Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2015-10-26T21:46:19Z No. of bitstreams: 1 JosileneMariaFerreiraPinheiro_DISSERT.pdf: 3185212 bytes, checksum: 56519f793fd36eb7ea7d22cd3c281a47 (MD5) / Approved for entry into archive by Elisangela Moura (lilaalves@gmail.com) on 2015-10-26T22:27:05Z (GMT) No. of bitstreams: 1 JosileneMariaFerreiraPinheiro_DISSERT.pdf: 3185212 bytes, checksum: 56519f793fd36eb7ea7d22cd3c281a47 (MD5) / Made available in DSpace on 2015-10-26T22:27:05Z (GMT). No. of bitstreams: 1 JosileneMariaFerreiraPinheiro_DISSERT.pdf: 3185212 bytes, checksum: 56519f793fd36eb7ea7d22cd3c281a47 (MD5) Previous issue date: 2014-06-04 / O per?odo neonatal, que compreende os primeiros 27 dias p?s-parto, ? uma fase considerada de vulnerabilidade ? sa?de infantil, fazendo-se necess?rio uma maior vigil?ncia pelo profissional de sa?de atrav?s de a??es que valorizam o bin?mio m?e/filho e o atendimento integral ao rec?m-nascido. Para tanto, esse trabalho objetivou avaliar as a??es de aten??o, a partir das estrat?gias preconizadas pelo Minist?rio da Sa?de. Trata-se de um estudo de corte transversal realizado a partir do banco de dados da pesquisa nacional de base populacional intitulada ?Chamada Neonatal: avalia??o da aten??o ao pr?-natal e aos menores de um ano nas regi?es Norte e Nordeste?. Utilizou-se como unidade amostral as m?es e as crian?as menores de 1 ano que compareceram a campanha de vacina??o do dia 12 de junho de 2010 nos nove munic?pios potiguares priorit?rios para o Pacto de Redu??o da Mortalidade Infantil e Neonatal. Para compor as vari?veis de estudo foram selecionadas as quest?es/a??es referentes ao per?odo neonatal e aos fatores sociodemogr?ficos, seguidas de uma an?lise descritiva e inferencial. Obteve-se uma amostra de 837 pares m?e/filho, sendo 57,6% na capital e 42,4% no conjunto dos interiores, que foi ponderada para representar os munic?pios do Estado. Predominaram as m?es com idade entre 20-29 anos, ensino m?dio completo, n?o benefici?rio de programa de transfer?ncia de renda; e crian?as do sexo masculino (51,2%). A freq??ncia das a??es de ?mbito hospitalar variou de 35% a 96% e as realizadas na Unidade B?sica de Sa?de (UBS) de 57% a 91,2%. A maioria das a??es teve associa??o com os hospitais de natureza p?blica e com a capital do estado (p<0,05). Os resultados para a maioria das a??es est?o abaixo do preconizado nos programas e pol?ticas de aten??o ? crian?a, e revelam as iniq?idades regionais em sa?de e a necessidade de envolvimento dos servi?os e dos profissionais na busca da integralidade do cuidado para possibilitarem melhor assist?ncia atrav?s de pr?ticas humanizadas nesse per?odo de maior vulnerabilidade. / The neonatal period, which includes the first 27 da ys postpartum, is a vulnerability phase in child health, making it necessary for a greater mon itoring by health professional through actions that add value to the binomial mother/child and comprehensive care to the newborn. To this end, this study aimed to evaluate the care actions the neonato from the strategies recommended by the Ministry of Health. This is a cr oss-sectional study carried out from the database of the national survey of population base entitled "Call Neonatal: evaluation of prenatal care and to children younger than one year old in the North and Northeast regions". It used as the sample unit the mothers and children yo unger than 1-year-old, costal residents of Rio Grande do Norte, Natal, Brazil, who attended th e vaccination campaign on June 12, 2010 in nine municipality?s priority for the Pact to Red uce Infant and Neonatal Mortality. To compose the study variables were selected issues/ac tions regarding the neonatal period and socio-demographic factors, followed by a descriptiv e and inferential analysis. A sample of 837 mother/child pairs was obtained, being 57.6% in capital and 42.4% in the whole from the interiors, which was weighted to represent the muni cipalities of the State. It was predominated by mothers aged between 20-29 years, complete high school, not entitled to income transfer program and male children (51.2%). The frequency of the actions of the hospital ranged from 35% to 96% and those performed at the Basic Health Unit (BHU) from 57% to 91.2%. Most actions had an association with hospitals and publi c nature of the state capital (p<0.05). The results for most of the actions are recommended in the care programs and policies for children, and reveal the regional inequities in hea lth and the need for the involvement of services and professionals in search of comprehensi ve care for enabling better care through humanized practices during this increased vulnerabi lity period.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-01-05T17:39:33Z No. of bitstreams: 1 AdrianaSantosLopes_DISSERT.pdf: 1559298 bytes, checksum: a28ce672741c5958818e0d30ee0e40a6 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2016-01-08T20:26:37Z (GMT) No. of bitstreams: 1 AdrianaSantosLopes_DISSERT.pdf: 1559298 bytes, checksum: a28ce672741c5958818e0d30ee0e40a6 (MD5) / Made available in DSpace on 2016-01-08T20:26:37Z (GMT). No. of bitstreams: 1 AdrianaSantosLopes_DISSERT.pdf: 1559298 bytes, checksum: a28ce672741c5958818e0d30ee0e40a6 (MD5) Previous issue date: 2014-04-23 / O acolhimento vem sendo proposto como uma ferramenta que contribui para humanizar o cuidado, ampliar o acesso dos usu?rios aos servi?os, garantir a resolutividade das demandas, organizar os servi?os e promover o fortalecimento de v?nculos entre profissionais e usu?rios. No munic?pio do Recife, esta pr?tica vem sendo incentivada pela gest?o e sua implementa??o pautada em atos normativos, com matrizes de avalia??o e proposi??o de metas, embasadas em um modelo pr?prio do munic?pio. Este estudo objetivou analisar a rela??o entre o acolhimento prescrito e o acolhimento real, bem como suas interfer?ncias nas rela??es de reciprocidade entre trabalhadores e usu?rios nas unidades de sa?de da aten??o b?sica do Recife. Utilizou como campo de investiga??o quatro unidades da Estrat?gia Sa?de da Fam?lia do Distrito Sanit?rio IV do munic?pio de Recife ? PE. A investiga??o teve um car?ter qualitativo e, para sua operacionaliza??o, realizou entrevistas com profissionais e usu?rios, cujos discursos, foram gravados pelo modo digital de voz e posteriormente transcritos manualmente, de forma literal. Os discursos obtidos foram analisados, em grande parte, atrav?s da abordagem metodol?gica do Discurso do Sujeito Coletivo (DSC), sendo tamb?m utilizada, em menor escala, a t?cnica da an?lise tem?tica, de forma dialogada, com aportes te?ricos e documentos oficiais relacionados ao tema. Os resultados apontaram que, na maior parte das unidades de sa?de, os profissionais executam os protocolos propostos e consideram que estes t?m influ?ncia positiva para o processo de trabalho no acolhimento, No entanto, fatores como demanda excessiva, estrutura f?sica das unidades, pouca resolutividade da rede de refer?ncia, singularidades das unidades, entre outros, apareceram dificultando o cumprimento do que foi prescrito e, desta forma gerando influ?ncia negativa sobre o processo de trabalho do acolhimento. As rela??es rec?procas tamb?m sofreram influ?ncias destes fatores, dificultando, assim, a circula??o de d?divas. Entretanto, outros fatores como acesso, resolutividade, atitude acolhedora e responsabiliza??o, potencializaram as trocas rec?procas entre profissionais e usu?rios. Os achados demandam que os atos prescritivos e as rela??es rec?procas do acolhimento s?o diretamente influenciadas pelas singularidades presentes nas comunidades, pelas variabilidades humanas e por fatores ligados ? estrutura e processo de trabalho e, portanto, devem ser operados com cautela com vistas a proporcionar um acolhimento real de qualidade / User embracement has been proposed as a tool that contributes to humanize the nursing, to increase the users? access to the services, to ensure the resolvability of claims, to organize the services and promote the strengthening of the links between them and the health professionals. In the city of Recife, this practice has been fomented by the municipal government and its implementation is guided by normative acts, with evaluation matrices and proposition of goals, based on a model created by the public administration. This study intended to analyze the relation between the prescribed user embracement and the real one and their interferences with the relations of reciprocity between workers and users in the health units of basic attention in Recife. Four units of the Family Health Strategy at the Sanitary District IV of the city of Recife ? PE were taken as an investigation field. The investigation had a qualitative character, so, Interviews were performed involving professionals and users whose speeches were recorded by the voice digital mode and literally transcript. The obtained speeches were analyzed mostly through the Discourse of the Collective Subject methodological approach, being also used, but on a smaller scale, the technique of thematic analysis, in the dialogic way, with theoretical contributions and official documents related to the theme. The results pointed that in most of the health units the professionals execute the proposed protocols and consider that these have a positive influence for the working process in user embracement, however, factors such as the excessive demand, the physical structure of the units, little resolvability of the reference network, singularities of the units, among others, have appeared, hampering the accomplishment of the prescribed, creating, thus, a negative influence on the working process of the user embracement. The reciprocal relations have also suffered the influences of these factors, which made difficult, therefore, the circulation of gift. Meanwhile, other factors such as access, resolvability, sheltering attitude and responsabilization, potentiated the reciprocal exchange between professionals and users. The findings demand the prescriptive acts and the reciprocal relations of the user embracement to be directly influenced by the singularities present in each community, by the human variabilities and by factors connected to the structure and working process, so it shall be operated with caution in order to provide a real user embracement with quality

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-03-10T20:24:53Z No. of bitstreams: 1 JeaneFrancoPires_DISSERT.pdf: 1066232 bytes, checksum: d9e738b192a2350bed992f266b418f52 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2016-03-17T00:02:56Z (GMT) No. of bitstreams: 1 JeaneFrancoPires_DISSERT.pdf: 1066232 bytes, checksum: d9e738b192a2350bed992f266b418f52 (MD5) / Made available in DSpace on 2016-03-17T00:02:56Z (GMT). No. of bitstreams: 1 JeaneFrancoPires_DISSERT.pdf: 1066232 bytes, checksum: d9e738b192a2350bed992f266b418f52 (MD5) Previous issue date: 2015-05-05 / O termo vitamina E refere-se a um grupo de oito compostos moleculares que diferem em estrutura e biodisponibilidade, sendo o RRR-alfa-tocoferol a forma mais ativa biologicamente. A composi??o de vitamina E no leite materno sofre varia??es ao longo da lacta??o, sendo o leite colostro mais rico neste micronutriente quando comparado ao leite de transi??o e maduro. Os rec?m-nascidos, especialmente os prematuros s?o mais suscept?veis a defici?ncia de vitamina E e para prevenir os danos causados por esta defici?ncia tem sido proposta a suplementa??o do neonato com este micronutriente, por?m, n?o existe consenso para realiza??o desta interven??o. Assim, a suplementa??o materna com RRR-alfa-tocoferol no p?s-parto pode ser uma boa alternativa para tentar elevar os n?veis de alfa-tocoferol no leite materno e, consequentemente, fornecer ao rec?m-nascido prematuro quantidades adequadas de vitamina E. Este estudo objetivou avaliar o efeito da suplementa??o com 400 UI de acetato de RRR-alfa-tocoferol em mulheres com partos prematuros, sobre a concentra??o de alfa-tocoferol no leite materno colostro, transi??o e maduro. Participaram do estudo 89 pu?rperas adultas saud?veis, que foram distribu?das no grupo controle (n = 51) e grupo suplementado (n = 38). Foram coletadas amostras de sangue e leite colostro logo ap?s o parto (leite 0h), vinte e quatro horas ap?s, nova al?quota de leite colostro foi coletado (leite 24h). O leite de transi??o e maduro foram coletados em sete dias (leite 7d) e trinta dias (leite 30d) ap?s o parto, respectivamente. A suplementa??o no grupo suplementado foi realizada ap?s a coleta de sangue e leite 0h. As an?lises de alfa-tocoferol foram realizadas por cromatografia l?quida de alta efici?ncia. Valores s?ricos de alfa-tocoferol menores que 516 ?g/dL foram considerados indicativos de defici?ncia nutricional. A concentra??o m?dia de alfa-tocoferol no soro das parturientes do grupo controle foi 1159,8 ? 292,4 ?g/dL e do grupo suplementado foi 1128,3 ? 407,2 ?g/dL (p = 0,281). Todas as pu?rperas apresentaram estado nutricional em vitamina E adequado. Em ambos os grupos, foi poss?vel observar que a concentra??o de vitamina E no leite colostro foi maior em rela??o ao leite de transi??o e maduro. No grupo suplementado, a concentra??o de alfa-tocoferol no leite 24h aumentou em 60% ap?s a suplementa??o, passando de 1339,3 ? 414,2 ?g/dL (leite 0h) para 2234,7 ? 997,3 ?g/dL (leite 24h). Enquanto que o grupo controle os valores no colostro 0h e colostro 24h foram semelhantes (p = 0,681). No leite de transi??o do grupo controle o valor de alfa-tocoferol foi 875,3 ? 292,4 ?g/dL e no grupo suplementado 1352,8 ? 542,3 ?g/dL, com aumento de 35% no grupo suplementado em rela??o ao controle (p < 0,001). No leite maduro as concentra??es de alfa-tocoferol entre o grupo controle (426,6 ? 187,5 ?g/dL) e suplementado (416,4 ? 214,2 ?g/dL) foram semelhantes (p = 0,853). Apenas o leite 24h do grupo suplementado atendeu o requerimento nutricional de alfa-tocoferol (4 mg/dia) do rec?m-nascido. Tais resultados evidenciam que o transporte deste micronutriente para o leite ocorre de maneira controlada e limitada. Dessa forma, a suplementa??o materna com vitamina E eleva a concentra??o de alfa-tocoferol no leite colostro e de transi??o e n?o influencia a concentra??o no leite maduro. Apenas o aumento no leite colostro foi suficiente para atingir o requerimento nutricional do rec?m-nascido prematuro. / The term vitamin E refers to a group of eight molecular compounds which differ in structure and bioavailability, and the RRR-alpha-tocopherol more biologically active form. The composition of vitamin E in breast milk undergoes variations during lactation, colostrum and milk richer in this micronutrient compared to transitional and mature milk. Newborns, especially premature infants are more susceptible to vitamin E deficiency and to prevent the damage caused by this deficiency has been proposed supplementation of neonates with this micronutrient, however, there is no consensus to carry out this intervention. Thus, maternal supplementation with RRRalpha-tocopherol in the postpartum period can be a good alternative to try to raise the alpha-tocopherol levels in breast milk and therefore provide the premature newborn adequate amounts of vitamin E. This study to evaluate the effect of supplementation with 400 UI acetate RRR-alpha-tocopherol in women with premature births, on the concentration of alpha-tocopherol in breast milk colostrum, transitional and mature. The study included 89 healthy adult women were enrolled in the control group (n = 51) and supplemented group (n = 38). Blood samples were collected and milk colostrum soon after birth (0h milk) twenty-four hours, new rate of colostrum milk was collected (24h milk). The transitional and mature milk were collected in seven days (7d milk) and thirty days (30d milk) after delivery, respectively. Supplementation in the supplemented group was held after the collection of blood and 0h milk. The alpha-tocopherol analyzes were performed by high-performance liquid chromatography. Serum levels of alpha-tocopherol less than 516 ?g/dL were considered indicative of nutritional deficiency. The average concentration of alphatocopherol in the serum of the control group mothers was 1159.8 ? 292.4 ?g/dL and the supplemented group was 1128.3 ? 407.2 ?g/dL (p = 0.281). All women had nutritional status in vitamin E suitable. In both groups, it was observed that the concentration of vitamin E in colostrum milk was higher compared to transitional and mature milk. In the supplemented group, the concentration of alpha-tocopherol in the milk increased 60 % after supplementation, from 1339.3 ? 414.2 ?g/dL (0h milk) to 2234.7 ? 997.3 ?g/dL (24h milk). While the control group values in colostrum 0h and colostrum 24h were similar (p = 0.681). In the control group the follow-on milk alphatocopherol value was 875.3 ? 292.4 ?g/dL and in the group supplemented 1352.8 ? 542.3 ?g/dL, an increase of 35% in the supplemented group compared to control (p <0.001). In mature milk alpha-tocopherol concentrations between the control group (426.6 ? 187.5 ?g/dL) and supplemented (416.4 ? 214.2 ?g/dL) were similar (p = 0.853). Only 24h milk supplemented group answered the nutritional requirement of alpha-tocopherol (4 mg/day) of the newborn. These results show that the transport of this micronutrient for milk occurs in a controlled and limited way. Thus, the native vitamin E supplementation increases the concentration of alpha-tocopherol in colostrum and milk and transition does not influence the concentration in mature milk. Only the increase in colostrum milk was sufficient to meet the nutritional requirement of premature newborns.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-04-03T22:22:48Z No. of bitstreams: 1 DeboraFeitosaDeFranca_DISSERT.pdf: 1200684 bytes, checksum: 04833e314831a68a3846b63143d49ffa (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-04-10T23:05:57Z (GMT) No. of bitstreams: 1 DeboraFeitosaDeFranca_DISSERT.pdf: 1200684 bytes, checksum: 04833e314831a68a3846b63143d49ffa (MD5) / Made available in DSpace on 2017-04-10T23:05:57Z (GMT). No. of bitstreams: 1 DeboraFeitosaDeFranca_DISSERT.pdf: 1200684 bytes, checksum: 04833e314831a68a3846b63143d49ffa (MD5) Previous issue date: 2016-12-06 / Objetivou-se analisar os eventos adversos relacionados ? terapia respirat?ria em rec?m-nascidos de alto risco de uma unidade neonatal. Trata-se de um estudo observacional, longitudinal e prospectivo, realizado em uma maternidade, unidade de referencia no Estado do Rio Grande do Norte para gravidez e nascimento de alto risco. Os dados foram coletados no per?odo de abril a setembro 2016, ap?s aprova??o do projeto no Comit? de ?tica em Pesquisa da UFRN com CAAE n? 51832415.0.0000.5537. A amostra foi composta por 82 rec?m-nascidos submetidos ? terapia ventilat?ria nas modalidades: ventila??o mec?nica invasiva, ventila??o mec?nica n?o invasiva e press?o positiva cont?nua das vias a?reas por prong nasal. Os resultados apontam que a incid?ncia dos eventos adversos foi de 48,8%, sendo o mais frequente a extuba??o n?o planejada (34%), seguida da les?o de septo nasal (13%), pneumonia associada ? ventila??o mec?nica (7%) e o pneumot?rax (6%). A probabilidade de ocorr?ncia de um evento adverso em rec?m-nascido submetido ? terapia ventilat?ria nos primeiros cinco dias de terapia ultrapassou os 40% (IC 95%). Existe associa??o entre a idade gestacional e a ocorr?ncia de eventos adversos, sendo os rec?m-nascidos com menos de 28 semanas os mais suscept?veis (p-valor 0,024). A raz?o de chance de um rec?m-nascido sofrer um evento adverso em gestacional extrema ? 5,57 vezes maior do que um a termo, IC 95% [1,44;21,60]. H? associa??o entre a modalidade de ventila??o mec?nica n?o invasiva e a ocorr?ncia de les?o de septo nasal (p-valor <0,001), em contra ponto n?o foi apontado associa??o entre a ocorr?ncia do mesmo evento e a modalidade CPAP nasal (p-valor 0,160). Os resultados da regress?o log?stica apontam associa??o entre a malforma??o cong?nita e a ocorr?ncia do evento adverso de uma forma geral (p-valor 0,003) e por tipo especificamente a extuba??o n?o planejada (p-valor 0,039). Portanto conclui-se que os rec?m-nascidos prematuros e portadores de malforma??o cong?nita s?o suscept?veis a ocorr?ncia desses eventos adversos. E como oportunidade de melhoria da assist?ncia recomenda-se a constru??o e valida??o de protocolos de preven??o da extuba??o n?o planejada, que atenda as especificidades dos portadores de malforma??o cong?nita, al?m do protocolo de manuseio m?nimo para prematuros extremos. / The objective was to analyze the adverse events related to respiratory therapy in high-risk newborns of a neonatal unit. It is an observational, longitudinal and prospective study, performed in a maternity unit, a reference unit in the State of Rio Grande do Norte for high-risk pregnancy and birth. The data were collected from April to September 2016, after approval of the project in the Research Ethics Committee of UFRN with CAAE n? 51832415.0.0000.5537. The sample consisted of 82 newborns submitted to ventilatory therapy in the modalities: invasive mechanical ventilation, non-invasive mechanical ventilation and continuous positive airway pressure per prong nasal. Results show that the incidence of adverse events was 48.8%, most frequently unplanned extubation (34%), followed by nasal septum injury (13%), ventilator-associated pneumonia (7%), and Or pneumothorax (6%). The probability of an adverse event occurring in a neonate undergoing ventilatory therapy in the first five days of therapy exceeded 40% (95% CI). There is an association between gestational age and the occurrence of adverse events, with newborn infants less than 28 weeks being the most susceptible (p-value 0.024). The odds ratio for a newborn suffering an adverse event in gestational extreme is 5.57 times greater than one full-term, 95% CI [1.44, 21.60]. There was an association between the non-invasive mechanical ventilation and the occurrence of nasal septum lesion (p-value <0.001). On the contrary, there was no association between the occurrence of the same event and the nasal CPAP modality (p-value 0.160). The results of the logistic regression show an association between the congenital malformation and the occurrence of the general adverse event (p-value 0.003) and by type specifically the unplanned extubation (p-value 0.039). Therefore it is concluded that premature newborns with congenital malformations are susceptible to the occurrence of these adverse events. And as an opportunity to improve care, it is recommended the construction and validation of protocols for prevention of unplanned extubation, which meets the specificities of patients with congenital malformations, in addition to the minimum protocol for the management of extremely premature infants.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-07-17T11:26:45Z No. of bitstreams: 1 CarlaIsmirnaSantosAlves_TESE.pdf: 809561 bytes, checksum: 624e9c16a8bfe7161d15b4883f4dac1f (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-07-17T14:42:40Z (GMT) No. of bitstreams: 1 CarlaIsmirnaSantosAlves_TESE.pdf: 809561 bytes, checksum: 624e9c16a8bfe7161d15b4883f4dac1f (MD5) / Made available in DSpace on 2017-07-17T14:42:40Z (GMT). No. of bitstreams: 1 CarlaIsmirnaSantosAlves_TESE.pdf: 809561 bytes, checksum: 624e9c16a8bfe7161d15b4883f4dac1f (MD5) Previous issue date: 2017-05-12 / Esse estudo se prop?s fazer a valida??o da escala de Screening Neurol?gico de Pr?-termo ao Termo, elaborado no decorrer do mestrado tomando como base os itens mais alterados nas escalas de Saint-Anne Dargassies, Amiel-Barrier-Shnider modificada e Prechtl. Essa escala ? composta de 6 itens: identifica??o e fatores neonatais; estados de consci?ncia; avalia??o da postura; avalia??o da movimenta??o espont?nea; atividade reflexa neonatal e avalia??o do t?nus muscular. Entre as vantagens do construto proposto destacam-se: ser composta por manobras f?ceis de aplicar e observar; ter pequena varia??o nas possibilidades de resposta; poder ser aplicada por profissionais de sa?de que lidam com rec?m-nascidos pr?-termo. A valida??o do construto proposto se deu pela an?lise do conte?do e da confiabilidade inter-observador em rela??o ao observador Padr?o Ouro (PO). Ainda dentro dos objetivos dessa pesquisa determinamos a confiabilidade da escala de Saint-Anne Dargassies. A amostra foi probabil?stica composta de 20 rec?m-nascidos pr?-termo (RNPT) sem complica??es, nascidos e atendidos na Unidade de Terapia Intensiva da Maternidade Escola Janu?rio Cicco, Natal/Brasil, no per?odo de agosto de 2012 a dezembro de 2013. Para testar a validade do screening proposto e a confiabilidade das escalas estruturou-se a coleta em: grupo I- composto pelo avaliador-1 (fisioterapeuta) e 2 (neonatologista); grupo II - composto pelo avaliador-3 (fisioterapeuta) e 4 (neurologista pedi?trico), e pelo PO (Neurologista Infantil experiente). Cada grupo avaliou independentemente 10 RNPT, totalizando ao final 20 RNPT. O PO avaliou o n total nas mesmas condi??es e dias dos grupos I e II. Com essa metodologia e com os resultados obtidos e analisados estatisticamente, elaborarmos um primeiro manuscrito: Confiabilidade da escala de Saint-Anne Dargassies na avalia??o do padr?o neurol?gico de rec?m-nascidos pr?-termo, sem complica??es. Observamos uma concord?ncia alta inter-observadores entre os grupos I - II em compara??o com o padr?o ouro na avalia??o padr?o postural (p <0,01). Em rela??o ? avalia??o dos reflexos primitivos, observou-se maior concord?ncia na avalia??o do reflexo palmar e do reflexo de Moro (p <0,01) para o grupo I em compara??o com o padr?o-ouro. Uma an?lise do t?nus demonstrou acordo heterog?neo, sem comprometer a confiabilidade da escala. Observou-se a probabilidade de igualdade entre as medidas do per?metro cef?lico nos dois grupos em compara??o com o padr?o-ouro. O destaque do nosso estudo foi validar este construto apresentando-o como uma escala v?lida, apta para identificar altera??es no padr?o neurol?gico de pr?termos ao termo, com evid?ncias de ser um instrumento confi?vel, com alta capacidade para discriminar suspeitos de altera??o e com grande reprodutibilidade no meio cl?nico, pedi?trico e da fisioterapia pedi?trica. O desenvolvimento desse projeto teve enfoque multidisciplinar, pois envolveu neurologista infantil, fisioterapeuta, neonatologista, m?dico especialista em neuro-imagem e estat?stico como preconizado pela PPGCSA. / Objectives: To assess the interrater reliability of the Saint-Anne Dargassies Scale in assessing the neurological patterns of health preterm newborns. Methods: Twenty preterm newborns met the inclusion criteria for participation in this prospective study. The neurologic examination was performed using the Saint-Anne Dargassies Scale following and having had normal serial cranial ultrasound. To test the reliability the study was structured as follows: group I (rater 1/physiotherapist; rater 2/neonatologist); group II (rater 3/physiotherapist; rater 4/child neurologist) and the gold standard. Results: High interrater agreement was observed between groups I ? II compared with the gold standard in assessing postural pattern (p < 0.01). Regarding the assessment of primitive reflexes, greater agreement was observed in the evaluation of the palmar grasp reflex and the Moro reflex (p < 0.01) for group I compared with the gold standard. An analysis of tone demonstrated heterogeneous agreement, without compromising the reliability of the scale. The probability of equality between measurements of head circumference in the two groups compared with the gold standard was observed. Conclusion: The Saint-Anne Dargassies Scale demonstrated high reliability and homogeneity with significant power of reproducibility and may be to identify preterm newborns suspected of having neurological deficits.

Radically Enactive Cognition (REC) claims that basic cognition is contentless and that non-basic cognition is contentful. This thesis argues that, as REC stands now, the position’s understanding of contentful cognition is unclear. Furthermore, the thesis focuses on the unclearness of whether REC conceives of contentful cognition as dynamical or as computational as a way to evaluate whether or not REC provides a substantially different account of cognition. The thesis further argues that both options are problematic and that there are good reasons to question whether REC has succeeded in providing a substantially different account of cognition. This is because if contentful cognition is understood as computational it implies giving up on enactivism, whereas, if it is understood as dynamical, REC’s account of content risks collapsing into either computationalism (or something close to computationalism, by understanding contentful cognition as the rule-based manipulation of representational content) or eliminativism.

Daten des humanen Genomprojektes zeigen, dass ca. 8% des gesamten humanen Genoms aus retroviralen Sequenzen besteht. Der überwiegende Teil dieser Proviren ist aufgrund verschiedener Mutationen defekt. Im Gegensatz zu allen anderen HERV Proviren scheinen einige HERV-K Proviren intakt zu sein und besitzen offene Leserahmen für alle viralen Proteine. Die Familie des humanen endogenen Retrovirus K HML2 umfasst ca. 30 eng verwandte Proviren. Zusätzlich zu den Strukturproteinen Gag und Env und der Reversen Transkriptase, exprimiert HERV-K zwei regulatorische Proteine, Rec und Np9. Beide sind im Nukleus lokalisiert und tumorigene Eigenschaften bzw. eine Expression in Assoziation mit Tumorgeweben wurde nachgewiesen. Neben Zelllinien, wie die Teratokarzinomzelllinie GH und einigen Brustkrebszelllinien, für die die Expression von HERV-K mRNA und die Produktion von Viruspartikeln bekannt ist, konnte die Expression von HERV-K Proteinen und Partikeln für Melanomzellen gezeigt werden. Volllängen mRNA von HERV-K war in allen untersuchten humanen Proben nachweisbar. Gespleißtes env und rec war in 39% der Gewebe und in 38% der Melanomzelllinien exprimiert. Zusätzlich werden HERV-H, -R und -W exprimiert. Von den auf spezifische Antikörper gegen HERV-K Proteine untersuchten Seren der Melanompatienten waren 16% positiv für das transmembrane Hüllprotein, jedoch reagierte kein Serum mit Re oder Np9. Da im Zuge der Entstehung von Tumoren immer auch eine Dedifferenzierung der entarteten Zellen diskutiert wird, wurde die Expression von HERVs in undifferenzierten, embryonalen Stammzellen bestimmt. In den untersuchten embryonalen Stammzellen lässt sich Volllängen mRNA, sowie gespleißte env, rec und np9 mRNA nachweisen. Während der Differenzierung zu neuronalen Vorläuferzellen sinkt die Expression jedoch wieder auf ein mit normalen Zellen vergleichbares Niveau. Obwohl gespleißte RNA und virale Proteine von HERV-K vor allem in Tumoren und Tumorzelllinien exprimiert werden, ist deren Funktion während der Tumorentstehung noch immer ungeklärt. Auch die Bedeutung der HERV-K Expression in humanen Stammzellen ist noch unklar, insbesondere in Hinblick auf eine mögliche Tumorigenität. / In contrast to all other human endogenous retroviruses, proviruses of the human endogenous retrovirus family HERV-K have maintained open reading frames for all viral proteins. Although most proviruses are defective, structural proteins Gag and Env, the reverse transcriptase and two regulatory proteins, Rec and Np9, have been described. Rec resembles the Rev protein of HIV and tumourigenic potential was confirmed. Np9 as well is located in the nucleus and expression in association with tumour tissues was observed. Additionally to cell lines known to produce HERV-K virus particles, such as the teratocarcinoma cell line GH and breast cancer cell lines, recently melanoma cells were described to express HERV-K proteins and particles. In order to study the expression of HERV-K, -H, -R and -W, in melanoma cell lines and biopsies primer sets were used. Antisera specific for HERV-K proteins were used for immunohistochemistry and sera from melanoma patients were investigated for HERV-K specific antibodies. Full length mRNAs of all HERVs were found in all human cells. Spliced env and rec of HERV-K were detected in 39% of the melanoma biopsies and in 38% of the melanoma cell lines. Expression of HERV-K in situ was shown by immunohistochemistry. In addition, 16% of the patients sera tested showed antibodies against the HERV-K transmembrane envelope protein, but no antibodies against Np9 or Rec could be detected. A certain dedifferentiation of cells as a consequence of tumour development is discussed. Therefore the expression of HERV-K in undifferentiated embryonic stem cells was investigated. The investigated stem cells showed expression of HERV-K full length, env, rec and np9 mRNA. Although the expression decreased with differentiation to neuronal precursor cells. Even though HERV-K mRNA and proteins were expressed in a high percentage of melanomas their function in tumour development is still unclear. As well as the meaning of the HERV-K expression in embryonic stem cells, particularly for a tumourigenic potential.

Continuous Evaluation of Time Varying Speech Quality (CETVSQ) is a method of subjective assessment of transmitted speech quality for long speech sequences containing quality fluctuations in time. This method is modeled for continuous evaluation of long speech sequences based on two subjective tasks. First task is to assess the speech quality during the listening and second task is to assess the overall speech quality after listening to the speech sequences. The development of continuous evaluation of time varying speech quality was motivated by fact that speech quality degradations are often not constant and varies in time. In modern IP telephony and wireless networks, speech quality varies due to specific impairments such as packet loss, echo, handover in networks etc. Many other standard methods already exist, which are being used for subjective assessment of short speech sequences. These methods such as ITU-T Rec. P.800 are well suited for only time constant speech quality. In this thesis work, it was required to implement CETVSQ methodology, so that it could be possible to assess long speech sequences. An analog hardware slider is used for the continuous assessment of speech qualities, as well as for overall quality judgments. Instantaneous and overall quality judgments are being saved into Excel file. The results stored in the Excel file are analyzed by applying different statistical measures. In evaluation part of the thesis work, subjects’ scores are analyzed by applying statistical methods to identify several factors that have originated in the CETVSQ methodology. A subjective test had already been conducted according to P.800 ACR method. The long speech sequences were divided into 8 seconds short sequences and then assessed using P.800 ACR method. In this study, the long speech sequences are assessed using CETVSQ methodology and comparison is conducted between P.800 ACR and CETVSQ results. It has been revealed that if long speech sequences are divided into short segments and evaluated using P.800 ACR, then P.800 ACR results will be different from the results obtained from CETVSQ methodology. The necessity of CETVSQ methodology is proved by this study.

Made available in DSpace on 2015-04-14T13:32:35Z (GMT). No. of bitstreams: 1 400854.pdf: 4138219 bytes, checksum: 4f521855c172770fded9d0e3536f9d8c (MD5) Previous issue date: 2008-03-14 / INTRODU??O: H? poucos estudos, e nenhum com cegamento, sobre o uso do m?todo do flush e da oximetria de pulso na verifica??o da press?o arterial em rec?m-nascidos. O m?todo do Doppler ? considerado padr?o para aferi??o n?o-invasiva da press?o arterial em neonatologia. OBJETIVO: Comparar as medidas de press?o arterial determinadas pelo m?todo do "flush", da oximetria de pulso e da oscilometria com o Doppler. M?TODOS: Foram realizadas medidas de press?o arterial em rec?m-nascidos a termo normais, prematuros est?veis e rec?m-nascidos doentes. Todas as medidas foram filmadas, editadas separadamente, codificadas e analisadas por tr?s neonatologistas independentes. RESULTADOS: Realizou-se 57 medidas por cada m?todo. Os m?todos do flush e da oximetria de pulso mostraram melhor coeficiente de correla??o com o Doppler do que a oscilometria (respectivamente, 0,89, 0,85 e 0,71; P<0,01). A diferen?a m?dia entre as medidas, seus respectivos desvios padr?es e o IC95% quando comparados com Doppler foram: -5,2?7,9 (-21,1 a 10,7) mmHg com o m?todo do flush ; 0,4?8,9 (-17,5 a 18,2) mmHg com a oximetria de pulso e 6,4?16,1 (-25,8 a 8,6) mmHg com a oscilometria. O m?todo do flush mostrou ser mais sens?vel do que o da oximetria e o da oscilometria para o diagn?stico de hipotens?o arterial (P<0,002). CONCLUS?ES: Os m?todos do flush e da oximetria de pulso s?o mais precisos e confi?veis para medir a press?o arterial de rec?m-nascidos, sendo que o m?todo do flush parece ser mais preciso para detectar hipotens?o que o m?todo de oscilom?trico.

Made available in DSpace on 2015-04-14T13:32:35Z (GMT). No. of bitstreams: 1 401051.pdf: 839175 bytes, checksum: 3d905f44b7571f7529c3d3850e67907c (MD5) Previous issue date: 2008-03-05 / Introdu??o: ? medida que o tratamento profil?tico ou precoce com surfactante mostrou-se vantajoso nos rec?m-nascidos prematuros com imaturidade pulmonar, renovou-se o interesse na busca de testes diagn?sticos nesta ?rea. A contagem dos corpos lamelares (CCL) e o teste das microbolhas est?veis (TME) no l?quido amni?tico s?o exames r?pidos e de baixo custo que podem ser realizados durante o trabalho de parto. Possivelmente, o uso combinado destes exames pode aumentar seus desempenhos diagn?sticos, por?m esta hip?tese ainda n?o foi testada. Objetivo: avaliar o desempenho do TME e da CCL no l?quido amni?tico, na predi??o da s?ndrome do desconforto respirat?rio (SDR) em rec?m-nascidos prematuros. M?todos: foi coletado l?quido amni?tico durante a ces?rea ou por via vaginal, em partos prematuros ocorridos no Hospital S?o Lucas da PUCRS no per?odo de mar?o de 2006 a novembro de 2007. A CCL foi realizada logo ap?s a coleta do material pelo contador de plaquetas Sysmex XT-1800I e o TME foi realizado posteriormente, pelo autor, cego para o desfecho. O diagn?stico de SDR foi estabelecido pela apresenta??o cl?nica e um raio-x de t?rax caracter?stico ou por rec?m-nascido que recebeu surfactante profil?tico e apresentava uma contagem de microbolhas no aspirado traqueal < 120 &#956;Nb/mm2 e/ou necessitou da segunda dose de surfactante. Resultados: dos 111 pacientes estudados, 20 (18%) apresentaram SDR. A m?dia do peso foi 2062 ? 639 gramas enquanto que a idade gestacional m?dia foi 32.8 ? 3 semanas. Para um ponto de corte <12.000 corpos lamelares/&#956;L a sensibilidade, a especificidade e a raz?o de verossimilhan?a positiva da CCL foram 90% (IC95%: 68-99%), 81% (IC95%: 72-89%) e 4.8 (IC95%: 3.2 7.4%) respectivamente. Para um ponto de corte X5 microbolhas/mm2, o TME apresentou uma sensibilidade de 90% (IC95%: 68-99%), uma especificidade de 79% (IC95%: 69-87%) e uma raz?o de verossimilhan?a positiva de 4.3 (IC95%: 2.8-6.6%). Usando os testes em conjunto (TME <7 &#956;b/mm2 E CCL X12000 corpos lamelares/&#956;L, para definir imaturidade pulmonar), a raz?o de verossimilhan?a positiva aumentou para 10.2 (IC95%: 5.2-20.2) e a especificidade aumentou para 91% (IC95%: 83-96%), enquanto que a sensibilidade permaneceu inalterada em 90% (IC95%: 68-99%). Conclus?o: a CCL e o TME no l?quido amni?tico possuem desempenho diagn?stico similar quando usados em separado para predizer a SDR. O uso combinado dos dois testes pode aumentar a especificidade e a raz?o de verossimilhan?a positiva sem modificar a sensibilidade.