Parto natural, normal e humanizado : a polissemia dos termos e seus efeitos sobre a atenção ao parto

A presente dissertação foi desenvolvida no Programa de Pós-Graduação em Enfermagem da Universidade Federal do Rio Grande do Sul. Discute e analisa as concepções de parto natural, normal e humanizado, tomando como referência o Programa de Humanização do Parto e do Nascimento preconizado pelo Ministério da Saúde e os conteúdos das falas de profissionais da medicina e da enfermagem que atuam em um hospital-escola no interior do Rio Grande do Sul. O objetivo da investigação foi delimitar as convergências e conflitos de maior relevância que permeiam essas concepções dos diferentes tipos de parto para discutir alguns dos possíveis efeitos dessas formas de compreensão sobre a organização e a implementação da atenção ao parto humanizado nesse local. É um estudo qualitativo do tipo estudo de caso e inscreve-se na intersecção dos campos dos estudos culturais e de gênero com um recorte em saúde reprodutiva. Foi aprovado pelo Comitê de Ética em Pesquisa da Instituição. Os procedimentos de investigação envolveram análise de conteúdo de documentos federais (Programa de Humanização do Parto e do Nascimento) e de entrevistas semi-estruturadas com o conjunto de médicos/as e enfermeiras que atuavam no centro obstétrico no período de realização do trabalho de campo. A análise realizada evidencia convergências, ambigüidades, sobreposições e conflitos entre os três termos e no interior de cada um deles, indicando que essa polissemia tem efeitos diretos sobre a forma como o parto é implementado na instituição, assim limitando as possibilidades de mudanças objetivadas com a Política de Humanização.

Estresse pós-traumático : sintomatologia e funcionamento cognitivo

O presente trabalho é composto por dois estudos independentes sobre o Transtorno de Estresse Pós-Traumático (TEPT). O primeiro estudo empregou procedimentos paralelos de análise de componentes principais em duas versões do Screen for Posttraumatic Stress Symptoms (SPTSS) respondidas por estudantes universitários norte-americanos (n = 2.389) e brasileiros (n = 755). Três componentes de primeira ordem (revivência/ansiedade; depressão; evitação) e um componente de segunda ordem (TEPT) representaram a estrutura interna do SPTSS. O segundo estudo empregou testes neuropsicológicos em estudantes universitários (N = 72) com graus variados de sintomatologia pós-traumática. Foi encontrada diferença significativa no desempenho em tarefas de atenção seletiva, função executiva e processamento emocional. Os estudos realizados contribuem para a compreensão do modelo conceitual e dos prejuízos cognitivos associados ao TEPT.

Avaliação da efetividade de estratégias não farmacológicas para o alívio da dor de parturientes na fase ativa do período de dilatação no trabalho de parto

This study was aim to evaluate the effectiveness of strategies non pharmacological for the relief of the intensity of the parturient pain in the phase activates of the dilation period in the labor. Is a clinic rehearse of the type therapeutic intervention before and after" with a quantitative approach, accomplished in the Humanized Unit of Childbirth of the Maternity Januário Cicco School of the Federal University of Rio Grande do Norte, in Natal/RN, whit 130 parturient, being 30 in the pre-test of the strategies and 100 in the application of the strategies non pharmacological combined (breathing exercises, muscular relaxation and lombossacral massage) and isolated (shower bath in a normal temperature). We used the visual analogical scale to evaluate the intensity of the pain of the study parturient before and after" to the application of the strategies in the phases of acceleration, maximum inclination and desaceleration in the phase activates of dilation period in the labor. The principal results showed that the majority of the study parturient was between 20 to 30 years old (60%); with incomplete fundamental teaching (85%); family income until 2 minimum wages (74%); 78% had a companion and these, 44% were the own husband. The oxytocin was administered in the parturient during the phase activates of the labor in 81% of the cases and only 15% these women didn´t reciev anything medication. We verified significant relief (ρ=0.000) of intensity of the pain of the study parturient after application of the strategies non pharmacological combined and isolated. We concluded that the strategies non pharmacological combined and isolated were effective in the relief of the pain of the study parturient in the phase activates de labor

Significados e percepções de puérperas sobre as síndromes hipertensivas da gravidez e parto prematuro

Hypertensive syndromes in pregnancy (HSP) are configured as one of the major complications in the pregnancy and postpartum period and can lead premature newborn and subsequent hospitalization of the newborn to the Neonatal Intensive Care Unit (NICU). This study aimed to analyze the perceptions, meanings and feelings of mothers on the hypertensive syndromes in pregnancy and premature obstetric labor. The research was qualitative and has a theoretical methodological the Social Representations Theory(SRT) in the approach to the Central Nucleus Theory. The study included 70 women, mean age 29 years, predominantly school to high school, most of them married or in consensual union, primiparous and prevalence of cesarean delivery occurred between 32 and 37 weeks of pregnancy.The data were collected from may to december 2008 in the Maternity School Januário Cicco in Natal , and obtained through the following instruments for data collection: questionnaire including questions about socio-demographic status; the Free Words Association Test (FWAT) and and verbalized mental image construction used three stimuli: such as pregnancy with high blood pressure, preterm birth and NICU, and interview with the following guiding question: what it meant for you to have a pregnancy with high blood pressure and consequently the birth of a premature baby? Data analysis was performed using multi-method obtained from the data processing by EVOC (Ensemble Programmes Permettant L 'Analyze des Évocations) and ALCESTE (Analyse Lexicale par Contexte d'un Ensemble de Segment de Texte) and thematic analysis in categories. The results will be presented in four thematic units under the following representative universes: HSP, prematurity as a result of HSP, NICU and the social representations of mothers on the hypertensive disorder of pregnancy sequenced premature birth and hospitalization of the child in the NICU. The results obtained by multimethod analyses showed similar constructions and point to death as the central nucleus and negative aspects, coping strategies, need of care, knowledge about the disease, fragility and meanings of the NICU as peripheral elements. It is considered that the perceptions, meanings and feelings of puerperal women in relation to HSPs and to premature delivery are a negative social representation, with representational elements that may have influenced the adverse effects on the disease and its consequences. We suggest action on the peripheral elements of this representation, with adequate orientation, early diagnosis, effective conduct, receptive attitude on the part of the team, health promotion measures and effective public policies, in order to improve the care provided to puerperal women, making them feel welcome and minimizing their suffering

Síndrome metabólica e fatores associados: estudo comparativo com mulheres que apresentaram pré-eclâmpsia e gravidez normal, acompanhadas cinco anos após o parto

Preeclampsia is defined as an extremely serious complication of the pregnancy-puerperium cycle with delayed emergence of cardiovascular risk factors, including metabolic syndrome. The research aimed estimate the prevalences of metabolic syndrome and associated factors in women with preeclampsia and normal pregnancy followed five years after childbirth. This is a cross-sectional observational study using a quantitative approach, conducted at a maternity school in the city of Natal in Rio Grande do Norte state. The sample was composed of 70 women with previous preeclampsia and 75 normal selected by simple random probability sampling. Subjects were analyzed for sociodemographic, obstetric, clinical, anthropometric and biochemical parameters. International Diabetes Federation criteria were adopted to diagnose metabol ic syndrome. The Kolmogorov-Smirnov, Mann-Whitney, Student s t, Pearson s chi-squared, and Fisher s exact tests, in addition to simple logistic regression, were used for data analysis, at a 5% significance level (p ≤ 0.05). Statistical tests demonstrated elevated body mass index (p = 0.001), predominance of family history of diabetes mellitus (p = 0.022) and significantly higher prevalence of metabolic syndrome in the preeclampsia group (37.1%) when compared to normal (22.7%) (p = 0.042). Intergroup comparison showed a high number of metabolic syndrome components in women with previous preeclampsia. Altered systolic and diastolic blood pressure (p < 0.001) was the most prevalent, followed by low concentrations of high-density lipoproteins (p = 0.049), and hyperglycemia (p=0.030). There was a predominance of the metabolic syndrome in women with schooling 0-9 years (42.4%) (p = 0.005), body mass index above 30Kg.m 2 (52.3%) (p < 0.001), uric acid high (62.5%) (p = 0.050 and family history of hypertension (38.5%) (p< 0.001). Multivariate analysis of the data showed that the body mass index above 30 kg.m2, education level less than 10 years of study (p < 0.001) and family history of hypertension (p = 0.002) remained associated with the metabolic syndrome after multivariate analysis of the data. It is considered Women with previous preeclampsia exhibited high prevalence of metabolic syndrome and their individual components in relation to normal, especially, altered systolic and diastolic blood pressure, low concentrations of high-density lipoproteins and hyperglycemia. The factors associated to this ou tcome were obesity, less than 10 years of schooling, and family history of hypertension. Overall, this study identified young women with a history of PE exposed to a higher cardiovascular risk than normal

O parto dos caminhos: Formação dos Sindicatos Rurais no Rio Grande do Norte (1960 - 1964)

The present work treats the movements dedicated to reinvidication per land and social rights for the field works, among 1960 and 1964. Trying to understand this question in the Rio Grande do Norte it is necessary to consider the connection between the catholic church and the rural syndicates besides the influence of the Brazilian communist party, and still other social movements and the state. The structures politics local, national and international, had considerable importance to the organization rural potiguares workers. The rural potiguares syndicate appear in 1961 - after a hard organization work starting of the Service of Rural Assistance - and expand itself through state until the middle of 1962. Soon the first big conflicts an important manifestation are perceive, indirectly referring to a increasing movement's performance. The Favoring Progresses chains co quested a biggest influence in the politics destiny of the Rio Grande do Norte, in front of integration among syndicates, educational projects, and favoring progress's politics. But the military coup hired that the hope overflow the field

O renascimento do parto e da (reinvenção da) emancipação social na blogosfera brasileira: contra o desperdício das experiências

The birth models of care are discussed, in the light of classical and contemporary social science theoretical background, emphasizing the humanistic model. The double spiral of the sociology of absences and the sociology of emergences is detailed, being based, on one hand, on the translation of experiences of knowledge, and, on the other, on the translation of experiences of information and communication, by revealing the movement articulated by Brazilian women on blogs that defend and bring into light initiatives aiming to recover natural and humanized birth. A cartography of the thematic ideas in birth literature is produced, resulting in the elaboration of a synthetic map on obstetric models of care in contemporaneity, pointing out the consequences of the obstetric model that has become hegemonic in contemporary societies, and comparing that model to others that work more efficaciously to mothers and babies. A symbolic cartography of the activism for humanizing birth on the Brazilian blogosphere is configured by the elaboration of an analytical map synthetizing the main mottos defended by the movement: Normal humanized birth; Against obstetrical violence; and Planned home birth. The superposition of the obstetric models of care s map and the rebirth of birth s analytical map indicates it is necessary to reinforce three main measures in order to make a paradigmatic turn in contemporary birth models of care possible: pave the way for the humanistic care of assistance in normal birth, by defending and highlighting practices and professionals that act in compliance with evidence based medicine, respecting the physiology of birth; denaturalize obstetric violence, by showing how routine procedures and interventions can be means of aggression, jeopardizing the autonomy, the protagonism and the respect towards women; and motivate initiatives of planned home birth, the best place for the occurrence of holistic experiences of birth. It is concluded that Internet tools have allowed a pioneer mobilization in respecting women s reproductive rights in Brazil and that the potential of the crowd s biopower that resides on the blogosphere can turn blogs into a hegemonic alternative way to reach more democratic forms of social organization. In that condition of being virtually hegemonic in contesting the established power, these blogs can be understood, therefore, as potentially great contra-hegemonic channels for the rebirth of birth and for the reinvention of social emancipation, as their author s articulate and organize themselves to strive against the waste of experience, trying to create reciprocal intelligibility amongst different experiences of world

Uso de morfina, xilazina e meloxicam para o controle da dor pós-operatória em cadelas submetidas à ovariossalpingo-histerectomia

Foram realizados estudos empregando-se analgésicos por via epidural e subcutânea em cadelas de diferentes raças e idades, submetidas à castração mediante celiotomia. Vinte animais foram tranquilizados e anestesiados com tiletamina-zolazepam, e aleatoriamente distribuídos em quatro grupos (n=5), de acordo com o fármaco e a via de administração. Os do grupo morfina (GM) foram submetidos à anestesia epidural no espaço lombossacro, com morfina (0,1mg/kg) associada ao cloreto de sódio a 0,9%. Aos do grupo xilazina (GX), foram administrados xilazina (0,2mg/kg) e cloreto de sódio a 0,9%. Os do grupo meloxicam (GME) receberam 0,2mg/kg do anti-inflamatório meloxicam associado ao cloreto de sódio a 0,9%, injetado pela via subcutânea. Os do grupo-controle (CG) receberam apenas cloreto de sódio a 0,9%. O volume final para as injeções epidurais foi padronizado para 0,3mL/kg. A mensuração inicial da concentração de cortisol plasmático, do ritmo cardíaco, da frequência respiratória e os parâmetros comportamentais foram registrados imediatamente antes do procedimento cirúrgico (M1). Registros adicionais foram apresentados às 2, 6, 12 e 24 horas após o procedimento cirúrgico (M2, M3, M4 e M5, respectivamente). As variáveis comportamentais foram avaliadas por meio de sinais clínicos e seus respectivos escores. em GX foram observadas depressão respiratória, bradicardia e concentração de cortisol mais alta do que o registrado no GM. A analgesia obtida pelo meloxicam foi considerada ineficiente. É possível concluir que a morfina, via epidural, promoveu menor incidência de efeitos colaterais e melhor analgesia e bem-estar animal.

Vivendo o bem estar no desconhecido: experiência da mulher com a presença do acompanhante no processo de parto

The humanization of the birth process is a current health policy priority. Within that perspective, the presence of a partner during the birth is a benefit guaranteed by the Law 111008/05. The purpose of this study is to comprehend the woman s experience with the presence of a birth partner as a legal right. It is a qualitative descriptive study based on Symbolic Interactionism and conducted using the grounded theory methodology. Data were collected by semi-structured interviews conducted during August to December 2006, with women that had the presence of a partner during their birth experience and that were in the first 24 hours of puerperium. Data analysis resulted in the identification of the phenomena: FEELING GOOD, RECOGNIZING THE BOND WITH THE PARTNER, RECOGNIZING THE IMPORTANCE OF THE EXPERIENCE and NOT KNOWING THE RIGHT. These enabled the identification of the central phenomenon LIVING THE WELL-BEING IN THE UNKNOWN. The study demonstrated that the birth experience with the presence of partner is a positive one, resulting in benefits such as tranquility, support, and assurance, which, in that context, signify well-being. However, the women do not visualize the experience as a right, therefore remaining alienated from their civic practice. The understanding of the experience was enabled by the conceptual construction obtained from the categories of the interactions between the women and their birth partners during the event. The explanation of the phenomenon LIVING THE WELL-BEING IN THE UNKNOWN reflects the theoretical structure obtained from the integration of the identified concepts. The study points out the need for health professionals to improve the information given to women during the birth process and to work the civic duties of the women in reproductive health

Avaliação de características de crescimento pós-desmama de animais Nelore puros e cruzados no estado do Mato Grosso do Sul

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Efeito da seleção para peso pós-desmama sobre indicadores da eficiência produtiva de vacas da raça Nelore

O objetivo deste estudo foi avaliar indicadores da eficiência produtiva de vacas Nelore selecionadas para peso pós-desmama, enfocados nas relações peso bezerro e peso da vaca, nos rebanhos controle (NeC), não-selecionados para peso pós-desmama, seleção (NeS) e tradicional (NeT). As análises envolveram 3929 e 3906 pesos dos bezerros aos 120 (P120) e 210 (P210) dias de idade, respectivamente. Os pesos das vacas àquelas idades também foram considerados, obtendo-se 3824 (PV120) e 3777 (PV210) registros, respectivamente, para 120 e 210 dias. A análise incluiu 183, 375 e 554 vacas dos rebanhos NeC, NeS e NeT, respectivamente. Para as análises utilizou-se o procedimento GLM/SAS, em modelos que incluíram os efeitos fixos de rebanho, ano e mês de nascimento, sexo do bezerro, idade da vaca ao parto e as interações rebanho x ano de nascimento e ano x mês de nascimento. Todos os efeitos foram significativos. Os resultados mostraram respostas correlacionadas positivas na seleção para peso pós-desmama nos pesos dos bezerros e, em menor magnitude, no peso das vacas. As relações peso bezerro e peso da vaca apresentaram valores médios ajustados de 249,0±2,1; 253,7±1,6; e 255,8±1,2 g/kg para R120 e 362,9±2,8; 368,5±2,1; e 374,6±1,7 para NeC, NeS e NeT em R210, respectivamente, indicando que, nas duas idades, os rebanhos NeS e NeT produziram mais quilogramas de bezerro por quilogramas de vaca, quando comparados ao NeC.

Efeitos do tratamento com lítio na memória aversiva, comportamentos relacionados à ansiedade e depressão e na expressão de BDNF em ratos

Lithium (Li) is the first choice to treat bipolar disorder, a psychiatric illness characterized by mood oscillations between mania and depression. However, studies have demonstrated that this drug might influence mnemonic process due to its neuroprotector, antiapoptotic and neurogenic effects. The use of Li in the treatment of cognitive deficits caused by brain injury or neurodegenerative disorders have been widely studied, and this drug shows to be effective in preventing or even alleviating the memory impairment. The effects of Li on anxiety and depression are controversial and the relationship of the effects of lithium on memory, anxiety and depression remain unknown. In this context, this study aims to: evaluate the effects of acute and chronic administration of lithium carbonate in aversive memory and anxiety, simultaneously, using the plus maze discriminative avoidance task (PMDAT); test the antidepressant effect of the drug through the forced swimming test (FS) and analyze brainderived neurotrophic factor (BDNF) expression in structures related to memory and emotion. To evaluation of the acute effects, male Wistar rats were submitted to i.p. administration of lithium carbonate (50, 100 or 200 mg/kg) one hour before the training session (PMDAT) or lithium carbonate (50 or 100 mg/kg) one hour before the test session (FS). To evaluation of the chronic effects, the doses administered were 50 or 100 mg/kg or vehicle once a day for 21 days before the beginning of behavioral tasks (PMDAT and FS). Afterwards, the animals were euthanized and their brains removed and submitted to immunohistochemistry procedure to quantify BDNF. The animals that received acute treatment with 100 and 200 mg/kg of Li did not discriminated between the enclosed arms (aversive and non-aversive) in the training session of PMDAT, showing that these animal did not learned the task. This lack of discrimination was also observed in the test session, showing that the animals did not recall the aversive task. We also observed an increased exploration of the open arms of these same groups, indicating an anxiolytic effect. The same groups showed a reduction of locomotor activity, however, this effect does not seem to be related with the anxiolytic effect of the drug. Chronic treatment with Li did not promote alterations on learning or memory processes. Nevertheless, we observed a reduction of open arms exploration by animals treated with 50 mg/kg when compared to the other groups, showing an anxiogenic effect caused by this dose. This effect it is not related to locomotor alterations since there were no alterations in these parameters. Both acute and chronic treatment were ineffective in the FS. Chronic treatment with lithium was not able to modify BDNF expression in hippocampus, amygdala and pre-frontal cortex. These results suggest that acute administration of lithium promote impairments on learning in an aversive task, blocking the occurrence of memory consolidation and retrieval. The reduction of anxiety following acute treatment may have prevented the learning of the aversive task, as it has been found that optimum levels of anxiety are necessary for the occurrence of learning with emotional context. With continued, treatment the animals recover the ability to learn and recall the task. Indeed, they do not show differences in relation to control group, and the lack of alterations on BDNF expression corroborates this result. Possibly, the regimen of treatment used was not able to promote cognitive improvement. Li showed acute anxiolytic effect, however chronic administration 4 promoted the opposite effect. More studies are necessary to clarify the potential beneficial effect of Li on aversive memory

A experiência de depressão na contemporaneidade: uma compreensão fenomenológico-existencial

The depression is one of the most common forms of getting ill nowaday. Due to the increase in incidence of depression cases registered worldwide, this theme has been the subject of important studies, especially regarding the symptomatological description and biological etiology of the disease. This research had the objective to understand the unique experience of depression experienced by people who recognize themselves in depression, under the focus of existential phenomenology of Martin Heidegger. To reach the proposed objective, individuals narratives interviews were conducted with four participants, starting from the triggering question, "from your experience, how is for you to being depressed?". The survey revealed that depression affects the whole person and is related to stressful life contexts. Depression was narrated as an experience of disempowerment and lack of self esteem and personal worth. The collaborators of the research referred to the depression from sad, angry, bored and pessimistic mood. The time is experienced as a restriction to the projective opening towards the possibilities of being in which the future is seen as catastrophic and the past lived as debt and guilt. The corporeality, in depression is experienced through the weight, fatigue and pains for no reason. The space is lived from the notion of fall and collapse. We also realized the desire for isolation and avoidance of social contact. Suicide is desired and represents the end of the suffering in life. The depression has proved, still, very stigmatized, because it is discredited and misunderstood. The stigma also addressed to the experience of hospitalization and the unsuitability to the socially imposed standards of beauty, which generates enough suffering to the depressed person. The medication was described based on its positive effects, as a balance and suffering reducer, but also as a producer of dependence. Were also identified according to the collaborators, traces of selfdemand, ordenality and being-for-others, characteristic of typus melancholicus. This study contributes to an understanding of the depression that goes beyond the merely biological perspective and symptomatology of the pathology. The investigation of the depressive experience, through the lens of Heidegger's phenomenology, showed us the phenomenon of the depression in their singularity, complexity and multiple meanings, showing the close relationship between the formation of the depression and the context of personal and social life of the participants

A humanização no parto e no nascimento: os saberes e as práticas no contexto de uma maternidade pública brasileira

The practice of medicine related to the gestational processes tend to be organized according to the context and the place of work, being thus dependent of the conditions both social and economical, and of the physical structure and the functionality of the services. The high mortality rate in this process has diminished, since 1986, the study made by the World Health Organization (WHO) as to the technical aspects and the social inequalities that influence this situation in different geographical contexts. This culminated recommendations that proposed the reorientation of the dynamical practice of medicine, with a focus on the safety of maternities. Brazil adopted, in the year 2000, the suggestions of the OMS, emphasizing the humanization as the main reason for these actions. However, this discussion tends to not consider the problems caused by the social inequalities and the epidemiological and social conditionings that define the actions of the Unified Health System (Sistema Único de Saúde SUS). In this area, this research seeks to analyze the practices, cares taken, and the universal symbol that promotes and rewards the assistance to the birth of children by the SUS. Besides the analysis of the public documents that deal with this subject, an ethnographic study was developed in a maternity in Natal/RN, considered a model of humanization after receiving the Galba de Araújo prize in 2002. In this stage, the methodological strategies were observed, and the focus of the individual interviews with workers and users of this service. In the analysis of the data, it became evident that the different professional workers and women who gave birth, tend to show concern of the standards the delimit production and reproduction of the practice of medicine, as they favor the absence of a critical posture of the actions destined to the population. Besides this, if became evident that the institutional difficulties associated to the economical, cultural, and political problems also difficult the involvement and the reflection of the workers in favor of assisting changes of the process. There is also a utilization of a perspective prescriptive of humanization in the everyday life of the social workers, without reflection of its meaning. Some workers present, in their statements, a preoccupation with the social and economical aspects that affect the practice of medicine, and with the limitations of the humanization discourse that disarticulates the necessities of those involved in the process of formation, and soon tend to return to the discussion of humanization while a kind practice characterized by the minimization of the interventionist actions. Now the users of the system show themselves before the dynamic of the services, submitting themselves to what is offered while assistance, without questioning and/or reflecting about their usual shortages. Therefore, to think of changes in the know and do of the practice of medicine destined to the birth of children implies reflection on the quotidian production of these practices and of the social contexts that influence the process of assistance in the practice of medicine. Herein it would be possible to predict the appropriation, by different workers concerning their exasperations and necessities, making them active in the pursuit of their rights as citizens