Made available in DSpace on 2016-07-27T14:20:14Z (GMT). No. of bitstreams: 1 Livia Kunz Sebba Vasconcelos Pitaluga.pdf: 1284255 bytes, checksum: cf3c336ed67b107cd178fba590bec5f3 (MD5) Previous issue date: 2014-02-11 / This work aims to identify, describe and analyze the perception of Doula s monitoring on Quality of Life of parturients users of a public maternity hospital in Goiânia. The material was organized into an introduction, two theoretical chapters, method, and finally two products drafted in the form of a scientific article. It ends by final considerations. The papers feature a quantitative and qualitative review on the subject. For both analyzes were assessed Quality of Life of 30 women, being 15 with the accompaniment of a Doula and 15 without such monitoring, with na age range between 18 and 40 years, and up to 24 hours postpartum. The quantitative evaluation (Article 1) was taken from the instrument WHOQOL Bref and has as its results that, the Doula s monitoring reduces the rate of cesarean sections and leads to more natural births. This study also concluded that Doula s monitoring generates bigger and better rates in the psychological dimension of the parturient. The qualitative assessment (Article 2) was taken from semi -structured interview and was analyzed by the method of Laurence Bardin. It was evaluated the perception of quality of life and labor with all the patients. The results understands that pregnant women, with and without the accompaniment of a Doula positively assessed the Quality of Life. However, the group of women without the accompaniment of a Doula diverged from the group with a Doula, due to understand that the absence of such assistance contributes negatively on their overall assessment of Quality of Life, but this result may have been minimized by the presence of distinct protective factors, possibly happening a process of compensation. This study understands that the presence of the Doula tends to increase the protection condition of pregnant women, bringing a positive perception of labor. / Este trabalho visa identificar, descrever e analisar a percepção do acompanhamento da Doula na Qualidade de Vida de parturientes usuárias de uma maternidade pública de Goiânia. O material foi organizado em uma introdução, dois capítulos teóricos, método e, por fim, dois produtos redigidos em forma de artigo científico. Encerra-se pelas considerações finais. Os artigos científicos apresentam uma avaliação quantitativa e outra qualitativa sobre o tema. Para ambas as análises foram avaliadas a Qualidade de Vida de 30 parturientes, sendo 15 com o acompanhamento da Doula e 15 sem o referido acompanhamento, com faixa etária de 18 a 40 anos, e em até 24 horas pós-parto. A avaliação quantitativa (artigo 1) foi feita a partir do instrumento Whoqol Breve e tem como resultados que, o acompanhamento da Doula diminui o índice de cesarianas e conduz a mais partos naturais. Este estudo, ainda, concluiu que o acompanhamento da Doula gera maior e melhores índices na dimensão psicológica da parturiente. A avaliação qualitativa (artigo 2) foi feita a partir de entrevista semi-estruturada e foi analisada pelo método de Laurence Bardin. Avaliou-se a percepção da Qualidade de Vida e do trabalho de parto com todas as parturientes. Os resultados compreendem que as parturientes, com e sem acompanhamento de Doula, avaliaram positivamente a Qualidade de Vida. Porém, o grupo de mulheres sem o acompanhamento da Doula diferiu do grupo com Doula por entender que a ausência dessa assistência contribui de forma negativa na sua avaliação geral da QV, mas tal resultado pode ter sido minimizado pela presença de distintos fatores de proteção, possivelmente ocorrendo um processo de compensação. Assim, este estudo compreende que a presença da Doula tende a aumentar a condição de proteção das parturientes, trazendo uma percepção positiva do trabalho de parto.

Submitted by JULIANA MARQUES PAIVA null (julianna_paiva@hotmail.com) on 2017-12-19T13:42:17Z No. of bitstreams: 1 Mestrado_final_Juliana.pdf: 1467462 bytes, checksum: 67a627b6e7e6238acf2c02f1debf086b (MD5) / Approved for entry into archive by Luciana Pizzani null (luciana@btu.unesp.br) on 2017-12-19T16:37:24Z (GMT) No. of bitstreams: 1 paiva_jm_me_int.pdf: 1467462 bytes, checksum: 67a627b6e7e6238acf2c02f1debf086b (MD5) / Made available in DSpace on 2017-12-19T16:37:24Z (GMT). No. of bitstreams: 1 paiva_jm_me_int.pdf: 1467462 bytes, checksum: 67a627b6e7e6238acf2c02f1debf086b (MD5) Previous issue date: 2017-11-23 / Objetivo: Avaliar o grau de satisfação dos acompanhantes durante o trabalho de parto, parto e puerpério na Maternidade do Hospital das Clínicas da Faculdade de Medicina de Botucatu (M-HC-FMB). Sujeitos e métodos: Foi realizado estudo descritivo após aplicação de questionário constituído de 61 questões, em 108 acompanhantes de parturientes que tiveram partos na (M-HC-FMB), no período de seis meses. Foram excluídos do estudo partos emergenciais e gestantes com diagnóstico prévio ou após o parto de malformações fetais. Para todas as comparações estatísticas foi considerado nível de significância de 95% (p<0,05). Resultados: Analisando as respostas obtidas, pelo questionário apresentado aos acompanhantes, observamos a necessidade de melhorias quanto às informações fornecidas aos mesmos sobre os diversos períodos fisiológicos do parto e necessidade de maiores cuidados com a infraestrutura da maternidade. Obtivemos elevado grau de satisfação quanto à qualidade do atendimento prestado, à equipe de saúde e às situações de interação com o recém-nascido, além da sensação positiva em ser membro ativo e importante no auxilio à parturiente durante o trabalho de parto, parto e pós-parto. Conclusão: O presente estudo, de uma população de acompanhantes de parturientes, permite concluir que, o grau de satisfação dos acompanhantes de parturientes, durante a assistência ao seu trabalho de parto, parto e puerpério imediato, foi positivo em relação aos resultados obtidos para a paciente e recém-nascido, a infraestrutura da maternidade e à equipe de saúde envolvida. Palavras-chave: acompanhante, parto, trabalho de parto, parturiente, grau de satisfação. / Abstract Objective: The purpose of this study was to evaluate the degree of satisfaction of companion in childbirth care provided by the Maternity Service of the Hospital das Clinicas, Faculdade de Medicina de Botucatu (M-HC-FMB). Material and methods: A descriptive study was carried out on companions who were present in childbirth care. One questionnaire contained 61 questions were applied in 108 companions referring to expectation, experience and satisfaction, applied in the postpartum, 12 hours after the birth. Were excluded from the study emergency deliveries and diagnosis before or after delivery of fetal malformations. For all statistical comparisons was considered level of significance 95% (p <0,05). Results: Analyzing the answers obtained by the questionnaire presented to the companying, we observed the need for improvements in more information provided to de companions before de childbirth and improvements in hospital´s infrastructure. We obtained a high degree of satisfaction in quality of care provided, health team and situations with the newbornn and the positive feeling being an active and important member assisting the parturient during labor, delivery and postpartum. Conclusion: The present study, allows to conclude that the level of satisfaction during the childbith was positive in all questions submitted (health team, infrastructure and issues related to the newborn).

Made available in DSpace on 2014-12-17T14:13:20Z (GMT). No. of bitstreams: 1 RejaneMBD.pdf: 747698 bytes, checksum: 1b6dd45195ffd44f6d359516f4fa41e8 (MD5) Previous issue date: 2007-08-16 / This study was aim to evaluate the effectiveness of strategies non pharmacological for the relief of the intensity of the parturient pain in the phase activates of the dilation period in the labor. Is a clinic rehearse of the type therapeutic intervention before and after" with a quantitative approach, accomplished in the Humanized Unit of Childbirth of the Maternity Janu?rio Cicco School of the Federal University of Rio Grande do Norte, in Natal/RN, whit 130 parturient, being 30 in the pre-test of the strategies and 100 in the application of the strategies non pharmacological combined (breathing exercises, muscular relaxation and lombossacral massage) and isolated (shower bath in a normal temperature). We used the visual analogical scale to evaluate the intensity of the pain of the study parturient before and after" to the application of the strategies in the phases of acceleration, maximum inclination and desaceleration in the phase activates of dilation period in the labor. The principal results showed that the majority of the study parturient was between 20 to 30 years old (60%); with incomplete fundamental teaching (85%); family income until 2 minimum wages (74%); 78% had a companion and these, 44% were the own husband. The oxytocin was administered in the parturient during the phase activates of the labor in 81% of the cases and only 15% these women didn?t reciev anything medication. We verified significant relief (&#961;=0.000) of intensity of the pain of the study parturient after application of the strategies non pharmacological combined and isolated. We concluded that the strategies non pharmacological combined and isolated were effective in the relief of the pain of the study parturient in the phase activates de labor / Este estudo teve como objetivo avaliar a efetividade de estrat?gias n?o farmacol?gicas para o al?vio da intensidade da dor de parturientes na fase ativa do per?odo de dilata??o durante o trabalho de parto. Trata-se de um ensaio cl?nico quantitativo do tipo interven??o terap?utica antes e ap?s , realizado na Unidade de Parto Humanizado da Maternidade Escola Janu?rio Cicco da Universidade Federal do Rio Grande do Norte em Natal/RN, com uma amostra de 130 parturientes, sendo 30 no pr?-teste e 100 na aplica??o de estrat?gias n?o farmacol?gicas combinadas (exerc?cios respirat?rios, relaxamento muscular e massagem lombossacral) e isolada (banho de chuveiro com temperatura ambiente). Para avaliar a intensidade da dor das parturientes do estudo antes e ap?s ? aplica??o das estrat?gias n?o farmacol?gicas nas fases de acelera??o, inclina??o m?xima e desacelera??o da fase ativa do trabalho de parto, utilizou-se para a coleta de dados a escala anal?gica visual. Os principais resultados apontam que a maioria das parturientes do estudo estavam na faixa et?ria entre 20 a 30 anos (60%), com o ensino fundamental incompleto (85%), renda familiar de at? 2 sal?rios m?nimos (74%), 78% tinham um acompanhantes e destes 44% era o pr?prio companheiro. A ocitocina foi administrada nas parturientes durante a fase ativa do trabalho de parto em 81% dos casos e apenas 15% dessas mulheres n?o receberam qualquer medica??o. Verificou-se al?vio significativo (&#961;=0,000) da intensidade da dor das parturientes do estudo ap?s a aplica??o das estrat?gias n?o farmacol?gicas combinadas e isolada. Conclui-se que as estrat?gias n?o farmacol?gicas combinadas e isolada foram efetivas no al?vio da dor das parturientes do estudo na fase ativa do trabalho de parto

<p dir="ltr">In the US, dogs are considered members of the family by many people. Dogs may be obtained from multiple sources, but many in the US originate from commercial breeding kennels (CBKs). Prioritizing adult dogs’ welfare while they are housed in these kennels is essential for their well-being not only while residing there, but throughout the rest of their lives in new environments for those who are rehomed after their breeding careers end. However, the research conducted in this population is scarce. Therefore, evaluating dogs’ overall welfare states and factors that may affect them in this population is crucial.</p><p dir="ltr">Maternal factors are one of many that may affect puppies’ welfare states. This topic has never been directly explored in US CBKs and has been understudied in all domestic dogs. Therefore, this dissertation sought to explore associations between maternal factors and puppy welfare indicators, and related topics.</p><p dir="ltr">Chapter 2 aimed to explore changes in indicators of dams’ welfare states (<i>n</i>= 74), such as behavioral responses to a mild stressor and stress-related physiology, throughout the peri-parturient period in 8 CBKs. The changes observed were most likely due to natural biological changes associated with the peri-parturient period, and no worrisome indicators of welfare were detected. Additionally, Chapter 3 sought to investigate the relationship between dams’ levels of fear and stress (<i>n</i>= 90), as indicated by behavior and stress-related physiology, and metrics indicative of their puppies’ welfare states (<i>n</i>= 390), such as behavior, stress-related physiology, and physical health, in 12 CBKs. Findings suggest some associations between dams’ fear and stress and their puppies’ behavioral responses to isolation, physiology, and physical health. To further explore these associations, Chapter 4 examined the relationships between dams’ (<i>n</i>= 79) and puppies’ (<i>n</i>= 291) behavioral responses to novel social and non-social stimuli in 11 CBKs. No significant associations between dams’ and puppies’ responses were discovered, and possible reasons such as kennel management practices, puppies’ mobility and hazard avoidance, and differences between dams’ and puppies’ early life experiences were discussed. Finally, as the type and level of maternal care dams provide may be indicative of their welfare and may also be related to puppy welfare, Chapter 5 aimed to characterize maternal behaviors in a CBK (<i>n</i>= 12) and working dog population focused on detection work (<i>n</i>= 8). This study uncovered common maternal behaviors in each population, such as nursing and licking puppies. It also revealed that the behaviors observed were consistent with those reported for other dog populations, and found that factors such as day, time of day, litter size, and whelping type may influence their expression.</p><p dir="ltr">Overall, results from these studies suggest that there were no worrisome changes in dams’ welfare states throughout the peri-parturient period. Additionally, dams’ levels of fear and stress may affect potential indicators of their puppies’ welfare states, such as stress-related physiology, behavioral responses to stressors, and physical health. Findings highlight the importance of closely monitoring dams throughout the peri-parturient period for consistent displays of fear and stress, and abnormal behaviors. Doing so may not only affect dams’ welfare but that of their puppies as well. Further, the characterization and exploration of factors that may affect maternal care in various populations provides the basis for future work to explore maternal care as a mechanism behind the significant associations between dam and puppy welfare. The results also provide a foundation for breeders and caretakers to monitor maternal care, and make breeding selection and management interventions as needed to best support dam and puppy welfare. Altogether, findings from this research may have salient implications for dam’s welfare states throughout the peri-parturient period, and puppies’ welfare states while housed with their dams and into adulthood.</p>

O metoprolol, um fármaco aceito no tratamento da hipertensão durante a gestação, está disponível na clínica como mistura racêmica dos enantiômeros S-(-) e R-(+), embora o S-(-)-metoprolol seja considerado o eutômero em termos do bloqueio do receptor 1 adrenérgico. O presente estudo avalia a influência do Diabetes mellitus gestacional na disposição cinética e no metabolismo enantiosseletivos do metoprolol em parturientes hipertensas. As parturientes hipertensas investigadas (n=35) com idade gestacional de 35-42 semanas e fenotipadas como metabolizadoras extensivas tipo metoprolol, foram distribuídas nos grupos controle (n=24) ou portadoras de Diabetes mellitus gestacional (n=11). As parturientes foram tratadas com dose única oral de 100 mg de tartarato de metoprolol racêmico 1-11 h antes do parto. Foram coletadas amostras seriadas de sangue materno (0-24h) e no momento do parto foram coletados simultaneamente sangue materno, sangue do cordão umbilical e líquido amniótico. Os enantiômeros do metoprolol e seus metabólitos foram quantificados por LC-MS/MS ou por detecção por fluorescência. A disposição cinética do metoprolol é enantiosseletiva em parturientes hipertensas com observação de maiores concentrações plasmáticas (AUC0- 113,42 vs 62,65 ng.h/mL) e menor clearance total aparente (344,21 vs 623,14 L/h) para o eutômero S-(-)-metoprolol. A formação do metabólito -hidroximetoprolol também é estereosseletiva com favorecimento do novo centro quiral 1R (AUC0- 1R/1S=2,84). O favorecimento da formação do R-(+)-ácido O-desmetilmetoprolóico (AUC0- 2,77 vs 2,66 g.h/mL) explica o acúmulo plasmático do S-(-)-metoprolol. O Diabetes mellitus gestacional compensado prolonga o tmax para ambos os enantiômeros do metoprolol (1,5 vs 2,5 h) e ácido O-desmetilmetoprolóico (2,0 vs 3,5 h) e para todos os isômeros do -hidroximetoprolol (2,0 vs 3,0 h). O Diabetes mellitus gestacional compensado não altera as razões isoméricas de concentrações plasmáticas do metoprolol, -hidroximetoprolol e ácido O-desmetilmetoprolóico. As razões de concentrações líquido amniótico/plasma materno obtidas para ambos os enantiômeros do metoprolol (3,0 para o R-(+)-metoprolol e 3,2 para o S-(-)-metoprolol) e para os isômeros do -hidroximetoprolol (5,1 para o 1\'S,2R; 4,0 para o 1\'S,2S; 1,6 para o 1\'R,2R e 2,3 para o 1\'R,2S) evidenciam maiores concentrações dos fármacos no líquido amniótico do que no plasma materno. No entanto, os enantiômeros do ácido O-desmetilmetoprolóico atingem menores concentrações no líquido amniótico do que no plasma materno das parturientes hipertensas (líquido amniótico/plasma materno = 0,29 e 0,37 respectivamente para os enantiômeros R-(+)- e S-(-)). A distribuição transplacentária é próxima a 1 para ambos os enantiômeros do metoprolol e para todos os isômeros do -hidroximetoprolol e próxima a 0,8 para ambos os enantiômeros do ácido O-desmetilmetoprolóico em parturientes hipertensas. O Diabetes mellitus gestacional compensado reduz em aproximadamente 20% a distribuição transplacentária dos isômeros 1S,2S; 1R,2R; e 1R,2S--hidroximetoprolol mas não altera a distribuição dos enantiômeros do metoprolol. / Metoprolol is a drug accepted in the treatment of hypertension during pregnancy and it is clinically available as a racemic mixture of its enantiomers S-(-) and R-(+) metoprolol, although S-(-)-metoprolol is considered the eutomer responsible for 1 adrenergic receptor blockade.This study evaluates the influence of gestational Diabetes mellitus on the kinetic disposition and metabolism of metoprolol enantiomers in hypertensive parturients. The investigated parturients (n=35) presented gestational age within 35 to 42 weeks, were phenotyped as extensive metabolizers of metoprolol and were distributed in the control group (n=24) or in the gestational Diabetes mellitus group (n =11). The parturients were treated with single oral dose of 100 mg racemic metoprolol tartrate 1-11 h before delivery. Maternal blood samples were collected until 24h after drug administration, whereas maternal blood, umbilical cord blood and amniotic fluid were simultaneously collected at delivery. Metoprolol enantiomers and its metabolites were quantified by LC-MS/MS or by fluorescence detection. Kinetic disposition of metoprolol is enantioselective in hypertensive parturients with observation of higher plasma concentrations (AUC0- 113.42 vs 62.65 ng.h/mL) and lower apparent total clearance (344.21 vs 623.14 L/h) for the S-(-)-metoprolol eutomer. The formation of -hydroxymetoprolol metabolite is also stereoselective in favor of the new chiral center 1\'R (AUC0- 1\'R/1\'S = 2.84). The formation in favor of R-(+)-metoprolol acid metabolite (AUC0- 2.77 vs 2.66 g.h/mL) explains the plasma accumulation of S-(-)-metoprolol. Gestational Diabetes mellitus prolongs tmax for both metoprolol enantiomers (1.5 vs 2.5 h), metoprolol acid metabolite (2.0 vs 3.5 h) and for all -hydroxymetoprolol isomers (2.0 vs 3.0 h). Gestational Diabetes mellitus does not alter the isomeric ratios of plasma concentrations of metoprolol, -hydroxymetoprolol and metoprolol acid metabolite. The concentrations of both metoprolol enantiomers (amniotic fluid/maternal plasma = 3.0 for R-(+)-metoprolol and 3.2 for the S-(-)-metoprolol) and -hydroxymetoprolol isomers (liquid amniotic fluid/maternal plasma = 5.1 for 1\'S,2R; 4.0 for 1\'S,2S; 1.6 for 1\'R,2R and 2.3 for 1\'R,2S) are higher in amniotic fluid than in maternal plasma. However, metoprolol acid metabolite enantiomers reach lower concentrations in amniotic fluid than in maternal plasma of hypertensive parturients (amniotic fluid/maternal plasma = 0.29 and 0.37 respectively for the R-(+)- and S-(-)- enantiomers). The transplacental distribution is approximately 1 for both enantiomers of metoprolol and all isomers of -hydroxymetoprolol and approximately 0.8 for both metoprolol acid metabolite enantiomers in hypertensive parturients. Gestational Diabetes mellitus reduces in approximately 20% the transplacental distribution of the isomers 1\'S,2S; 1\'R,2R and 1\'R,2S--hidroximetoprolol but does not alter the transplacental distribution of both metoprolol enantiomers.

A total of 12 multicomponent solutions of various compositions were developed in which we attempted to blend calcium and phosphoric salts, which usually precipitate and form sediments. Among the medicines of similar composition and purpose registered in Lithuania, there is none containing all three important macroelements: Ca, Mg, and P. After the tests, one of the solutions tested – C2 – was registered in Lithuania and was manufactured by AB Ukmergės Biofabrikas (Lithuania) for several years. Production technology of the developed preparation – Kamavetas – is patented (patent No. LT 4509 B. 1999 05 25). Kamavetas is the first preparation created and manufactured in Lithuania, which contains Ca, Mg, and P salts and glucose. It is convenient to use, because the animal receives several mineral substances within a single infusion.

O metoprolol, um fármaco aceito no tratamento da hipertensão durante a gestação, está disponível na clínica como mistura racêmica dos enantiômeros S-(-) e R-(+), embora o S-(-)-metoprolol seja considerado o eutômero em termos do bloqueio do receptor 1 adrenérgico. O presente estudo avalia a influência do Diabetes mellitus gestacional na disposição cinética e no metabolismo enantiosseletivos do metoprolol em parturientes hipertensas. As parturientes hipertensas investigadas (n=35) com idade gestacional de 35-42 semanas e fenotipadas como metabolizadoras extensivas tipo metoprolol, foram distribuídas nos grupos controle (n=24) ou portadoras de Diabetes mellitus gestacional (n=11). As parturientes foram tratadas com dose única oral de 100 mg de tartarato de metoprolol racêmico 1-11 h antes do parto. Foram coletadas amostras seriadas de sangue materno (0-24h) e no momento do parto foram coletados simultaneamente sangue materno, sangue do cordão umbilical e líquido amniótico. Os enantiômeros do metoprolol e seus metabólitos foram quantificados por LC-MS/MS ou por detecção por fluorescência. A disposição cinética do metoprolol é enantiosseletiva em parturientes hipertensas com observação de maiores concentrações plasmáticas (AUC0- 113,42 vs 62,65 ng.h/mL) e menor clearance total aparente (344,21 vs 623,14 L/h) para o eutômero S-(-)-metoprolol. A formação do metabólito -hidroximetoprolol também é estereosseletiva com favorecimento do novo centro quiral 1R (AUC0- 1R/1S=2,84). O favorecimento da formação do R-(+)-ácido O-desmetilmetoprolóico (AUC0- 2,77 vs 2,66 g.h/mL) explica o acúmulo plasmático do S-(-)-metoprolol. O Diabetes mellitus gestacional compensado prolonga o tmax para ambos os enantiômeros do metoprolol (1,5 vs 2,5 h) e ácido O-desmetilmetoprolóico (2,0 vs 3,5 h) e para todos os isômeros do -hidroximetoprolol (2,0 vs 3,0 h). O Diabetes mellitus gestacional compensado não altera as razões isoméricas de concentrações plasmáticas do metoprolol, -hidroximetoprolol e ácido O-desmetilmetoprolóico. As razões de concentrações líquido amniótico/plasma materno obtidas para ambos os enantiômeros do metoprolol (3,0 para o R-(+)-metoprolol e 3,2 para o S-(-)-metoprolol) e para os isômeros do -hidroximetoprolol (5,1 para o 1\'S,2R; 4,0 para o 1\'S,2S; 1,6 para o 1\'R,2R e 2,3 para o 1\'R,2S) evidenciam maiores concentrações dos fármacos no líquido amniótico do que no plasma materno. No entanto, os enantiômeros do ácido O-desmetilmetoprolóico atingem menores concentrações no líquido amniótico do que no plasma materno das parturientes hipertensas (líquido amniótico/plasma materno = 0,29 e 0,37 respectivamente para os enantiômeros R-(+)- e S-(-)). A distribuição transplacentária é próxima a 1 para ambos os enantiômeros do metoprolol e para todos os isômeros do -hidroximetoprolol e próxima a 0,8 para ambos os enantiômeros do ácido O-desmetilmetoprolóico em parturientes hipertensas. O Diabetes mellitus gestacional compensado reduz em aproximadamente 20% a distribuição transplacentária dos isômeros 1S,2S; 1R,2R; e 1R,2S--hidroximetoprolol mas não altera a distribuição dos enantiômeros do metoprolol. / Metoprolol is a drug accepted in the treatment of hypertension during pregnancy and it is clinically available as a racemic mixture of its enantiomers S-(-) and R-(+) metoprolol, although S-(-)-metoprolol is considered the eutomer responsible for 1 adrenergic receptor blockade.This study evaluates the influence of gestational Diabetes mellitus on the kinetic disposition and metabolism of metoprolol enantiomers in hypertensive parturients. The investigated parturients (n=35) presented gestational age within 35 to 42 weeks, were phenotyped as extensive metabolizers of metoprolol and were distributed in the control group (n=24) or in the gestational Diabetes mellitus group (n =11). The parturients were treated with single oral dose of 100 mg racemic metoprolol tartrate 1-11 h before delivery. Maternal blood samples were collected until 24h after drug administration, whereas maternal blood, umbilical cord blood and amniotic fluid were simultaneously collected at delivery. Metoprolol enantiomers and its metabolites were quantified by LC-MS/MS or by fluorescence detection. Kinetic disposition of metoprolol is enantioselective in hypertensive parturients with observation of higher plasma concentrations (AUC0- 113.42 vs 62.65 ng.h/mL) and lower apparent total clearance (344.21 vs 623.14 L/h) for the S-(-)-metoprolol eutomer. The formation of -hydroxymetoprolol metabolite is also stereoselective in favor of the new chiral center 1\'R (AUC0- 1\'R/1\'S = 2.84). The formation in favor of R-(+)-metoprolol acid metabolite (AUC0- 2.77 vs 2.66 g.h/mL) explains the plasma accumulation of S-(-)-metoprolol. Gestational Diabetes mellitus prolongs tmax for both metoprolol enantiomers (1.5 vs 2.5 h), metoprolol acid metabolite (2.0 vs 3.5 h) and for all -hydroxymetoprolol isomers (2.0 vs 3.0 h). Gestational Diabetes mellitus does not alter the isomeric ratios of plasma concentrations of metoprolol, -hydroxymetoprolol and metoprolol acid metabolite. The concentrations of both metoprolol enantiomers (amniotic fluid/maternal plasma = 3.0 for R-(+)-metoprolol and 3.2 for the S-(-)-metoprolol) and -hydroxymetoprolol isomers (liquid amniotic fluid/maternal plasma = 5.1 for 1\'S,2R; 4.0 for 1\'S,2S; 1.6 for 1\'R,2R and 2.3 for 1\'R,2S) are higher in amniotic fluid than in maternal plasma. However, metoprolol acid metabolite enantiomers reach lower concentrations in amniotic fluid than in maternal plasma of hypertensive parturients (amniotic fluid/maternal plasma = 0.29 and 0.37 respectively for the R-(+)- and S-(-)- enantiomers). The transplacental distribution is approximately 1 for both enantiomers of metoprolol and all isomers of -hydroxymetoprolol and approximately 0.8 for both metoprolol acid metabolite enantiomers in hypertensive parturients. Gestational Diabetes mellitus reduces in approximately 20% the transplacental distribution of the isomers 1\'S,2S; 1\'R,2R and 1\'R,2S--hidroximetoprolol but does not alter the transplacental distribution of both metoprolol enantiomers.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Perçu pendant fort longtemps comme un saint anaphrodite et « castré » avant d’être reconnu comme l’écrivain le plus sensuel des Lettres grecques modernes, Alexandre Papadiamantis (1851-1911), auteur prolifique de près de cent quatre-vingt nouvelles et de trois romans et trésor national hellène, est un artiste antinomique qui ne cesse d’intriguer la critique et de susciter des débats contradictoires. Le présent travail propose une lecture de son œuvre complète axée sur un sujet controversé dont aucune étude systématique n’a été entreprise, malgré un siècle de surabondante critique littéraire : le désir érotique, que nous entendons essentiellement comme le rapport à un objet de convoitise explicitement ou implicitement désigné comme tel, humain ou inhumain, vivant ou inanimé, suscitant un certain nombre de réactions physiques et/ou psychiques et sollicitant un réseau complexe de sens, de sensations, de méditations, d’excitations et de significations représentées par le biais des mots. Une telle définition emphatise l’imbrication de la pulsion et du langage et distingue le désir de l’amour, ce dernier constituant plutôt une stase du désir, un arrêt et une fixation sur l’« autre ». Notre objectif est de comprendre comment l’érotisme ainsi défini s’exprime dans les textes, quels en sont les enjeux psychologiques, les interconnexions avec les techniques narratives, les choix stylistiques et les particularités linguistiques et quelles transformations littéraires il subit dans l’œuvre, en somme, quels sont sa destinée mythique, son aboutissement idéologique et son apothéose thématique, en somme son issue dans l’écriture. / Viewed for ages as an anaphrodite and « castrated » saint before being recognized as the most sensual writer in modern Greek literature, Alexandros Papadiamantis (1851-1911), prolific author of approximately one hundred and eighty short stories, and three historical novels, and deemed to be a Hellenic national treasure, is an antinomic artist who keeps intriguing critics and arousing open debates. The present thesis offers a reading of his complete work based on a controversial subject of which no systematic study has been undertaken before, despite a century of numerous literary comments : erotic desire, defined as the connexion with an objet of lust explicitely or implicitely defined as such, human or inhuman, alive or inanimated, and which rises a number of physical and/or psychological reactions, a complex network of meanings, sensations, meditations, actions and fantasies represented through words. This definition emphasizes the interweaving of drive and language and discerns between desire and love, the latter being rather a stasis of desire, and a fixation on the « other ». Our goal is to understand how eroticism thus defined is expressed throughout the texts, to point out the psychological issues associated with it, its interconnections with the narrative techniques, stylistic choices and linguistic particularities and the literary transformations it undergoes throughout the Papadiamantian opus, that is to say its mythic destiny, its ideological culmination and its thematic apotheosis, in short its outcome in writing.

Made available in DSpace on 2016-08-19T17:47:12Z (GMT). No. of bitstreams: 1 MARINA SANTOS PEREIRA.pdf: 2759143 bytes, checksum: 8d0908875a3d409346c21287c16ed099 (MD5) Previous issue date: 2009-07-30 / An ethnographic study about Associação das Parteiras Tradicionais do Maranhão (Maranhão Traditional Midwives Association) located in the district of Anjo da Guarda, Itaqui-Bacanga area, in the surrounding region of São Luís, capital of the state of Maranhão. In accordance with the account of 18 associated midwives, the research focused on investigating how the association was created, the relationship between the midwives and local health care municipal department, and the actions derived from such relationship. This study also points out the activities developed by traditional midwives that give assistance to pregnant and parturient women in Itaqui-Bacanga area, as a complement to the health services rendered by Serviço Público de Saúde do Hospital e Maternidade Nossa Senhora da Penha (Public Health Care of Nossa Senhora da Penha Hospital-Maternity). The research also focused on childbirth ritual performed by local midwives, considering such ritual as a result of empirical knowledge. The research points out that the tasks carried out by traditional midwives help pregnant women become conscious that they require prenatal care. It indicates that the procedures performed by midwives provide psychological comfort to pregnant and parturient women. The research also shows that these procedures humanize the attendance of such patients. / Estudo etnográfico sobre a Associação das Parteiras Tradicionais do Maranhão, situada no bairro do Anjo da Guarda, na região da área Itaqui-Bacanga, zona periférica da capital São Luís. Investigou-se o processo de surgimento da Associação, a partir dos relatos de dezoito parteiras associadas, e sua relação com a Secretaria Municipal de Saúde, bem como suas ações. Evidencia também este estudo as atividades desenvolvidas por essas parteiras tradicionais com as gestantes e parturientes da área Itaqui-Bacanga, como complemento ao Serviço Público de Saúde do Hospital e Maternidade Nossa Senhora da Penha. Investigou-se, ainda, o ritual do parto realizado pelas parteiras, tendo como fundamento o saber adquirido empiricamente. O resultado da pesquisa apontou que o trabalho desenvolvido pelas parteiras tradicionais contribui com o processo de conscientização das gestantes para a realização do pré-natal, além de proporcionar conforto psicológico para as gestantes e parturientes, humanizando assim o atendimento prestado à mulher no período gravídico.