Bakgrund: Inom neonatal intensivvård vårdas prematura barn med sina föräldrar och personalen bör ha ett helhetsperspektiv på barnet och dess familj. Två metoder som används för att bland annat skapa förutsättningar för föräldra- barnkontakt, är Newborn Individualized Development Care and Assessment Program (NIDCAP) och känguruvård. Det finns ett flertal hinder som kan försvåra föräldra- barnkontakten när ett barn föds prematurt och sjuksköterskan har en central roll i att främja kontakten. Syfte: Syftet med denna studie är att belysa upplevelsen av att bli förälder till ett prematurt barn i behov av neonatal intensivvård. Metod: Datainsamlingen har skett genom semistrukturerade intervjuer. Totalt intervjuades fem föräldrar/föräldrapar. Materialet har analyserats med inspiration av kvalitativ innehållsanalys. Resultat: I berättelserna om föräldrarnas upplevelser identifierades ett övergripande tema, Mitt barns liv vilar i era händer, baserat på både positiva och negativa upplevelser från deras tid inom neonatal intensivvård. Detta tema bygger på sex kategorier: Trygg med personalen, Att få bli barnets förälder, Nöjd familj, Otrygg med personalen, Svårigheter att bli barnets förälder och Brist på samtal. Slutsats: När ett barn föds prematurt och är i behov av neonatal intensivvård finns det faktorer som personalen kan påverka för att underlätta den tidiga föräldra- barnkontakten. Klinisk betydelse: Med en ökad medvetenhet hos personal inom neonatal intensivvård om vad föräldrarna upplever som positivt/negativt i vården kan denna utvecklas och förbättras. En del i detta är att göra föräldrarna mer delaktiga i vården. / Background: In the Neonatal Intensive Care Unit premature infants and their parents are cared for, the staff´s holistic approach to the infant and their family is essential. Two methods used to create opportunities for contact between the parent and the infant are NIDCAP and kangaroo care. There are several obstacles that may hinder this contact when an infant is born prematurely and the nurse has a key role in promoting this contact. Purpose: The purpose of this study is to enlighten the experience of being the parent of a premature infant in need of Neonatal Intensive Care. Methods: Data collection was made through semi-structured interviews. Five parents /couple of parents were interviewed. The material has been analyzed with the inspiration of qualitative content analysis. Result: In the interviews with the parents an overarching theme were identified, My infant's life rests in your hands, based on both the positive and negative experiences during their time in Neonatal Intensive Care Unit. The theme is based on six categories: Secure with the staff, Becoming a parent, Happy family, Insecurity with the personnel, Difficulties to become the infant's parent, and Lack of dialogue. Conclusion: When an infant is born prematurely and in the need of Neonatal Intensive Care there are factors that the staff can affect in order to facilitate the early parent-child contact. Clinical significance: With an increased awareness among the neonatal intensive care staff what parents perceive as the positive/ negative, the care can be developed and improved. A part of this is to make parents more involved in the care of their infants.

No description available.

ROP undersökningen har visat sig vara en stressande och smärtsam undersökning för det prematura barnet. Vid ROP-undersökning är det barnsjuksköterskan som ansvarar för omvårdnaden om det prematura barnet på neonatalavdelning. Inga publicerande studier har identifierats inom området där sjuksköterskors upplevelser är beskrivna i samband med en ROP-undersökning. Suftet med pilotstudien var att belysa barnsjuksköterskors upplevelser i samband med ROP-undersökningar på prematura barn födda innan gestationsvecka 32. Pilotstudien har en kvalitativ deskreptiv design med semistrukturerade intervjuer som datainsamlingsmetod. Resultatet visade att optimal omvårdnad och föräldramedverkan bidrog till en gynnsam omvårdnad enligt barnsjuksköterskorna. Smärtskattning, arbetsmiljö, barnfokus och information var utvecklingsområden som identifierades. Temat som framkom var att barnsjuksköterskorna upplevde att beteendestödjande interventioner har en skonsam inverkan på det prematura barnet vid en ROP-undersökning. Utifrån resultatet i pilotstudien vore det av intresse att undersöka barnsjuksköterskans omvårdnadsobservationer för att bedöma smärtförnimmelser vid en ROP-undersökning i en fullskalig studie. Vidare forskning inom detta område kan leda till att den evidensbaserade omvårdnande vid ROP-undersökning på det prematura barnet utvecklas.

Este estudo teve como objetivo geral a análise do gene FMR1 (Fragile X Mental Retardation gene 1) quanto a sua relação com a insuficiência ovariana primária (Fragile X-related Primary Ovarian Insufficiency, FXPOI). No Capítulo I, apresentamos revisão da literatura sobre FXPOI. A pré-mutação do gene FMR1 constitui a mais frequente causa genética de predisposição para menopausa precoce e entre os casos familiais, cerca de 10% estão associados à pré-mutação do gene FMR1. Entretanto, pouco se conhece sobre a expressão do gene no ovário de mamíferos e os mecanismos pelos quais a pré-mutação causa POI permanecem desconhecidos. O Capítulo II apresenta os resultados do estudo da expressão do gene FMR1 nos ovários adultos, humano e murino. As enormes dificuldades inerentes à obtenção e ao estudo de células germinativas femininas nos levaram a estudar células da granulosa humana (HGC), que são de fácil obtenção, como subprodutos de procedimentos de fertilização in vitro. Também estudamos a expressão do Fmr1 em células da granulosa de camundongos da linhagem CD1 (MGC), coletadas nos ovidutos, após estimulação da ovulação. As células da granulosa interagem intensamente com os ovócitos durante a foliculogênese, transmitindo sinais através do ovário e apoiando o crescimento e a maturação dos ovócitos durante as últimas fases do crescimento folicular. É, portanto, possível que alterações celulares induzidas pela pré-mutação do gene FMR1 nas HGC afetem o crescimento folicular, a taxa de ovulação e a fecundidade. Padronizamos os protocolos de isolamento e de cultivo das HGC do fluido folicular e confirmamos a origem das células isoladas pela expressão de marcadores de HGC, por RT-PCR, e pela natureza lipídica dos grânulos citoplasmáticos, pela coloração com o corante lipofílico DiI. Demonstramos, por RT-PCR que as HGC isoladas do líquido folicular expressam o mRNA do FMR1. Em camundongos, também por RT-PCR, evidenciamos a expressão do mRNA do Fmr1 em ovócitos e nas MGC, coletados do oviduto após hiper-estimulação da ovulação. Por hibridação in situ de RNA em HCG cultivadas, detectamos o mRNA do FMR1 disperso no citoplasma e no núcleo, concentrado em regiões cujas características indicaram ser nucléolos. Essa mesma distribuição foi observada em fibroblastos cultivados. Essa provável localização nucleolar sugere que o transcrito do FMR1, nessas células, constitua ribonucleoproteínas mensageiras, para seu direcionamento do nucléolo para sítios citoplasmáticos específicos, onde ocorre sua tradução. Verificamos, por Western blotting, que as HGC expressam, em níveis elevados, isoformas da FMRP, com massa molecular entre 60 e 95 kDa. Determinamos a localização subcelular da FMRP nas HGC e da Fmrp nas MGC, por imunocoloração. Os sinais de hibridação foram visualizados dispersos, em grânulos finos, no citoplasma das HGC e das MGC, de maneira semelhante ao padrão de distribuição da proteína em neurônios. Nos filopódios das MGC, observamos marcação concentrada em alguns pontos, de forma semelhante ao padrão, previamente descrito, de distribuição da Fmrp em espinhas dendríticas de neurônios de hipocampo de rato, constituindo grânulos de RNA, que promovem o transporte de mRNA e controlam a tradução. O padrão de distribuição semelhante entre neurônios e MGC pode refletir similaridade da função da Fmrp nos dois tecidos. A indução de estresse oxidativo nas HGC por tratamento com arsenito sódico, levou a proteína a deixar de ter distribuição citoplasmática difusa e passar a fazer parte de grânulos de estresse perinucleares, colocalizando-se com TIA-1, marcador dessas estruturas. Resultados semelhantes foram anteriormente obtidos em células HeLa e no hipocampo de rato. Esses resultados apoiam a hipótese de que a FMRP participa do mecanismo transitório de parada da tradução após estresse. No Capítulo III, descrevemos nossas tentativas para obtenção de linhagem de células tronco embrionárias (ESC) de camundongo knockin (KI) quanto a pré-mutação do gene Fmr1. Para a obtenção de embriões KI, fêmeas selvagens (WT; linhagem C57) foram cruzadas com machos KI (linhagem C57/BL6) e fêmeas KI foram cruzadas com machos WT. Pretendíamos comparar a expressão do gene Fmr1 na linhagem de ESC KI e linhagem de ESC WT, inclusive durante a diferenciação Não tivemos sucesso, o que pode ser atribuído às dificuldades inerentes à obtenção de ESC. No acompanhamento dos primeiros quatro dias do desenvolvimento in vitro dos embriões, alterações de clivagem e parada de desenvolvimento foram mais frequentemente observadas nos embriões obtidos de fêmeas KI. Entretanto as taxas médias de sobrevivência de ovócitos para blastocistos e de embriões com 8 a 16 células para blastocistos não diferiram estatisticamente entre as fêmeas KI e selvagens; a grande variabilidade entre o número de blastocistos obtidos por fêmea e o pequeno número delas nos grupos KI (seis) e selvagem (sete) indicam que esses resultados devem ser interpretados com cautela. A análise da proteína Fmrp nos blastocistos, por imunocoloração, mostrou distribuição provavelmente citoplasmática, com padrão granular de marcação, sendo as granulações mais frequentes nos blastocistos de fêmeas WT, porém mais grosseiras nos blastocistos de fêmeas KI. Esse conjunto de dados é sugestivo de efeito da pré-mutação do gene Fmr1 em fêmea murina sobre o início do desenvolvimento de seus embriões. Esse aspecto necessita investigação mais aprofundada / This study aimed at investigating the FMR1 gene (Fragile X Mental Retardation gene 1), regarding its relationship with primary ovarian insufficiency (Fragile X-related Primary Ovarian Insufficiency, FXPOI). In Chapter I, we present a literature review on FXPOI. The FMR1 premutation is the most frequent genetic cause of predisposition to premature ovary insufficiency (POI) and, among the POI familial cases, about 10% are associated with the FMR1 gene premutation. However, little is known about the gene expression in the mammal ovary, and the mechanisms by which the premutation causes POI remain unknown. Chapter II presents the study of the FMR1 gene expression in the human and murine adult ovaries. The enormous difficulties inherent in obtaining and studying female germ cells led us to study human granulosa cells (HGC), which are easily obtained as byproducts of in vitro fertilization procedures. We also studied the FMR1 expression in granulosa cells of mice of the CD1 strain (MGC), collected from the oviducts after ovulation induction. Granulosa cells interact functionally with oocytes during folliculogenesis, transmitting signals through the ovary and supporting growth and maturation of oocytes during the later stages of follicular growth. It is, therefore, possible that cellular changes induced by the FMR1 premutation in HGCs affect follicular growth, ovulation rate and fecundity. We standardized protocols for isolation and culture of HGCs obtained from follicular fluid and confirmed the origin of the isolated cells by the expression of HGC markers, using RT-PCR, and by the lipid nature of the cytoplasmic granules, as demonstrated by the staining with the lipophilic dye DiI. We demonstrated, by RT-PCR, that HGCs isolated from follicular fluid express the FMR1 mRNA. In mice, also by RT-PCR, we detected the Fmr1 mRNA in oocytes and in the MGCs, collected from the oviduct after ovulation hyperstimulation. Using RNA in situ hybridization on cultured HCGs, we detected the FMR1 mRNA dispersed in the cytoplasm and, in the nucleus, concentrated in regions whose features indicated to be nucleoli. This same distribution was observed in cultured fibroblasts. This probable nucleolar localization of the FMR1 transcript in these cells suggests that it constitutes messenger ribonucleoproteins for further targeting to specific cytoplasmic sites where translation occurs. We verified, by Western blotting, that HGCs express high levels of the main FMRP isoforms, with molecular mass between 60 and 95 kDa. We determined the FMRP subcellular localization in HGCs and that of Fmrp in MGCs, by immunostaining. The hybridization signals were seen scattered in fine granules in the cytoplasm of both HGCs and MGCs, in a pattern of distribution similar to that observed in neurons. In the MGC filopodia, the protein labeling was concentrated at some sites, similar to the previously described pattern of Fmrp distribution in neuronal dendritic spines of rat hippocampus, where it is part of RNA granules, promoting mRNA transport and translation control. The similar distribution pattern between neurons and MGC may reflect the similarity of FMRP function in both tissues. The induction of oxidative stress in the HGC by treatment with sodium arsenite led the protein to leave its diffuse cytoplasmic distribution to become part of perinuclear stress granules, co-localized with TIA-1, a marker of these structures. Similar results were previously obtained in HeLa cells and in rat hippocampus. These results support the hypothesis that FMRP participates in the mechanism of the transient translation arrest after stress. In Chapter III, we describe our attempts to obtain an embryonic stem cell line (ESC) from knock-in mice (KI) for the FMR1 premutation. To obtain KI embryos, wild females (WT, strain C57) were crossed with males KI (strain C57/BL6), and KI females were crossed with WT males. We planned to compare the expression of the fmr1 gene in the ESCs from the KI and WT strains, including during differentiation. We did not succeed in obtaining an ESC KI line, which can be attributed to difficulties inherent to the procedure. At follow-up of the first four days of in vitro development of embryos, changes in cleavage and developmental arrest were more frequently observed in embryos obtained from KI females. Meanwhile, the average survival rates of oocytes to blastocysts, and 8-16 cell embryos to blastocysts were not statistically different between the KI and WT females. The great variability among the numbers of blastocysts obtained per female and the small size of the KI (six females) and WT (seven females) groups indicate that these results should be interpreted with caution. Immunostaining analysis of the Fmrp in blastocysts showed a probably cytoplasmic distribution, with a granular pattern of labeling, the grains being more common in blastocysts from WT females, but coarser in blastocysts from KI females. These data are suggestive that the Fmr1 premutation in murine females affects the early development of their embryos. This aspect needs further investigation

Submitted by PPG Biologia Celular e Molecular (bcm@pucrs.br) on 2018-04-17T11:55:36Z No. of bitstreams: 1 LAURA_ESTEVES_PETERSEN_TES.pdf: 11032751 bytes, checksum: 519545881a34767f1600d5189b0ddc8e (MD5) / Approved for entry into archive by Caroline Xavier (caroline.xavier@pucrs.br) on 2018-05-04T17:09:09Z (GMT) No. of bitstreams: 1 LAURA_ESTEVES_PETERSEN_TES.pdf: 11032751 bytes, checksum: 519545881a34767f1600d5189b0ddc8e (MD5) / Made available in DSpace on 2018-05-04T17:15:58Z (GMT). No. of bitstreams: 1 LAURA_ESTEVES_PETERSEN_TES.pdf: 11032751 bytes, checksum: 519545881a34767f1600d5189b0ddc8e (MD5) Previous issue date: 2018-03-14 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Rheumatoid Arthritis (RA) is an autoimmune and inflammatory disease which leads to premature immunosenescence and the development of articular and extra-articular manifestations, including joint damage and cognitive dysfunction, respectively. Peripheral immune system cells and the chronic inflammation, both of great importance for RA, are potentials mechanisms involved in cognitive dysfunction. In contrast, experimental studies have shown the beneficial contribution of immune cells, mainly T cells reactive to central nervous system (CNS) antigens, to neurogenesis and neuroplasticity. Previous data have shown that RA patients besides to have worse performance in cognitive tests, have significantly lower levels of B cells and higher levels of senescent T cells (CD8+CD28-). However, is not known yet which B cells subpopulations are related to poor cognitive performance, if clinical severity of disease (active and controlled disease) impacts on cognition and which factor is responsible for remodeling of peripheral immunity (immunosenescence). Hypotheses about the contribution of latent infections (Cytomegalovirus; CMV), for the development of immunosenescence (observed by telomere shortening and increase of CD28- cells) have been raised. However, it remains in discussion the CMV soroprevalence and its relation with the development of premature immunological senesce in RA. Based on this findings, in this work we have broadly assessment the cognition of RA patients with active and controlled disease, peripheral levels of lymphocytes subsets (T and B cells), neurotrophic factors, cytokines besides that CMV soroprevalence and immunosenescence profile (telomere length and CD28- cells). This work also proposed to explore the relationship between immune mediators, neurotrophic factors and cognitive performance, besides the association between CMV and immunosenescence. For this purpose, 102 RA patients (67 active and 35 controlled disease) and 30 healthy controls adjusted for age, gender and schooling were recruited. The cognitive function, levels of stress and depression were assessment by means of neurocognitive tests (Mini Mental State Examination, Logical memory, digit span, Trail Making Test, N-back, Stroop word-colors) and specific questionnaires (Beck Depression Inventory ?II for depression and Perceived Stress Scale for stress). Twenty ml of blood were collected and, after plasma separation, the peripheral blood mononuclear cells (PBMCs) were isolated by centrifugation gradient. PBMCs were immunophenotyped by flow cytometry to investigate the frequency of T and B cells subsets. The genomic DNA was isolated from PBMCs and the telomere length was evaluated by real time PCR. Neurotrophic factors, cytokines, IgM and IgG anti-CMV were measured in plasma by means of ELISA (NF and CMV) and Citometric Bead Array (CBA; cytokines). In general, patients with active disease had worse cognitive performance, followed by patients with controlled disease producing cells, in addition to high levels of cytokines, with the exception of IL-17A. Higher levels of BDNF were found in patients with active RA followed by controlled disease and control group. The peripheral levels of GDNF were lower in patients with active RA than control group. The IL-6 was predictor of the performance in Trail Making test. IgM and IgG anti-CMV antibody titers did not differ between patients and controls. Only IgG anti-CMV was positively associated with age and senescent cells. In conclusion, RA patients with active disease had worse performance in cognitive tasks that were related to peripheral immune mediators (cells and cytokines). Besides that, we found that late infection (IgG) by CMV were associated only with CD4+CD27-CD28- and haven?t correlated with other immunosenescence characteristics. However, understand in which sense e how the relationship between the peripheral environment and the CNS is established, may contribute to development of preventive interventions to cognitive impairments and premature immunosenescence, since both factors are associated to health and well-being of individuals. / A artrite reumatoide (AR) ? uma doen?a autoimune inflamat?ria que leva ? imunossenesc?ncia prematura e ao desenvolvimento de manifesta??es articulares e extraarticulares, entre elas a destrui??o da articula??o e o decl?nio cognitivo, respectivamente. C?lulas do sistema imune perif?rico e a inflama??o cr?nica, ambos de grande import?ncia para a AR, s?o potenciais mecanismos envolvidos na disfun??o cognitiva. Em contrapartida, estudos experimentais tem revelado a contribui??o ben?fica das c?lulas imunol?gicas, principalmente c?lulas T reativas a ant?genos do sistema nervoso central (SNC), para a neurog?nese e neuroplasticidade. Dados pr?vios apontam que pacientes com AR al?m de apresentarem piores desempenhos nos testes cognitivos, tem significativamente menos c?lulas B e mais c?lulas T com perfil senescente (CD8+CD28-). Entretanto ainda n?o se sabe quais subpopula??es de c?lulas B est?o relacionadas ao pior desempenho cognitivo, se a severidade cl?nica da doen?a (doen?a ativa e controlada) impacta sobre a cogni??o e qual fator seria respons?vel pelo remodelamento da imunidade perif?rica (imunossenesc?ncia). Hip?teses sobre a contribui??o de infec??es latentes, como a causada pelo citomegalov?rus (CMV), para o desenvolvimento da imunossenesc?ncia, observada pelo encurtamento telom?rico e aumento na frequ?ncia de c?lulas CD28-, tem sido levantadas. Por?m, permanece em discuss?o a soropreval?ncia da infec??o pelo CMV e sua real rela??o com o desenvolvimento da senesc?ncia imunol?gica prematura na AR. Com base nestas constata??es, nesta tese n?s avaliamos amplamente a cogni??o de pacientes com AR ativa e controlada, n?veis perif?ricos de subtipos linfocit?rios (c?lulas T e B), fatores neurotr?ficos (FN), citocinas, al?m da soropositividade para CMV e perfil de imunossenesc?ncia prematura (encurtamento telom?rico e aumento de c?lulas CD28-). Esta tese tamb?m se prop?s explorar a rela??o entre mediadores imunes, FN e desempenho cognitivo, e a associa??o entre CMV e caracter?sticas de imunossenesc?ncia. Para esta finalidade, 102 pacientes com AR (67 com doen?a ativa e 35 com doen?a controlada) e 30 controles saud?veis ajustados para idade, g?nero e escolaridade foram recrutados. A fun??o cognitiva, n?veis de estresse e depress?o foram avaliados por meio de testes neurocognitivos (Mini Exame do Estado Mental, Mem?ria L?gica, Subteste de D?gitos, Trail Making Test, N-back, Stroop palavras-cores) e question?rios espec?ficos (Beck Depression Inventory ?II e Escala de Estresse Percebido). Foram coletados 20 ml de sangue e, ap?s a separa??o do plasma, as c?lulas mononucleares do sangue perif?rico (PBMCs) foram isoladas por gradiente de centrifuga??o. PBMCs foram imunofenotipadas por citometria de fluxo para investigar a frequ?ncia de subpopula??es de c?lulas T e B. FN, citocinas, IgM e IgG anti-CMV foram dosados no plasma atrav?s da t?cnica de ELISA (FN e CMV) e Citometric Bead Array (CBA; citocinas). De forma geral, pacientes com doen?a ativa tiveram o pior desempenho nos testes cognitivos, seguido pelos indiv?duos com doen?a controlada e grupo controle. Pacientes com AR tiveram elevados n?veis perif?ricos de c?lulas B imaturas e produtoras de anticorpos, al?m de elevados n?veis das citocinas, com exce??o da IL-17. Maiores concentra??es de BDNF foram observadas nos indiv?duos com AR ativa, seguido pelo grupo controlado e controle. Os n?veis perif?ricos de GDNF foram menores em pacientes com AR ativa do que em indiv?duos controle. A IL-6 apresentou-se como preditora do desempenho do Trail Making Test. T?tulos dos anticorpos IgM e IgG anti-CMV n?o diferiram entre pacientes e controles. Somente o IgG anti-CMV foi relacionado positivamente com idade e c?lulas senescentes. Concluindo, pacientes com AR ativa apresentam pior desempenho em tarefas cognitivas as quais est?o relacionadas a mediadores imunes perif?ricos. Al?m disso, observou-se que infec??es tardias pelo CMV (t?tulos de anticorpos IgG anti-CMV) foram somente associadas a c?lulas T senescentes e n?o se correlacionaram com outras caracter?sticas da imunossenesc?ncia. Portanto, compreender em qual sentido e como a rela??o entre o ambiente perif?rico e do SNC se estabelece, pode contribuir para o desenvolvimento de interven??es preventivas ao d?ficit cognitivo e senesc?ncia prematura, uma vez que ambos fatores est?o associados a sa?de e o bem ? estar dos indiv?duos.

Bakgrund För tidig födsel innebär ökade risker för barnets liv och hälsa. Att få ett mycket för tidigt fött barn och därmed behöva vårdas på neonatalavdelning kan vara traumatiskt, omvälvande och stressande för mammor och kan ha stor betydelse för deras livskvalitet. Syfte Att beskriva mammor till för tidigt födda barns livskvalitet och påverkande faktorer upp till 12 månader efter förlossningen. Metod Studien hade en kvantitativ design och var en longitudinell kohortstudie där mammor (n=493) till barn som vårdats på sex olika neonatalavdelningar i Sverige fick svara på enkäter om livskvalitet (SF-36) vid fyra olika tillfällen under det första året efter förlossningen. Data har analyserats för att se vilka faktorer som kan ha haft betydelse för mammans livskvalitet samt om det fanns några skillnader över tid. Resultat Lägst livskvalitet skattades vid utskrivning från neonatalavdelning med en signifikant och successiv förbättring de kommande 12 månaderna (p <0,01). Inom grupperna med olika faktorer fanns vissa signifikanta skillnader i livskvalitet med liten eller medelhög effektstorlek i några dimensioner av livskvalitet. Slutsats Mammorna skattade lägre livskvalitet vid utskrivning än senare under det första året och det fanns skillnader i livskvalitet mellan olika grupper av mammor. Detta är viktig kunskap för hälso- och sjukvårdspersonal i mötet med mammor till för tidigt födda barn. Klinisk tillämpbarhet Resultatet kan hjälpa barnmorskor och även barnsjuksköterskor och distriktsjuksköterskor att få en bättre förståelse för mammor till för tidigt födda barn och därmed kunna förebygga ohälsa och stötta mammorna för att främja en god anknytning till barnet. / Background Premature birth involves an increased risk for the child's life and health. Having a preterm infant and thus needing care at a neonatal unit may be traumatic and stressful for mothers and also have a great impact on their quality of life. Aim To describe the quality of life among mothers of preterm infants and influencing factors up to 12 months after birth. Method The study had a quantitative design and was a longitudinal cohort study. Mothers (n = 493) of preterm infants who were cared for at six neonatal units in Sweden answered questionnaires about quality of life (SF-36) on four different occasions during the first year after birth. Data has been analyzed to see which factors that may have had an impact on the mother's quality of life and whether there were any differences over time. Results The lowest quality of life was estimated at discharge from the neonatal unit with a significant and gradual improvement in the first year after delivery (p<0,01). Within the different groups of mothers, there were significant differences in quality of life with a small or medium effect size in some dimensions of quality of life. Conclusion The mothers in this study rated their quality of life lowest at the time for discharge from the neonatal unit, and there were differences in quality of life between different groups of mothers. This is important knowledge for healthcare professionals. Clinical application The result of this study may help midwives and other healthcare professionals to gain a better understanding of mothers of preterm infants and their situation and thereby prevent mental illness and support the mothers to promote secure attachment with their children.

Diss. (sammanfattning) Umeå : Umeå universitet, 2007. / Härtill 4 uppsatser.

OBJECTIVE: to study the preditivity of PAMG-1 test for patients with suspected premature rupture of membranes (PROM). METHODS: fifty patients with suspected PROM were selected and allocated them into two groups (25 with PROM and 25 without PROM). All patients were subjected to the PAMG-1 test. The preditivity of PAMG-1 test was evaluated for the time between the exam and birth and days in hospital after delivery. For statistical analysis we used the t test, Mann-Whitney and chi-square. A level of 5% of significance was accepted (p<0,05). RESULTS: the sensitivity, specificity, positive and negative predictive values for the PAMG-1 test were 92%. The rates of false positive and false negative were 8%. The accuracy of the test was found to be 92%. The time between the exam and birth was 29h for patients with positive test and 287,8h for patients with negative test (p=0,0001) and maternal hospitalization was 29h and 130h, respectively (p=0,001). CONCLUSIONS: the PAMG-1 test has high preditivity in suspected cases of premature rupture of amniotic membranes, with low rates of false positive and false negative test results. Moreover, it can reduce the time of maternal hospital stay or avoid maternal hospitalization and thereby reduce public health expenditures. / OBJETIVO: estudar a preditividade diagnóstica do teste da PAMG-1 para pacientes com suspeita de ruptura prematura das membranas amnióticas (RUPREME). MÉTODOS: foram selecionadas consecutivamente 50 pacientes com suspeita de RUPREME e alocadas em dois grupos (25 com RUPREME confirmada pelo exame clínico e 25 com RUPREME descartada pelo exame clínico). Todas as pacientes foram submetidas ao teste da PAMG-1. Foram avaliadas a preditividade do teste da PAMG-1, tempo entre a realização do exame e nascimento e tempo de internação materna. Para a análise estatística foi utilizado o teste t de Student, Mann-Whitney e qui-quadrado. O nível de significância admitido foi p<0,05. RESULTADOS: a sensibilidade, especificidade, valores preditivos positivo e negativo para o teste da PAMG-1 foram de 92%. As taxas de falsos positivo e negativo foram de 8%. A acurácia do teste foi 92%. O tempo entre a realização do exame e nascimento foi 29h nas pacientes com teste da PAMG-1 positivo e 287,8h nas pacientes com teste negativo (p=0,0001) e o tempo de internação materna foi 29h e 130h, respectivamente (p=0,001). CONCLUSÕES: o teste da PAMG-1 apresenta elevada preditividade diagnóstica nos casos de suspeita de ruptura prematura de membranas, com baixas taxas de falsos positivo e negativo. Além disso, pode reduzir o tempo ou evitar a hospitalização materna e dessa forma, reduzir gastos com saúde pública.

Made available in DSpace on 2016-07-01T13:10:24Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-04-24. Added 1 bitstream(s) on 2016-07-01T13:14:07Z : No. of bitstreams: 1 000866191.pdf: 1592677 bytes, checksum: cbfcdb8a7242a22f947e68ab4cde944d (MD5) / Introdução: O Trabalho de Parto Pré-Termo (TPP) e a Rotura Prematura de Membranas Pré-Termo (RPM-PT) acarretam severas complicações para o binômio materno-fetal. Entre os fatores de risco associados ao TPP e à RPM-PT, a predisposição genética vem ganhando importância. Contudo, a associação entre genes polimórficos, ancestralidade e a patogênese do TPP e da RPM-PT permanece alusiva. Objetivo: Determinar a associação entre marcadores informativos de ancestralidade (AIMs) e polimorfismos de nucleotídeo único (SNPs) dos genes da Interleucina-1 beta (IL1B), IL6, Receptor de IL6 (IL6R), Fator de Necrose Tumoral Alfa (TNFA), Receptor de TNF alpha (TNFR), IL10, Receptor Toll-like 2 (TLR2), TLR4, Metaloproteinase 9 (MMP9), Inibidor de Metaloproteinase 1 (TIMP1) e TIMP2 maternos e fetais e o TPP e a RPM-PT. Pacientes e Métodos: Foram coletados swabs bucais de gestantes com TPP e/ou RPM-PT e DE seus filhos (TPP: 137 mulheres e 88 filhos; RPM-PT: 64 mulheres e 44 filhos) atendidas no Hospital das Clínicas da Faculdade de Medicina de Botucatu, UNESP, entre os anos de 2003 e 2014. O grupo controle foi constituído por 201 mulheres que tiveram gestações resolvidas a termo e seus 201 filhos, pareadas ao grupo caso por idade materna e sexo do recém-nascido. O DNA total foi extraído dos swabs bucais e submetido à identificação de AIMs por análise de fragmentos e genotipagem de SNPs utilizando Taqman® SNP Genotyping Assays (Applied Biosystems) e Reação em Cadeia da Polimerase (PCR). O software Structure v2.3.4 foi utilizado para estimar mistura étnica materna. Teste de desequilíbrio de ligação e proporção da Hardy-Weinberg foram testados com Genepop 3.4 e haplótipos inferidos com Phase. Os dados sociodemográficos e biológicos foram comparados utilizando os testes de χ2, teste exato de Fisher, Regressão Logística, Manova, Mann-Whitney e Odds Ratio. Resultados: Nas amostras maternas, o TPP foi associado a maior... / Introduction: A genetic predisposition to Preterm Labor (PTL) and Preterm Premature Rupture of Membranes (PPROM) has been suggested; however the relevance of polymorphisms and ancestry to susceptibility to PTL and PPROM in different populations remains unclear. Objective: To evaluate the association between Ancestry Informative Markers (AIM) and Single Nucleotide Polymorphisms (SNPs) in Interleukin-1 beta (IL1B), IL6, IL6 Receptor (IL6R), Tumor Necrosis Factor Alpha (TNFA), TNF Receptor (TNFR), IL10, Toll Like Receptor 2 (TLR2), TLR4, Metalloproteinase 9 (MMP9), Tissue Inhibitors of Metalloproteinase 1 (TIMP1) and TIMP2 genes and the susceptibility to PTL and PPROM in Brazilian women. Patients and Methods: Oral swabs were collected from women with PTL and/or PPROM and their babies (PTL: 137 women and 88 babies; PPROM: 64 women and 44 babies) seen at the Botucatu Medical School's Hospital, between 2003 and 2014. Control group included 402 mother-babies pairs of term deliveries, matched to case group by age and newborn gender. After DNA extraction, AIMs were identified by fragment analysis and SNPs by Taqman® SNP Genotyping Assays (Applied Biosystems) and Polymerase Chain Reaction (PCR). The software Structure v2.3.4 was used to estimate ethnic admixture of mothers. Linkage Disequilibrium and Hardy-Weinberg proportions were tested with Genepop 3.4 and haplotypes inferred using Phase. Mann-Whitney, χ2, Fisher's exact test, Logistic Regression models, Odds Ratio and Manova were used in data analysis. Results: Regarding maternal samples, PTL was associated to European ancestry and smoking and African ancestry was protective. Regarding ancestry analysis, self-reported ethnicity only explained 20% and 15% of the global variation in African and European contributions, respectively. Fetal IL10-592 C and IL10-819 C were also associated to PTL. Maternal alleles IL10-1082 G and TLR2 A increased the risk ...

Orientador: Márcia Guimarães da Silva / Coorientador: Steven Witkin / Banca: Leandro Gustavo de Oliveira / Banca: Erick da Cruz Castelli / Banca: Rodrigo Paupério Soares de Camargo / Banca: Gisele Alboreghetti Nair / Resumo: Introdução: O Trabalho de Parto Pré-Termo (TPP) e a Rotura Prematura de Membranas Pré-Termo (RPM-PT) acarretam severas complicações para o binômio materno-fetal. Entre os fatores de risco associados ao TPP e à RPM-PT, a predisposição genética vem ganhando importância. Contudo, a associação entre genes polimórficos, ancestralidade e a patogênese do TPP e da RPM-PT permanece alusiva. Objetivo: Determinar a associação entre marcadores informativos de ancestralidade (AIMs) e polimorfismos de nucleotídeo único (SNPs) dos genes da Interleucina-1 beta (IL1B), IL6, Receptor de IL6 (IL6R), Fator de Necrose Tumoral Alfa (TNFA), Receptor de TNF alpha (TNFR), IL10, Receptor Toll-like 2 (TLR2), TLR4, Metaloproteinase 9 (MMP9), Inibidor de Metaloproteinase 1 (TIMP1) e TIMP2 maternos e fetais e o TPP e a RPM-PT. Pacientes e Métodos: Foram coletados swabs bucais de gestantes com TPP e/ou RPM-PT e DE seus filhos (TPP: 137 mulheres e 88 filhos; RPM-PT: 64 mulheres e 44 filhos) atendidas no Hospital das Clínicas da Faculdade de Medicina de Botucatu, UNESP, entre os anos de 2003 e 2014. O grupo controle foi constituído por 201 mulheres que tiveram gestações resolvidas a termo e seus 201 filhos, pareadas ao grupo caso por idade materna e sexo do recém-nascido. O DNA total foi extraído dos swabs bucais e submetido à identificação de AIMs por análise de fragmentos e genotipagem de SNPs utilizando Taqman® SNP Genotyping Assays (Applied Biosystems) e Reação em Cadeia da Polimerase (PCR). O software Structure v2.3.4 foi utilizado para estimar mistura étnica materna. Teste de desequilíbrio de ligação e proporção da Hardy-Weinberg foram testados com Genepop 3.4 e haplótipos inferidos com Phase. Os dados sociodemográficos e biológicos foram comparados utilizando os testes de χ2, teste exato de Fisher, Regressão Logística, Manova, Mann-Whitney e Odds Ratio. Resultados: Nas amostras maternas, o TPP foi associado a maior... / Abstract: Introduction: A genetic predisposition to Preterm Labor (PTL) and Preterm Premature Rupture of Membranes (PPROM) has been suggested; however the relevance of polymorphisms and ancestry to susceptibility to PTL and PPROM in different populations remains unclear. Objective: To evaluate the association between Ancestry Informative Markers (AIM) and Single Nucleotide Polymorphisms (SNPs) in Interleukin-1 beta (IL1B), IL6, IL6 Receptor (IL6R), Tumor Necrosis Factor Alpha (TNFA), TNF Receptor (TNFR), IL10, Toll Like Receptor 2 (TLR2), TLR4, Metalloproteinase 9 (MMP9), Tissue Inhibitors of Metalloproteinase 1 (TIMP1) and TIMP2 genes and the susceptibility to PTL and PPROM in Brazilian women. Patients and Methods: Oral swabs were collected from women with PTL and/or PPROM and their babies (PTL: 137 women and 88 babies; PPROM: 64 women and 44 babies) seen at the Botucatu Medical School's Hospital, between 2003 and 2014. Control group included 402 mother-babies pairs of term deliveries, matched to case group by age and newborn gender. After DNA extraction, AIMs were identified by fragment analysis and SNPs by Taqman® SNP Genotyping Assays (Applied Biosystems) and Polymerase Chain Reaction (PCR). The software Structure v2.3.4 was used to estimate ethnic admixture of mothers. Linkage Disequilibrium and Hardy-Weinberg proportions were tested with Genepop 3.4 and haplotypes inferred using Phase. Mann-Whitney, χ2, Fisher's exact test, Logistic Regression models, Odds Ratio and Manova were used in data analysis. Results: Regarding maternal samples, PTL was associated to European ancestry and smoking and African ancestry was protective. Regarding ancestry analysis, self-reported ethnicity only explained 20% and 15% of the global variation in African and European contributions, respectively. Fetal IL10-592 C and IL10-819 C were also associated to PTL. Maternal alleles IL10-1082 G and TLR2 A increased the risk ... / Doutor