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Depression occurs in approximately 20% of pregnant women, and up to 25% of them experience anxiety. Several pregnancy complications and labour and delivery outcomes have been associated with antenatal depression and anxiety, such as higher rates of nausea and vomiting, bleeding, psychosomatic complaints, preterm labour and delivery complications. Neonatal outcomes include lower Apgar scores, shorter gestation, smaller head circumference, and increased admissions to the neonatal intensive care unit. Research Questions: 1. To examine the prevalence of pregnancy complications and neonatal outcomes in this study sample. 2. To examine whether there is a difference in the association between observed pregnancy complications and neonatal outcomes and major depression, when depression is episodic compared to when the depression is continuous. 3. To examine whether there is a difference in the association between observed pregnancy complications and neonatal outcomes and mild depression, when the mild depression is episodic compared to when it is continuous. 4. To examine whether there is a difference in the association between observed pregnancy complications and neonatal outcomes and anxiety, when anxiety is episodic compared to when it is continuous. Methods: The data for this study was collected for the Feelings in Pregnancy and Motherhood Study (FIP). This population-based study interviewed 649 participants three times: in the second trimester, the third trimester, and in the early postpartum. Participants were screened for depression and anxiety with the Edinburgh Postnatal Depression Scale (EPDS), using the validated cut-off scores of >12 and >4 respectively. Sociodemographic data as well as detailed risk behaviours, and sources of stress and coping, were explored. Finally, pregnancy, labour and delivery and neonatal complications were collected. Descriptive and multivariate logistic regression analyses were completed. Results: Major depression in the second trimester was significantly associated with gestational diabetes (OR: 3.518; 95% CI 1.56, 7.93) and swelling/edema (OR: 2.099; 95% CI 1.13, 3.89). Major depression that occurred continuously throughout pregnancy was significantly associated with induced labour (2.417; 95% CI 0.99, 5.92) and antenatal bleeding/abruption (OR: 2.099; 95% CI 1.13, 3.89). Anxiety in the second trimester was significantly associated with caesarean birth (OR: 0.522; 95% CI 0.29, 0.95). Anxiety occurring continuously throughout pregnancy was significantly associated with swelling/edema (OR: 1.816; 95% CI 1.19, 2.77) and there was a significant interaction between age and anxiety that predicted epidural use during pregnancy: while age decreased in the participants who had anxiety in both trimesters, the likelihood of using an epidural increased. Finally, mild depression in the second trimester was significantly associated with antenatal bleeding/abruption (OR: 2.124; 95% CI 1.09, 4.14) and PROM (OR: 2.504; 95% CI 1.04, 6.05). Mild depression in the third trimester was associated with caesarean birth (OR: 0.298; 95% CI 0.10, 0.86). Mild depression that occurred continuously throughout pregnancy was significantly associated with the use of vacuum/forceps in delivery or an operative delivery (OR: 4.820; 95% CI 1.10, 21.16). Conclusions: These results show that episodic depression and anxiety can have a more profound impact on pregnancy complications and labour and delivery outcomes than continuous depression and anxiety. Furthermore, the results demonstrate that even mild depression can have a significant negative impact on pregnancy complications and labour and delivery outcomes. These results further highlight the imperative need for women to be screened and treated for depression and anxiety during pregnancy.

Memoria para optar al Título Profesional de Médico Veterinario. / La diarrea neonatal (DN) es la patología más frecuente y la primera causa de muerte en terneros, generando altas pérdidas en la industria. Los tratamientos más utilizados incluyen el uso de antibióticos de amplio espectro. El uso de antibacterianos específicos podría contribuir al control de esta patología. El objetivo del presente estudio fue evaluar el efecto de un producto comercial formulado a base de bacteriófagos específicos para el control de E.coli y Salmonella spp., sobre la presentación de DN y peso al destete en terneras Holstein de la zona central de Chile. Para ello, se trabajó en dos lecherías comerciales ubicadas en las regiones de Valparaíso y Metropolitana, donde se asignaron aleatoriamente 80 terneras recién nacidas a dos grupos en cada predio, un grupo control y un grupo experimental. El grupo experimental recibió 0,5 gramos de un controlador microbiológico (Milkeeper S®, Phage Technologies, Santiago, Chile) a base de bacteriófagos específicos contra E. coli, Salmonella panama, S. dublin, S. mbandaka y S. typhimurium, disueltos en la leche o sustituto, dos veces al día hasta el destete. El grupo control recibió, 0,5 gramos de un placebo a base de almidón disuelto en la leche o sustituto, dos veces al día hasta el destete. Se evaluó en cada ternera el peso al nacimiento, proteínas séricas totales (PST) entre el 3er a 5to día de vida, peso a los 30, 60 y 75 días aproximadamente, como también se registraron los casos de enfermedad y muertes. Las incidencias de diarrea no fueron diferentes (p=0,79) entre el grupo control (50%) y el grupo experimental (42,5%). Tampoco se observaron diferencias en la mortalidad registrada en el periodo, siendo de 7,5% en el grupo control y de 5% en el grupo experimental. Por otro lado, la duración de los cuadros fue significativamente menor (p=0,03) en las terneras tratadas con el bacteriófago (5,9±1,81 días) que en el grupo control (8,5 ± 4,24 días) y se observó una tendencia a una menor severidad de las diarreas en las terneras tratadas. Las terneras del grupo experimental tuvieron una tendencia a una mayor ganancia diaria de peso que las del grupo control (628gr/día y 578gr/día, respectivamente; p=0,07), y un mayor peso al destete que las del grupo control (82,0 kg y 78,0 kg, respectivamente; p=0,03). Se concluye que el producto testeado no disminuye en forma significativa la incidencia de DN en terneras, pero sí la duración y la severidad de estas, mejorando significativamente el peso al destete. / The neonatal diarrhea (ND) is the most common disease and the main cause of death in calves, generating high losses in the industry. The most widely used treatments include the use of broad-spectrum antibiotics. The use of specific antibacterials could help to control this disease. The aim of this study was to evaluate the effect of a commercial product formulated with specific bacteriophages for control of E. coli and Salmonella spp., on the presentation of ND and weaning weight in Holstein calves of central Chile. The study was conducted in two commercial dairies located in Valparaiso and Metropolitan regions, where 80 newborn calves were randomly assigned to two groups on each farm, a control group and an experimental group. The experimental group received 0.5 grams of a microbiological controller (Milkeeper S®, Phage Technologies, Santiago, Chile) based on specific bacteriophages against E. coli, Salmonella panama, S. dublin, S. Mbandaka and S. typhimurium, dissolved in milk or substitute, twice a day until weaning. The control group received 0.5 grams of a placebo based on starch dissolved in the milk replacer, twice a day until weaning. Birth weight, total serum protein (TSP) from the 3rd to 5th day of life, weight at about 30, 60 and 75 days, and illness and deaths frequencies were also registered. The incidences of diarrhea were not different (p = 0.79) between the control group (50%) and the experimental group (42.5%). No differences were observed in mortality rates during the period, with 7.5% in the control group and 5% in the experimental group. On the other side, the duration of the episodes of diarrhea was significantly lower (p = 0.03) in calves treated with bacteriophage (5.9 ± 1.81 days) than in the control group (8.5 ± 4.24 days ) and a trend toward a lower severity of diarrhea in treated calves was observed. The calves of the experimental group had a trend to greater daily weight gain than the control group (628gr / day and 578gr / day, respectively; p = 0.07), and increased weaning weight than the control group (82.0 kg and 78.0 kg, respectively; p = 0.03). It is concluded that the tested product does not significantly decrease the incidence of DN in calves, but affects the duration and severity of that, significantly improving weaning weight. / Financiamiento: VETNOVO, EIP-2014.

Diethylstilbestrol (DES) is one of the synthetic estrogen available today for therapeutic use. It is also referred to as a carcinogenic agent, with a great number of side effects reported between maternal ingestion of DES during pregnancy, as a postovulatory agent to prevent implantation and possible occurrence of carcinoma in the progeny of women known to be aborterse. In the present study, experiments were done to determine the effects of DES on the estrogen titer of the maternal, fetal and neo-natal plasma ovarian homogenates of female Long-Evans rats. Adult and 30-day old rats were treated via stomach intubation with 35 mg/2cc/kg body wt of DES. The estrous cycle of the rats was monitored and vaginal smear cell counts were determined in 0.5 cc saline smear volume. Radioimmunoassay was used to determine the estradiol levels in the plasma and ovarian homogenates. Results showed no changes in the estrous cycle synchrony of the maternal rats, while the estrous cycle of the treated 30-dayold rats has synchronous. The vaginal smear cell count was significantly greater in the two groups of treated rats studied than in the controls. Comparing the mean estradrol value for the plasma and ovarian homogenates in the maternal rats, an obvious increase in the plasma E2 level was obtained as compared to small, decrease in the mean value of ovarian E2 level. There was no difference in the mean value of pooled ovarian homogenate E2 level of the control saline, control and DES-treated 19-1/2-day old rats. A significant decrease in the plasma E2 mean value of 30-day old treated rats was obtained when compared to both control groups. There was no significant increase in ovarian homogenate E2 level of both treated and the control groups. In light of these results, DES has a secondary effect, asynchronous cell proliferation in the vaginal epithelia leading to prolonged specific stages of the estrous cycle of the young adult female rats. Also, DES causes an increase in plasma E2 levels of treated maternal rats and a decrease in plasrna E2 levels of 30-dayold rats. Finally, DES has no effect on the estrogen level of the ovarian homogenates of the maternal, fetal and 30-clay-old young Long-Evans female rats.

Faculty of Speech,Language,Pathology and Audilogy School of Humanities and community Development 9604968n lynzicrisp@yahoo.co.uk / This study endeavored to explore the opportunities afforded parents to develop optimal communication with their infants during their experience of the NICU in a private-sectored hospital. Six sets of parents participated in a semi-structured interview and completed a short questionnaire. They were interviewed one year after their infants were discharged from the NICU. The interview and questionnaire probed the three main components that are known to influence the development of optimal communication between parents and their infants in the Neonatal Intensive Care Unit (NICU): the infant’s prematurity and medical condition; the nature of the NICU; and the parents’ ability to adjust and adapt to the challenges faced during the NICU experience. The data obtained was analysed qualitatively using a constant comparative method. Six main themes emerged: preparedness; contact with the infant; bonding; information; support; and previous parenting experience. The findings reflected that the parents were afforded limited opportunities for the development of adequate infant-parent interaction. The implications of this study highlight the need for appropriate developmental and family-centred care to be implemented within NICUs in private-sector hospitals, the role of the speech-language therapist in the NICU team to be defined, and future research into the nature of the care provided within NICUs in South Africa.

MSc, Nursing, Faculty of Health Sciences, University of the Witwatersrand, 2009

Introdução: As infecções relacionadas à assistência à saúde (IRAS) estão entre as principais causas de morte e aumento de estados de morbidez em doentes hospitalizados. Os recém-nascidos são suscetíveis a infecção, pois seus mecanismos de defesa ainda não estão maduros e ocupam um ambiente em que antibióticos e procedimentos invasivos são freqüentes. As mãos são consideradas as principais vias de disseminação de IRAS e a eficaz higienização é a medida importante para evitar as infecções. A capacitação e educação permanente dos profissionais de saúde são ferramentas essenciais para a construção de resultados positivos e o ambiente simulada desponta como estratégia pedagógica. Objetivo: Avaliar a efetividade de uma intervenção educativa em cenário simulado no aumento da adesão à higiene das mãos pela equipe de enfermagem e na redução das IRAS em uma Unidade de Terapia Intensiva Neonatal (UTIN). Método: Estudo quase-experimental, com abordagem quantitativa, que incluiu todos os profissionais de enfermagem da UTIN de um hospital universitário terciário no interior paulista. A pesquisa foi aprovada por Comitê de Ética em Pesquisa e desenvolvida em três etapas, incluindo a avaliação da adesão à higienização das mãos conforme os cinco momentos recomendados pela Organização Mundial da Saúde (OMS), antes e após intervenção educativa em cenário simulado com casos clínicos contextualizados com a realidade do serviço. As taxas de IRAS foram computadas em uma série histórica de 35 meses, sendo apenas o último mês no pós intervenção. Os dados foram analisados pelo programa STATA, com uso de estatística descritiva. Resultados: Na etapa pré intervenção, os profissionais realizaram a higiene das mãos em 41,2% das vezes, valor que aumentou após a simulação para 59,7% de ações realizadas conforme indicação. A técnica executada para higiene das mãos aumentou de 76,6% para 85,2% de conformidade após intervenção. A higiene das unhas e extremidades ainda é a maior fragilidade dos participantes na execução da técnica. Todas as categorias profissionais tiveram aumento entre 17 a 19% na adesão à higienização das mãos, com significância estatística na comparação pré e pós intervenção: p<0,001 para enfermeiros e técnicos de enfermagem; p=0,005 para auxiliares de enfermagem. Na análise da higiene das mãos, em três dentre os cinco momentos recomendados pela OMS as médias de adesão aumentaram significativamente, sendo antes (p<0,001) e após (p=0,008) o contato com o RN e após o contato com superfícies (p<0,001). As médias de adesão antes do procedimento asséptico (de 57,6% para 72,7%) e após exposição a fluídos (de 77,3% para 95,5%) aumentaram, apesar de não haver significância estatística. A taxa de IRAS no mês subsequente a intervenção (8,5%) não decresceu em comparação ao mês anterior a intervenção (7,8%), sendo que tais taxas foram relativamente inferiores em 19 dos 35 meses de coleta. Conclusão: Confirma-se a hipótese primária que a taxa de adesão à higiene das mãos pela equipe de enfermagem aumentou após a intervenção educativa em cenário simulado, em comparação com a taxa antes da intervenção, todavia, rejeitase a hipótese secundária, pois a taxa de IRAS não reduziu no mês subseqüente a intervenção educativa, em comparação com a taxa no mês pré intervenção / Background:The infections acquired in healthcare environments not only increase morbidity in hospitalized patientsbut also causea great number of deaths. Newborns (NBs) are susceptible to infection due to their immature defense mechanisms allied to the high frequency of antibiotics prescription and invasive procedures. As hands are considered the key dissemination pathway of healthcare-associated infections (HAI), the effective hand hygiene compliance is the most important measure to prevent infections. Healthcare professionals training and permanent education, mainly those based on simulation strategies, are essential tools to achieveour main goal, that is healthcare associated infections control.Objective:To evaluate the effectiveness of an educational intervention, in a simulated scenario, in the increase of hand hygiene adherence by the nursing team and in the reduction of HAI in a Neonatal Intensive Care Unit (NICU).Method:Quasi-experimental study with a quantitative approach including all nursing professionals at the NICU of a tertiary university hospital in the countryside of the São PauloState. After the approval by the Ethics Research Committee, the study was developed in three phases, including the evaluation of hand hygiene adherence in a simulation setting according to the five moments recommended by WHO, before and after the educational intervention, based on local clinical cases. HAI rates have been computed in a historical series of the 35 months, being only last month in post-intervention. Data were analyzed using the software STATA, using descriptivestatistics.Results: In the pre-intervention phase, the professionalsperformedhand hygiene in 41,2% of times,which increased after simulation, with 59.7% of actions performed as indicated.In relation to the technique employed for hand hygiene, it moved from 76.6% to 85.2% of conformance after intervention. Thehygiene of nails and extremitiesis still the greatest fragility of the participants performing the technique. All professionals categories had between 17 to 19% of increasing the hand hygiene compliance, with statistical significance in the pre and post intervention comparison: p<0,001 for nurses and nursing technicians; p=0,005 for nursing assistant. The analysis of the hand hygiene in three out of the five moments recommended by WHO,showed that the average of adherence significantly increased, being before (p<0,001) and after (p=0,008) the contact with NBs and after the contact with surfaces (p<0,001). The averages of adherence before aseptic procedure (57,6% to 72,7%) and after exposure to fluids (77,3% to 95,5%) increased, however without statistical significance.The HAI rates in the following month of intervention (8,5%) did not drop compared to the month before the intervention (7,8%), and these rates were relatively lower in 19 out of the 35 months of data collect. Conclusion: The primary hypothesis was confirmed, as the adherence hand hygiene through the nursing team increased post educational intervention in simulated scenario, in comparison with the rates before the intervention. However, the secondary hypothesis was rejected, because the HAI rates did not reduced in the following month of educational intervention, in comparison with the rates in the pre-intervention month