bardin, como referencial metodológico. O estudo foi realizado em duas instituições públicas de ensino superior, situadas no interior do estado de São Paulo, que empregam metodologias de ensino diferenciadas; o Curso de Graduação em Enfermagem da Faculdade de Medicina de Botucatu, UNESP, localizado no município de Botucatu e o Curso de Graduação em Enfermagem da Faculdade de Medicina de Marília, FAMEMA, localizado no município de Marília. A coleta de dados foi realizada a partir da perspectiva dos docentes e discentes do 2º e 4ª anos de Enfermagem, com o apoio de questões norteadoras por meio de entrevistas gravadas e formulários de auto-preenchimento, respectivamente. As questões éticas foram consideradas de acordo com a resolução 466/12 do Conselho Nacional de Saúde (CNS) e da Comissão Nacional de ética em Pesquisa (CONEP), obtendo parecer favorável da Faculdade de Medicina de Botucatu, UNESP, com número CAAE: 18459013.0.3001.5413 e parecer nº 417.358. Em seguida, o projeto de pesquisa foi submetido ao parecer do CEP da Faculdade de Medicina de Marília, FAMEMA, obtendo aprovação com parecer nº 432.360. Nos resultados do estudo emergiram, na perspectiva dos docentes, as seguintes categorias temáticas sobre os fatores que influenciam no desenvolvimento de habilidades comunicativas nos graduandos de Enfermagem: a prática promove a aquisição de habilidades comunicativas; as características individuais dos estudantes; a utilização de... / This is a qualitative study aiming at understanding the development of communication skills in undergraduate Nursing students and their teachers' action in such teaching-learning process by considering different types of curricular organizations. The theoretical framework used was based on the studies by Braga and Silva in order to understand communication competence in Nursing teaching and learning. Content analysis according to Bardin was used as a methodological framework. The study was performed in two public institutions of higher education located in inner São Paulo state which employ differentiated teaching methodologies: the Undergraduate Nursing Program of Botucatu Medical School, UNESP, located in the city of Botucatu, and the Undergraduate Nursing Program Marília Medical School, FAMEMA, located in the city of Marília. Data were collected from the perspective of professors and students of the 2nd and 4th years of the Nursing Program, based on guiding questions by means of taped interviews and selfadministered questionnaires, respectively. Ethical issues were considered according to Resolution 466/12 by the National Health Care Council (Conselho Nacional de Saúde - CNS) and the National Research Ethics Committee (Comissão Nacional de Ética em Pesquisa - CONEP), thus obtaining approval by the Botucatu Medical School, UNESP, according to CAAE number: 18459013.0.3001.5413 and Process Number 417.358. Next the research project was submitted to evaluation by the Research Ethics Committee of Marília Medical School, FAMEMA, and approved according to Process Number 432.360. The following thematic categories concerning the factors that influence the development of communication skills in undergraduate Nursing students emerged in the results of the study, according to the professors' perspective: the practice promotes the development of communication skills; the students' individual characteristics; the use of active ...

Made available in DSpace on 2014-06-11T19:27:44Z (GMT). No. of bitstreams: 0 Previous issue date: 2004Bitstream added on 2014-06-13T20:36:11Z : No. of bitstreams: 1 kerche_ltrl_me_botfm.pdf: 560618 bytes, checksum: 73e382097a4197d2e252b34f5a64a0f0 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Identificar fatores de risco para a macrossomia fetal na população de gestantes portadoras de diabete ou hiperglicemia diária. Método - Estudo retrospectivo, tipo caso-controle, incluindo 803 pares de mães e recém-nascidos desta população específica, distribuídos em dois grupos - macrossômicos (casos, n = 242) e não-macrossômicos (controles, n = 561). Foram comparadas variáveis relativas à idade, paridade, peso e índice de massa corporal (IMC), ganho de peso (GP), antecedentes de diabete, hipertensão arterial e tabagismo, tipo e classificação do diabete e indicadores do controle glicêmico no terceiro trimestre. As médias foram avaliadas pelo teste F e as variáveis categorizadas foram submetidas à análise univariada, utilizando-se o teste do qui-quadrado (c²). Os resultados significativos foram incluídos no modelo de regressão múltipla, para identificação do risco independente de macrossomia, considerando-se OR, IC95% e valor de p. Para todas as análises foi estabelecido o limite de significância estatística de 5% (p < 0,05). Resultados - Observou-se associação significativa entre macrossomia e GP > 16kg, IMC = 25kg/m2, antecedentes pessoais, obstétricos e, especificamente, o de macrossomia, classificação nos grupos de Rudge (IB e IIA + IIB), média glicêmica (MG) ³120mg/dL e média de glicemia pósprandial (MPP) ³ 130mg/dL no terceiro trimestre. Na análise de regressão múltipla, o GP > 16kg (OR = 1,79; IC95% = 1,23 ¾ 1,60), o IMC = 25kg/m² (OR = 1,83; IC95% = 1,27 ¾ 2,64), o antecedente pessoal de diabete (OR = 1,56; IC95% = 1,05 ¾ 2,31) e de macrossomia (OR = 2,37; IC95% = 1,60 ¾ 3,50) e a MG ³120mg/dL no terceiro trimestre (OR = 1,78; IC95% = 1,13 ¾ 2,80) confirmaram risco independente para macrossomia nestas gestações de risco. Conclusão - O GP > 16Kg, o IMC ³ 25Kg/m2, a MG ³ 120mg/dL no terceiro trimestre e a presença... / To identify risk factors for fetal macrosomia in pregnant women having diabetes or daily hyperglycemia. Method – Retrospective study, control-case, including 803 pairs of mothers and newborns belonging to this specific population, distributed in two groups- macrosomic (cases, n = 242) and non-macrosomic (controls, n = 561). Variables related to age, parity, weight and body mass index (BMI), weight gain (WG), diabetes history, high blood pressure and tabagism, diabetes type and classification and glycemic control indicators in the third trimester were compared. The means were evaluated by the F test and the categorized variables were submitted to univariate analysis using the chi square test (c²). The significative results were included in the multiple regression model for the identification of macrosomia independent risk considering OR, 95% CI and p value. The statistical significance limit of 5% was established for all the analysis. Results – There was significative association between macrosomia and WG > 16kg, BMI = 25kg/m², personal, obstetric and macrosomic history, classification in the Rudge groups (IB and IIA + IIB), glycemic mean (GM) = 120mg/dL and postprandial glycemic mean (PPGM) = 130mg/dL in the third trimester. In the multiple regression analysis, the WG > 16kg (OR= 1,79; 95%CI= 1,23 - 1,60), the BMI ³ 25kg/m² (OR = 1,83; 95% CI = 1,27 - 2,64), the diabetes personal history (OR = 1,56; 95%CI = 1,05 - 2,31), and of macrossomia (OR = 2,37; 95%CI= 1,60- 3,50) and the GM ³ 120mg/dL in the third trimester (OR = 1,78; 95%= 1,13 - 2,80) confirmed independent risk for macrossomia in these risk pregnancies. Conclusion – The WG > 16kg, the BMI ³ 25kg/m², the GM = 120mg/dL in the third trimester and macrosomia and diabetes personal history were identified as risk factors for fetal macrosomia in pregnant women having diabetes or daily hyperglycemia.