Sono e esquemas mal-adaptativos precoces em estudantes do ensino superior

Contextualização: Recentemente tem-se verificado um aumento do número de estudos que relacionam conceitos da personalidade, tais como os Esquemas Mal-adaptativos Precoces (EMP), com a psicopatologia e com outras condições, tais como a obesidade, a dor crónica e o comportamento sexual agressivo. No entanto, a investigação acerca da relação entre os problemas de sono e os EMP encontra-se ainda numa fase inicial. Objetivos: Os objetivos do presente estudo foram investigar uma potencial relação entre os EMP e a má qualidade de sono em estudantes do ensino superior e observar que EMP apresentavam associações de maior magnitude com a qualidade de sono nesta população específica. Métodos: Estudantes de diversas universidades e institutos de ensino superior de Portugal foram convidados a responder a uma versão online dos questionários Escala Básica de Sintomas de Insónia e Qualidade de Sono (BaSIQS) e Questionário de Esquemas de Young (YSQ-S3). A partir da amostra total obtida de estudantes do ensino superior de nacionalidade portuguesa (N = 1253) foi selecionada uma primeira subamostra (n1 = 409), usando como critérios de inclusão a idade (entre os 18 e os 25 anos) e as pontuações extremas de qualidade de sono da BaSIQS (má versus boa qualidade de sono). A partir da n1 extraiu-se uma segunda subamostra de participantes (n2 = 249), com características de um estudante “típico” do ensino superior (estatuto de aluno ordinário, solteiro, sem filhos, sem problemas de saúde, não medicado). Para estudar a relação entre os EMP, medidos pelo YSQ-S3, e a qualidade de sono foi aplicada uma MANOVA (Análise de Variância Multivariada) para cada um dos cinco domínios esquemáticos (“Distanciamento e Rejeição”, “Autonomia e Desempenho Deteriorados”, “Limites Deteriorados”, “Influência dos Outros” e “Vigilância Excessiva e Inibição”), para ambas as subamostras (n1 e n2). Resultados: No que diz respeito à n2, os estudantes com má qualidade de sono apresentaram níveis significativamente mais elevados dos EMP “Abandono/ Instabilidade”, “Desconfiança/ Abuso”, “Isolamento Social/ Alienação” (Domínio “Distanciamento e Rejeição”), “Vulnerabilidade ao Mal e à Doença” (Domínio “Autonomia e Desempenho Deteriorados”), “Grandiosidade/ Limites Indefinidos” (Domínio “Limites Deteriorados”), “Autossacrifício” (Domínio “Influência dos Outros”) e “Negativismo/ Pessimismo” (Domínio “Vigilância Excessiva e Inibição”). Conclusões: Estes dados mostram que os EMP estão associados à má qualidade de sono. No entanto, são necessários estudos adicionais para melhor compreender esta relação e a sua implicação na prática clínica.

Amor que vai, desamor que vem. Maus tratos nas relações de intimidade: aleatoriedade ou prévia (de)limitação da herança parental?

A presente investigação visa apurar se existem esquemas parentais (EPs) ou mal-adaptativos precoces (EMPs) que predisponham à escolha, por parte de mulheres vítimas de violência na intimidade, de parceiros potencialmente agressores. Adicionalmente pretende identificar como se manifesta a vitimação com os tipos de relacionamento amoroso de reparação narcísica. O estudo, de cariz quantitativo, recorre a três instrumentos (QEP, QE e ITRA) preenchidos por 27 mulheres com idades compreendidas entre os 23- 67 anos, das quais 10 sofreram algum tipo de violência numa relação de intimidade. Este estudo concluiu que existem EPs e EMPs que parecem predispor à escolha de parceiros amorosos abusivos. Estas escolhas amorosas parecem estar relacionadas com a tendência para enveredar por tipos de relacionamento amoroso mais patológico, nomeadamente, os tipos evitante-desnarcisante e eufórico-idealizante. Posto isto, criou-se um modelo que caracteriza vítimas e não-vítimas de violência nas relações de intimidade com uma precisão de 96,3% com base nos resultados dos instrumentos anteriores; When sorrow replaces love Violence in intimate relationships: Randomness or effects of parental heritage? Abstract: This research aims at determining whether there are schemas originated by parenting styles (PSs) or early maladaptive schemas (EMSs) that predispose women, who were victims of violence in their intimate relationships, to choose abusive romantic partners. Additionally it intends to identify how victimization reveals itself through romantic relationship types that are due to repair the Self narcissistic vulnerabilities. This quantitative study relies on three instruments (PSQ, SQ, ITRA) filled by 27 women with ages between 23-67, 10 of which were victims of violence in their intimate relationships. This study concludes that there are PSs and EMSs that seem to predispose to the choice of abusive romantic partners. These romantic choices seem to be related with the predisposition to more pathological romantic relationship types, namely, the avoidant-devaluate and euphoricidealizing types. Following this, a model was created to characterize individuals as victims or non-victims of violence in their intimate relationships with a precision of 96.3%, based on the results of the instruments above.

Vinculação, Estilos Educativos Parentais e Esquemas Precoces Mal Adaptativos em Reclusos

Introdução: Sobretudo estudos internacionais focam a importância da vinculação e dos estilos educativos parentais no desenvolvimento de comportamentos delinquentes e antissociais. Em Portugal, alguns estudos focados na população reclusa, analisam, separadamente, estilos educativos parentais, personalidade e esquemas precoces mal adaptativos mas, segundo sabemos, nenhum explora, simultaneamente, a vinculação, os estilos educativos parentais e os esquemas precoces mal adaptativos nesta população. São nossos objetivos caracterizar uma amostra de reclusos quanto à vinculação em diferentes relacionamentos, estilos educativos parentais e esquemas precoces mal adaptativos (EPM) e, sobretudo, explorar associações entre estas três variáveis (e destas com variáveis sociodemográficas, familiares, clínicas e relativas à pena). Metodologia: 44 reclusos do sexo masculino (M = 37,3 anos; DP = 10,98; variação = 23-67) preencheram voluntariamente um questionário sociodemográfico e os seguintes instrumentos: EMBU – Memórias de Infância, Experiências em Relações Próximas - Questionário de Estruturas Relacionais e Questionário de Esquemas de Young (QEY). Resultados: Verificou-se, quanto às associações entre vinculação e estilos educativos parentais que: menor suporte emocional paterno associou-se a maior evitamento pai, evitamento mãe e evitamento companheira; menor suporte emocional materno associou-se a maior evitamento mãe, evitamento pai, ansiedade mãe e ansiedade pai; maior rejeição paterna associou-se a maior evitamento mãe, evitamento pai, ansiedade mãe e ansiedade pai; maior rejeição materna associou-se a maior evitamento pai e evitamento mãe. No que toca às associações entre as dimensões de vinculação e EPM, é de enfatizar a associação positivas entre os EPM do domínio distanciamento e rejeição com o evitamento mãe, ansiedade mãe e ansiedade pai, particularmente, os EPM de abandono, desconfiança/abuso e isolamento social, por consistentemente se associaram às dimensões de vinculação. No domínio autonomia e desempenho deteriorados, o fracasso e a dependência/incompetência associaram-se positivamente ao evitamento mãe, a dependência/incompetência à ansiedade pai e o fracasso ao evitamento companheira. Quanto ao domínio limites deteriorados, a grandiosidade associou-se positivamente à ansiedade pai. No domínio vigilância e inibição o pessimismo/negativismo correlacionou-se positivamente com a ansiedade mãe e pai e a autopunição com a ansiedade mãe. Quanto às associações entre dimensões de estilos educativos parentais e os EPM, o domínio distanciamento e rejeição apresentou, de novo resultados relevantes: menores níveis de suporte emocional materno associaram-se a maiores níveis de privação emocional; maiores níveis de rejeição e sobreproteção materna e paterna a maiores os níveis de abandono; maiores níveis de rejeição materna e paterna a maiores níveis de desconfiança/abuso; maiores níveis de rejeição materna e sobreproteção materna e paterna a maiores níveis de isolamento social; maiores níveis de rejeição e sobreproteção paterna a maiores níveis de defeito. Enfatiza-se, também, a associação entre níveis maiores de rejeição paterna e os EPM de grandiosidade, padrões excessivos e pessimismo. Maiores níveis de rejeição materna associaram-se a maiores níveis de pessimismo e autopunição. Discussão: Embora numa amostra pequena, este estudo explorou, pela primeira vez, numa amostra de reclusos portugueses, em simultâneo, associações entre a vinculação, os estilos educativos parentais e os esquemas precoces mal adaptativos. O domínio esquemático distanciamento e rejeição parece ser o mais influenciado pela vinculação estabelecida em diferentes relacionamentos e pelos estilos educativos parentais. / Introduction: Mainly international studies focus on the importance of attachment and parental rearing styles in the development of delinquent and antisocial behaviors. In Portugal some studies focused in the inmate population analyze, separately, parental rearing styles, personality and early maladaptive schemas but, to our knowledge, none simultaneously explores attachment, parental rearing styles and early maladaptive schemas in this population. It is our objective to characterize a sample of inmates concerning attachment in different relationships, parental rearing styles and early maladaptive schemas (EMS) and, above all, explore associations between this three variables (and also with sociodemographic, family, clinic and sentence related variables). Methodology: 44 male inmates (M = 37,3 years; SD = 10,98; variation = 23-67) voluntarily filled in a sociodemographic questionnaire and the following instruments: EMBU – Childhood Memories, Experiments in Close Relationships – Structural Relationship Form and the Young Schema Questionnaires (YSQ) Results: we verified, regarding associations between attachment and parental rearing styles that: less paternal emotional support associated with higher father avoidance (in attachment), mother avoidance and partner avoidance; less maternal emotional support associated with higher mother avoidance, father avoidance, mother anxiety and father anxiety; higher paternal rejection associated with higher mother avoidance, father avoidance, mother anxiety and father anxiety; higher mother rejection associated with father avoidance and mother avoidance. Regarding associations between attachment dimensions and EMS, we emphasize positive associations between EMS in the disconnection and rejection domain with mother avoidance, mother anxiety and father anxiety, particularly, the abandonment, distrust/abuse and social isolation EMS, as they were consistently associated with the this attachment dimension. In the impaired autonomy and performance domain, the failure and dependency/incompetence EMS are positively associated with mother avoidance, the dependence/incompetence EMS to father anxiety and failure to partner avoidance. About the impaired limits domain, grandiosity EMS positively associated with father anxiety. In the overvigilance and inhibition domain, pessimist/negativism EMS positively correlated with mother and father anxiety and self-punishment EMS with mother anxiety. About the associations between parental rearing styles and the EMS, the disconnection and rejection domain presented again relevant results: lower levels of maternal emotional support associated with higher levels of emotional deprivation; higher levels of maternal and paternal rejection and overprotection associated with higher levels of abandonment; higher levels of maternal and paternal rejection associated with higher levels of distrust/abuse; higher levels of maternal rejection and maternal and paternal overprotection associated with higher levels of social isolation; higher levels of paternal rejection and overprotection associated with higher levels of defectiveness. We also emphasize the association between higher levels of paternal rejection and the grandiosity, excessive patterns and pessimism EMS. Higher levels of maternal rejection associated with higher levels of pessimism and self-punishment EMS. Discussion: Although in a small sample, this study explored, for the first time, in sample of Portuguese inmates, simultaneously, the associations between attachment, parental rearing styles and early maladaptive schemas. The schematic domain of disconnection and rejection seems to be the most influenced by the established attachment in different relationships and by parental rearing styles.

Uma vida de relações falhadas: continuidade ou mudança?: estudo sobre a herança psíquica e os desamores narcísicos na vida adulta

Este estudo propôs-se investigar, como os Esquemas Iniciais Desadaptativos (EIDs) concebidos pelo indivíduo e a sua representação dos Estilos Parentais (EPs), influenciam na escolha amorosa da vida adulta considerando os relacionamentos amorosos de reparação narcísica: Submisso-Idealizador, Eufórico-Idealizante e Evitante-Desnarcisante. A amostra constituiu-se por 225 (jovens) adultos/as portugueses/as, entre os 23 e 63 anos, que tivessem tido ou possuíssem na altura do estudo uma relação amorosa. A investigação de natureza quantitativa utilizou como instrumentos o: Inventário de Tipos de Relacionamento Amoroso (ITRA), Questionário de Esquemas (QE) e Questionário de Estilos Parentais (QEP). Segundo os resultados, evidenciou-se a associação de EIDs0F 1 e EPs1F 2 mais precoces e rígidos (incondicionais) aos três tipos de relacionamento amoroso, verificou-se uma herança psíquica trans-geracional com conteúdos individuais e relacionais mantidos e apurou-se a necessidade de o sujeito procurar relações fornecedoras de uma imagem mais completa do seu self desestruturado, concluindo-se que houve uma continuidade de relações falhadas; Abstract: A lifetime of failed relationships: continuity or change? Study about the psychic heritage and narcissistic unlove in adulthood. This study proposes to investigate, how the Early Maladaptive Schemas (EIDs) conceived by the individual and, their representation about the Parental Styles (EPs), influence the choice of adulthood loving relationships considering the romantic relationships of narcissistic repair: Submissive-Idealizer, Euphoric-Idealizing and Avoidant-Devaluate. The sample consisted of 225 Portuguese (young) adults, between 23 and 63 years old, who have had or maintained at the time of the study a loving relationship. The quantitative research used as instruments the: Inventory Types of Loving Relationship (ITRA), Schema Questionnaire (QE) and Parental Styles Questionnaire (QEP). According to the results, it showed the association of more early and rigid (unconditional) EIDs2F 3 and EPs3F 4 with the three types of love relationship, it was found a trans-generational psychic inheritance with individual and relational content maintained and found out the need for the subject pursuit for supplier relations of a more complete image of your self unstructured, concluding that there was a continuity of failed relationships.

Factor structure and internal consistency of the Young Schema Questionnaire (Short Form) in Korean and Australian samples

We investigated cross-cultural differences in the factor structure and psychometric properties of the 75-item Young Schema Questionnaire-Short Form (YSQ-SF). Participants were 833 South Korean and 271 Australian undergraduate students. The South Korean sample was randomly divided into two sub-samples. Sample A was used for Exploratory Factor Analysis (EFA) and sample B was used for Confirmatory Factor Analysis (CFA). EFA for the South Korean sample revealed a 13-factor solution to be the best fit for the data, and CFA on the data from sample B confirmed this result. CFA on the data from the Australian sample also revealed a 13-factor solution. The overall scale of the YSQ-SF demonstrated a high level of internal consistency in the South Korean and Australian groups. Furthermore, adequate internal consistencies for all subscales in the South Korean and Australian samples were demonstrated. In conclusion, the results showed that YSQ-SF with 13 factors has good psychometric properties and reliability for South Korean and Australian University students. Korean samples had significantly higher YSD scores on most of the 13 subscales than the Australian sample. However, limitations of the current study preclude the generalisability of the findings to beyond undergraduate student populations. (c) 2006 Elsevier B.V. All rights reserved.

Early change in maladaptive defense style and development of the therapeutic alliance

Résumé Cette étude examine les changements précoces dans le Style Défensif Maladaptatif (SDM), le développement de l'alliance thérapeutique et la relation entre le SDM et l'alliance au cours d'une psychothérapie psychodynamique ultra-brève. Soixante-huit patients ambulatoires du centre de consultation psychiatrique et psychothérapique ont bénéficié d'une intervention psychodynamique en quatre séances. Les mesures des défenses et de l'alliance étaient effectuées à la première et à la dernière séance. Les patients qui ont débuté l'intervention avec une alliance faible et qui l'ont terminée avec une alliance haute (groupe de patients avec une alliance de croissance linéaire) ont diminué leur utilisation de défenses maladaptatives de manière significative au cours de la thérapie, alors que ce n'a pas été le cas pour les patients des groupes à alliances haute-stable et basse-stable. Les résultats ont montré qu'à la fin de l'intervention, le SDM et l'alliance étaient corrélés pour tous les patients. Cette corrélation intéressait plus particulièrement le groupe avec une alliance de croissance linéaire. Ces résultats suggèrent, que le développement de l'alliance thérapeutique reflètent le travail de collaboration entre le patient et son thérapeute alors qu'ils essayent de mieux comprendre les causes de la crise du patient. Cette compréhension peut aider à réduire les défenses initialement activées pour permettre au patient de se défendre de l'anxiété et d'un sentiment de détresse. Abstract This study examined the early change in Maladaptive Defense Style (MDS), the development of the Therapeutic Alliance, and the relationship between MDS and alliance, in a short psychodynamic intervention. Sixty-eight outpatients from a psychiatric clinic completed a four-session psychodynamic intervention. Defense and alliance measures were collected at the intake and the final session. Patients who began the intervention with a poor alliance but ended with a good alliance (linear growth therapeutic alliance group) significantly decreased their use of maladaptive defenses over the course of therapy, while patients in the high and low alliance groups did not. Results showed that at the end of the intervention, MDS and alliance were related across all patients. This relation concerned particularly the linear growth therapeutic alliance profile. These results suggest that the developing therapeutic alliance might reflect the collaborative work between the patient and the therapist as they try to understand the causes of the crisis. This understanding might help reduce maladaptive defenses that were initially activated to ward off anxiety and distress.

Using a domain-specific language to enrich ETL schemas

Today it is easy to find a lot of tools to define data migration schemas among different types of information systems. Data migration processes use to be implemented on a very diverse range of applications, ranging from conventional operational systems to data warehousing platforms. The implementation of a data migration process often involves a serious planning, considering the development of conceptual migration schemas at early stages. Such schemas help architects and engineers to plan and discuss the most adequate way to migrate data between two different systems. In this paper we present and discuss a way for enriching data migration conceptual schemas in BPMN using a domain-specific language, demonstrating how to convert such enriched schemas to a first correspondent physical representation (a skeleton) in a conventional ETL implementation tool like Kettle.

Angiotensin II-mediated adaptive and maladaptive remodeling of cardiomyocyte excitation-contraction coupling.

Cardiac hypertrophy is associated with alterations in cardiomyocyte excitation-contraction coupling (ECC) and Ca(2+) handling. Chronic elevation of plasma angiotensin II (Ang II) is a major determinant in the pathogenesis of cardiac hypertrophy and congestive heart failure. However, the molecular mechanisms by which the direct actions of Ang II on cardiomyocytes contribute to ECC remodeling are not precisely known. This question was addressed using cardiac myocytes isolated from transgenic (TG1306/1R [TG]) mice exhibiting cardiac specific overexpression of angiotensinogen, which develop Ang II-mediated cardiac hypertrophy in the absence of hemodynamic overload. Electrophysiological techniques, photolysis of caged Ca(2+) and confocal Ca(2+) imaging were used to examine ECC remodeling at early ( approximately 20 weeks of age) and late ( approximately 60 weeks of age) time points during the development of cardiac dysfunction. In young TG mice, increased cardiac Ang II levels induced a hypertrophic response in cardiomyocyte, which was accompanied by an adaptive change of Ca(2+) signaling, specifically an upregulation of the Na(+)/Ca(2+) exchanger-mediated Ca(2+) transport. In contrast, maladaptation was evident in older TG mice, as suggested by reduced sarcoplasmic reticulum Ca(2+) content resulting from a shift in the ratio of plasmalemmal Ca(2+) removal and sarcoplasmic reticulum Ca(2+) uptake. This was associated with a conserved ECC gain, consistent with a state of hypersensitivity in Ca(2+)-induced Ca(2+) release. Together, our data suggest that chronic elevation of cardiac Ang II levels significantly alters cardiomyocyte ECC in the long term, and thereby contractility, independently of hemodynamic overload and arterial hypertension.

Maladaptive exploratory behavior and neuropathology of the PS-1 P117L Alzheimer transgenic mice.

Patients with the early-onset Alzheimer's disease P117L mutation in the presenilin-1 gene (PS-1) present pathological hallmarks in the hippocampus, the frontal cortex and the basal ganglia. In the present work we determined by immunohistochemistry which brain regions were injured in the transgenic PS-1 P117L mice, in comparison to their littermates, the B6D2 mice. Furthermore, as these regions are involved in novelty detection, we investigated the behavior of these mice in tests for object and place novelty recognition. Limited numbers of senile plaques and neurofibrillary tangles were detected in aged PS-1 P117L mice in the CA1 only, indicating that the disease is restrained to an initial neuropathological stage. Western blots showed a change in PSD-95 expression (p=0.03), not in NR2A subunit, NR2B subunit and synaptophysin expressions in the frontal cortex, suggesting specific synaptic alterations. The behavioral tests repeatedly revealed, despite a non-significant preference for object or place novelty, maladaptive exploratory behavior of the PS-1 P117L mice in novel environmental conditions, not due to locomotor problems. These mice, unlike the B6D2 mice, were less inhibited to visit the center of the cages (p=0.01) and they continued to move excessively in the presence of a displaced object (p=0.021). Overall, the PS-1 P117L mice appear to be in an initial Alzheimer's disease-like neuropathological stage, and they showed a lack of reaction toward novel environmental conditions.

The early transcriptomic response to interleukin 1β and interleukin 33 in rat neonatal cardiomyocytes

In the heart, inflammatory cytokines including interleukin (IL) 1β are implicated in regulating adaptive and maladaptive changes, whereas IL33 negatively regulates cardiomyocyte hypertrophy and promotes cardioprotection. These agonists signal through a common co-receptor but, in cardiomyocytes, IL1β more potently activates mitogen-activated protein kinases and NFκB, pathways that regulate gene expression. We compared the effects of external application of IL1β and IL33 on the cardiomyocyte transcriptome. Neonatal rat cardiomyocytes were exposed to IL1β or IL33 (0.5, 1 or 2h). Transcriptomic profiles were determined using Affymetrix rat genome 230 2.0 microarrays and data were validated by quantitative PCR. IL1β induced significant changes in more RNAs than IL33 and, generally, to a greater degree. It also had a significantly greater effect in downregulating mRNAs and in regulating mRNAs associated with selected pathways. IL33 had a greater effect on a small, select group of specific transcripts. Thus, differences in intensity of intracellular signals can deliver qualitatively different responses. Quantitatively different responses in production of receptor agonists and transcription factors may contribute to qualitative differences at later times resulting in different phenotypic cellular responses.

Fractalkine (cx3cl1) Is Involved In The Early Activation Of Hypothalamic Inflammation In Experimental Obesity.

Hypothalamic inflammation is a common feature of experimental obesity. Dietary fats are important triggers of this process, inducing the activation of toll-like receptor-4 (TLR4) signaling and endoplasmic reticulum stress. Microglia cells, which are the cellular components of the innate immune system in the brain, are expected to play a role in the early activation of diet-induced hypothalamic inflammation. Here, we use bone marrow transplants to generate mice chimeras that express a functional TLR4 in the entire body except in bone marrow-derived cells or only in bone marrow-derived cells. We show that a functional TLR4 in bone marrow-derived cells is required for the complete expression of the diet-induced obese phenotype and for the perpetuation of inflammation in the hypothalamus. In an obesity-prone mouse strain, the chemokine CX3CL1 (fractalkine) is rapidly induced in the neurons of the hypothalamus after the introduction of a high-fat diet. The inhibition of hypothalamic fractalkine reduces diet-induced hypothalamic inflammation and the recruitment of bone marrow-derived monocytic cells to the hypothalamus; in addition, this inhibition reduces obesity and protects against diet-induced glucose intolerance. Thus, fractalkine is an important player in the early induction of diet-induced hypothalamic inflammation, and its inhibition impairs the induction of the obese and glucose intolerance phenotypes.

Neonatal Outcomes Of Late Preterm And Early Term Birth.

To compare neonatal deaths and complications in infants born at 34-36 weeks and six days (late preterm: LPT) with those born at term (37-41 weeks and six days); to compare deaths of early term (37-38 weeks) versus late term (39-41 weeks and six days) infants; to search for any temporal trend in LPT rate. A retrospective cohort study of live births was conducted in the Campinas State University, Brazil, from January 2004 to December 2010. Multiple pregnancies, malformations and congenital diseases were excluded. Control for confounders was performed. The level of significance was set at p<0.05. After exclusions, there were 17,988 births (1653 late preterm and 16,345 term infants). A higher mortality in LPT versus term was observed, with an adjusted odds ratio (OR) of 5.29 (p<0.0001). Most complications were significantly associated with LPT births. There was a significant increase in LPT rate throughout the study period, but no significant trend in the rate of medically indicated deliveries. A higher mortality was observed in early term versus late term infants, with adjusted OR: 2.43 (p=0.038). LPT and early term infants have a significantly higher risk of death.

Newborn Hearing Screening And Early Diagnostic In The Nicu.

The aim was to describe the outcome of neonatal hearing screening (NHS) and audiological diagnosis in neonates in the NICU. The sample was divided into Group I: neonates who underwent NHS in one step and Group II: neonates who underwent a test and retest NHS. NHS procedure was automated auditory brainstem response. NHS was performed in 82.1% of surviving neonates. For GI, referral rate was 18.6% and false-positive was 62.2% (normal hearing in the diagnostic stage). In GII, with retest, referral rate dropped to 4.1% and false-positive to 12.5%. Sensorineural hearing loss was found in 13.2% of infants and conductive in 26.4% of cases. There was one case of auditory neuropathy spectrum (1.9%). Dropout rate in whole process was 21.7% for GI and 24.03% for GII. We concluded that it was not possible to perform universal NHS in the studied sample or, in many cases, to apply it within the first month of life. Retest reduced failure and false-positive rate and did not increase evasion, indicating that it is a recommendable step in NHS programs in the NICU. The incidence of hearing loss was 2.9%, considering sensorineural hearing loss (0.91%), conductive (1.83%) and auditory neuropathy spectrum (0.19%).

Hypothermia And Early Neonatal Mortality In Preterm Infants.

To evaluate intervention practices associated with hypothermia at both 5 minutes after birth and at neonatal intensive care unit (NICU) admission and to determine whether hypothermia at NICU admission is associated with early neonatal death in preterm infants. This prospective cohort included 1764 inborn neonates of 22-33 weeks without malformations admitted to 9 university NICUs from August 2010 through April 2012. All centers followed neonatal International Liaison Committee on Resuscitation recommendations for the stabilization and resuscitation in the delivery room (DR). Variables associated with hypothermia (axillary temperature <36.0 °C) 5 minutes after birth and at NICU admission, as well as those associated with early death, were analyzed by logistic regression. Hypothermia 5 minutes after birth and at NICU admission was noted in 44% and 51%, respectively, with 6% of early neonatal deaths. Adjusted for confounding variables, practices associated with hypothermia at 5 minutes after birth were DR temperature <25 °C (OR 2.13, 95% CI 1.67-2.28), maternal temperature at delivery <36.0 °C (OR 1.93, 95% CI 1.49-2.51), and use of plastic bag/wrap (OR 0.53, 95% CI 0.40-0.70). The variables associated with hypothermia at NICU admission were DR temperature <25 °C (OR 1.44, 95% CI 1.10-1.88), respiratory support with cold air in the DR (OR 1.40, 95% CI 1.03-1.88) and during transport to NICU (OR 1.51, 95% CI 1.08-2.13), and cap use (OR 0.55, 95% CI 0.39-0.78). Hypothermia at NICU admission increased the chance of early neonatal death by 1.64-fold (95% CI 1.03-2.61). Simple interventions, such as maintaining DR temperature >25 °C, reducing maternal hypothermia prior to delivery, providing plastic bags/wraps and caps for the newly born infants, and using warm resuscitation gases, may decrease hypothermia at NICU admission and improve early neonatal survival.