Includes bibliographical references (leaves 228-257). Aims to determine the impact of maternal undernutrition during late gestation and during the periconceptional and gestational periods on fetal growth, fetal blood pressure and the fetal hypothalamo-pituitary adrenal axis in the sheep.

Includes bibliographical references (leaves 228-257). / xxii, 257 leaves : ill. ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Aims to determine the impact of maternal undernutrition during late gestation and during the periconceptional and gestational periods on fetal growth, fetal blood pressure and the fetal hypothalamo-pituitary adrenal axis in the sheep. / Thesis (Ph.D.)--University of Adelaide, Dept. of Physiology, 2001

M.Ed. / Failure-to-thrive syndrome presents itself as severely inadequate weight increase in children under the age of five without any organic aetiology. It is found particularly in developing countries, constituting about half the malnutrition figures for children under five. Failure-to-thrive research has shown that this is a complex syndrome for which it is difficult to find an aetiology. There are frequently signs of disrupted emotional bonding between mother and child, as well as problematic mother-child interactions. However, the maternal attributes which contribute to the phenomenon are not yet fully understood. Intervention is usually unsuccessful. This study aims to investigate the role of the mother in order to increase understanding of the failure-to-thrive phenomenon. The research design is qualitative, explorative, descriptive and contextual. A multiple casestudy method was used. Three mothers were selected for the study. Data was gathered by means of interviews, supplemented by the observation of interactions and the researcher's own impressions. The interviews were videotaped in their entirety, and were transcribed verbatim afterwards. All data sources were synthesised in the form of case studies. Then the data was interpreted in the light of object-relation theory. The results suggest the importance of several factors already present before the birth of the child, including inadequate emotional care during the mothers' own childhood, and maternal inability to control their emotions. In all the cases studied, the pregnancy was unplanned and additional external stressors made the pregnancy more difficult. These mothers experienced their children as a threat, as competition or as symbols of their powerlessness. These mothers described their children as "wild" and demanding. Observation of interactions indicated that this type of behaviour in the children may be an attempt to attain affection from their mothers, or an anxious reaction to the mothers' inability to set limits. The restlessness of these children exacerbated the mothers' sense of inadequacy and contributed to a vicious cycle. These mothers were unable to provide what Winnicott describes as "good enough mothering". They were too emotionally needy themselves. Observations of interactions revealed an inability to adjust to the needs relevant to the children's age groups, inadequate responsiveness, inconsistency, instrumental care and a lack of involvement. It appeared that these mothers had themselves not been mothered enough during their own early development, so that they could not internalise these attributes. Their descriptions suggest inadequate environmental provision for what babies need in their first year of life to experience the world as a secure place, to reach personal integration and to interact trustfully with others. This early deprivation of the mother obviously has implications for the way these women treat their own children at the age when these mothers themselves were neglected as children. Suggested intervention tends to focus on support and mothering for the mothers, but the most appropriate type of intervention is individual psychotherapy which allows adequate internalisation of the "good mother" image. This would facilitate personal integration, enabling the mother to focus on her child's needs, freed from her own.

Submitted by SBI Biblioteca Digital (sbi.bibliotecadigital@puc-campinas.edu.br) on 2018-02-20T11:53:48Z No. of bitstreams: 1 ISABELA BERNASCONI JOSE.pdf: 1712904 bytes, checksum: a60a60f1cbb4056edf9f0326d215a4f9 (MD5) / Made available in DSpace on 2018-02-20T11:53:48Z (GMT). No. of bitstreams: 1 ISABELA BERNASCONI JOSE.pdf: 1712904 bytes, checksum: a60a60f1cbb4056edf9f0326d215a4f9 (MD5) Previous issue date: 2017-12-04 / ?Introduction: Enteral Nutrition Therapy (ENT) is the preferential way to feed critically ill patients and its main goal is to prevent and treat nutritional deficiencies and hospital malnutrition. Achieving energy and protein targets in these patients is a daily challenge for the care team in the intensive care setting. Objective: To monitor the energy and protein delivery and the inadequacies of ENT in critically ill patients admitted to an intensive care unit (ICU). Method: In this prospective longitudinal study, 82 patients admitted in the ICU of an university hospital were studied. The following variables were evaluated: energetic and protein goals of ENT, the prescribed and delivered ENT, the causes and frequencies of the insufficient delivery and enteral nutrition outcomes. These patients had their nutritional diagnosis defined by anthropometric parameters, laboratory tests and nutritional risk screening tools (NUTRIC score and nutritional risk screening). For the statistical analysis, the Wilcoxon test, the Chi-square test or the Fisher exact test and the Mann-Whitney test were used. Results: The average energy goal was 2132.91 kcal and protein goal was 113.96 g per day. The average energy delivery was 53.44% of the target and protein was 43.72% of the target, a statistically significant difference for both variables (p<0.0001). There was a statistically significant difference (p<0.0001) for all comparisons made between the goal, prescription and infusion of ENT. The average energy prescribed was 68% (p<0,0001) of the target, and 53% (p<0,0001) of the energy target was delivered. The average protein prescribed was 58% (p<0,0001) of the target, and only 43% (p<0,0001) of was delivered. The patients received 72% of what was prescribed for both, energy and protein. All patients presented an inadequacy of the ENT delivery and for 90%, there was no justification for the delay of the ENT delivery. Half (50%) of the patients in ENT were at nutritional risk. Conclusion: The ENT does not meet entirely the critically ill patients energy and protein needs. The complications that affect these patients interrupts the delivery of the ENT, as well as preventable delays. Such findings consolidate the importance of adequate and careful monitoring of ENT in critically ill patients. / Introdu??o: A terapia nutricional enteral (TNE) ? a via de escolha preferencial para nutrir pacientes graves e tem como principal objetivo prevenir e tratar as defici?ncias nutricionais e a desnutri??o hospitalar. Atingir as metas energ?ticas e proteicas nestes pacientes ? um desafio di?rio para a equipe de cuidados no ambiente da terapia intensiva. Objetivo: Monitorar a oferta energ?tica e proteica e as inadequa??es da TNE em pacientes cr?ticos internados em uma unidade de terapia intensiva. M?todo: Em um estudo longitudinal prospectivo, foram estudados 82 pacientes internados em uma unidade de terapia intensiva de um hospital universit?rio. Foram avaliadas as seguintes vari?veis: metas energ?tica e proteica da (TNE), os valores prescritos e administrados da (TNE), as causas e frequ?ncias das inadequa??es na infus?o da dieta, e os desfechos da terapia nutricional. O diagn?stico nutricional foi definido por meio de par?metros antropom?tricos, exames laboratoriais e instrumentos de rastreamento nutricional (nutric score e nutritional risk screening). Para a an?lise estat?stica foi utilizado o teste de Wilcoxon, o teste Qui-quadrado ou teste Exato de Fisher e o teste de Mann-Whitney. Resultados: A m?dia da meta energ?tica foi de 2.132,91 kcal e a proteica foi de 113,96 g por dia. A infus?o m?dia de energia foi de 53,44% da meta e de prote?na foi de 43,72% da meta, diferen?a estatisticamente significante para ambas as vari?veis (p<0,0001). Verificou-se diferen?a estatisticamente significante (p<0,0001) para todas as compara??es efetuadas entre a meta, prescri??o e infus?o da TNEE. Para a caloria, a prescri??o foi em m?dia 68% (p<0,0001) do valor da meta calculada, sendo infundido 53% (p<0,0001) do valor da meta energ?tica. Para a prote?na, a prescri??o foi em m?dia 58% (p<0,0001) do valor da meta, sendo infundido em m?dia 43% (p<0,0001) do valor da meta proteica. Foi infundido 72% do que foi prescrito tanto para caloria como para prote?na. Todos os pacientes avaliados apresentaram algum tipo de intercorr?ncia na infus?o e para 90% dos pacientes n?o houve justificativa para o atraso na infus?o. Cinquenta por cento (50%) dos pacientes em TNE apresentavam risco nutricional. Conclus?o: A TNE n?o supre totalmente as necessidades energ?ticas e proteicas dos pacientes cr?ticos. As complica??es que acometem o paciente grave interrompem a infus?o da dieta, bem como atrasos evit?veis. Tais achados refor?am a import?ncia do monitoramento adequado e cuidadoso da terapia nutricional enteral no paciente grave.

Orientador: Vanda Maria Gimenes Gonçalves / Tese (doutorado) - Universidade Estadual de Campinas. Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-15T08:45:17Z (GMT). No. of bitstreams: 1 Campos_Denise_D.pdf: 1881685 bytes, checksum: af706b0aedc7772254376e13f4bf60c0 (MD5) Previous issue date: 2010 / Resumo: A desnutrição intra-uterina tem sido associada a morbidade neurológica em longo prazo. Tendo em vista que os lactentes nascidos pequenos para a idade gestacional (PIG) representam um modelo de estudo para essa situação e que a maioria dos trabalhos focaliza a idade escolar, o presente estudo teve como objetivo comparar o desempenho motor de lactentes nascidos a termo PIG com lactentes nascidos a termo adequados para a idade gestacional (AIG) no 1°, 2°, 3° e 6° meses. Tratou-se de um estudo prospectivo e seccional. Os neonatos foram selecionados na maternidade do Centro de Atenção Integral a Saúde da Mulher da Universidade Estadual de Campinas, no período de maio de 2000 a julho de 2003, obedecendo aos seguintes critérios de inclusão: recém-nascidos (RN) residentes na região de Campinas, que permaneceram no alojamento conjunto, resultantes de gestação de feto único, com idade gestacional entre 37 e 41 semanas, com peso ao nascimento classificado entre o percentil 10 e 90 da curva de crescimento fetal para o grupo AIG e, abaixo do percentil 10 para o grupo PIG. Foram excluídos: RN com síndromes genéticas, malformações e infecções congênitas. Para avaliação foi utilizada a Escala Motora das Bayley Scales of Infant Development-II. A partir da pontuação do Index Score (IS), com media 100 e desvio padrão de 15, os lactentes foram classificados com performance acelerada (IS=115), performance dentro dos limites normais (IS=85-114), performance levemente atrasada (IS=70-84) ou performance significantemente atrasada (IS=69). Para analise dos dados foi considerado o valor do IS obtido no 1°, 2°, 3° e 6° meses. Quando houve diferença significativa de IS entre os grupos PIG e AIG, as provas daquela idade e as características familiares que poderiam contribuir para as diferenças foram investigadas. A amostra compreendeu 63 lactentes (18 PIG; 45 AIG) no 1° mês, 68 lactentes (25 PIG; 43 AIG) no 2° mês, 68 lactentes (22 PIG; 46 AIG) no 3° mês e 66 lactentes (24 PIG; 42 AIG) no 6° mês. O grupo PIG apresentou media de IS significativamente menor que o grupo AIG no 2° e 6° meses. Nesses períodos, houve menor proporção de lactentes do grupo PIG que realizaram com sucesso as seguintes provas: "faz movimentos alternantes para arrastar em prono", "troca de decúbito lateral para dorsal", "equilibra a cabeça", "senta sozinho momentaneamente por 2 segundos" e "senta sozinho por 30 segundos". Considerando as características familiares, os grupos diferiram quanto a ocupação materna, escolaridade materna e renda per capita, de modo que no grupo PIG houve maior freqüência de mães que não trabalhavam fora do lar, que apresentavam menos de 8 anos de estudo e com baixa renda familiar. Os resultados obtidos sugerem que os lactentes nascidos a termo PIG estão sob maior risco para apresentar alterações no desenvolvimento motor / Abstract: Intrauterine malnutrition has been associated with long-term neurological morbidity. Considering that infants born small for gestational age represent a study model for this condition and that most studies focus on school age children, the present study aimed to compare the motor performance of infants born small for gestational age (SGA) with those appropriate for gestational age (AGA) at 1, 2, 3, and 6 months. This was a cross-sectional and prospective study. The neonates were selected at the Neonatology Service of the Center for Integral Attention to Women's Health-University of Campinas, between May 2000 and July 2003, according to the following criteria: healthy newborns resident in the region of Campinas, resulting of single fetus pregnancies, with gestational age between 37 and 41 weeks, with birthweight between the 10th and 90th percentiles of fetal growth curves for the AGA group and under the 10th percentile for the SGA group. Newborns with genetic syndromes, congenital malformations and infections were excluded. The Motor Scale of Bayley Scales of Infant Development-II was used for evaluation. Using the index score (IS), with a mean of 100 and standard deviation of 15, the infants were classified as presenting accelerated performance (IS=115), within normal performance limits (IS=85- 114), mildly delayed performance (IS=70-84) or significantly delayed performance (IS=69). The IS during the 1st, 2nd, 3rd and 6th months of life were considered in the analysis of the results obtained. When a significant difference in IS occurred between the SGA and AGA groups, the items at that age and the family characteristics that could contribute to these differences were investigated. The sample comprised 63 infants (18 SGA; 45 AGA) aged 1 month, 68 infants (25 SGA; 43 AGA) aged 2 months, 68 infants (22 SGA; 46 AGA) aged 3 months and 66 infants (24 SGA; 42 AGA) aged 6 months. The SGA group presented a mean motor IS lower than the AGA group at 2 and 6 months. For these periods, the SGA group presented a lower proportion of infants who successfully performed the following skills: "makes crawling movements", "turns from side to back", "balances head", "sits alone momentarily" and "sits alone for 30 seconds". Considering the family characteristics, the groups differed with respect to maternal occupation, maternal education and family income; therefore, the SGA group showed a large number of mothers who did not work outside the home, had less than 8 years of study and low family incomes. The results obtained suggest that the infants who are SGA present a greater risk for adverse motor outcomes / Doutorado / Ciencias Biomedicas / Doutor em Ciências Médicas