Produção de sentidos sobre a maternidade: uma experiência no Programa Mãe Canguru

Este artigo analisa, sob a perspectiva da relação entre a família e instituições de saúde, os sentidos produzidos sobre a maternidade em um programa de saúde neonatal desenvolvido na rede pública - o Programa Mãe Canguru. A partir de entrevistas e observações feitas com usuárias durante sua participação no programa, buscamos apreender como as práticas discursivas e não discursivas sobre maternidade e maternagem, difundidas nesse processo, se articulam com as experiências concretas dessas mulheres para produzir novas configurações subjetivas. Na interpretação dos dados, realizada através de análise do discurso, os aspectos mais significativos das falas das entrevistadas foram agrupados em quatro núcleos de sentido: família e religião; o impacto do nascimento prematuro; desconfiança e resistência nas relações com instituições e profissionais de saúde; e a experiência com o Programa Mãe Canguru. Ao final, procurou-se identificar as principais estratégias e formas de singularização utilizadas por essas mulheres ao atribuírem sentidos ao papel materno.

Práticas institucionais/discursivas acerca dos cuidados com os bebês prematuros e/ou de baixo peso: o programa canguru

The Kangaroo Program was implemented in Brazil in 2000 through the Unified Health System (Sistema Único de Saúde SUS) sustained with a humanized rethoric of health care assistance. This program adopts the skin-to-skin contact contributing to the mother-infant bond, breastfeeding and promoting security in mother s care. The users of SUS are encouraged to live in the maternity ward to follow the baby health improvement. However, it was verified in previous observations that mothers participation in the Kangaroo Program has been done through an imposed practice. Therefore, this study intended to understand the texts that permeate the kangaroo practice. This research was developed through two studies: 1) an historic exploration of motherhood concept and an analysis of how the motherhood is presented in the official document that orients the program; 2) an analysis of institutional dynamic of Kangaroo Program, emphasizing the study about the health workers everyday practice, the mothers view about their life in the maternity wards, and the attendance practice. It is highlighted that the relation between this two studies allowed the comprehension abouthow the official discourses can influence the health workers behaviors and how their viewpoint and position can shape the everyday work in a public health program. This research, supported by Institutional Ethnography, considers that people s practices and experiences are socially organized and shaped by broad social forces. The discourse method was used in the documental analysis and in the analysis of qualitative data from empiric research. The research showed that the kangaroo program has been an excellent way to save resources and to improve some baby s biologic and psychological aspects. However, this program has failed to consider the social, economic and cultural complexity of mothers and the structural limitation of the health care system. The official document uses the economic and medical approach, following the hegemonic biomedical model and the life style of the people that don t use the public health system. Consequently, the program has not been successful because it is planned without people participation. On the other hand, it was verified that although some professionals are committed with their work, the mainly does not consider mothers participation as an active process, using the institutional power as a social control to keep mothers uninformed about the possibility to leave the maternity wards. As a result, the research also showed that mothers perceive the program as mandatory and not as option that can improve pleasure moments. It is, therefore, necessary to consider the complex social determinants of health that can increase mothers participation in the Kangaroo Program. Bringing these issues into debate can be a reflective exercise on citizenship and governance, allowing spaces for the improvement of public health programs

Avaliação dos resultados neonatais do método canguru no Brasil

Objective: To evaluate the results of the kangaroo mother method in Brazil. Methods: A prospective cohort study comparing 16 units that have or do not have the second phase of the kangaroo mother method: eight were national centers of excellence for the kangaroo mother method (study group) and eight were part of the Brazilian Neonatal Research Network (control group). A total of 985 newborn infants with birth weights of 500 to 1,749 g were enrolled. Multivariate analyses employedmultiple linear regression and Poisson regression with robust adjustment. Results: The adjusted analysis (controlled for birth weight, gestational age, Score for Neonatal Acute Physiology Perinatal Extension II, Neonatal Therapeutic Intervention Scoring System, and maternal age and educational level) demonstrated that mean length of hospital stay (p = 0.14) and intercurrent clinical conditions in the intermediate or kangaroo unit were equal for both groups. Weight (p = 0.012), length (p = 0.039) and head circumference (p = 0.006) at 36 weeks' corrected gestational age were all lower at the kangaroo units. The kangaroo units exhibited superior performance in relation to exclusive breastfeeding at discharge (69.2 vs. 23.8%, p=0.022). Conclusions: The evidence suggests that the humanization strategy adopted by the Brazilian Ministry of Health is a safe alternative to conventional treatment and a good strategy for promoting breastfeeding. Copyright © 2008 by Sociedade Brasileira de Pediatria.

Maternidade e práticas de saúde: o instituído e o possível

Pós-graduação em Psicologia - FCLAS

Elapid Snake Venom Analyses Show the Specificity of the Peptide Composition at the Level of Genera Naja and Notechis

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

O impacto do Método Mãe Canguru no processo de aprendizagem de prematuros de baixo peso: Revisão da literatura

Technology advances and scientific studies in Neonatal Intensive Care Units (NICU) have contributed significantly to reduce mortality and morbidity of at-risk newborns (NB). However, they are more likely to present neurological and/or developmental psychomotor delay with neurological and sensory alterations. Therefore, proposals for neonatal intervention were developed with the aim of protecting the baby and offering appropriate incentives to minimize the effects of hospital intervention. To this end, programs of protective measures such as the Kangaroo Mother Care (KMC) were developed. Given the relevance of the issue described, this systematic review critically appraises articles from the national and international literature, published in recent years (from 2000 to 2011), that describe whether the KMC can be a protective factor for the development of writing in premature infants. The textual search was conducted using the Virtual Health Library (VHL), a website that covers publications worldwide, allowing access to articles from health science, including LILACS, IBECS, MEDLINE, Cochrane Library and SciELO, as database. The findings revealed that infants who participated in the KMC program showed improvements in their development and that factors such as low-birth-weight prematurity and learning disorders have close relationship with the onset of motor impairments and changes in psychomotor development. The findings showed no articles describing the KMC as a protective factor for the incidence of dysgraphia. Thus, we emphasize the importance of conducting further studies on these topics.

Investigation of a new acetogen isolated from an enrichment of the tammar wallaby forestomach

Background: Forestomach fermentation in Australian marsupials such as wallabies and kangaroos, though analogous to rumen fermentation, results in lower methane emissions. Insights into hydrogenotrophy in these systems could help in devising strategies to reduce ruminal methanogenesis. Reductive acetogenesis may be a significant hydrogen sink in these systems and previous molecular analyses have revealed a novel diversity of putative acetogens in the tammar wallaby forestomach.Results: Methanogen-inhibited enrichment cultures prepared from tammar wallaby forestomach contents consumed hydrogen and produced primarily acetate. Functional gene (formyltetrahydrofolate synthetase and acetyl-CoA synthase) analyses revealed a restricted diversity of Clostridiales species as the putative acetogens in the cultures. A new acetogen (growth on H-2/CO2 with acetate as primary end product) designated isolate TWA4, was obtained from the cultures. Isolate TWA4 classified within the Lachnospiraceae and demonstrated > 97% rrs identity to previously isolated kangaroo acetogens. Isolate TWA4 was a potent hydrogenotroph and demonstrated excellent mixotrophic growth (concomitant consumption of hydrogen during heterotrophic growth) with glycerol. Mixotrophic growth of isolate TWA4 on glycerol resulted in increased cell densities and acetate production compared to autotrophic growth. Co-cultures with an autotrophic methanogen Methanobrevibacter smithii revealed that isolate TWA4 performed reductive acetogenesis under high hydrogen concentration (> 5 mM), but not at low concentrations. Under heterotrophic growth conditions, isolate TWA4 did not significantly stimulate methanogenesis in a co-culture with M. smithii contrary to the expectation for organisms growing fermentatively.Conclusions: The unique properties of tammar wallaby acetogens might be contributing factors to reduced methanogen numbers and methane emissions from tammar wallaby forestomach fermentation, compared to ruminal fermentation. The macropod forestomach may be a useful source of acetogens for future strategies to reduce methane emissions from ruminants, particularly if these strategies also include some level of methane suppression and/or acetogen stimulation, for example by harnessing mixotrophic growth capabilities

(at)tendaendo Il Cielo, progetto per una chiesa a Ottawa

Progetto per una chiesa cattolica ad Ottawa, capitale del Canada. Nel lotto dove sorgeva la chiesa di Saint Charles su Beechwood Avenue, nel quartiere storicamente francofono di Vanier, si è progettata la nuova chiesa con le annesse opere parrocchiale. Dopo un'attenta analisi del sito sono state identificate le peculiarità storiche, paesaggistiche e socio-culturali della chiesa esistente e nel nuovo progetto si valorizzano i punti di forza del precedente edificio e li si integrano con un'architettura contemporanea. L'architettura sacra è stata sviluppata facendo riferimento all'archetipo della tenda che è, fin dalle origine della soria della salvezza cristiana, il tempio in cui Dio si rivela e in cui si rende presente fra gli uomini: "E il Verbo si fece carne e pose la sua tenda in mezzo a noi" (Giovanni 1, 14)

The efficacy of non-pharmacological interventions in the management of procedural pain in preterm and term neonates. A systematic literature review

BACKGROUND: Neonates in a neonatal intensive care unit are exposed to a high number of painful procedures. Since repeated and sustained pain can have consequences for the neurological and behaviour-oriented development of the newborn, the greatest attention needs to be paid to systematic pain management in neonatology. Non-pharmacological treatment methods are being increasingly discussed with regard to pain prevention and relief either alone or in combination with pharmacological treatment. AIMS: To identify effective non-pharmacological interventions with regard to procedural pain in neonates. METHODS: A literature search was conducted via the MedLine, CINAHL, Cochrane Library databases and complemented by a handsearch. The literature search covered the period from 1984 to 2004. Data were extracted according to pre-defined criteria by two independent reviewers and methodological quality was assessed. RESULTS: 13 randomised controlled studies and two meta-analyses were taken into consideration with regard to the question of current nursing practice of non-pharmacological pain management methods. The selected interventions were "non-nutritive sucking", "music", "swaddling", "positioning", "olfactory and multisensorial stimulation", "kangaroo care" and "maternal touch". There is evidence that the methods of "non-nutritive sucking", "swaddling" and "facilitated tucking" do have a pain-alleviating effect on neonates. CONCLUSIONS: Some of the non-pharmacological interventions have an evident favourable effect on pulse rate, respiration and oxygen saturation, on the reduction of motor activity, and on the excitation states after invasive measures. However, unambiguous evidence of this still remains to be presented. Further research should emphasise the use of validated pain assessment instruments for the evaluation of the pain-alleviating effect of non-pharmacological interventions.

The Amplifier - v. 8,(a-11) no. 11

in this issue...M Days, Library Museum, Copper Guards, Loretta Peck, Chess Club, table tennis, mine surveying, Cable TV, campus parking, Kangaroo Court, Convocation

EphA4 (Sek1) receptor tyrosine kinase is required for the development of the corticospinal tract

Members of the Eph family of tyrosine kinase receptors have been implicated in the regulation of developmental processes and, in particular, axon guidance in the developing nervous system. The function of the EphA4 (Sek1) receptor was explored through creation of a null mutant mouse. Mice with a null mutation in the EphA4 gene are viable and fertile but have a gross motor dysfunction, which is evidenced by a loss of coordination of limb movement and a resultant hopping, kangaroo-like gait. Consistent with the observed phenotype, anatomical studies and anterograde tracing experiments reveal major disruptions of the corticospinal tract within the medulla and spinal cord in the null mutant animals. These results demonstrate a critical role for EphA4 in establishing the corticospinal projection.

Contacto pele-a-pele e amamentação na primeira hora de vida

Enquadramento – O contacto pele-a-pele na primeira hora de vida tem benefícios para a mãe e para o recém-nascido, bem como um papel importante no estabelecimento da amamentação. Objetivos – Analisar a evidência científica dos benefícios do contacto pele-a-pele e amamentação na primeira hora de vida; determinar a prevalência do contacto pele-a-pele e da amamentação na primeira hora de vida; verificar quais são os fatores (variáveis sociodemográficas, contextuais da gravidez e do parto, e variáveis relativas ao recémnascido) que interferem nas práticas do contacto pele-a-pele e amamentação na primeira hora de vida. Método – Revisão sistemática da literatura no estudo empírico I. Efetuou-se uma pesquisa na PUBMED, The Cochrane Library, Scielo e Google Académico, estudos publicados entre janeiro de 2011 e dezembro de 2014. Destes foram selecionados 4 estudos, posteriormente analisados, que tiveram em consideração os critérios de inclusão previamente estabelecidos. Dois revisores avaliaram a qualidade dos estudos a incluir utilizando a grelha para avaliação crítica de um estudo descrevendo um ensaio clínico prospetivo, aleatório e controlado de Carneiro (2008). No estudo empírico II seguiu-se um tipo de estudo quantitativo e descritivo simples, de coorte transversal, desenvolvido no serviço de Obstetrícia do Centro Hospitalar Cova da Beira, segundo um processo de amostragem não probabilística por conveniência (n = 382). A recolha de dados efetuou-se através da consulta dos processos clínicos, entre janeiro e dezembro de 2014, das mulheres com idade ≥ 18 anos que tiveram um parto vaginal com feto vivo após as 37 semanas de gestação. Resultados – Evidência de que o contacto precoce pele-a-pele, imediatamente após o parto, é um potencial estímulo sensorial, que abrange o aquecimento do recém-nascido e a estimulação tátil e olfativa, maior estabilização da temperatura, frequência respiratória e nível de glicémia, com diminuição do choro. Está associado à promoção espontânea da amamentação. Na amostra constituída por 382 mulheres, dos 18 aos 46 anos, verificou-se que o contacto pele-a-pele ocorreu em apenas 26,6% da amostra. Cerca de 92,6% da amostragem deu de mamar na primeira hora de vida. No grupo de mulheres em que houve contacto pele-a-pele e amamentação, prevalecem as que têm idade igual ou inferior a 34 anos (66,3%) e predomínio das mulheres que tiveram 5 ou mais consultas (95,9%) de vigilância da gravidez. Conclusão – Face a estes resultados e com base na evidência científica disponível que recomenda o contacto pele-a-pele imediatamente após o parto e promoção da amamentação na primeira hora de vida, assume-se como indispensável que os profissionais invistam na sua formação e assumam um papel importante para a realização deste contacto, estimulando e facilitando esta prática, assim como a realização de mais estudos científicos com contributos para o estabelecimento e manutenção desta prática. Palavras-chave: Contacto pele-a-pele; amamentação; primeira hora de vida.

Do harvest refuges buffer kangaroos against evolutionary responses to selective harvesting?

There is a wealth of literature documenting a directional change of body size in heavily harvested populations. Most of this work concentrates on aquatic systems, but terrestrial populations are equally at risk. This paper explores the capacity of harvest refuges to counteract potential effects of size-selective harvesting on the allele frequency,of populations. We constructed a stochastic, individual-based model parameterized with data on red kangaroos. Because we do not know which part of individual growth would change in the course of natural selection, we explored the effects of two alternative models of individual growth in which alleles affect either the growth rate or the maximum size. The model results show that size-selective harvesting can result in significantly smaller kangaroos for a given age when the entire population is subject to harvesting. In contrast, in scenarios that include dispersal from harvest refuges, the initial allele frequency remains virtually unchanged.

Fine-scale spatial genetic correlation analyses reveal strong female philopatry within a brush-tailed rock-wallaby colony in southeast Queensland

We combine spatial data on home ranges of individuals and microsatellite markers to examine patterns of fine-scale spatial genetic structure and dispersal within a brush-tailed rock-wallaby (Petrogale penicillata) colony at Hurdle Creek Valley, Queensland. Brush-tailed rock-wallabies were once abundant and widespread throughout the rocky terrain of southeastern Australia; however, populations are nearly extinct in the south of their range and in decline elsewhere. We use pairwise relatedness measures and a recent multilocus spatial autocorrelation analysis to test the hypotheses that in this species, within-colony dispersal is male-biased and that female philopatry results in spatial clusters of related females within the colony. We provide clear evidence for strong female philopatry and male-biased dispersal within this rock-wallaby colony. There was a strong, significant negative correlation between pairwise relatedness and geographical distance of individual females along only 800 m of cliff line. Spatial genetic autocorrelation analyses showed significant positive correlation for females in close proximity to each other and revealed a genetic neighbourhood size of only 600 m for females. Our study is the first to report on the fine-scale spatial genetic structure within a rock-wallaby colony and we provide the first robust evidence for strong female philopatry and spatial clustering of related females within this taxon. We discuss the ecological and conservation implications of our findings for rock-wallabies, as well as the importance of fine-scale spatial genetic patterns in studies of dispersal behaviour.

Morphometric and cladistic analyses of the phylogeny of Macropodinium (Ciliophora : Litostomatea : Macropodiniidae)

Phylogenetic studies of the genus Macropodinium were conducted using two methods; phenetics and cladistics. The phenetic study of morphometrics suggested that the genus could be divided into 3 groups attributable mostly to cell size and shape. The cladistic study also split the genus into 3 groups related to cell size but groups were further distinguished by patterns of ornamentation. Reconciliation of both approaches revealed considerable congruence, however, it also suggested the existence of convergences in the phenetic study and a lack of resolution in the cladistic study. The morphological diversity of Macropodinium is probably due to evolutionary trends such as increasing body size, allometry and polymerisation of structures. None of these trends, however, was uniformly directional and differential effects were observed in different regions of the phylogenetic tree. Comparison of the phylogeny of Macropodinium to a consensus phylogeny of the macropodids revealed limited incongruence between the 2 trees. The ciliate groups could be related to 2 host groups; the wallaby genera and the kangaroo and wallaroo subgenera. The association with these host groups may be the result of phyletic codescent, ecological resource tracking or a combination of both. Further studies of both host and ciliate phylogeny are necessary to resolve these effects.