Avaliação da qualidade da atenção ao parto nos colegiados de gestão regional Cuesta Botucatu e Vale do Jurumirim

The humanization of childbirth implies the understanding of this event as an important experience, and requires the redefinition of human relationships from the review of the assistance project, the understanding of pregnant women condition and human rights. To evaluate child birth assistance using a score that was developed by Botucatu Cuesta Regional Management and Jurumirim Valley Collegiates. This is an epidemiological, descriptive study that is inserted in the field of evaluation of services, programs or health projects. The data has been obtained by direct observation of deliveries, emphasizing the humane care. Results: Approximately one third of the women gave birth in a tertiary hospital (34.1%) and it was their first babies (33%).24.8% of the women received prenatal care in high-risk services. 67.1% of the births were normal, and 84.7% had no companions in the delivery room. In 47.1% of the cases the delivery was performed by obstetrician who used anesthesia in 44.7% and episiotomy in 48.2% of the deliveries. More than half of the newborns were attended by the pediatrician in the delivery room and had a delivery graph completed. Although the present study shows that 67.1% of the births were normal, caesarean rate can be considered excessive, as the WHO points out that c-sections above 15% are unlikely to be justifiable. It is important to emphasize that the Ministry of Health has to have a commitment with all women to promote safe motherhood, even in cases when the pregnancy involves a risk for both the mother and the fetus. It is noteworthy that the created score allowed us to assess variables related to the humanization of childbirth and only average and quite similar situations among the three services were evidenced. We hope that with this study, managers and professionals that work in this area can be subsidized in order to offer effective humane assistance and quality service in the delivery

Incidência, fatores de risco e consequências de defeitos congênitos em recém-nascidos e natimortos

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Itinerário terapêutico de mães de crianças que foram a óbito no período neonatal em município do interior paulista

Pós-graduação em Enfermagem - FMB

Histomorfometria do útero de gatas submetidas à ovariosalpingohisterectomia

Histomorphometric data were obtained from cats uterine horns: either nulliparous (n = 6), primiparous (n = 6), multiparous (n = 6) and treated with contraceptive (n = 6). The material was collected after surgery, fixed in paraformaldehyde and embedded in paraplast® resin to be sliced in a microtome. The obtained sections were stained with hematoxylin - eosin and measured under a light microscope: uterine wall total thickness (μm), endometrium total height, endometrial glands diameter and glandular epithelia height, total myometrium, internal and external myometrium and vascular layer thickness. It was concluded that: 1 - contraceptive use and number of pregnancies altered the uterine structure, 2 - one pregnancy does not appear to affect the uterine lining structures as occurs in multiparous cats, 3 – there was no variation on the evaluated structures between nulliparous and primiparous cats except for inner myometrium, 4 - the total myometrium hight and the endometrium hight showed similar variations except for the contraceptive treated cats group, 5 - the outer myometrium showed marked changes in the treated cats, 6 – the less marked morphological variations were for the endometrial glands diameter and glandular epithelium hight, 7 - the presence of dilated endometrial glands was found only in treated cats.

Os (Des) caminhos da sífilis congênita em Botucatu/São Paulo

Pós-graduação em Enfermagem (mestrado profissional) - FMB

Boulware Family Papers - Accession 102

The Boulware Family Papers consist of photocopies of a plantation journal (302 pages) kept by Thomas McCullough Boulware I (1829-1889) and a genealogy of the Boulware family written by James Richmond Boulware II of Lakeland, Florida, in 1948. The journal concerns the Blackstocks Plantation in Chester County, South Carolina and subjects include the planting of crops and farming of land; family events, such as deaths, births and marriages; family travel and vacations; church affairs, including the local temperance league; land sales; free black and northerners in Chester County after the Civil War.

Population Growth of Antarctic Fur Seals: Limitation by a Top Predator, The Leopard Seal?

Antarctic fur seals (Arctocephalus gazella) in the South Shetland Islands are recovering from 19th-century exploitation more slowly than the main population at South Georgia. To document demographic changes associated with the recovery in the South Shetlands, we monitored fur seal abundance and reproduction in the vicinity of Elephant Island during austral summers from 1986/1987 through 1994/1995. Total births, mean and variance of birth dates, and average daily mortality rates were estimated from daily live pup counts at North Cove (NC) and North Annex (NA) colonies on Seal Island. Sightings of leopard seals (Hydrurga leptonyx) and incidents of leopard seal predation on fur seal pups were recorded opportunistically during daily fur seal research at both sites. High mortality of fur seal pups, attributed to predation by leopard seals frequently observed at NC, caused pup numbers to decline rapidly between January and March (i.e., prior to weaning) each year and probably caused a long-term decline in the size of that colony. The NA colony, where leopard seals were never observed, increased in size during the study. Pup mortality from causes other than leopard seal predation appeared to be similar at the two sites. The number of pups counted at four locations in the Elephant Island vicinity increased slowly, at an annual rate of 3.8%, compared to rates as high as 11% at other locations in the South Shetland Islands. Several lines of circumstantial evidence are consistent with the hypothesis that leopard seal predators limit the growth of the fur seal population in the Elephant Island area and perhaps in the broader population in the South Shetland Islands. The sustained growth of this fur seal population over many decades rules out certain predator–prey models, allowing inference about the interaction between leopard seals and fur seals even though it is less thoroughly studied than predator–prey systems of terrestrial vertebrates of the northern hemisphere. Top-down forces should be included in hypotheses for future research on the factors shaping the recovery of the fur seal population in the South Shetland Islands.

Mating behaviour, nympho-imaginal development and description of a new Mesabolivar species (Araneae: Pholcidae) from the Brazilian dry forest

A new species of Mesabolivar is described from Brazilian forests: Mesabolivar delclaroi. The mating behaviour, postembryonic development, number of egg sacs and eggs, birth rate, number of instars, developmental time until adulthood, sex ratio and size of cephalothorax (per instar) were recorded. The sexual behaviour was described and categorized into four steps: courtship, pre-copulation, copulation and post-copulation. After hatching, individuals presented five instars until maturity. The mean number of eggs (42 +/- 16.6) and live births (31.5 +/- 3.4) of the first egg sac were significantly greater than that of a second one (23.8 +/- 3.8, and 19.25 +/- 3.9, respectively). The developmental time from birth to adulthood (130.8 +/- 9.6 days) did not differ significantly between egg sacs produced (128.61 +/- 11.1). The size of the cephalothorax did not differ among adults or between sexes. The sex ratio revealed a shift in favour of females (4: 3).

Risk factors for birth-related perineal trauma: a cross-sectional study in a birth centre

Aim and objectives. To identify maternal, newborn and obstetric factors associated with birth-related perineal trauma in one independent birth centre. Background. Risk factors for birth-related perineal trauma include episiotomy, maternal age, ethnicity, parity and interventions during labour including use of oxytocin, maternal position at time of birth and infant birth weight. Understanding more about these factors could support the management of vaginal birth to prevent spontaneous perineal trauma, in line with initiatives to reduce routine use of episiotomy. Design. Cross-sectional study. Methods. Data were retrospectively collected from one independent birth centre in Brazil, during 20062009. The dependent variable (perineal trauma) was classified as: (1) intact perineum or first-degree laceration, (2) second-degree laceration and (3) episiotomy (right mediolateral or median). Results. There were 1079 births during the study period. Parity, use of oxytocin during labour, position at time of giving birth and infant birth weight were associated with second-degree lacerations and episiotomies. After adjusting for parity, oxytocin, maternal position at the expulsive stage of labour and infant birth weight influenced perineal outcomes among primiparae only. Conclusions. Although the overall rate of episiotomies in this study was low compared with national data, it was observed that younger women were most vulnerable to this intervention. In this age group in particular, the use of oxytocin as well as semi-upright positions at the time of birth was associated with second-degree lacerations and episiotomies. Relevance to clinical practice. The use of upright alternative positions for birth and avoidance of use of oxytocin could reduce the risk of perineal trauma from lacerations and need to perform episiotomy.

Spatial analysis of the social vulnerability of adolescent pregnancy

The purpose of this study was to present a spatial analysis of the social vulnerability of teenage pregnancy by geoprocessing data on births and deaths present on the Brazilian Ministry of Health databases in order to support intersectoral management actions and strategies based on spatial analysis in neighborhood areas. The thematic maps of the educational, occupational, birth and marital status of mothers, from all births and deaths in the city, presented a spatial correlation with teenage pregnancy. These maps were superimposed to produce social vulnerability map of adolescent pregnancy and women in general. This process presents itself as a powerful tool for the study of social vulnerability.

Factors associated with preterm birth in Campina Grande, Paraiba State, Brazil: a case-control study

A case-control study (2008-2009) analyzed risk factors for preterm birth in the city of Campina Grande, Paraiba State, Brazil. A total of 341 preterm births and 424 controls were included. A multiple logistic regression model was used. Risk factors for preterm birth were: previous history of preterm birth (OR = 2.32; 95% CI: 1.25-4.29), maternal age (OR = 2.00; 95% CI: 1.00-4.03), inadequate prenatal care (OR = 2.15; 95% CI: 1.40-3.27), inadequate maternal weight gain (OR = 2.33; 95% CI: 1.45-3.75), maternal physical injury (OR = 2.10; 95% CI: 1.22-3.60), hypertension with eclampsia (OR = 17.08; 95% CI: 3.67-79.43) and without eclampsia (OR = 6.42; 95% CI: 3.50-11.76), hospitalization (OR = 5.64; 95% CI: 3.47-9.15), altered amniotic fluid volume (OR = 2.28; 95% CI: 1.32-3.95), vaginal bleeding (OR = 1.54; 95% CI: 1.01-2.34), and multiple gestation (OR = 22.65; 95% CI: 6.22-82.46). High and homogeneous prevalence of poverty and low maternal schooling among both cases and controls may have contributed to the fact that socioeconomic variables did not remain significantly associated with preterm birth.

The profile of women who have experienced cesarean section and obstetric care at a public maternity hospital in Ribeirao Preto

The present paper presents the social and obstetric profile of women undergoing cesarean childbirth at a public maternity hospital in the interior of Sao Paulo state. This is a quantitative, retrospective, descriptive study performed using documental research. The collected data refer to the period between July and December 2005, and between January and June 2006. A total of 670 records were reviewed. A 23% rate of cesarean births was identified at the institution studied during the aforementioned period. The studied population was characterized as having a low level of education, living in a common-law relationship, and not having a paid occupation. The main indications for cesarean sections were iterativity and acute fetal distress. The findings revealed an emphasis on obstetric nursing in the low-risk normal childbirth scenario, considering the non-interventionist character inherent to their education and training.

Human Adipose-Derived Mesenchymal Stromal Cells Injected Systemically Into GRMD Dogs Without Immunosuppression Are Able to Reach the Host Muscle and Express Human Dystrophin

Duchenne muscular dystrophy (DMD), a lethal X-linked disorder, is the most common and severe form of muscular dystrophies, affecting I in 3,500 male births. Mutations in the DMD gene lead to the absence of muscle dystrophin and a progressive degeneration of skeletal muscle. The possibility to treat DMD through cell therapy has been widely investigated. We have previously shown that human adipose-derived stromal cells (hASCs) injected systemically in SJL mice are able to reach and engraft in the host muscle, express human muscle proteins, and ameliorate the functional performance of injected animals without any immunosuppression. However, before starting clinical trials in humans many questions still need to be addressed in preclinical studies, in particular in larger animal models, when available. The best animal model to address these questions is the golden retriever muscular dystrophy (GRMD) dog that reproduces the full spectrum of human DMD. Affected animals carry a mutation that predicts a premature termination codon in exon 8 and a peptide that is 5% the size of normal dystrophin. These dogs present clinical signs within the first weeks and most of them do not survive beyond age two. Here we show the results of local and intravenous injections of hASCs into GRMD dogs, without immunosuppression. We observed that hASCs injected systemically into the dog cephalic vein are able to reach, engraft, and express human dystrophin in the host GRMD dystrophic muscle up to 6 months after transplantation. Most importantly, we demonstrated that injecting a huge quantity of human mesenchymal cells in a large-animal model, without immunosuppression, is a safe procedure, which may have important applications for future therapy in patients with different forms of muscular dystrophies.

Birth in Brazil: national survey into labour and birth

Background: Caesarean section rates in Brazil have been steadily increasing. In 2009, for the first time, the number of children born by this type of procedure was greater than the number of vaginal births. Caesarean section is associated with a series of adverse effects on the women and newborn, and recent evidence suggests that the increasing rates of prematurity and low birth weight in Brazil are associated to the increasing rates of Caesarean section and labour induction. Methods: Nationwide hospital-based cohort study of postnatal women and their offspring with follow-up at 45 to 60 days after birth. The sample was stratified by geographic macro-region, type of the municipality and by type of hospital governance. The number of postnatal women sampled was 23,940, distributed in 191 municipalities throughout Brazil. Two electronic questionnaires were applied to the postnatal women, one baseline face-to-face and one follow-up telephone interview. Two other questionnaires were filled with information on patients' medical records and to assess hospital facilities. The primary outcome was the percentage of Caesarean sections (total, elective and according to Robson's groups). Secondary outcomes were: post-partum pain; breastfeeding initiation; severe/near miss maternal morbidity; reasons for maternal mortality; prematurity; low birth weight; use of oxygen use after birth and mechanical ventilation; admission to neonatal ICU; stillbirths; neonatal mortality; readmission in hospital; use of surfactant; asphyxia; severe/near miss neonatal morbidity. The association between variables were investigated using bivariate, stratified and multivariate model analyses. Statistical tests were applied according to data distribution and homogeneity of variances of groups to be compared. All analyses were taken into consideration for the complex sample design. Discussion: This study, for the first time, depicts a national panorama of labour and birth outcomes in Brazil. Regardless of the socioeconomic level, demand for Caesarean section appears to be based on the belief that the quality of obstetric care is closely associated to the technology used in labour and birth. Within this context, it was justified to conduct a nationwide study to understand the reasons that lead pregnant women to submit to Caesarean sections and to verify any association between this type of birth and it's consequences on postnatal health.

Brazilian multicenter study on prevalence of preterm birth and associated factors

Abstract Background The occurrence of preterm birth remains a complex public health condition. It is considered the main cause of neonatal morbidity and mortality, resulting in a high likelihood of sequelae in surviving children. With variable incidence in several countries, it has grown markedly in the last decades. In Brazil, however, there are still difficulties to estimate its real occurrence. Therefore, it is essential to establish the prevalence and causes of this condition in order to propose prevention actions. This study intend to collect information from hospitals nationwide on the prevalence of preterm births, their associated socioeconomic and environmental factors, diagnostic and treatment methods resulting from causes such as spontaneous preterm labor, prelabor rupture of membranes, and therapeutic preterm birth, as well as neonatal results. Methods/Design This proposal is a multicenter cross-sectional study plus a nested case-control study, to be implemented in 27 reference obstetric centers in several regions of Brazil (North: 1; Northeast: 10; Central-west: 1; Southeast: 13; South: 2). For the cross sectional component, the participating centers should perform, during a period of six months, a prospective surveillance of all patients hospitalized to give birth, in order to identify preterm birth cases and their main causes. In the first three months of the study, an analysis of the factors associated with preterm birth will also be carried out, comparing women who have preterm birth with those who deliver at term. For the prevalence study, 37,000 births will be evaluated (at term and preterm), corresponding to approximately half the deliveries of all participating centers in 12 months. For the case-control study component, the estimated sample size is 1,055 women in each group (cases and controls). The total number of preterm births estimated to be followed in both components of the study is around 3,600. Data will be collected through a questionnaire all patients will answer after delivery. The data will then be encoded in an electronic form and sent online by internet to a central database. The data analysis will be carried out by subgroups according to gestational age at preterm birth, its probable causes, therapeutic management, and neonatal outcomes. Then, the respective rates, ratios and relative risks will be estimated for the possible predictors. Discussion These findings will provide information on preterm births in Brazil and their main social and biological risk factors, supporting health policies and the implementation of clinical trials on preterm birth prevention and treatment strategies, a condition with many physical and emotional consequences to children and their families.