MMed (Paediatrics), Faculty of Health Sciences, University of the Witwatersrand / The aim of regionalisation of neonatal services is to offer a basic level of care to the majority of the obstetric/neonatal population who are at low risk, with smaller numbers of more specialised hospitals offering higher levels of care to the fewer, higher-risk patients. On review of relevant literature there has long been a shortage of neonatal intensive care unit (NICU) beds in the South African public sector. This study was an audit within a referral system in the public sector. The aim was to identify the need for NICU beds, establish whether the need was being met, ascertain which patients required referral and which were accepted, and delineate factors that influenced the outcome of acceptance versus refusal. Subjects and Methods Data collection took place between 30 October and 11 December 2006. Seven health facilities in southern Gauteng were included as study sites. These included 2 primary healthcare clinics, 3 district, 1 regional hospital and the tertiary referral facility, Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). The study included all neonates requiring transfer to a NICU, for any reason, during the study period. Data collection relied upon completion of information sheets by doctors requesting or accepting transfer of ill neonates at each of the hospitals involved. The primary outcome was acceptance or refusal at CMJAH NICU. Secondary outcome was survival or death within the study period. Results Forty-seven external requests for NICU beds were recorded at CMJAH and another 22 requests came for births within CMJAH. Only 13 (28%) of external requests were accepted. All internal requests were accommodated. Most requests came from level 2 (district or regional) hospitals, many outside the designated referral system, mainly for infants with respiratory distress. Infants older than 24 hours of age (OR 0.16; 95% CI 0.04-0.65), those with congenital abnormalities, and those requiring surgery (OR 0.11; CI 0.23-0.57) were significantly more likely to be accepted. Greater numbers of staff on duty at CMJAH also correlated with the probability of acceptance into NICU. Conclusion Relatively few external requests were accepted. CMJAH provides sub-specialist services including paediatric surgery and therefore should accept patients requiring such management. However, there was a high number of patients refused admission for ‘simple’ neonatal respiratory conditions. Level 2 hospitals should be able to manage these. Furthermore, hospitals are not following strict referral protocols. The findings are indicative of the continued shortage of neonatal intensive care beds, poor adherence to referral guidelines, and a general failure of regionalisation within the sector under consideration.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A falta de conhecimento por parte das mÃes acerca da saÃde ocular dos seus filhos à um denominador comum encontrado quando sÃo abordadas sobre essa temÃtica, principalmente relacionado à estimulaÃÃo visual, componente de valor significativo na saÃde ocular dos recÃm-nascidos. Nesse intuito, objetivamos aplicar um manual com Ãnfase na estimulaÃÃo visual para mÃes de crianÃas com risco para alteraÃÃes visuais e validar material e mÃtodo para educaÃÃo e saÃde aplicado à estimulaÃÃo visual de crianÃas prematuras e/ou com riscos para alteraÃÃes visuais. A coleta de dados foi realizada de abril a junho de 2005 em trÃs momentos metodolÃgicos. No primeiro momento, o manual foi avaliado por trÃs especialistas; no segundo, foi reformulado a partir das suas sugestÃes; e no terceiro, o manual foi aplicado com as mÃes internadas na enfermaria mÃe-canguru, sendo realizadas entrevistas gravadas, as quais abordaram itens de avaliaÃÃo apÃs a leitura do manual. Os dados foram organizados segundo Bardin (1977) e analisados conforme Nietshe (2000). As sugestÃes, de acordo com indicaÃÃo dos especialistas, contemplaram a contracapa, com a identificaÃÃo completa das autoras; acrÃscimo de um item sobre a histÃria obstÃtrica e outro sobre sinais e sintomas de alteraÃÃes visuais; modificaÃÃo de um desenho sobreposto ao texto que dificultava a leitura; Ãnfase ao tÃpico sobre a participaÃÃo dos pais na promoÃÃo à saÃde ocular dos seus filhos; atualizaÃÃo da literatura; e ampliaÃÃo do material criado para todas as crianÃas com riscos para alteraÃÃes visuais, nÃo apenas para os prematuros. Em seguida foi promovido o segundo momento, com a inserÃÃo do conteÃdo sugerido pelos especialistas. ApÃs a anÃlise temÃtica das 12 entrevistas, identificamos quatro temas, a saber: PercepÃÃo do manual, Conhecimento das mÃes acerca da saÃde ocular, Estrutura do manual e PromoÃÃo à saÃde ocular. ConcluÃmos que o manual facilitou a aprendizagem sobre a estimulaÃÃo visual, como tambÃm facilitarà a identificaÃÃo de alteraÃÃes visuais durante a convivÃncia familiar, alÃm de proporcionar incentivo à continuidade da estimulaÃÃo no domicÃlio como fator indispensÃvel para o desenvolvimento da crianÃa, seja ela prematura ou nÃo. Ao mencionar os componentes contemplados pela tecnologia emancipatÃria, como o exercÃcio da consciÃncia crÃtica, a cidadania, a liberdade e a autonomia, afirmamos que cada um deles esteve presente na aplicaÃÃo do manual, inserindo-o na prÃtica junto Ãs mÃes como tecnologia emancipatÃria. / The lack of knowledge on the part of mothers about their childrenâs ocular health is a common denominator found when they are asked about this theme, mainly concerning the visual stimulation, which is a component of significant value to the newborn babiesâ ocular health. Thus, one aimed to apply a handbook highlighting the visual stimulation for mothers of children with risk to visual alterations and to validate material and method for education and health applied to visual stimulation of premature children and/or with risks to visual alterations. Data collection was carried out from April to June, 2005 in three methodological moments. On the first moment, the handbook was analyzed by three experts, on the second one, the handbook was reformulated starting from the suggestions and on the third moment the handbook was applied to the mothers admitted to the kangaroo-mother ward, with record of interviews where the items of evaluation were approached after the reading of the handbook. The data were described according to Bardin (1977) and Nietsche(2000). Referring to the first moment, one suggested changes in the handbookâs back page, with the complete identification of the authors, addition of an item about the obstetric history and another about signs and symptoms of visual alterations; change of a drawing that was over the text making it difficult to read; emphasis on the topic about the participation of parents on the promotion of ocular health to their children; update on the literature; and enlargement of the material created for all the children with risks to visual alterations, not only the premature ones. Next, one carried out the second methodological moment, with the corrections suggested by the experts, being all obeyed. After the thematic analysis of the 12 interviews, one identified four themes: Perception of the handbook, Knowledge of mothers about ocular health, Handbookâs structure and Promotion of the ocular health. We concluded that the handbook facilitated the learning about visual stimulation, as well as it will make that the visual deficit, in case it appears, is noticed as precocious as possible, in the family life. Besides encouraging the stimulation at home as an indispensable factor to the development of the child, be it premature or not. By mentioning the components contemplated by the emancipatory technology, to know: the exercise of critical conscience, citizenship, freedom and autonomy; we affirm that each one of them was present at the application of the handbook about visual stimulation, what makes the handbook, as well as the practice together with the mothers as emancipatory technology.

Made available in DSpace on 2016-04-29T14:17:12Z (GMT). No. of bitstreams: 1 Leticia Lofiego Sanchez Chrispi.pdf: 249606 bytes, checksum: 5a8880db24d7977933709e4c0c21001b (MD5) Previous issue date: 2007-12-05 / This research on the social determinants that lead mothers to abandon newborns putting them at risk of life, reflects a concern about the situation experienced nowadays by many women and newborn babies in our country. For a better approach of the reality experienced by these women and understanding of what permeates their act, has been used as a feature testimonials of the individuals -these mothers- and as methodology the oral story. Even with all problems involving this research because it is a field characterized by silence, where the desire for non-identification is firmly present in the reality of mothers who have abandoned their children at risk, the attainment of this reality only became possible when the focus was on these women. The identity given to the woman, socially and historically, in terms of peer pressure related to motherhood / maternal and the fear and shame of challenging the myth of innate maternal love, establish essential determinants to the reality here searched. The discrimination that mothers who give away their children bear, the lack of a support network (family/community) and the social policies restricting family and the woman are also important resolutions which, sometimes, imbricate with each other. / A presente pesquisa sobre determinantes sociais que levam mães a abandonarem seus filhos recém-nascidos, colocando-os em situação de risco de vida, traduz uma preocupação acerca da realidade vivenciada atualmente por inúmeras mulheres e recém-nascidos em nosso país. Para melhor aproximação da realidade concreta vivenciada por estas mulheres e entendimento do que permeia seu ato, foram utilizados depoimentos dos sujeitos - essas mães - tendo como metodologia a história oral. Mesmo com toda dificuldade que envolve esta pesquisa por se tratar de uma área caracterizada pelo silêncio, já que o desejo de não identificação se faz fortemente presente na vida dessas mães que abandonaram seu filho em situação de risco, a apreensão desta realidade só se tornou possível ao ser direcionado o olhar a essas mulheres. A identidade atribuída à mulher, social e historicamente, no que se refere à pressão social relacionada à maternidade / maternagem e o medo e a vergonha de desafiar o mito do amor materno inato, constituem determinantes fundamentais para a realidade aqui pesquisada. O preconceito sofrido pelas mães que entregam seus filhos, a falta da rede de apoio (familiar / comunitária) e as políticas sociais restritivas à família e à mulher também são importantes determinações, que se imbricam em alguns momentos

Orientador: Vera Lucia Pamplona Tonete / Resumo: Introdução: atualmente, embora se constate a redução dos índices de morbimortalidade infantil em todas as regiões do país, ainda há muito que se fazer para promover a saúde de crianças, especialmente daquelas mais vulneráveis. O presente estudo aborda o tema da vigilância à saúde de recém-nascidos de risco, com base em protocolo de organização de serviços. Considera-se que protocolo compõe-se de rotinas de cuidados e ações de gestão de um determinado serviço, equipe ou departamento, elaborado a partir da produção de conhecimentos e práticas dos profissionais envolvidos, com respaldo de evidências científicas. Objetivo: elaborar protocolo de organização de serviços para a redução de óbitos infantis na região de saúde do Vale do Jurumirim, São Paulo, com enfoque na vigilância à saúde de recém-nascidos de risco. Aspectos metodológicos: trata-se de uma pesquisa-intervenção, composta por uma etapa inicial, quando foi realizado estudo transversal e descritivo sobre o perfil epidemiológico regional de recém-nascidos vivos em 2013 e das crianças que foram a óbito nesse mesmo ano, durante o primeiro ano de vida, buscando a correspondência aos critérios de risco ao nascer indicados pelo Ministério da Saúde. Nesta primeira etapa, buscou-se também caracterizar a rede de atenção à saúde materno-infantil disponível na região em foco. Em uma etapa posterior, foi realizada intervenção participativa, que incluiu duas oficinas de oito horas para elaboração do protocolo pretendido, envolvendo 3... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Although it is currently noticed a decline in infant mortality rate in all the regions of the country there is still a lot to do to promote child health care, especially those children who are more vulnerable. The current study deals with the topic of health monitoring of newborn babies at risk based on service organizing protocol. It is considered that protocol consists of routine care and management procedure of a particular service, team or department, by putting together healthcare professionals’ knowledge and experience and supported by scientific evidences. Objective: Putting together service organizing protocol to decline infant mortality in the region of Vale do Jurumirim, São Paulo, focused on health care monitoring of newborn babies at risk. Methodological Aspects: It is about intervention survey consisted of an initial stage when it was done a transversal and descriptive study of the regional epidemic profile of newborn babies born in 2013 and one-year-old children or younger who died that year, aiming at the correspondence between risk criteria at birth according to the Department of Health. In this initial stage, attention to maternal-infant health care was given when it was available in that region. In a later stage, participative intervention was carried out, which included two eight-hour workshops to put together intended protocol, involving 34 managers and healthcare professionals and maternal-infant health care monitoring of that particular reg... (Complete abstract click electronic access below) / Mestre

Submitted by JULIANA PIERAMI DE FREITAS null (jupierami@hotmail.com) on 2016-04-28T23:49:36Z No. of bitstreams: 1 Dissertacao Juliana 2504.pdf: 1553097 bytes, checksum: 7fab2bad78418aed6d927c6d8c388edc (MD5) / Approved for entry into archive by Felipe Augusto Arakaki (arakaki@reitoria.unesp.br) on 2016-05-02T16:57:55Z (GMT) No. of bitstreams: 1 freitas_jp_me_bot.pdf: 1553097 bytes, checksum: 7fab2bad78418aed6d927c6d8c388edc (MD5) / Made available in DSpace on 2016-05-02T16:57:55Z (GMT). No. of bitstreams: 1 freitas_jp_me_bot.pdf: 1553097 bytes, checksum: 7fab2bad78418aed6d927c6d8c388edc (MD5) Previous issue date: 2016-03-02 / Introdução: atualmente, embora se constate a redução dos índices de morbimortalidade infantil em todas as regiões do país, ainda há muito que se fazer para promover a saúde de crianças, especialmente daquelas mais vulneráveis. O presente estudo aborda o tema da vigilância à saúde de recém-nascidos de risco, com base em protocolo de organização de serviços. Considera-se que protocolo compõe-se de rotinas de cuidados e ações de gestão de um determinado serviço, equipe ou departamento, elaborado a partir da produção de conhecimentos e práticas dos profissionais envolvidos, com respaldo de evidências científicas. Objetivo: elaborar protocolo de organização de serviços para a redução de óbitos infantis na região de saúde do Vale do Jurumirim, São Paulo, com enfoque na vigilância à saúde de recém-nascidos de risco. Aspectos metodológicos: trata-se de uma pesquisa-intervenção, composta por uma etapa inicial, quando foi realizado estudo transversal e descritivo sobre o perfil epidemiológico regional de recém-nascidos vivos em 2013 e das crianças que foram a óbito nesse mesmo ano, durante o primeiro ano de vida, buscando a correspondência aos critérios de risco ao nascer indicados pelo Ministério da Saúde. Nesta primeira etapa, buscou-se também caracterizar a rede de atenção à saúde materno-infantil disponível na região em foco. Em uma etapa posterior, foi realizada intervenção participativa, que incluiu duas oficinas de oito horas para elaboração do protocolo pretendido, envolvendo 34 gestores e profissionais da atenção e vigilância à saúde materno-infantil da referida região. Os dados de cunho quantitativo foram colhidos de bancos públicos e documentos oficiais e descritos estatisticamente, enquanto que os de cunho qualitativo foram obtidos a partir do preenchimento do modelo proposto por Werneck, Faria e Campos, anotações em diário de campo e de roteiro com questões que nortearam as discussões durante as oficinas. Este estudo foi aprovado pelo Comitê de Ética em Pesquisa da Faculdade de Medicina de Botucatu da Universidade Estadual Paulista. Resultados: no ano de 2013, na região de saúde do Vale do Jurumirim foram contabilizados 3748 nascidos vivos, sendo que 9,8% desses apresentaram correspondência a pelo menos um dos critérios de risco ao nascer estudados. Neste mesmo ano, ocorreram 47 óbitos infantis, com 80,8% desses no componente neonatal, distribuídos em 12 municípios dos 17 municípios da região. Constatou-se que houve em todos os óbitos infantis correspondência a pelo menos um dos critérios de risco ao nascer estudados. Sobre vigilância e atenção à saúde materno-infantil, verificou-se que existiam fragilidades quanto ao trabalho em rede, bem como não se tinham estabelecidas estratégias para identificação e segmento de crianças expostas a riscos de adoecer e morrer. Com base nesses achados, coletivamente, foi possível estabelecer: os critérios de risco ao nascer para classificar os recém-nascidos vivos da região e a forma de considerá-los; o elenco de atividades a serem desenvolvidas, com seus respectivos responsáveis; os mecanismos de acompanhamento e avaliação; bem como o fluxograma de atividades para detecção e abordagem de recém-nascido de risco. Considerações finais: como produto desta pesquisa-intervenção foi elaborado o protocolo para a vigilância de recém-nascidos de risco na região de saúde do Vale do Jurumirim. Considera-se que o processo para tal produção foi cientificamente respaldado, contando com a participação ampla e ativa dos profissionais envolvidos com a vigilância e atenção à saúde materno-infantil dessa região. Sendo por definição um instrumento a ser revisto periodicamente, recomenda-se a avaliação do protocolo elaborado após um ano de sua implementação. / Introduction: Although it is currently noticed a decline in infant mortality rate in all the regions of the country there is still a lot to do to promote child health care, especially those children who are more vulnerable. The current study deals with the topic of health monitoring of newborn babies at risk based on service organizing protocol. It is considered that protocol consists of routine care and management procedure of a particular service, team or department, by putting together healthcare professionals’ knowledge and experience and supported by scientific evidences. Objective: Putting together service organizing protocol to decline infant mortality in the region of Vale do Jurumirim, São Paulo, focused on health care monitoring of newborn babies at risk. Methodological Aspects: It is about intervention survey consisted of an initial stage when it was done a transversal and descriptive study of the regional epidemic profile of newborn babies born in 2013 and one-year-old children or younger who died that year, aiming at the correspondence between risk criteria at birth according to the Department of Health. In this initial stage, attention to maternal-infant health care was given when it was available in that region. In a later stage, participative intervention was carried out, which included two eight-hour workshops to put together intended protocol, involving 34 managers and healthcare professionals and maternal-infant health care monitoring of that particular region. Information characterized by quantity was collected from public data and statistical official documents whereas information characterized by quality was collected from the filling out of model proposed by Werneck, Faria and Campos, notes in field log and itinerary containing questions asked during the workshop. This study was approved by Ethic Committee in Survey of the Medical University in Botucatu of the Paulista State University. Results: In 2013, 3,748 newborn babies were born in Vale do Jurumirim region, 9.8% showed at least one correspondence of the risk criteria studied. That year, 47 infants died, 80.8% during neonatal in 12 cities of that 17-city region. It was noticed that there was, at birth, at least one correspondence of the risk criteria studied in all the infant deaths. When it comes to maternalinfant health care monitoring, it was checked that there were flaws in networking and strategies to identify children exposed to risks of becoming sick and dying had not been established. Based on these findings, it has been possible to establish collectively: risk criteria at birth to classify newborn babies in the region and the way to consider them; activities to be developed with their respective responsible ones; the mechanics of accompanying and evaluating; as well as the flow chart of activities to detect and approach newborn babies at risk. Final Consideration: As a product of this intervention survey, a protocol to monitor newborn babies at risk in the region of Vale do Jurumirim was put together. It is considered that the procedure to produce such a protocol was scientifically supported, counting on the ample and active participation of healthcare professionals concerned with maternal-infant health care in that region. It is also, by definition, a tool to be revised periodically, evaluation of this protocol is recommended after one year of its implementation.

BACKGROUND AND OBJECTIVES: Streptococcus agalactiae (Group B Streptococcus, GBS) is the leading cause of neonatal infections and deaths in human. It can also cause infections in pregnant women and non-pregnant adults. Penicillin and ampicillin are antibiotics of choice for the treatment of GBS infections. Erythromycin and clindamycin are used as alternative therapy in penicillin allergic patients, however resistance to these agents has been increasingly observed. This present study was undertaken to determine the colonization rate of GBS, susceptibility profile and the mechanism of antibiotic resistance in pregnant women and their babies at Dr. George Mukhari Academic Hospital in Pretoria. METHODS: Rectal and vaginal swabs were collected from pregnant women; ear and umbilical swabs from newborns over an 11 month period. Samples were cultured on selective media (CNA agar and Todd-Hewitt broth) and GBS positively identified using morphological and biochemical tests including Gram staining, hemolytic activity, catalase test, bile esculin, CAMP test and Latex agglutination test. The susceptibility testing was done using the Kirby-Bauer and E-test methods. The D-test method was used to determine the inducible clindamycin resistance. Multiplex PCR with were used to detect different genes coding for resistance. RESULTS: Out of the 413 patients evaluated, 128 (30.9%) were positive with GBS. All isolates were sensitive to penicillin and ampicillin. Erythromycin and clindamycin resistance was 21.1% and 17.2% respectively; of which 69% harbouring constitutive MLBB, 17.4% inducible MLSB. The alteration of ribosomal target encoded by ermB genes was the commonest mechanism of resistance observed in 55% of isolates, 38% of isolates had both ermB and linB genes and efflux pump mediated by mefA genes was detected in one of isolates. Conclusion: This study reaffirms the appropriateness of penicillin as the antibiotic of choice for treating GBS infection. However it raises the challenges of resistance to the macrolides and lincosamides. More GBS treatment options for penicillin allergic patients need to be researched. / Health Studies / M.Sc. (Life Sciences (Microbiology))

BACKGROUND AND OBJECTIVES: Streptococcus agalactiae (Group B Streptococcus, GBS) is the leading cause of neonatal infections and deaths in human. It can also cause infections in pregnant women and non-pregnant adults. Penicillin and ampicillin are antibiotics of choice for the treatment of GBS infections. Erythromycin and clindamycin are used as alternative therapy in penicillin allergic patients, however resistance to these agents has been increasingly observed. This present study was undertaken to determine the colonization rate of GBS, susceptibility profile and the mechanism of antibiotic resistance in pregnant women and their babies at Dr. George Mukhari Academic Hospital in Pretoria. METHODS: Rectal and vaginal swabs were collected from pregnant women; ear and umbilical swabs from newborns over an 11 month period. Samples were cultured on selective media (CNA agar and Todd-Hewitt broth) and GBS positively identified using morphological and biochemical tests including Gram staining, hemolytic activity, catalase test, bile esculin, CAMP test and Latex agglutination test. The susceptibility testing was done using the Kirby-Bauer and E-test methods. The D-test method was used to determine the inducible clindamycin resistance. Multiplex PCR with were used to detect different genes coding for resistance. RESULTS: Out of the 413 patients evaluated, 128 (30.9%) were positive with GBS. All isolates were sensitive to penicillin and ampicillin. Erythromycin and clindamycin resistance was 21.1% and 17.2% respectively; of which 69% harbouring constitutive MLBB, 17.4% inducible MLSB. The alteration of ribosomal target encoded by ermB genes was the commonest mechanism of resistance observed in 55% of isolates, 38% of isolates had both ermB and linB genes and efflux pump mediated by mefA genes was detected in one of isolates. Conclusion: This study reaffirms the appropriateness of penicillin as the antibiotic of choice for treating GBS infection. However it raises the challenges of resistance to the macrolides and lincosamides. More GBS treatment options for penicillin allergic patients need to be researched. / Health Studies / M. Sc. (Life Sciences (Microbiology))