Educação em saúde e a família do bebê prematuro: uma revisão integrativa

OBJETIVO: Identificar as necessidades de educação em saúde da família do recém-nascido pré-termo. MÉTODOS: Revisão integrativa de literatura, com buscas nas bases de dados PubMED e Literatura Latino-Americana e do Caribe em Ciências da Saúde, entre 1999 e 2011, e com uso dos descritores (prematuro, enfermagem neonatal, cuidados de enfermagem e alta hospitalar) em inglês, espanhol e português. RESULTADOS: Os dez estudos selecionados foram categorizados em três temáticas: a participação nos cuidados do filho, o preparo para a alta hospitalar e uso de material educativo. A maioria das atividades de educação em saúde é direcionada às mães e está relacionada aos cuidados básicos diários e, ainda, é incipiente a participação nestas atividades, a fim de promover o vínculo e aumentar a confiança no cuidado. CONCLUSÃO: Observou-se a necessidade de elaborar estratégias, embasadas nas metodologias ativas de aprendizagem, auxiliadas por materiais educacionais que facilitem a inserção dos pais na unidade neonatal e nos cuidados com seu filho.

Liderança: o que pensam executivos brasileiros sobre o tema?

Este artigo tem como objetivo central apresentar resultados de estudo destinado a investigar as principais questões e desafios em torno da temática da liderança e seu desenvolvimento, na contemporaneidade, segundo a perspectiva de altos executivos de grandes empresas brasileiras. Considerando tal propósito, seus objetivos específicos podem ser assim descritos: 1. investigar sentidos atribuídos e estilos de liderança articulados à vivência e prática dos executivos investigados; 2. investigar temas-chave ao desenvolvimento de lideranças no atual contexto dos negócios e das organizações; 3. identificar tendências, novos temas e desafios em torno da temática da liderança, no contemporâneo. Como referencial teórico cabe salientar revisão de literatura envolvendo descrição evolutiva dos estudos sobre a temática, com destaque para as principais correntes e abordagens teórico-metodológico-conceituais. Em termos metodológicos, a pesquisa que subsidiou os resultados deste estudo pode ser caracterizada como de natureza qualitativa e caráter descritivo, tendo seus dados primários derivados de entrevistas semiestruturadas e em profundidade realizadas com 13 altos executivos de grandes corporações, nacionais e internacionais, situadas nos estados de São Paulo e Minas Gerais. Após tratamento dos dados, com o auxílio do software de tratamento qualitativo NVivo 8, foi possível agrupar os principais temas e desafios identificados em torno da liderança em três temas-chave: Sentidos, Competências, Estilos e Desafios associados à Liderança no Contemporâneo; Desenvolvimento de Lideranças; Liderança e Contexto Capacitante. O estudo possibilitou, também, identificar atributos de competência e estilos de liderança requeridos como respostas ao atual contexto dos negócios e das organizações, segundo a perspectiva dos executivos entrevistados. Concomitantemente, foi possível constatar novos desafios e preocupações em relação à temática da liderança, como, por exemplo, lidar com as novas gerações - em especial a chamada Geração Y - que, em breve, deverão assumir posições-chave nas organizações, em decorrência da aposentadoria dos Baby Boomers. Em suma, os achados permitem, a partir da perspectiva dos próprios atores diretamente envolvidos na problemática da liderança, no contexto empresarial, a emergência de questões e desafios a serem contemplados em novas agendas de desenvolvimento e linhas de pesquisa sobre o tema.

Relazione gestante-feto, modalità del parto e sviluppo fisico del bambino

Extensive literature outlined that the quality of the mother-foetus relationship is considered the main feature with regard to the quality of postnatal mother-infant interaction and also to the child’s psychical development. Nowadays the relationship between the pregnant woman and her foetus is viewed as the central factor of the somatic dialogue between the functioning of the maternal and the foetal organisms. This dialogue is responsible for the physic development of the child, as well as of its psychosomatic structure. Therefore the research area has necessarily had to extend to the analysis of psychological processes concerning: the pregnancy, the couple that is bound by parenthood, the influence of intergenerational dynamics. In fact, the formation of maternal identity, as well as that of the relationship between the woman and the foetus, refers to the pregnant woman’s relationship with her parents, especially with her mother. The same pregnancy, considered as a psychosomatic event, is directly influenced by relational, affective and social factors, particularly by the quality of the interiorized parental relations and the quality of the current relationships (such as that with her partner and with her family of origin). Some studies have begun to investigate the relationship between the pregnant woman and the foetus in term of “prenatal attachment” and its relationship with socio-demographic, psychological e psychopathological aspects (such as pre and post partum depression), but the research area is still largely unexplored. The present longitudinal research aimed to investigate the quality of the pregnant womanfoetus relationship by the prenatal attachment index, the quality of the interiorized relationship with woman’s parents, the level of alexithymic features and maternity social support, in relation with the modulation of the physiology of delivery and of postpartum, as well as of the physical development of the child. A consecutive sample of 62 Italian primipara women without any kind of pathologies, participated in the longitudinal study. In the first phase of this study (third trimester of the pregnancy), it has investigated the psychological processes connected to the affective investment of the pregnant women towards the unborn baby (by Prenatal Attachment Inventory), the mothers’ interiorized relationship with their own parents (by Parental Bonding Instrument), the social and affective support from their partner and their family of origin are able to supply (by Maternity Social Support Scale), and the level of alexithymia (by 20-Toronto Alexithymia Scale). In the second phase of this study, some data concerning the childbirth course carried out from a “deliverygram” (such as labour, induction durations and modalities of delivery) and data relative to the newborns state of well-being (such as Apgar and pH indexes). Finally, in the third phase of the study women have been telephoned a month after the childbirth. The semistructured interview investigated the following areas: the memory concerning the delivery, the return to home, the first interactions between the mother and the newborn, the breastfeeding, the biological rhythms achieved from newborns. From the data analysis a sample with a good level of prenatal attachment and of support social and a good capability to mental functioning emerged. An interesting result is that the most of the women have a great percentage of “affectionless control style” with both parents, but data is not sufficient to interpret this result. Moreover, considering the data relative to the delivery, medical and welfare procedures, that have been necessary, are coherent with the Italian mean, while the percentage of the caesarean section (12.9%) is inferior to the national percentage (30%). The 29% of vaginal partum has got epidural analgesia, which explains the high number (37%) of obstetrician operations (such as Kristeller). The data relative to the newborn (22 male, 40 female) indicates a good state of well-being because Apgar and pH indexes are superior to 7 at first and fifth minutes. Concerning the prenatal phase, correlation analysis showed that: the prenatal attachment scores positively correlated with the expected social support and negatively correlated with the “externally oriented thinking” dimension of alexithymia; the maternity social support negatively correlated with total alexithymia score, particularly with the “externally oriented thinking” dimension, and negatively correlated with maternal control of parental bonding. Concerning the delivery data, there are many correlations (after all obvious) among themselves. The most important are that the labour duration negatively correlated with the newborn’s index state of well-being. Finally, concerning the data from the postpartum phase the women’ assessments relative to the partum negatively correlated with the duration of the delivery and positively correlated with the assessment relative to the return to home and the interaction with the newborn. Moreover the length of permanence in the hospital negatively correlated with women’s assessments relative to the return to home that, in turn, positively correlated with the quality of breastfeeding, the interaction between the mother and the newborn and the biological regulation of the child. Finally, the women’ assessments relative to breastfeeding positively correlated with the mother-child interactions and the biological rhythms of children. From the correlation analysis between the variables of the prenatal phase and the data relative to the delivery, emerged that the prenatal attachment scores positively correlated with the dilatation stage scores and with the newborn’s Apgar index at first minute, the paternal care dimension of parental bonding positively correlated with the lengths of the various periods of childbirth like so the paternal control dimension with placental stage. Moreover, emerged that the expected social support positively correlated with the lengths of the various periods of childbirth and that the global alexithymia scores, particularly “difficulty to describe emotions” dimension, negatively correlated with total childbirth scores. From the correlation analysis between the variables of the prenatal phase and variable of the postpartum phase emerged that the total alexithymia scores positively correlated with the time elapsed from the childbirth to the breastfeeding of the child, the difficulty to describe emotions dimension of the alexithymia negatively correlated with the quality of the breastfeeding, the “externally oriented thinking” dimension of the alexithymia negatively correlated with mother-child interactions, and finally the paternal control dimension of the parental bonding negatively correlated with the time elapsed from the child to the breastfeeding of the child. Finally, from the analysis of the correlation between the data of the partum and the women’s assessments of the postpartum phase, emerged the negative correlation between the woman’s assessment relative to the delivery and the quantitative of obstetrician operations and the lengths of the various periods of childbirth, the positive correlation between the women’s assessment about the length of delivery periods and the real lengths of the same ones, the positive relation between woman’s assessment relative to the delivery and the Apgar index of children. In conclusion, there is a remarkable relation between the quality of the relationship the woman establishes with the foetus that influences the course of the pregnancy and the delivery that, in turn, influences the postpartum outcome, particularly relative to the mother-children relationship. Such data should be confirmed by heterogeneous populations in order to identify vulnerable women and to project focused intervention.

Elementi postmoderni nell'horror americano contemporaneo. Forme testuali e culturali della mutazione 1968-1998

This research argues for an analysis of textual and cultural forms in the American horror film (1968- 1998), by defining the so-called postmodern characters. The “postmodern” term will not mean a period of the history of cinema, but a series of forms and strategies recognizable in many American films. From a bipolar re-mediation and cognitive point of view, the postmodern phenomenon is been considered as a formal and epistemological re-configuration of the cultural “modern” system. The first section of the work examines theoretical problems about the “postmodern phenomenon” by defining its cultural and formal constants in different areas (epistemology, economy, mass-media): the character of convergence, fragmentation, manipulation and immersion represent the first ones, while the “excess” is the morphology of the change, by realizing the “fluctuation” of the previous consolidated system. The second section classifies the textual and cultural forms of American postmodern film, generally non-horror. The “classic narrative” structure – coherent and consequent chain of causal cues toward a conclusion – is scattered by the postmodern constant of “fragmentation”. New textual models arise, fragmenting the narrative ones into the aggregations of data without causal-temporal logics. Considering the process of “transcoding”1 and “remediation”2 between media, and the principle of “convergence” in the phenomenon, the essay aims to define these structures in postmodern film as “database forms” and “navigable space forms.” The third section applies this classification to American horror film (1968-1998). The formal constant of “excess” in the horror genre works on the paradigm of “vision”: if postmodern film shows a crisis of the “truth” in the vision, in horror movies the excess of vision becomes “hyper-vision” – that is “multiplication” of the death/blood/torture visions – and “intra-vision”, that shows the impossibility of recognizing the “real” vision from the virtual/imaginary. In this perspective, the textual and cultural forms and strategies of postmodern horror film are predominantly: the “database-accumulation” forms, where the events result from a very simple “remote cause” serving as a pretext (like in Night of the Living Dead); the “database-catalogue” forms, where the events follow one another displaying a “central” character or theme. In the first case, the catalogue syntagms are connected by “consecutive” elements, building stories linked by the actions of a single character (usually the killer), or connected by non-consecutive episodes about a general theme: examples of the first kind are built on the model of The Wizard of Gore; the second ones, on the films such as Mario Bava’s I tre volti della paura. The “navigable space” forms are defined: hyperlink a, where one universe is fluctuating between reality and dream, as in Rosemary’s Baby; hyperlink b (where two non-hierarchical universes are convergent, the first one real and the other one fictional, as in the Nightmare series); hyperlink c (where more worlds are separated but contiguous in the last sequence, as in Targets); the last form, navigable-loop, includes a textual line which suddenly stops and starts again, reflecting the pattern of a “loop” (as in Lost Highway). This essay analyses in detail the organization of “visual space” into the postmodern horror film by tracing representative patterns. It concludes by examining the “convergence”3 of technologies and cognitive structures of cinema and new media.

Confronto fra cerchiaggio cervicale elettivo, eco-indicato e d’emergenza dal 2001 al 2013

Obiettivi: L’obiettivo dello studio è stato quello di valutare l’utilizzo del cerchiaggio cervicale, in relazione alle diverse indicazioni per cui è stato eseguito, presso la Clinica Ostetrica e Ginecologica del Policlinico Universitario Sant’Orsola-Malpighi di Bologna, tra Gennaio 2001 e Dicembre 2013. Outcome secondario e’ stato quello di paragonare i risultati ottenuti con le più recenti evidenze scientifiche per valutare come esse abbiano influenzato l’utilizzo del cerchiaggio nel nostro centro. Materiali e metodi: valutazione osservazionale di tutte le pazienti sottoposte a cerchiaggio cervicale presso il nostro centro. La popolazione di studio e’ stata suddivisa in 5 gruppi in relazione all’indicazione per cui il cerchiaggio e’ stato eseguito: cerchiaggio elettivo (I), eco indicato (II), d’emergenza (III), in gravidanze gemellari (IV) e in gravidanze trigemine (V). Di tutte le pazienti e’ stato valutato l’outcome della gravidanza (epoca gestazionale al parto, peso neonatale, Apgar score) e l’appropriatezza dell’indicazione al cerchiaggio. Risultati: nel corso dei 13 anni in studio sono stati eseguiti 191 cerchiaggi: 109 nel I gruppo, 24 nel II, 39 nel III, 13 e 6 rispettivamente nel IV e V gruppo. In un caso il cerchiaggio e’ stato eseguito per via laparoscopica prima dell’insorgenza della gravidanza. La distribuzione dei diversi tipi di cerchiaggio e’ cambiata: dal 2007 non vengono seguiti cerchiaggi in gravidanze multiple, sono diminuiti quelli elettivi e sono aumentati i cerchiaggi d’emergenza pur essendo i casi con morbilità materna maggiore: in una paziente si e’ verificato un aborto settico con shock settico materno e si e’ reso necessario un intervento di isterectomia. Conclusioni: l'applicazioni di indicazioni piu' selettive all’esecuzione del cerchiaggio hanno determinato una forte riduzione dell’utilizzo da tale procedura. L'aumento dell'utilizzo del cerchiaggio d’emergenza e' legato al fatto che rappresenta l’ultima chance per convertire un aborto inevitabile in un parto di neonato vivo in casi estremi.

Analisi e ottimizzazione delle prestazioni e dell'affidabilità di una macchina per il packaging di prodotti igienico-sanitari

L’oggetto di studio di questo lavoro, svolto presso l’azienda Vire Automation del gruppo Bucci Industries di Faenza, è una macchina per il packaging di prodotti igienico-sanitari, più precisamente pannolini baby. Dopo una prima indagine di mercato svolta con l’aiuto dei commerciali dell’azienda, si sono ipotizzate una serie di soluzioni tecniche per migliorare il funzionamento e le prestazioni della macchina. Tramite uno strumento detto Casa della qualità si sono evidenziate le soluzioni tecniche che risultano più apprezzate dal mercato e per questo posseggono una maggior priorità di realizzazione. Si è intervenuti su di un gruppo funzionale per lo spostamento orizzontale del prodotto che agisce superiormente rispetto al pianale di processo e sul trasporto pioli che invece agisce per ostacolo tra cilindri di acciaio ed i prodotti. In particolare per il primo si è realizzato un apposito studio delle grandezze cinematiche in gioco e, dopo una progettazione 3D, si sono stimate le coppie motrici richieste dal nuovo asse che è risultato vantaggioso rispetto al precedente. Per il secondo invece, vista l’esigenza di ottenere un gruppo rifasatore che permettesse alla macchina di funzionare correttamente nonostante i ritardi di arrivo dei prodotti dalla linea di produzione, si è realizzata una nuova gestione logica del gruppo per sopperire alla peggior condizione di funzionamento verificabile e si è riprogettato il gruppo per dotarlo delle nuove necessarie caratteristiche.

Studio e ottimizzazione del modulo raggruppatore di una macchina confezionatrice per prodotti igienico sanitari femminili

Le macchine automatiche prodotte dall’azienda VIRE Automation di Faenza sono atte al confezionamento di prodotti igienico sanitari del settore baby, femminile e adulto. La macchina può essere suddivisa in due gruppi funzionali, il primo legato al raggruppamento dei prodotti in pile e il secondo dedicato al confezionamento vero e proprio. Il presente elaborato consiste nello studio e nella progettazione del raggruppatore della macchina dedicata ai prodotti femminili; in particolare lo scopo è il corretto funzionamento del gruppo con performance superiori a quelle attuali. Il progetto si è articolato nell’applicazione del metodo della Casa della Qualità come strumento di supporto, per poi passare allo studio della parte logica della macchina e ad un'analisi cinematica e dinamica del gruppo estrattore; infine vengono presentate ulteriori soluzioni tecniche adottate.

Patent arterial duct, bottle-meal, and fatal myocardial ischaemia

A patent arterial duct in pre-term neonates is frequent. Systemic complications consecutive to left-to-right shunting are well known but fatal myocardial ischaemia has not been described till now. The presented premature baby died from catecholamine refractory cardiogenic shock. Autoptic examination revealed acute ischaemic changes predominantly in the inner third of myocardium, speaking of coronary hypoperfusion due to a steal phenomenon secondary to the patent arterial duct.

Burning Skies: A Novella

Burning Skies is a seventy-page novella completed as an Honors Thesis in Creative Writing. The story is set in Los Angeles, California, during the 1992 riots surrounding the controversy over the beating of Rodney King by four white police officers. The story is toldthrough the perspectives of the four main characters: Erin, a woman who is four months pregnant with a baby she desperately wants; her husband David, who has moved the couple out to California so that he can pursue his dream of being a cinematographer; Abby, David’s deeplyreligious younger sister who has unexpectedly flown out to Los Angeles from her home in Indiana after discovering her husband’s infidelity; and Cameron, a black man training to be a pastor who Abby has befriended through her years of missionary work in Los Angeles.The novella follows the events of the riots as they break out all across the city and the personal dramas of each of the four main characters, looking at how the public interacts with theprivate and examining the ways in which explosions in the public and political sphere can ricochet into our private and personal lives. It is a story about the political and racial climate in Los Angeles in the early 1990s, but it is also a story about four human beings, about their needs and their desires, about their struggles to survive in an unpredictable world. The novella showcases the skills and techniques the author has learned after four years of studying fiction at Bucknell University; it can best be described as a work of realistic fiction.

[Anaesthesia and breast-feeding: should breast-feeding be discouraged?]

Until a few years ago an interruption of breast-feeding for 12 or even 24 hours was recommended for breast-feeding mothers after anaesthesia, this is no longer valid. If it is the mother's wish, if she is sufficiently awake and physically able, there is no reason not to start breast-feeding a mature and healthy baby immediately after recovery from a general or regional anaesthesia. Even breast-feeding after a Caesarean delivery with administration of the common anaesthetics in the usual (single) doses is no longer considered to be a problem since the amount of the substance taken up from colostrum is vanishingly small in comparison to the amount that is transferred by transplacental routes. Neither the pharmacological properties of the drugs used in association with anaesthesia nor clinical experience justify an interruption of breast-feeding.

Something is Missing from 124": Confronting Postmodern Absences in Toni Morrison's Beloved"

My thesis is divided into three chapters that build on one another as they show different examples of absences in the historical setting of Beloved and how the characters try to find creative uses of language to overcome them. As I argue that language plays animportant role in a search for meaning, my first chapter is about specific absences of language in Beloved. My second chapter is about the many absent characters in Beloved, such as Baby Suggs' children and husband, Halle, Howard and Buglar. In my third chapter, I analyze entities that are either missing from the text, or which represent a loss to Baby Suggs, Sethe, and Denver

Aging and mental health in the decade ahead: What psychologists need to know

Until relatively recently, most psychologists have had limited professional involvement with older adults. With the baby boomers starting to turn 65 years old in 2011, sheer numbers of older adults will continue to increase. About 1 in 5 older adults has a mental disorder, such as dementia. Their needs for mental and behavioral health services are not now adequately met, and the decade ahead will require an approximate doubling of the current level of psychologists' time with older adults. Public policy in the coming decade will face tensions between cost containment and facilitation of integrated models of care. Most older adults who access mental health services do so in primary care settings, where interdisciplinary, collaborative models of care have been found to be quite effective. To meet the needs of the aging population, psychologists need to increase awareness of competencies for geropsychology practice and knowledge regarding dementia diagnosis, screening, and services. Opportunities for psychological practice are anticipated to grow in primary care, dementia and family caregiving services, decision-making-capacity evaluation, and end-of-life care. Aging is an aspect of diversity that can be integrated into psychology education across levels of training. Policy advocacy for geropsychology clinical services, education, and research remains critical. Psychologists have much to offer an aging society

Extrinsic causes of erosion. Behavioral factors

During and after an erosive challenge, behavioral factors play a role in modifying the extent of erosive tooth wear. The manner that dietary acids are introduced into the mouth (gulping, sipping, use of a straw) will affect how long the teeth are in contact with the erosive challenge. The frequency and duration of exposure to an erosive agent is of paramount importance. Night-time exposure (e.g. baby bottle-feeding) to erosive agents may be particularly destructive because of the absence of salivary flow. Health-conscious individuals tend to ingest acidic drinks and juices more frequently and tend to have higher than average oral hygiene. While good oral hygiene is of proven value in the prevention of periodontal disease and dental caries, frequent toothbrushing with abrasive oral hygiene products may enhance erosive tooth wear. Unhealthy lifestyles such as consumption of designer drugs, alcopops and alcohol abuse are other important behavioral factors.

Neonatological and pulmonological management of bilateral pulmonary sequestration in a neonate

BACKGROUND: Bronchopulmonary sequestration is a lung malformation characterized by nonfunctioning lung tissue without primary communication with the tracheobronchial tree. Intrauterine complications such as mediastinal shift, pleural effusion or fetal hydrothorax can be present. We present the case of a newborn with bilateral intralobar pulmonary sequestration. METHODS: Prenatal ultrasonography in a primigravida at 20 weeks of gestation revealed echogenic masses in the right fetal hemithorax with mediastinal shift towards the left side. Serial ultrasound confirmed persistence of the lesion with otherwise appropriate fetal development. Delivery was uneventful and physical examination revealed an isolated intermittent tachypnea. Chest CT scan and CT angiography showed a bilateral intrathoracic lesion with arterial supply from the aorta. Baby lung function testing suggested possible multiple functional compartments. RESULTS: Right and left thoracotomy was performed at the age of 7 months. A bilateral intralobar sequestration with vascularisation from the aorta was resected. Pathological and histological examination of the resected tissue confirmed the surgical diagnosis. At the age of 24 months, the child was doing well without pulmonary complications. CONCLUSIONS: Bilateral pulmonary sequestration requires intensive prenatal and postnatal surveillance. Though given the fact of a bilateral pulmonary sequestration, postnatal outcome showed similar favourable characteristics to an unilateral presentation. Baby lung function testing could provide additional information for optimal postnatal management and timing of surgical intervention.

PCR and real-time PCR primers developed for detection and identification of Bifidobacterium thermophilum in faeces

BACKGROUND: Culture-independent methods based on the 16S ribosomal RNA molecule are nowadays widely used for assessment of the composition of the intestinal microbiota, in relation to host health or probiotic efficacy. Because Bifidobacterium thermophilum was only recently isolated from human faeces until now, no specific real-time PCR (qPCR) assay has been developed for detection of this species as component of the bifidobacterial community of the human intestinal flora. RESULTS: Design of specific primers and probe was achieved based on comparison of 108 published bifidobacterial 16S rDNA sequences with the recently published sequence of the human faecal isolate B. thermophilum RBL67. Specificity of the primer was tested in silico by similarity search against the sequence database and confirmed experimentally by PCR amplification on 17 Bifidobacterium strains, representing 12 different species, and two Lactobacillus strains. The qPCR assay developed was linear for B. thermophilum RBL67 DNA quantities ranging from 0.02 ng/microl to 200 ng/microl and showed a detection limit of 10(5) cells per gram faeces. The application of this new qPCR assay allowed to detect the presence of B. thermophilum in one sample from a 6-month old breast-fed baby among 17 human faecal samples tested. Additionally, the specific qPCR primers in combination with selective plating experiments led to the isolation of F9K9, a faecal isolate from a 4-month old breast-fed baby. The 16S rDNA sequence of this isolate is 99.93% similar to that of B. thermophilum RBL67 and confirmed the applicability of the new qPCR assay in faecal samples. CONCLUSION: A new B. thermophilum-specific qPCR assay was developed based on species-specific target nucleotides in the 16S rDNA. It can be used to further characterize the composition of the bifidobacterial community in the human gastrointestinal tract. Until recently, B. thermophilum was considered as a species of animal origin, but here we confirm with the application of this new PCR assay the presence of B. thermophilum strains in the human gut.