Avaliação da qualidade da assistência à mulher e ao filho durante o parto normal

The practices developed in the everyday life of obstetric services are sometimes out of step with the recommendations of the public health policies. Accordingly, this research had the objective of assessing the quality of the care provided to women and children during cases of natural childbirth in municipal public maternity wards of the city of Natal/RN, Brazilian Northeast. We developed a cross-sectional and quantitative study in two maternity wards that provide care actions to pregnant women at regular risk (maternity wards A and B). The participants were 314 puerperal women who were treated during the period between April and July 2014, whose children were born alive, through transpelvic way, with spontaneous or induced beginning of labor and that showed physical and emotional conditions to respond to the proposed questions. The data collection instrument was constructed on the basis of the recommendations of the World Health Organization focused on the care of normal childbirth and validated by skilled judges, and the final version has obtained optimum agreement (k = 0,96; IVC = 0,99). Associated with these recommendations, we used three indicators: percentage of women with induced labor or subjected to elective cesarean section (Indicator A); percentage of women served by a qualified health professional during labor and childbirth (Indicator B); and Bologna Index (Indicator C). The research obtained a favorable opinion of the Research Ethics Committee from the Federal University of Rio Grande do Norte, under the nº 562.313 and Certificate of Presentation for Ethics Appreciation: 25958513.0.0000.5537. The analysis of categories related to the recommendations of the World Health Organization was conducted by means of absolute and relative frequency and the Chi-square Pearson’s and Fisher’s exact tests made the comparison of the differences observed between the two maternity wards. Furthermore, we calculated the percentage of the indicators A and B and with the results of the Indicator C, the quality was assessed as follows: the closer to 5, the better will be the quality, and the closer to 0, the worst will be the quality, and the Mann-Whitney U test was used to compare the differences of the obtained averages. The significance level of 5% was considered in all statistical tests. The differences between the maternity wards were identified with regard to the provision of liquids orally (p=0,018), stimulus for non-supine positions (p=0,002), existence of partograph (p=0,001), support or welcoming by health professionals (p= 0,047), intravenous infusion (p<0,001), supine position (p<0,001), use of oxytocin (p<0,001), food and liquid restriction (p= 0,002) and, lastly, the fact of the touch is performed by more than 1 examiner (p=0,011). The indicators A and B showed percentages of 13,09% and 100%, respectively. The overall average of the Indicator C was equal to 2,07 (± 0,74). There was a statistically significant difference between the averages of the maternity wards (p<0,001). The care actions provided during the process of labor and childbirth is inappropriate, especially in the maternity ward B. It is necessary to implement improvements and redesign the obstetric model in force

Avaliação do ensino da obstretícia e da assistência ao parto sob a percepção dos graduandos em medicina e enfermagem na Universidade Federal do Rio Grande do Norte

OBJETIVE: To evaluate the perception of Medical and Nursing students of Medicine and Nursing graduation courses at the Federal University of Rio Grande do Norte (UFRN), on obstetrics teaching and labor assistance in the context of the maternal care provided by the Maternity Hospital Januário Cicco (MEJC) and contribute to curricular updating planning of teaching obstetrics, in accordance with the principles of humanization. METHODS: It was conducted a study of cross-cutting approach and qualitative and quantitative descriptive method, with students in medicine and nursing of UFRN, who were attending or had been attended the midwifery disciplines medicine; and women's health in nursing. The data were collected through a questionnaire with objective and subjective questions, and stored in a database, spreadsheet software Excel / Office 2010 with all the variables. RESULTS: We interviewed 169 students, 118 of medical school and 51 from the nursing program, of which 46.75% were male and 53.25% female. The largest number of medical respondents is the 11th period (40.67%), and nursing, on 10, (43.15%). These students witnessed 1,073 births, and (61.8%) vaginal deliveries. The obstetricians were the most performed vaginal deliveries (40%). Nurses performed only (8.13%). The assistance provided to women during the process of labor and delivery, was configured as suitable for 87.58% of respondents and these glimpsed humane conduct. Students who performed deliveries, 76.27% were medical and 11.76% were nursing. All had guidance while doing them. A total of 19.50% medical students reported that there is a prejudice against vaginal delivery, particularly for the humanized birth, unlike all nursing students (100%) who reported that there is this prejudice. Most students (73%) showed preference for vaginal delivery, especially nursing students. On the knowledge of myths in relation to vaginal delivery, 60.35% answered that they know some. CONCLUSION: This study presents itself as a highly relevant, since the results may contribute to curricular changing and updating related to obstetrics teaching, but also serve as a resource for analysis of humanization practices that should be developed in educational institutions and which are recommended by the Ministry of Health.

Influência da paridade, do tipo de parto e do nível de atividade física sobre a musculatura do assoalho pélvico em mulheres na pós-menopausa

The post-menopause stage is characterized by hormonal and organic alterations of ovarian failure. One of the most important of these is muscles alterations of the pelvic floor (MPF). According to current literature, in young women gynecological and obstetric factors, as well as lifestyles and habits influence that loss of function. However, there is still uncertainty about the influence of those variables in the MPF functions in post-menopause women. Thus, this study aimed at seeing if there is an influence from number of births, the type of birth and the level of physical activity on the MPF of post-menopause women. Another objective of this study was to compare MPF force in women who had had vaginal births with those who had been subjected to cesarean sections, those with different levels of physical activity and those with artificial and natural menopause in the initial and latter stages. Furthermore, the test of muscular force was compared to perineometry. Using observational, analytical and transversal observations, 100 women in the post-menopausal stage of life, between the ages of 45 and 65, were examined. They were divided according to the menopausal stage into three groups: women who had undergone hysterectomies, those in the initial stages of postmenopause and those in the late stage of postmenpause. The patients were questioned about social, demographic, gynecological and obstetric factors. All the volunteers were submitted to a physical examination where their height and weight were measured to arrive at the corporal mass index and their waist measurements were taken. The evaluation of the pelvic floor was conducted with muscular force tests and perineometry. These results were analyzed with statistical description and ANOVA statistical tests, multiple regression and Kolmogorov-Smirnov evaluations. The results showed homogeneity with regard to social demographic and anthropometric characteristics among the women in the final test sample (n=85). It was also seen that most of the women in all three groups were married (p=0.51) and catholic (p=0.13). The average per capital income varied between $R585.47 (+/-466.67) and $R1,271.83 (+/-1,748.95), with no significant difference between the groups (p=0.05). The G>6 group presented an average age between 58.95 (+/-3.96) which was significantly greater that the G<6 group´s average age (53.21+/- 3.88) (p=0.000). There was no difference between the groups´ anthropometric characteristics of weight (p=0.32), height (p=0.72) and corporal mass index (p=0.34), nor in the waist measurements (p=0.33). Furthermore, no significant difference was noted in the MPF function of women who had had normal births, cesarean sections or a combination of the two (TFM p=0.897; perineum measurement p=0.502). Likewise, no differences were seen in the MPF function of women who had one, two to three or four or more births (TFM p=0.28, perineum measurement p=0.13). Finally, no difference was perceived among those with different levels of physical activity (TFM p=0.663; perineum measurement p=0.741). Therefore, we found that the type of delivery, number of births and physical activity had no influence on the muscular function of the pelvic floor among the women studied. It is believed that decline in muscular function in post-menopause women is fundamentally related to the process of aging.

Análise da força propulsora do motor de indução linear alimentado com imposição de corrente

This work intent to study the motive power provided by the plane linear induction motor, in a lock condition. It uses a method of imposition of the electric current to the stator via a frequency convertor PWM driven by a refed platform. The reading of the motive power was performed by a load cell using an electronic circuit for reading and conditioning of the signal. Aiming a complete analysis of the linear motor, it was performed a computational modeling that employs all relevant parameters to the study of the locked machine. At the end it was held a theoric-experimental confrontation that evaluated the effectiveness of the proposed method.

Trajetórias e fatores associados a qualidade de vida de mães de recém-nascidos pré-termos de muito baixo peso até três anos após o parto

Preterm birth is a public health problem worldwide. It holds growing global incidence rates, high mortality rates and a risk of the long-term sequelae in the newborn. It is also poses burden on the family and society. Mothers of very low birth weight (VLBW) preterm infants may develop psychological disorders, and impaired quality of life (QoL). Factors related to mothers and children in the postpartum period may be negatively associated with the QoL of these mothers. The aim of this study was to assess factors possibly associated with the QoL of mothers of VLBW preterm newborns during the first three years after birth. Mothers of VLBW preterm answered the World Health Organization Quality of Life (WHOQOL)-bref and the Beck Depression Inventory (BDI) in five time points up to 36 months postpartum, totalizing 260 observations. The WHOQOL–bref scores were compared and correlated with sociodemographic and clinical variables of mothers and children at discharge (T0) and at six (T1), twelve (T2), 24 (T3) and 36 (T4) months after the delivery. We used the Kruskal Wallis test to compared scores across different time points and correlated WHOQOL-bref scores with the sociodemographic and clinical variables of mothers and preterm infants. Multiple linear regression models were used to evaluate the contribution of these variables for the QoL of mothers. The WHOQOL–bref scores at T1 and T2 were higher when compared to scores in T0 in the physical health dimension (p = 0.013). BDI scores were also higher at T1 and T2 than those at T0 (p = 0.027). Among the maternal variables that contributed most to the QoL of mothers, there were: at T0, stable marital union (b= 13.60; p= 0.000) on the social relationships dimension, gestational age (b= 2.38; p= 0.010) in the physical health dimension; post-hemorrhagic hydrocephalus (b= -10.05; p= 0.010; b= -12.18; p= 0.013, respectively) in the psychological dimension; at T1 and T2, Bronchopulmonary dysplasia (b= -7.41; p= 0.005) and female sex (b= 8,094; p= 0.011) in the physical health dimension and environment, respectively. At T3, family income (b= -12.75’ p= 0.001) in the environment dimension, the SNAPPE neonatal severity score (b= -0.23; p= 0.027) on the social relationships dimension; at the T4, evangelical religion (b= 8.11; p= 0.019) and post-hemorrhagic hydrocephalus (b: -18.84 p: 0.001) on the social relationships dimension. The BDI scores were negatively associated with WHOQOL scores in all dimensions and at all times points: (-1.42 ≤ b ≤ -0.36; T0, T1, T2, T3 and T4). We conclude that mothers of preterm infants VLBW tend to have a transient improvement in the physical well-being during the first postpartum year. Their quality of life seems to return to levels at discharge between two and three years after delivery. The presence of maternal depressive symptoms and diagnosis of post-hemorrhagic hydrocephalus or BDP are factors negatively associated with the QoL of mothers. Social, religious and economic variables are positively associated with the QoL of mothers of VLBW preterm.

Expectativas da grávida em relação ao parto

Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de licenciada em Enfermagem

Prevalencia de acortamiento y embudización del cérvix, y factores asociados a parto prematuro en mujeres atendidas en el Hospital Vicente Corral Moscoso 2012. Cuenca

Objetivo: Determinar la prevalencia del acortamiento del cérvix más embudización y otros factores asociados al parto prematuro, en mujeres de 20 a 34 semanas de gestación que acuden al hospital Vicente Corral Moscoso 2012. Materiales y Métodos: Se realizó un estudio transversal en mujeres embarazadas entre 20 y 34 semanas de gestación, durante el año 2012. Las pacientes fueron asignadas en forma secuencial cumpliendo los criterios de inclusión y exclusión. La longitud cervical y la presencia o no de embudización fueron medidas con Ecografía Transvaginal y los demás datos se obtuvieron de la ficha clínica y por entrevista directa siendo trascritas a un cuestionario; mismos que fueron procesados con software Microsoft Exel y SPSS. Resultados obtenidos: La prevalencia de partos prematuros fue del 12,06%. La prevalencia de acortamiento cervical fue del 14%, la de embudización del 4,5%. Dentro de los factores de riesgo asociados al parto prematuro con significancia estadística se muestran: acortamiento del cérvix, embudización del cérvix, la escolaridad y el antecedente de parto prematuro. Conclusiones: Seestudió un grupo de 506 mujeres cuya edad gestacional mínima fue de 20 semanas la máxima de 34,6 con una media de 30,14. La edad inferior fue de 16 años y la superior de 42, con una media de 24,18. La prevalencia de partos prematuros fue del 12,06%. La prevalencia de acortamiento cervical fue del 14% y la de embudización del 4,5%. Dentro de los factores de riesgo asociados al parto prematuro con significancia estadística se muestran: acortamiento del cérvix, embudización del cérvix, la escolaridad y el antecedente de parto prematuro.

Quitosana na indução de resistência ao tombamento de plântulas de espécies olerícolas e no controle de fitopatógenos in vitro

Induction of resistance is defined as the activation of a state of resistance against diseases which is induced systemically in plants by the use of biotic or abiotic agents without any modification of the plant genome, occurring non-specific way, by activating genes coding for various plant defense responses. Chitosan is a polymer derived from the deacetylation of chitin, which is found in large quantities in crustacean shell, and studied with the potential to control plant pathogens, both by its direct fungistatic action, as the ability to induce protection of plants, indicating the presence of molecules of elicitoras characteristics. Three experiments with objective of evaluating the potential of chitosan in the seedling resistance induction were developed, beet (Beta vulgaris) seeds, cucumber (Cucumis sativus) seeds and tomato (Solanum lycopersicum) seeds, and the control of Fusarium sp., Rhizoctonia solani K¨uhn e Pythium sp. in vitro conditions. The experimental design was completely randomized, with four replications. Beet seeds, tomato and cucumber were submerged in chitosan solution for 20 minutes, in concentrations of 0.25, 0.5, 1 and 2% in the control and distilled water. Seeds were sown in trays containing Plantmax Florestalr substrate sterilized and inoculated with Fusarium sp., Rhizoctonia solani K¨unh and Pythium sp., respectively for the three cultures. The experiment was conducted for 14 days in growth chamber with controlled temperature (25 C 2 C), light (12 hour photoperiod) and humidity (70% 10%). The evaluations were seed emergency, seedling damping-off, seedling length, fresh weight and activity of the enzymes phenylalanine amˆonia-liase (PAL), chitinase and b-1,3-glucanase. It was also rated the mycelial growth of Fusarium sp., Pythium sp. and R. solani on P.D.A. (Potato-Dextrose and Agar) culture medium containing chitosan at the same concentrations evaluated in seeds. For beet growing, seed treatment with chitosan presented higher emergence and the length of the seedlings, and reduced the percentage of tipping. Treatment with chitosan activated the systemic acquired resistance with expression of chitinase and b-1,3-glucanase enzymes. For the tomato crop in chitosan concentration of 0.25% favored the emergency of seedlings, reduced the incidence of tipping and activated the PAL enzymes, chitinase and b-1,3-glucanase. In cucumber on the concentration of up 0.5% favored seedlings emergence and reduces the incidence of tipping. Chitosan activated the PAL enzymes and b-1,3-glucanase. Chitosan also presented fungistatic action on the initial growth of Pythium sp. and R. solani in vitro conditions, however, such action did not prevail until the end of the experiment. To Fusarium sp. the concentration of chitosan resulted in the reduction of mycelial growth in vitro.

Potencial do óleo de Aloysia citriodora Palau no controle de fitopatógenos e na indução de resistência ao tombamento de plântulas de feijão, pepino e beterraba

The crops are affected by pests and diseases that decrease productivity. Among them are the damping off of seedlings that can occur in pre and post-emergence. In bean crops, cucumber and beet these diseases occur, being caused by various pathogens, especialy fitopathogenic fungi. Several measures are used for the controle of such diseases, among them, is the chemical seed treatment fungicides. However, society has become increasingly concerned about the quality and food and environmental contamination, generation a growting search for sensitive products to humans and the environment. The use of essential oils to control plant pathogens is an example of alternative tested by science in the search for less aggressive technologies. This study aimed to evaluate the efficiency of the use of essential oil Aloysia citriodora, in control of pathogens causing damping off in beans, cucumber and beet. This thesis was divided in four chapters, the introductory first, and the other addressing the control of Pythium sp. in beans, Sclerotinia sclerotiorum on cucumber, and Fusarium sp. on beet. The methodology consisted of four experiments in each pathosystem, with all the work done at the Federal Technological University of Parana, Campus Dois Vizinhos. In the first experiment evaluated the fungistatic and fungicidal effect of the essential oil of A. citriodora on PDA in vitro in mycelial growth of pathogens studied. In the second experiment evaluated the in vitro effect of essential oil concentrations of A. citriodora in BD medium on microscope slides, on the germination of sporangia Pythium sp. and conidia Fusarium sp., and in Petri dishes with PDA medium, the sclerotia germination speed index of S. sclerotiorum. In the third experiment, we evaluated in germination test in paper roll (PR), the phytotoxic effect or not the use of essential oil concentrations of A. citriodora in dry bean seed, cucumber and beet. The variables used to assess this experiment were the germination percentage, mediun green mass per plant and average length of seedlings. In the fourth experiment we assessed the effect of treating bean seeds, cucumber and beet with essential oil contents of A. citriodora, seeds in their subsequent substrates contamined with pathogens studied, Pythium sp., S. sclerotiorum and Fusarium sp. In this experiment we used the following variables: percentage of emergence, percentage of post-emergence damping off, green average mass per plant, average length per plant and biochemical analyzes. The biochemistry of plant tissues evaluated were as follows: protein content, enzymatic activities of peroxidases, phenylalanine ammonia-liase (PAL), chitinases and β-1,3-glucanases. The in vitro results show that the essential oil has fungistatic and fungicidal effect on mycelial growth, on sporangia germination, conidia and sclerotia of the pathogens studied in this work, wich may be related to its major components, citral and limonene. The oil also exhibits low phytotoxicity to seeds of the species studied, only in beans decreases germination in most studied dosage (0,25%), cucumber also in the higher dosage (0,25%) reduce the length of seedlings, and beet there were no negative effects to the seedlings. In the test in substrate contaminated with the pathogens, the use of essential oil: increased germination and decreased post emergence damping off of beans seedlings; at a concentration of 0,0625% decreases post emergence damping off in cucumber. In biochemical analyzes found an increase in the enzymatic activity of peroxidases and β-1,3-glucanases on beans, and glucanases on cucumber, and increased enzyme activity of peroxidases on beet, showing action in resistance induction at damping off.

Parto podálico: su incidencia en el H.V.C.M. y las complicaciones más frecuentes desde Abril 1977-Abril 1982

Doctor en Medicina y Cirugía

Indução de resistência e tratamento de sementes de soja com fosfitos de potássio

The use of inputs containing phosphites have been presenting results in many studies, taking on importance to the control of diseases in some cultures and demonstrating the resistance induction in seedlings, with ability to activate defense mechanisms, conferring protection to plants against microorganisms. The soybean crop is recognized for its importance in providing grains and derivatives for human consumption, animal, production of biofuels, pharmaceuticals, among others. Positive results obtained through studies based on resistance inducers in some cultures arouse the interest for further study. The objective of this study was to evaluate the effect of potassium phosphites on the resistance induction and treatment of soybean seeds. Therefore were conducted four laboratory studies at the Federal Technological University of Paraná, Campus of Dois Vizinhos. In the first study it was evaluated the quality attributes of the seeds and the resistance induction as seed treatment. Then it was verified that phosphites have action upon the seedlings metabolism in due to seed treatment, having the phosphite Reforce® contributed to seed quality attributes and phosphites FitofosK® and Fitofos K Plus® induced the resistance increasing the activity of β-1,3-glucanase. In the second study it was evaluated the the resistance induction in soybean cotyledons, in which the phosphites demonstrated induction potential of phytoalexin gliceolin. In the third study It was evaluated the soybean seed health treated with potassium phosphites.. it was observed that the phosphites reduced the incidence of many fungi on seeds, especially of storage fungi like Aspergillus sp. and Fusarium semitectum. In the fourth study it was evaluated the in vitro effect of potassium phosphites on pathogenic fungi of the culture. And it was found direct action of phosphites on the mycelial growth of Fusarium semitectum, Pythium sp. and Sclerotinia sclerotiorum. Based on these results, we concluded that potassium phosphites have potential in seeds treatment, as resistance inducer and on in vitro control of phytopathogens.

Prevalencia y factores de riesgo en amenaza de parto pretérmino en las pacientes atendidas en el Hospital Vicente Corral Moscoso en el año 2006

Se realizó un estudio observacional de tipo transversal. Se analizaron como factores de riesgo asociados: parto pretérmino previo, infección de vías urinarias, anemia, embarazo múltiple, trastornos hipertensivos, control prenatal y edad. La muestra fue propositiva, no aleatoria (728 mujeres) se calculó mediante Epi Info v 3.2.2 con los siguientes criterios: tamaño poblacional 4000 partos, prevalencia esperada 10, precisión 2, nivel de confianza 95La información fue obtenida directamente de las pacientes por medio de encuestas y exámenes clínicos y de laboratorio correspondientes. Los datos se procesaron en Epi Info. Resultados: la prevalencia de Amenaza de Parto pretérmino fue del 13. Los factores de riesgo asociados fueron: parto pretérmino previo (RP 3.05, IC 951.8-4.9), infección de vías urinarias (RP 3.99 IC 952.7-5.8); anemia (RP 1.70 IC 951.17-2.47). El control prenatal (RP 1.41 IC 950.96-2.08), embarazo múltiple (RP 2.34 IC 950.89-6.15), son factores asociados pero no estadísticamente significativa. En tanto que los trastornos hipertensivos (RP 0.45 IC 950.19-1.07) y la edad menor de 19 o mayores de 35 años (RP 0.92 IC 950.60-1.42) son factores protectores pero no estadísticamente significativa. Conclusiones: la prevalencia de APP en el HVCM es de 13. Los factores asociados son: el antecedente de parto pretérmino, la infección de vías urinarias y la anemia