Relação precoce mãe-filho. Revisão dos indicadores pós-parto do projeto Maternidade com Qualidade no CHBM-EPE

O aleitamento materno exclusivo é uma recomendação universal e o contacto pele-a-pele mãe/recém-nascido é fator de desenvolvimento para a díade. O trabalho académico desenvolvido centra-se nos indicadores de medida e evidência - amamentação na 1ª hora de vida & contacto pele a pele entre a díade. Tal enraíza-se no projeto Maternidade com Qualidade, da Ordem dos Enfermeiros Portugueses e em curso no Centro Hospitalar Barreiro-Montijo EPE. O projeto iniciou-se em setembro de 2015, seguindo-se os procedimentos que se relatam no atual documento. No diagnóstico de situação recolheu-se o estado dos indicadores. A vertente de investigação considerou como amostras profissionais e utentes do Centro Hospitalar Barreiro-Montijo e recolheu dados. A intervenção realizada produziu evolução positiva nos indicadores. O bonding em período sensível é reconhecido pelos profissionais como um elemento relevante nos cuidados. Com a implementação deste projeto contribuiu-se para a melhoria da qualidade dos cuidados na área de saúde materna; Mother-Child early relationship. Evaluating postpartum indicators from the Project Maternity with Quality at CHBM-EPE ABSTRACT: Exclusive breastfeeding is a universal recommendation and skin-to-skin mother / newborn is a development factor for the dyad. The academic work focuses on the measurement indicators and evidence - breastfeeding within the 1st hour of life & skin-to-skin between the dyad. This is rooted in the Maternity design with quality, of the Portuguese Nurses and ongoing in-Hospital Center Barreiro Montijo EPE. The project began in September 2015, following the procedures that are reported in the current document. In the situation analysis was collected status indicators. The research strand considers sample practitioners and users Barreiro-Montijo Hospital Center and collects data. The intervention performed produced positive results for these indicators. The bonding in the sensitive period is recognized by professionals as an important element in the care. With the implementation of this project contributed to improving the quality of care in maternal health.

Ellen Key e la rete delle scuole nuove in Europa (1899-1914)

La ricerca parte dall’intento di indagare le relazioni che intrattenne Ellen Key con i fondatori delle scuole nuove in Europa a cavallo del Novecento e il contributo che lei offrì alla loro disseminazione. All’inizio del Novecento Ellen Key era al centro del dibattito pedagogico e femminista, non solo in Svezia ma in tutta l’Europa Centrale e anche in Italia, dove compì lunghi soggiorni (1900-1901 e 1906-1908). La pedagoga svedese fu un’intellettuale che sostenne strenuamente la libertà di espressione e di stampa, fu promotrice di una Carta dei diritti dei bambini e fautrice di politiche sociali per la protezione della maternità e della relazione madre-bambino. Al volgere del Ventesimo secolo si verificò l’emergere di una serie di esperimenti pedagogici innovativi che presero le mosse dalla Abbotsholme school fondata da Cecil Reddie, nel 1889, e si diffusero in Francia con la fondazione della Ecole des Roches da parte di Edmond Demolins, in Germania con le scuole di campagna (Landerziehungsheime di Ilseburg, Haubinda e Bieberstein) fondate da Hermann Lietz, la comunità scolastica di Wickersdorf e la Odenwaldschule di Paul Geheeb. Ellen Key si relazionò con questi importanti esperimenti pedagogici e, grazie ai suoi continui spostamenti, visitò alcune scuole nuove. Nello specifico la ricerca prende le mosse dall’analisi dei manoscritti e dei carteggi del fondo Ellen Key, presso la Biblioteca Reale di Stoccolma e la biblioteca privata di Ellen Key a Villa Strand. Dai documenti analizzati emerge come la scrittrice svedese, abbia assunto un ruolo di mediatrice per la disseminazione delle Scuole Nuove che nei primissimi anni del Novecento raggiunsero un elevato grado di diffusione.

Lives apart? Experiences of transnational motherhood by Georgian labour migrants to Italy and their children

International labour migration processes of the last decades saw increasing numbers of solo female migrants employed in the developed countries. Many of these women were mothers who left their children in the sending countries and thus gave rise to a controversial phenomenon of transnational motherhood. The present thesis is based on the first empirical study of intergenerational narratives of mothers, Georgian labour migrants to Italy, and their children, left behind in Georgia. Mothers’ international labour migration is a challenge to the traditional ideology of motherhood. Although unconsciously migrant mothers often adhere to “alternative”, “rational”, future-oriented model(s) of parenting, they continue to live their experiences in the framework of traditional understandings of motherhood, which appears to be unequipped to “frame” transnational motherhood as, from its point of view, mothers’ choice to leave their children is reprehensible, yet transnational mothers’ physical absence is not an equivalent of “leaving” their children. Informants’ narratives strongly suggest that long periods of physical separation did not jeopardize bonds between mothers and children in transnational families. While informants’ selection bias is probable, the mother-child bond was not “broken” and the very essence of motherhood remained intact. Many forms of mothers’ and children’s online co-presence were documented during the interviews. Interviews also prove that the Internet cannot be considered a solution to the problem of family separation, experienced painfully by both mothers and children: it may reduce the pain caused by separation, but cannot be a substitute for mothers’ physical absence from their families. Despite the pain caused by separation, mothers’ emigration appeared to be the right decision made for the good of the family. Interviewed mothers almost univocally reported readiness to “keep going on”, and continue working in emigration to help their children until physically able to do so, because, as they put it, “motherhood never ends”.

Three-year-olds' attachment play narratives and their associations with internalizing problems

Representational strategies of emotion regulation during play are believed to protect children against behaviour problems. Yet, before the age of 4, it appears that children rely more on their attachment figure than on representational strategies to assuage distress. The study was aimed at testing whether 3-year-olds' narrative features during the Attachment Story Completion Task (ASCT) could predict concurrent internalizing problems assessed by the mothers' and fathers' ratings of the child, using the Child Behaviour Checklist Regression analyses including gender, IQ, socio-economic status and ASCT dimensions revealed that representations of supportive caregiving predicted mother-reported internalizing problems (negative association), whereas positive resolution and attachment strategies (security, deactivation, hyperactivation, disorganization) did not. Results were interpreted with reference to Bowlby's hypotheses regarding the aetiology of depression and anxiety disorders. (PsycINFO Database Record (c) 2007 APA, all rights reserved)

Quality Of Attachment, Perinatal Risk, And Mother-Infant Interaction In A High-Risk Premature Sample

Thirty-three families, each with a premature infant born less than 33 gestational weeks, were observed in a longitudinal exploratory study. Infants were recruited in a neonatal intensive care unit, and follow-up visits took place at 4 months and 12 months of corrected age. The severity of the perinatal problems was evaluated using the Perinatal Risk Inventory (PERI; A.P. Scheiner & M.E. Sexton, 1991). At 4 months, mother infant play interaction was observed and coded according to the CARE-index (P.M. Crittenden, 2003); at 12 months, the Strange Situation Procedure (SSP; M.D.S. Ainsworth, M.C. Blehar, E. Waters. & S. Wall, 1978) was administered. Results indicate a strong correlation between the severity of perinatal problems and the quality of attachment at 12 months. Based on the PERI, infants with high medical risks more frequently tended to be insecurely attached. There also was a significant correlation between insecure attachment and dyadic play interaction at 4 months (i.e., maternal controlling behavior and infant compulsive compliance). Moreover, specific dyadic interactive patterns could be identified as protective or as risk factors regarding the quality of attachment. Considering that attachment may have long-term influence on child development, these results underline the need for particular attention to risk factors regarding attachment among premature infants.

The mother-infant relationship and infant attachment in a south African peri-urban settlement

A sample of 147 mother-infant dyads was recruited from a peri-urban settlement outside Cape Town and seen at 2- and 18-months postpartum. At 18 months, 61.9% of the infants were rated as securely attached (B); 4.1% as avoidant (A); 8.2% as resistant (C); and 25.8% disorganized (D). Postpartum depression at 2 months, and indices of poor parenting at both 2 and 18 months, were associated with insecure infant attachment. The critical 2-month predictor variables for insecure infant attachment were maternal intrusiveness and maternal remoteness, and early maternal depression. When concurrent maternal sensitivity was considered, the quality of the early mother-infant relationship remained important, but maternal depression was no longer predictive. Cross-cultural differences and consistencies in the development of attachment are discussed.

The role played by the interaction between genetic factors and attachment in the stress response in infancy

Background: The importance of understanding which environmental and biological factors are involved in determining individual differences in physiological response to stress is widely recognized, given the impact that stress has on physical and mental health. Methods: The child-mother attachment relationship and some genetic polymorphisms (5-HTTLPR, COMT and GABRA6) were tested as predictors of salivary cortisol and alpha amylase concentrations, two biomarkers of hypothalamic-pituitary-adrenocortical (HPA) axis and sympathetic adrenomedullary (SAM) system activity, during the Strange Situation (SS) procedure in a sample of more than 100 healthy infants, aged 12 to 18 months. Results: Individual differences in alpha amylase response to separation were predicted by security of attachment in interaction with 5-HTTLPR and GABRA6 genetic polymorphisms, whereas alpha amylase basal levels were predicted by COMT x attachment interaction. No significant effect of attachment, genetics and their interaction on cortisol activity emerged. Conclusions: These results help to disentangle the role played by both genetic and environmental factors in determining individual differences in stress response in infancy. The results also shed light on the suggestion that HPA and SAM systems are likely to have different characteristic responses to stress.

Infant-mother attachment and the growth of externalizing problems across the primary-school years

Background:  Some contend that attachment insecurity increases risk for the development of externalizing behavior problems in children. Method:  Latent-growth curve analyses were applied to data on 1,364 children from the NICHD Study of Early Child Care to evaluate the association between early attachment and teacher-rated externalizing problems across the primary-school years. Results:  Findings indicate that (a) both avoidant and disorganized attachment predict higher levels of externalizing problems but (b) that effects of disorganized attachment are moderated by family cumulative contextual risk, child gender and child age, with disorganized boys from risky social contexts manifesting increases in behavior problems over time. Conclusions:  These findings highlight the potentially conditional role of early attachment in children’s externalizing behavior problems and the need for further research evaluating causation and mediating mechanisms.

Parent-Child Dynamics and Emerging Adult Religiosity: Attachment, Parental Beliefs, and Faith Support

Parental religiosity has been shown to predict child and adolescent religiosity, but the role of parents in emerging adult religiosity is largely unknown. We explored associations among emerging adult religiosity, perceived parental religiosity, perceived similarity to mother's and to father's religious beliefs, parental faith support, and parental attachment. Participants were 481 alumni of two Christian colleges and completed surveys online. Emerging adult religiosity (measured by Christian orthodoxy and intrinsic religiosity) was high and similar to parents' religiosity. Perceived similarity to parents' religious beliefs, faith support, and attachment to fathers predicted emerging adult religiosity. However, parental religiosity alone was a weak predictor and functioned as a negative suppressor variable when combined with similarity to parents' beliefs and faith support. Findings underscore the importance of parental support and parent-child relationship dynamics more than the level of parental religiosity and point to possibly unique roles for mothers and fathers in emerging adult religiosity.

Validação da security scale para a população portuguesa: Análise fatorial confirmatória e estudo empírico davinculação na pré-adolescência

Dissertação de Mestrado apresentada no ISPA – Instituto Universitário para obtenção do grau de Mestre em Psicologia especialidade de Psicologia Clínica.

[child Protection Network And The Intersector Implementation Of The Circle Of Security As Alternatives To Medication].

To describe the clinical history of a child with aggressive behavior and recurring death-theme speech, and report the experience of the team of authors, who proposed an alternative to medication through the establishment of a protection network and the inter-sector implementation of the circle of security concept. A 5-year-old child has a violent and aggressive behavior at the day-care. The child was diagnosed by the healthcare center with depressive disorder and behavioral disorder, and was medicated with sertraline and risperidone. Side effects were observed, and the medications were discontinued. Despite several actions, such as talks, teamwork, psychological and psychiatric follow-up, the child's behavior remained unchanged. A unique therapeutic project was developed by Universidade Estadual de Campinas' Medical School students in order to establish a connection between the entities responsible for the child's care (daycare center, healthcare center, and family). Thus, the team was able to develop a basic care protection network. The implementation of the inter-sector circle of security, as well as the communication and cooperation among the teams, produced very favorable results in this case. This initiative was shown to be a feasible and effective alternative to the use of medication for this child.

DOUBLE ANEUPLOIDY (48,XXY,+21) OF MATERNAL ORIGIN IN A CHILD BORN TO A 13-YEAR-OLD MOTHER: EVALUATION OF THE MATERNAL FOLATE METABOLISM

Double aneuploidy, (48,XXY,+21) of maternal origin in a child born to a 13-year-old mother: evoluation of the maternal folate metabolism: The occurrence of non-mosaic double trisomy is exceptional in newborns. In this paper, a 48,XXY,+21 child, the parental origin of the extra chromosomes and the evaluation of the maternal folate metabolism are presented. The infant was born to a 13-year-old mother and presented with the typical clinical features of Down syndrome (DS). The origin of the additional chromosomes was maternal and most likely resulted from errors during the first meiotic division. Molecular analysis of 12 genetic polymorphisms involved in the folate metabolism revealed that the mother is heterozygous for the MTHFR C677T and TC2 A67G polymorphisms, and homozygous for the mutant MTRR A66G polymorphism. The maternal homocysteine concentration was 4.7 mu mol/L, a value close to the one considered as a risk factor for DS in our previous study. Plasma methylmalonic acid and serum folate concentrations were 0.17 mu mol/L and 18.4 ng/mL, respectively. It is possible that the presence of allelic variants for the folate metabolism and Hey concentration might have favored errors in chromosomal disjunction (hiring gametogenesis in this young mother. To our knowledge, this is the first patient with non-mosaic Down-Klinefelter born to a teenage mother, resulting from a rare fertilization event combining an abnormal 25,XX,+21 oocyte and a 23,Y spermatozoon.

Surveillance of mother-to-child HIV transmission: socioeconomic and health care coverage indicators

OBJECTIVE: To identify clustering areas of infants exposed to HIV during pregnancy and their association with indicators of primary care coverage and socioeconomic condition. METHODS: Ecological study where the unit of analysis was primary care coverage areas in the city of Porto Alegre, Southern Brazil, in 2003. Geographical Information System and spatial analysis tools were used to describe indicators of primary care coverage areas and socioeconomic condition, and estimate the prevalence of liveborn infants exposed to HIV during pregnancy and delivery. Data was obtained from Brazilian national databases. The association between different indicators was assessed using Spearman's nonparametric test. RESULTS: There was found an association between HIV infection and high birth rates (r=0.22, p<0.01) and lack of prenatal care (r=0.15, p<0.05). The highest HIV infection rates were seen in areas with poor socioeconomic conditions and difficult access to health services (r=0.28, p<0.01). The association found between higher rate of prenatal care among HIV-infected women and adequate immunization coverage (r=0.35, p<0.01) indicates that early detection of HIV infection is effective in those areas with better primary care services. CONCLUSIONS: Urban poverty is a strong determinant of mother-to-child HIV transmission but this trend can be fought with health surveillance at the primary care level.

HIV rapid testing as a key strategy for prevention of mother-to-child transmission in Brazil

OBJECTIVE: To assess the feasibility of HIV rapid testing for pregnant women at maternity hospital admission and of subsequent interventions to reduce perinatal HIV transmission. METHODS: Study based on a convenience sample of women unaware of their HIV serostatus when they were admitted to delivery in public maternity hospitals in Rio de Janeiro and Porto Alegre, Brazil, between March 2000 and April 2002. Women were counseled and tested using the Determine HIV1/2 Rapid Test. HIV infection was confirmed using the Brazilian algorithm for HIV infection diagnosis. In utero transmission of HIV was determined using HIV-DNA-PCR. There were performed descriptive analyses of sociodemographic data, number of previous pregnancies and abortions, number of prenatal care visits, timing of HIV testing, HIV rapid test result, neonatal and mother-to-child transmission interventions, by city studied. RESULTS: HIV prevalence in women was 6.5% (N=1,439) in Porto Alegre and 1.3% (N=3.778) in Rio de Janeiro. In Porto Alegre most of women were tested during labor (88.7%), while in Rio de Janeiro most were tested in the postpartum (67.5%). One hundred and forty-four infants were born to 143 HIV-infected women. All newborns but one in each city received at least prophylaxis with oral zidovudine. It was possible to completely avoid newborn exposure to breast milk in 96.8% and 51.1% of the cases in Porto Alegre and Rio de Janeiro, respectively. Injectable intravenous zidovudine was administered during labor to 68.8% and 27.7% newborns in Porto Alegre and Rio de Janeiro, respectively. Among those from whom blood samples were collected within 48 hours of birth, in utero transmission of HIV was confirmed in 4 cases in Rio de Janeiro (4/47) and 6 cases in Porto Alegre (6/79). CONCLUSIONS: The strategy proved feasible in maternity hospitals in Rio de Janeiro and Porto Alegre. Efforts must be taken to maximize HIV testing during labor. There is a need of strong social support to provide this population access to health care services after hospital discharge.