Aplicação do processo de relação interpessoal de Travelbee com mãe de recém-nascido internado em uma unidade neonatal

Objetivou-se aplicar o processo de relação interpessoal com mãe a de um recém-nascido que se encontrava internado em unidade neonatal, utilizando a Teoria da Relação Interpessoal de Joyce Travelbee. Estudo de caso, de natureza descritiva, desenvolvido em unidade de internação neonatal, em dezembro e janeiro de 2004. A Coleta de dados realizou-se mediante entrevista semi-estruturada, com interação pessoa-pessoa. Aplicou-se um instrumento contendo seis perguntas que revelaram possibilidades de ajuda mútua ante os problemas de saúde do filho. Buscou-se amenizar as angústias, dúvidas e medos, por meio da interação com a mãe. Constatou-se que a abordagem teórica foi relevante e serviu como guia para a enfermeira aplicar um cuidar mais ético e humano.

Neonatal treatment with recombinant ectodysplasin prevents respiratory disease in dogs with X-linked ectodermal dysplasia.

Patients with defective ectodysplasin A (EDA) have X-linked hypohidrotic ectodermal dysplasia (XLHED; OMIM#305100), a condition comprising hypotrichosis, inability to sweat, abnormal teeth, and frequent pulmonary infections. The XLHED dogs show the same clinical signs as humans with the disorder, including frequent respiratory infections that can be fatal. The respiratory disease in humans and dogs is thought to be due to the absence of tracheal and bronchial glands which are a vital part of the mucociliary clearance mechanism. In our XLHED model, the genetically missing EDA was replaced by postnatal intravenous administration of recombinant EDA resulting in long-term, durable corrective effect on adult, permanent dentition. After treatment with EDA, significant correction of the missing tracheal and bronchial glands was achieved in those dogs that received higher doses of EDA. Moreover, successful treatment resulted in the presence of esophageal glands, improved mucociliary clearance, and the absence of respiratory infection. These results demonstrate that a short-term treatment at a neonatal age with a recombinant protein can reverse a developmental disease and result in vastly improved quality of life.

Investigação do reflexo vermelho em recém-nascidos e sua relação com fatores da história neonatal

O teste do reflexo vermelho é parte importante do exame ocular do recém-nascido. Buscou-se investigá-lo em recém-nascidos prematuros (RNPT) e sua relação com fatores da história neonatal. Estudo descritivo, exploratório, quantitativo, realizado numa maternidade pública, em Fortaleza-CE, em março, abril e maio de 2004, com 114 RNPTs. Para o registro dos dados, utilizou-se um formulário próprio e para a realização do exame, um oftal-moscópio direto. Considerou-se pertinente os seguintes achados da história neonatal: 68% dos RNPTs obtiveram Apgar inferior a sete no primeiro minuto; 112 utilizaram oxigenoterapia e 68, fototerapia. Quanto ao reflexo vermelho, 13 (11%) apresentaram alteração, com associação estatística significativa entre este e o Apgar no primeiro minuto de vida (p= 0,041). Os achados preocuparam, pois, dez dos 13 RNPTs, com alteração no reflexo vermelho, tinham retinopatia da prematuridade.

Cancer mortality in Europe, 2000-2004, and an overview of trends since 1975.

BACKGROUND: To update the pattern of cancer mortality in Europe. Materials and methods: We analysed cancer mortality in 34 European countries during 2000-2004, with an overview of trends in 1975-2004 using data from the World Health Organization. RESULTS: From 1990-1994 to 2000-2004, overall cancer mortality in the European Union declined from 185.2 to 168.0/100 000 (world standard, -9%) in men and from 104.8 to 96.9 (-8%) in women, with larger falls in middle age. Total cancer mortality trends were favourable, though to a variable degree, in all major European countries, including Russia, but not in Romania. The major determinants of these favourable trends were the decline of lung (-16%) and other tobacco-related cancers in men, together with the persistent falls in gastric cancer, and the recent appreciable falls in colorectal cancer. In women, relevant contributions came from the persistent decline in cervical cancer and the recent falls in breast cancer mortality, particularly in northern and western Europe. Favourable trends were also observed for testicular cancer, Hodgkin lymphomas, leukaemias, and other neoplasms amenable to treatment, though the reductions were still appreciably smaller in eastern Europe. CONCLUSION: This updated analysis of cancer mortality in Europe showed a persistent favourable trend over the last years.

Health behaviours, socioeconomic status, and mortality: further analyses of the British Whitehall II and the French GAZEL prospective cohorts

BACKGROUND: Differences in morbidity and mortality between socioeconomic groups constitute one of the most consistent findings of epidemiologic research. However, research on social inequalities in health has yet to provide a comprehensive understanding of the mechanisms underlying this association. In recent analysis, we showed health behaviours, assessed longitudinally over the follow-up, to explain a major proportion of the association of socioeconomic status (SES) with mortality in the British Whitehall II study. However, whether health behaviours are equally important mediators of the SES-mortality association in different cultural settings remains unknown. In the present paper, we examine this issue in Whitehall II and another prospective European cohort, the French GAZEL study. METHODS AND FINDINGS: We included 9,771 participants from the Whitehall II study and 17,760 from the GAZEL study. Over the follow-up (mean 19.5 y in Whitehall II and 16.5 y in GAZEL), health behaviours (smoking, alcohol consumption, diet, and physical activity), were assessed longitudinally. Occupation (in the main analysis), education, and income (supplementary analysis) were the markers of SES. The socioeconomic gradient in smoking was greater (p<0.001) in Whitehall II (odds ratio [OR] = 3.68, 95% confidence interval [CI] 3.11-4.36) than in GAZEL (OR = 1.33, 95% CI 1.18-1.49); this was also true for unhealthy diet (OR = 7.42, 95% CI 5.19-10.60 in Whitehall II and OR = 1.31, 95% CI 1.15-1.49 in GAZEL, p<0.001). Socioeconomic differences in mortality were similar in the two cohorts, a hazard ratio of 1.62 (95% CI 1.28-2.05) in Whitehall II and 1.94 in GAZEL (95% CI 1.58-2.39) for lowest versus highest occupational position. Health behaviours attenuated the association of SES with mortality by 75% (95% CI 44%-149%) in Whitehall II but only by 19% (95% CI 13%-29%) in GAZEL. Analysis using education and income yielded similar results. CONCLUSIONS: Health behaviours were strong predictors of mortality in both cohorts but their association with SES was remarkably different. Thus, health behaviours are likely to be major contributors of socioeconomic differences in health only in contexts with a marked social characterisation of health behaviours. Please see later in the article for the Editors' Summary.

Lung cancer mortality in European women: trends and predictions.

Female lung cancer mortality increased by 50% between the mid 1960s and the early 2000s in the European Union (EU). To monitor the current lung cancer epidemic in European women, we analyzed mortality trends in 33 European countries between 1970 and 2009 and estimated rates for the year 2015 using data from the World Health Organization. Female lung cancer mortality has been increasing up to recent calendar years in most European countries, with the exceptions of Belarus, Russia, and Ukraine, with relatively low rates, and the UK, Iceland and Ireland, where high rates were reached in mid/late 1990s to leveled off thereafter. In the EU, female lung cancer mortality rates rose over the last decade from 11.3 to 12.7/100,000 (+2.3% per year) at all ages and from 18.6 to 21.5/100,000 (+3.0% per year) in middle-age. A further increase is predicted, to reach 14/100,000 women in 2015. Lung cancer mortality trends have been more favorable over the last decade in young women (20-44 years), particularly in the UK and other former high-risk countries from northern and central/eastern Europe, but also in France, Italy, and Spain where mortality in young women has been increasing up to the early 2000s. In the EU as a whole, mortality at age 20-44 years decreased from 1.6 to 1.4/100,000 (-2.2% per year). Although the female lung cancer epidemic in Europe is still expanding, the epidemic may be controlled through the implementation of effective anti-tobacco measures, and it will probably never reach the top US rates.

A percepção da família sobre sua presença em uma Unidade de Terapia Intensiva Pediátrica e Neonatal

O estudo, de abordagem qualitativa, teve por objetivo compreender como as famílias percebem a própria presença na unidade de terapia intensiva pediátrica e neonatal, e a aceitação dessa presença por parte dos profissionais de saúde. Os dados foram coletados por meio de entrevista semiestruturada a 14 pais de crianças internadas na UTI pediátrica e neonatal de dois hospitais na Região Noroeste do Paraná. Para a interpretação dos dados, optou-se pela análise de conteúdo. Os resultados revelaram o sofrimento vivenciado pelos pais, as alterações que ocorreram na dinâmica familiar em face da hospitalização do filho, e a percepção dos benefícios da sua permanência junto à criança, do acolhimento e dos cuidados recebidos. Concluiu-se que os pais valorizam o fato de os profissionais demonstrarem respeito e atenção para com eles e a criança, criando elos de afetividade e confiança, além de gratidão pelo cuidado.

Processo de trabalho na Unidade de Terapia Intensiva Neonatal: construção de uma atenção orientada pela integralidade

Trata-se de um estudo qualitativo, que teve como objetivo analisar a ação dos profissionais e sua contribuição na construção da integralidade do cuidado ao recém-nascido internado na Unidade de Terapia Intensiva Neonatal (UTIN). O estudo foi realizado no Hospital Sofia Feldman, em Belo Horizonte (Minas Gerais), e teve como sujeitos 10 profissionais que assistem o recém-nascido na UTIN, e 7 pais de recém-nascidos ali internados. Para coleta de dados utilizaram-se a Oficina de Trabalho e a Observação Participante. O tratamento e a análise dos dados coletados foram feitos por meio de Análise de Discurso. A partir dos dados, evidenciaram-se as potencialidades da prática dos profissionais orientada pelo sentido da integralidade, os atos de saúde que materializam ou não a integralidade, as diferentes percepções dos participantes acerca do trabalho realizado pela equipe, e de que forma a lógica da organização do processo de trabalho inscreve o fazer do coletivo de trabalhadores.

Tecnologia e humanização na Unidade de Terapia Intensiva Neonatal: reflexões no contexto do processo saúde-doença

Trata-se de reflexão acerca da tecnologia e da humanização do cuidado ao recém-nascido, tendo como preceito teórico o processo saúde-doença. São estabelecidos alguns paralelos entre as concepções de saúde e de doença, e suas influências em nosso modelo de agir e pensar nos espaços da assistência, como sujeitos do cuidado neonatal. O método mãe-canguru é apresentado como tecnologia relacional, que propõe o acolhimento da unidade família-bebê na Unidade de Terapia Intensiva Neonatal, valorizando as vivências e necessidades primordiais de afetividade e compreensão.

Trends in smoking and lung cancer mortality in Switzerland.

Patterns of cigarette smoking in Switzerland were analyzed on the basis of sales data (available since 1924) and national health surveys conducted in the last decade. There was a steady and substantial increase in cigarettes sales up to the early 1970s. Thereafter, the curve tended to level off around an average value of 3,000 cigarettes per adult per year. According to the 1981-1983 National Health Survey, 37% of Swiss men were current smokers, 25% were ex-smokers, and 39% were never smokers. Corresponding porportions in women were 22, 11, and 67%. Among men, smoking prevalence was higher in lower social classes, and some moderate decline was apparent from survey data over the period 1975-1981 mostly in later middle-age. Trends in lung cancer death certification rates over the period 1950-1984 were analyzed using standard cross-sectional methods and a log-linear Poisson model to isolate the effects of age, birth cohort, and year of death. Mortality from lung cancer increased substantially among Swiss men between the early 1950s and the late 1970s, and levelled off (around a value of 70/100,000 men) thereafter. Among women, there has been a steady upward trend which started in the mid-1960s, and continues to climb steadily, although lung cancer mortality is still considerably lower in absolute terms (around 8/100,000 women) than in several North European countries or in North America. Cohort analyses indicate that the peak rates in men were reached by the generation born around 1910 and mortality stabilized for subsequent generations up to the 1930 birth cohort. Among females, marked increases were observed in each subsequent birth cohort. This pattern of trends is consistent with available information on smoking prevalence in successive generations, showing a peak among men for the 1910 cohort, but steady upward trends among females. Over the period 1980-1984, about 90% of lung cancer deaths among Swiss men and about 40% of those among women could be attributed to smoking (overall proportion, 85%).

Promoção de vínculo afetivo na Unidade de Terapia Intensiva Neonatal: um desafio para as enfermeiras

As observações do cotidiano na Unidade de Terapia Intensiva Neonatal (UTIn), as reflexões sobre a dicotomia entre a teoria, o discurso e o modo de atuação de muitos enfermeiros junto aos pais dos recém-nascidos, suscitaram-nos inquietações que nos levaram a desenvolver este estudo, com os objetivos de conhecer a vivência da enfermeira no cuidado ao recém-nascido e aos seus pais na UTIn e compreender como as enfermeiras vivenciam o processo de vínculo afetivo entre recém-nascidos internados em UTIn e seus pais. Realizamos a pesquisa de acordo com a abordagem da fenomenologia social de Alfred Schütz. Os sujeitos do estudo foram oito enfermeiras assistenciais, com experiências em UTIn de hospitais públicos e privados. Dentre as categorias concretas do vivido, que emergiram dos discursos, destacamos o Contato Humano. Os resultados da análise mostraram que as enfermeiras percebem-se como elo de aproximação entre filhos e pais e acreditam que exercem papel importante na formação de vínculo afetivo entre eles.

Exploring the conditions for a mortality crisis: bringing context back into the debate

This study engages with the debate over the mortality crises in the former Soviet Union and Central and Eastern Europe by 1) considering at length and as complementary to each other the two most prominent explanations for the post-communist mortality crisis, stress and alcohol consumption; 2) emphasizing the importance of context by exploiting systematic similarities and differences across the region. Differential mortality trajectories reveal three country groups that cluster both spatially and in terms of economic transition experiences. The first group are the countries furthest west in which mortality rates increased minimally after the transition began. The second group experienced a severe increase in mortality rates in the early 1990s, but recovered previous levels within a few years. These countries are located peripherally to Russia and its nearest neighbours. The final group consists of countries that experienced two mortality increases or in which mortality levels had not recovered to pre-transition levels well into the 21st century. Cross-sectional time-series data analyses of men’s and women’s age and cause-specific death rates reveal that the clustering of these countries and their mortality trajectories can be partially explained by the economic context, which is argued to be linked to stress and alcohol consumption. Above and beyond many basic differences in the country groups that are held constant—including geographically and historically shared cultural, lifestyle and social characteristics—poor economic conditions account for a remarkably consistent share of excess age-specific and cause-specific deaths.

Origin and outcome of multiple pregnancies in Bern, Switzerland, 1995-2006 and the current proposal of the Swiss parliament to revise the Swiss law of reproductive medicine: Switzerland quo vadis?

INTRODUCTION: Infertility treatments are a major source of the increase in multiple pregnancies (MPs). AIMS: The aims of the present study were (1.) to investigate the origin and maternal/neonatal outcomes of MP and (2.) to review the different measures that can be adopted to reduce these serious complications. METHODS: The study included all women with multiple births between 1 January 1995 and 31 December 2006 at the University Hospital of Bern, Switzerland. The outcomes associated with the various origins of MP (natural conception, ovarian stimulation [OS] ‒ in-vitro fertilisation [IVF-ICSI]) were analysed using a multinomial logistic regression model. An analysis of the Swiss law on reproductive medicine and its current proposed revision, as well as a literature review using Pubmed, was carried out. RESULTS: A total of 592 MP were registered, 91% (n = 537) resulted in live births. There was significantly more neonatal/maternal morbidity in MP after OS compared with natural conception and even with the IVF-ICSI group. With a policy of elective single embryo transfer (eSET), twin rates after IVF-ICSI can be reduced to <5% and triplets to <1%. CONCLUSIONS: After OS, more triplets are found and the outcome of MP is worse. MP is known to be associated with morbidity, mortality, and economic and social risks. To counteract these complications (1.) better training for physicians performing OS should be encouraged and (2.) the Swiss law on reproductive medicine needs to be changed, with the introduction of eSET policies. This would lead to a dramatic decrease in neonatal and maternal morbidity/mortality as well as significant cost reductions for the Swiss healthcare system.

A saúde neonatal na perspectiva de atenção contínua à saúde da mulher e da criança

O estudo é uma revisão narrativa de teses e dissertações concluídas no período de 2000 a 2009 produzidas pelo Grupo de Pesquisa Enfermagem Obstétrica e Neonatal e pelo Núcleo de Estudos e Pesquisa em Aleitamento Materno da Escola de Enfermagem da Universidade de São Paulo que focalizaram os fatores maternos e perinatais que repercutem na saúde neonatal. A produção científica evidencia alinhamento com as diretrizes estabelecidas pelos órgãos de saúde nacionais e internacionais para a promoção da saúde neonatal e infantil.