Thèses : « Neonatal deaths »

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Hatupopi, Saara K. « Investigating factors contributing to neonatal deaths in 2013 at a national hospital in Namibia ». University of the Western Cape, 2017. http://hdl.handle.net/11394/5617.

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Magister Curationis - MCur
Background: The neonatal period starts at birth and ends 28 days after birth, and is the most defence less period in the newborn's life. Improving newborn health is a priority for the Ministry of Health and Social Services (MoHSS) in Namibia. The national neonatal mortality rate stood at 21.80 per 1000 live births in the country, and Namibia was unable to attain Millennium Development Goal 4 which focused on reduction of the child mortality rate by two-thirds between 1990 and 2015. Aim: This study investigated the factors contributing to neonatal deaths at a national hospital in the Khomas region of Namibia, with the following objectives: (i) to identify causes of early neonatal deaths; (ii) to identify the causes of late neonatal deaths; and (iii) to identify avoidable and unavoidable factors contributing to neonatal deaths. Methodology: The study used a quantitative research approach with a retrospective descriptive design to investigate factors contributing to neonatal deaths. The primary data were collected from a population of 231 record files of all neonates who died during the period 1 January to 31 December 2013 while admitted to the national hospital before 28 completed days of life. Results: The study identified that of the neonates who died, 67.1% (n=155) were early neonatal deaths (during the first 0–7 days of life), while 32.9% (n=76) died during the late neonatal period (from 8–28 days of life). Of the neonates who died, 50.6% (n=117) were male and 48.48% (n=112) were female. The causes of early and late neonatal deaths were similar, although they happened at different stages. The causes of early neonatal deaths have been identified as respiratory distress syndrome (RDS) – 24.2% (n=56); neonatal sepsis – 12.1% (n=28); birth asphyxia – 11.7 % (n=27); congenital abnormalities – 14.7 % (n=34); hemorrhagic diseases of newborns – 3.9% (n=9); and unknown – 0.6% (n=1). Neonatal sepsis caused the highest number of late neonatal deaths 17.7 %,( n=41); followed by RDS – 7.4% (n=17); congenital abnormalities – 3.9% (n=9); birth asphyxia – 3.1% (n=7); birth trauma – 0.4% (n=1); and unknown factors – 0.4 % (n=1). The study revealed that avoidable factors related to healthcare providers had a severe impact on neonatal deaths, while congenital abnormalities were unavoidable factors. Conclusion: The study concluded that most neonatal deaths are related to actions or inactions of the healthcare providers and could be avoided. Recommendations: Based on the results of the study, further research is required to assess the knowledge, skills, and behaviors of the healthcare providers. Training and education about neonatal resuscitation needs to be carried out on a regular basis.

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Lorenzo-Luaces, Felipe. « A Study of the Two Major Causes of Neonatal Deaths : Perinatal Conditions and Congenital Anomalies ». UNF Digital Commons, 1994. http://digitalcommons.unf.edu/etd/116.

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Infant mortality is a public health concern in the United states. We concentrate on neonatal mortality for its high accountability of infant mortality. In this paper we study the neonatal mortality of Florida's 1989 live birth cohort. The data has been analyzed for two major causes of deaths: perinatal conditions and congenital anomalies. We use the KAPLAN-MEIER method to estimate the survival probabilities. For each cause, data were fit to the Weibull models and Extreme Value models to estimate the parameters of the survival curves. The results indicate that primary factors for each cause of neonatal deaths are very low birth weight, prior pregnancies of the mother, and late initiation of prenatal care when the variables are considered separately. The conclusion still remains the same for perinatal conditions when the interaction effects of the factors are considered, but we do not conclude similarly for the congenital anomalies at the same interaction level.

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Aboobakur, Maimoona Pimonpan Isarabhakdi. « Influence of maternal and service factors on neonatal deaths and still births in the Maldives / ». Abstract, 2006. http://mulinet3.li.mahidol.ac.th/thesis/2549/cd392/4838760.pdf.

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Lawn, J. E. « 4 million neonatal deaths : an analysis of available cause-of-death data and systematic country estimates with a focus on 'birth asphyxia' ». Thesis, University College London (University of London), 2009. http://discovery.ucl.ac.uk/19027/.

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Background: Of the world’s four million neonatal deaths, 99% occur in low/middleincome countries, but most information relates to the 1% dying in high-income countries. Reliable cause-of-death data are lacking. The aim of this thesis is to develop programmatically-relevant, national estimates for neonatal cause-of-death, focusing on “birth asphyxia” to illustrate specific challenges in the available data and for systematic national estimates. Objectives: 1. Review estimation methods, giving implications for neonatal cause-of-death estimation. 2. Propose programmatic categories for neonatal cause-of-death, reviewing measurement options for intrapartum-related outcomes (“birth asphyxia”). 3. Identify and analyse existing neonatal cause-of-death data. 4. Estimate intrapartum-related neonatal deaths for all countries, comparing single-cause and multi-cause models. 5. Summarise priorities for improving neonatal cause-of-death estimates and input data. Data inputs: Case definitions were reviewed for neonatal cause-of-death and intrapartumrelated outcomes. Six programmatically relevant cause-of-death categories were defined, plus a residual “other neonatal” category. Two sources of neonatal cause-of-death data were examined: Vital Registration (VR) datasets for countries with high coverage (>90%) based on a new analysis from 83 countries; and published/unpublished studies identified through systematic searches. Inclusion criteria for representativeness and comparability were applied. Data from 44 countries with VR (96,797 neonatal deaths) and from 56 studies (29 countries, 13,685 neonatal deaths) met inclusion criteria, despite screening almost 7,000 abstracts. These data represent <3% of the world’s neonatal deaths. Thus estimation is necessary for global level information. No useable data were identified from Central and North-West Africa, or Central Asia. Modelling: Methods were developed to estimate intrapartum-related neonatal deaths (single-cause), and then simultaneously estimate seven causes of neonatal death (multi-cause). Applying these proportions to the numbers of neonatal deaths in 192 countries gives a global estimate of intrapartum-related neonatal deaths of 0.90 (0.65-1.17) million using single-cause and 0.91 (0.60-1.08) million using multi-cause methods. Discussion: The multi-cause model has become WHO’s standard method for neonatal cause-of-death estimates. However, complex statistical models are not a panacea. More representative data are required. Simplified case definitions and consistent hierarchical cause-of- death attribution would improve comparability, especially for intrapartum-related deaths.

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Vergnano, S. « Verbal autopsy for stillbirth and neonatal deaths : comparing population cause specific mortality fraction using two methods ». Thesis, University College London (University of London), 2012. http://discovery.ucl.ac.uk/1349291/.

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Background: Every year 3.2 million infants are stillborn and 3.6 million die within the first month. Up to 98% of these deaths occur in countries with inadequate or non-existent vital registration systems, where cause of death data are sparse and mostly derived from verbal autopsies (VA). It has been advocated that VA are included in routine national statistics. This thesis proposes and compares the strengths and limitations of methodologies to collect and interpret VA data for stillbirths and neonatal deaths. Methods: Data were derived from three research areas in Malawi, Nepal and Mumbai. The development of classifications, diagnostic algorithms and questionnaires for VA, suitable for physician review interpretation is described. A probabilistic method to analyse all age deaths (InterVA) was adapted for stillbirths and neonatal deaths. Cause specific mortality fractions were compared using physicians’ review and InterVA. Results: Neonatal mortality rate in Malawi was 25/1000 livebirths (LB), in Nepal 31/1000 LB and in Mumbai 16/1000 LB. A total of 922 VA including both live and stillbirths were analysed to establish causes of death. Stillbirths accounted for 44-54% of deaths. Of neonatal deaths, in Malawi the majority were attributed to severe infections according to physician review (55%) and InterVA (46%); in Nepal (43%) and Mumbai (61%) perinatal asphyxia was most common according to InterVA. In Nepal however, physician review ascribed the majority of neonatal deaths to severe infections (50%). Kappa statistics for individual agreement comparing both methods was 0.60 (CI 0.567-0.702) in Malawi, 0.62(CI 0.59- 0.65) in Nepal and 0.48(0.40 - 0.50) in Mumbai. Discussion: Different VA interpretation methods exist, however standardised procedures are necessary for international comparison. The role of physician review in interpreting VA is changing while computerised methods are becoming more widespread. The modified InterVA model provides a rapid and consistent method to establish causes of stillbirths and neonatal deaths, however it requires further refinements and ultimately a validation study using a comparison other than physician review.

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Lewycka, S. O. « Reducing maternal and neonatal deaths in rural Malawi : evaluating the impact of a community-based women's group intervention ». Thesis, University College London (University of London), 2011. http://discovery.ucl.ac.uk/1310258/.

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Background: Maternal and neonatal mortality are high in Malawi, and cost-effective and sustainable interventions are needed in order to reduce mortality rates and make progress to achieve Millennium Development Goals 4 and 5 for mother and child health. Where health systems are weak and many women deliver at home, community-based interventions have the potential to make an important contribution to health improvements. Methods: A cluster-randomised study with a factorial design was used to evaluate the impact of two community-based interventions on maternal and child health outcomes. A prospective pregnancy and birth monitoring system was developed to collect information on pre-specified pregnancy, birth and infant outcomes. The research presented here focuses on the women’s group intervention, which uses participatory methods to mobilise communities to take actions for maternal and child health problems they identify. Results: 18,562 pregnancies were followed up, resulting in 18,340 live births, 362 stillbirths, 434 neonatal deaths and 73 maternal deaths. 11,450 live births were identified retrospectively, resulting in 484 infant deaths. Statistically significant reductions in maternal and neonatal mortality as a result of the women’s group intervention were not seen (adjusted odds ratio 0.94 (95% CI 0.56-1.61) and 0.95 (95% CI 0.71-1.28) respectively). There were significant improvements in antenatal care and immunisation, and reductions in births attended by traditional birth attendants, and there were non-significant reductions in mortality and increases in health-care seeking. Discussion: Although women’s groups showed promising signs of community-level action for mother and child health, methodological factors, such as low power and baseline imbalance after randomisation, may have limited the ability of this study to detect an impact of the intervention on mother and child health outcomes. Design and implementation factors may also have caused delays and limited the measurable impact of the intervention at this time. Follow-up over a longer period may show greater impact.

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Chowdhury, Md Hafizur Rahman. « Neonatal deaths in a rural area of Bangladesh : an assessment of causes, predictors and health care seeking using verbal autopsy ». Thesis, Curtin University, 2008. http://hdl.handle.net/20.500.11937/1526.

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Poor neonatal health is a major contributor to mortality in under-five children in developing countries, accounting for more than two thirds of all deaths in the first year of life, and for about half of all deaths in children under-five. A major constraint to effective neonatal survival programmes in developing countries, such as Bangladesh, has been the lack of accurate epidemiological data on neonatal deaths. The current study aimed to (1) describe the causes of neonatal death in a rural subdistrict of Bangladesh; (2) describe associated birth and obstetric characteristics of neonatal deaths; (3) describe the patterns of care-seeking practices during the fatal neonatal illness episode; (4) compare deaths and care-seeking patterns between the Maternal and Child Health and Family Planning (MCH-FP) service area of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) and the adjoining government service area; (5) identify the predictors of neonatal deaths; and (6) assess the accuracy in assigning causes of death from verbal autopsy data by comparing physician review with medical assistant review and computer-based algorithm.This study was carried out during 2003 and 2004 in a demographic surveillance area in the Matlab rural sub-district of eastern Bangladesh. The surveillance system covers a population of ~220,000 and is maintained by ICDDR,B. Community health workers (CHRW) visit each household monthly to record vital demographic, morbidity and health care seeking data. Half of the surveillance population receives MCH-FP services from ICDRR,B (ICDDR,B service area) and the remaining half receives standard government services (government service area).Verbal autopsies, consisting of retrospective interviews with caregivers of recently deceased neonates about the circumstances leading to their death, were carried out by the staff trained in verbal autopsy. The interviews were held with the mothers of all deceased neonates (n=365) who had died during 2003 and 2004. The verbal autopsy data were then independently reviewed by three physicians and a medical assistant to assign a direct cause of death and an originating cause of death. A computer algorithm using evidence-based clinical signs and/or symptoms was also used for assigning cause of death. Agreement of at least two of the three physicians was used to determine direct causes of death. Diagnostic accuracy and reliability of medical assistant and algorithm in assigning direct cause of death were evaluated by comparing with the diagnoses provided by the physicians. Linked epidemiological data on all live births in the Matlab area during 2003 and 2004 were also analysed.There were 365 deaths among the 11,291 live births recorded during 2003 and 2004, yielding a neonatal mortality rate (NMR) of 32.3 per 1000 live births. The NMR was lower in the ICDDR,B area compared to the government area. Of all neonatal deaths, 37% occurred within 24 hours, 76% within three days, 84% within seven days, and the remaining 16% between eight and 28 days of birth.Five causes accounted for 85% of the deaths: birth asphyxia (45%), prematurity/low birth weight (LBW) (15%), sepsis/meningitis (12%), respiratory distress syndrome (7%), and pneumonia (6%). The majority of neonatal death cases were low birth weight (56%) and singleton births (82%). There were some differences in the distribution of causes of death between the ICDDR,B and government areas, the most notable being prematurity/LBW which was twice as common in the ICDDR,B area than in government area.Strikingly, more than a third (37%) of the deceased neonates had not been taken to any source of health care for the fatal illness episode, and another quarter (25%) sought care from traditional healers or from unqualified practitioners. Only 37% sought modern biomedical care from a doctor or paramedic.Among the 365 neonatal deaths, a much higher proportion (48.5%) of the deliveries occurred at a health facility in the ICDDR,B area, compared to 15.3% in the government area. Vaginal delivery was the commonest mode of delivery in both areas, with a higher proportion of caesarean sections in the ICDDR,B area (9.3%) compared with the comparison government area (1.6%).The verbal autopsy method appears to be highly effective in that agreement on a direct cause of death was reached by at least two physicians in 339 (93%) cases. Using the physician review as the gold standard, the medical assistant review of causes of death demonstrated a sensitivity ranging from 47.7% to 83.5% depending on the cause of death, a specificity ranging from 93.0% to 97.5%, and kappa values ranging from 0.51 to 0.77. Similarly, depending on the cause of death, algorithm demonstrated a sensitivity ranging from 35.6% to 77.4%, specificity ranging from 86.8% to 95.9%, and kappa values ranging from 0.24 to 0.69.Independent predictors of neonatal mortality included lack of maternal education, single parity, and lack of antenatal care (ANC) during the last trimester. Male sex of the neonate, multiple births, and facility-based delivery were also significantly associated with excess neonatal mortality.In conclusion, the study highlighted the central role of birth asphyxia, prematurity/LBW, and sepsis/meningitis in neonatal deaths, indicating that the core of interventional packages to prevent neonatal deaths in rural Bangladesh should incorporate these causes. Community awareness about early care seeking, skilled attendance at delivery, and training and integration into mainstream services of traditional/unqualified care practitioners are some of the approaches needed to reduce neonatal mortality further. Improving access to female education and antenatal care would also have beneficial effects on neonatal survival.This study revealed the value of both review by medical assistant and computerbasedalgorithm to reliably assign major causes of neonatal deaths from verbalautopsy data. Further research could be undertaken to develop optimal combinationsof the medical assistant and hierarchical algorithm for assigning major causes ofdeath in low-resource settings such as Matlab.

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Santos, Patricia Carla dos. « Análise socioespacial dos nascimentos, óbitos neonatais e fetais ocorridos no município de São Paulo em 2010 ». Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/6/6132/tde-17052017-164401/.

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Introdução - O estudo de eventos de saúde deve levar em conta que as características dos indivíduos de uma determinada localidade não constituem simples somatórios das medidas de cada um dos sujeitos e há que se considerar um modelo explicativo baseado em níveis de organização e na estrutura de dependência entre o nível individual e o nível de contexto onde esses sujeitos estão inseridos. Assim, a análise dos nascimentos e da mortalidade neonatal e fetal pode incorporar diferentes variáveis associadas ao contexto onde se expressam considerando a complexidade e as particularidades dessas ocorrências numa população e num espaço tão diverso. Metodologia - Foi realizado estudo transversal dos nascimentos, óbitos neonatais (<28 dias de vida) e óbitos fetais de mães residentes e ocorridos no município de São Paulo. Os endereços de residência materna foram geocodificados e foi calculada a distância entre as residências e o hospital de ocorrência. Além disso, cada indivíduo foi caracterizado com informações socioeconômicas do Censo Demográfico de 2010, segundo área de Ponderação. Os setores censitários de residência foram classificados segundo Índice Paulista de Vulnerabilidade Social IPVS. Os hospitais foram classificados em SUS e não SUS e para os Nascidos Vivos (e óbitos neonatais) também foram classificados segundo referência para atendimento de risco gestacional. Foram obtidos aglomerados de Nascidos Vivos (NV) através da técnica de varredura espacial. Através de análise multinível foi verificado o efeito do contexto socioeconômico na mortalidade neonatal e fetal. Resultados - Verificou-se que os aglomerados tanto SUS como não SUS não são homogêneos entres si, com diferenças em relação à idade das mães, escolaridade, número de consultas pré-natal e prematuridade. A distância média teórica percorrida pelas mães até o hospital foi 51,8% menor nos aglomerados SUS que nos não SUS. A menor distância nos nascimentos SUS indica a regionalização da assistência ao parto no município de São Paulo. Os resultados mostraram que há um aumento da taxa de mortalidade neonatal com o aumento da vulnerabilidade social. Houve um efeito contextual da vulnerabilidade social e observa-se que apenas as variáveis individuais que representam as características da gestação, recém-nascido e assistência pré-natal mostraram-se associadas à mortalidade neonatal. O efeito contextual da vulnerabilidade social nas variáveis individuais que representam as características da gestação, feto e escolaridade materna mostrou-se associadas à mortalidade fetal. Na modelagem multinível não foi observada variabilidade importante da mortalidade fetal entre os níveis. Conclusões - A detecção de aglomerados e sua caracterização socioeconômica das áreas contribuem para o entendimento do padrão de nascimentos e nas intervenções de saúde pública, proporcionando melhoria no atendimento das necessidades de acesso ao pré-natal e parto de forma mais eficiente. Os resultados em relação à mortalidade neonatal e fetal revelam que as desigualdades sociais estão presentes na cadeia causal desses dois desfechos e o que contribui com a compreensão dos fatores de risco para a mortalidade neonatal e fetal, principalmente no que diz respeito à participação da vulnerabilidade social na mortalidade e explicita a distância entre a residência materna e o hospital como um indicador socioeconômico
Introduction - The study of health events should take into account that the characteristics of the individuals of a given locality are not simple sums of the measures of each one of the subjects and it is necessary to consider an explanatory model based on levels of organization and the structure of dependence between the Individual level and the context level where these subjects are inserted. Thus, the analysis of neonatal and fetal births and mortality can incorporate different variables associated to the context considering the complexity and the peculiarities of these occurrences in a population and in such a diverse space. Methodology - A cross-sectional study of births, neonatal deaths (<28 days of life) and fetal deaths of resident mothers occurred in the city of. The maternal residence addresses were geocoded to calculate the distance between the residences and the hospital. In addition, each individual was characterized with socioeconomic information from the Demographic Census of 2010, according to the weighting areas. The census tracts of residence were classified according to Index of Social Vulnerability - IPVS. Hospitals were classified in SUS and non-SUS and for live births (and neonatal deaths) were also classified according to reference for gestational risk care. The clusters of live births (LB) were obtained through the spatial sweep technique. The effect of the socioeconomic context on neonatal and fetal mortality was verified by multilevel analysis. Results - It was verified that the clusters both SUS and non-SUS are not homogeneous between them, with differences in relation to the mothers\' age, schooling, number of prenatal consultations and prematurity. The mean theoretical distance traveled by the mothers to the hospital was 51.8% lower in the SUS clusters than in the non-SUS. The shorter distance in SUS births indicates the regionalization of childbirth care in the city of São Paulo. The results showed that there is an increase in the neonatal mortality rate with increased social vulnerability. There was a contextual effect of social vulnerability and it was observed that only the individual variables that represent the characteristics of gestation, newborn and prenatal care were shown to be associated with neonatal mortality. The contextual effect of social vulnerability on the individual variables that represent the characteristics of gestation, fetus and maternal schooling has been shown to be associated with fetal mortality. In the multilevel modeling whose context was the level of vulnerability of the place of maternal residence, no significant variability of fetal mortality between the levels was observed. Conclusion - The detection of clusters and their socioeconomic characterization of the areas contribute to the understanding of the birth pattern and the public health interventions, providing an improvement in the attendance of prenatal access and delivery needs in a more efficient way. The results in relation to neonatal and fetal mortality reveal that social inequalities are present in the causal chain of these two outcomes and that contributes to the understanding of the risk factors for neonatal and fetal mortality, especially with regard to the participation of social vulnerability In mortality and explicit the distance between the maternal residence and the hospital as a socioeconomic indicator

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Hofer, Amanda. « Causes and circumstances of neonatal deaths in 108 consecutive cases over a 10-year period at the children's hospital of Lucerne, Switzerland / ». [S.l.] : [s.n.], 2009. http://www.ub.unibe.ch/content/bibliotheken_sammlungen/sondersammlungen/dissen_bestellformular/index_ger.html.

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Sleutjes, Fernanda Cristina Manzini [UNESP]. « Avaliação dos óbitos neonatais no Departamento Regional de Saúde VI - Bauru ». Universidade Estadual Paulista (UNESP), 2011. http://hdl.handle.net/11449/106049.

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Investigar os óbitos neonatais pode ser uma importante estratégia para redução da mortalidade infantil e fetal, pois contribui para melhorar a qualidade da informação sobre esse evento adverso e possibilita a adoção, pelos serviços de saúde, de medidas para a prevenção de óbitos evitáveis. Objetivo Geral: avaliar os óbitos neonatais investigados no Departamento Regional de Saúde VI – Bauru, considerando-se os Colegiados de Gestão Regional, no ano de 2009. Metodologia: estudo descritivo e transversal, que analisou 162 óbitos investigados, a partir das informações digitadas no Sistema de Informações sobre Mortalidade Neonatal (SIM-Neo). Os resultados são apresentados de forma descritiva e a partir de escore síntese que considerou a qualidade da atenção ao pré-natal, ao parto e ao recém-nascido; fatores de risco pré-natal, no parto e com relação ao recém-nascido e situação sociodemográfica materna. Para análise dos escores foi ajustado um modelo para proporções do tipo logístico, considerando Colegiados e categorias como efeitos principais e a interação Colegiados versus categorias. Resultados: passaram por alguma investigação 88,5% dos óbitos ocorridos e 67,3% tiveram investigação completa. A análise dos escores relativos à qualidade da atenção pré-natal evidenciou diferença quando se consideraram os piores resultados (escore menores que cinco), sendo o Colegiado Vale do Jurumirim diferente e melhor que o de Bauru e o de Lins. Com relação à qualidade da assistência ao parto, houve diferença quando se compararam os Colegiados Vale do Jurumirim, Bauru e Cuesta Botucatu com Lins, sendo pior a situação de Lins. Para a qualidade da atenção ao neonato, os Colegiados de Bauru e Jaú diferiram e foram melhores que o Vale do Jurumirim. Quanto ao risco do neonato, o Colegiado Vale do Jurumirim...
Introduction: Investigating neonatal deaths can be an important strategy to reduce child and fetal mortality as it contributes to improve the quality of information on such adverse event and allows for the adoption of measures for prevention of evitable deaths by health care services. Objective: To evaluate neonatal deaths investigated at the Regional Health Department VI (DRS VI) – Bauru by taking into account the Regional Management Collegiates in 2009. Methodology: This is a descriptive crosssectional study that analyzed 162 deaths investigated from the information entered on the Neonatal Mortality Information System (SIM-Neo). Results are presented in a descriptive fashion and based on a synthesis score which considered the quality of prenatal care, the care to delivery and the care to newborns; prenatal risk factors, delivery risks and those related to newborns as well as maternal sociodemographic conditions. For score analysis, a logistic model was fitted for proportions by taking into account Collegiates and categories as main effects and the Collegiate-versuscategory interaction. Results: 88.5% of the occurring deaths underwent some investigation, and 67.3% were completely investigated. The analysis of the scores related to the quality of prenatal care showed difference when the worse scores (scores lower than five) were considered, and Vale do Jurumirim Collegiate was different and better than those in Bauru and Lins. As regards the quality of care to delivery, difference was found when comparing the Collegiates in Vale do Jurumirim, Bauru and Cuesta Botucatu with that in Lins, and Lins showed the worst situation. As for the quality of care to neonates, the Collegiates in Bauru and Jau differed and were better than that in Vale do Jurumirim. Concerning risk to neonates, the Collegiate... (Complete abstract click electronic access below)

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Nuuyoma, Vistolina Nenayishula. « An exploration of perceptions regarding the feasibility of implementation of Kangaroo Mother Care in the maternity ward of Tsumeb district hospital, Namibia ». Thesis, University of the Western Cape, 2012. http://hdl.handle.net/11394/5135.

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Magister Public Health - MPH
Background: Every year, about 20 million infants are born with low birth weight globally, putting a heavy burden on health care and social systems, especially in developing countries as they are often understaffed and/or lack optimally functional equipment. In 1978, Dr E. Rey proposed the Kangaroo Mother Care (KMC) programme which was further developed by coworkers at one of the largest obstetric facilities in Santa Fe de Bogotá, Colombia. KMC was introduced as an alternative to the expensive and seldom used traditional methods to care for low birth weight infants. KMC is currently not practised at Tsumeb district hospital despite many infants born with low weight in the district. Aim: The aim of the study was to explore perceptions regarding the implementation of Kangaroo Mother Care in the maternity ward of Tsumeb district hospital. Study design: This was a qualitative exploratory study. Study population and sampling: The study population are doctors and nurses working in Tsumeb district, the Chief Medical Officer (CMO) as well as the health programme administrators in the family health division of the Ministry of Health and Social Services (MOHSS), Oshikoto region. Purposive sampling was used to select participants. Results: Perceptions were grouped into three main themes namely the parent-related, health worker-related and baby-related. Parent-related perceptions include self-trust, increased competency, less frustration, and active involvement of parents in baby care, which are similar to the literature and regarded as benefits of KMC. Health worker-related perceptions included both reduced workload and an increased workload. Baby-related perceptions are reduced morbidity, increased bonding and improved care. The study also revealed the barriers to KMC implementation as well as factors that can make KMC implementation a success. Conclusions: Three broad themes emerged from the study, parent-related, health worker-related and baby-related. Most of the health workers’ perceptions are similar to the benefits of KMC found in the literature but, some health workers have negative perceptions regarding KMC.

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Sleutjes, Fernanda Cristina Manzini. « Avaliação dos óbitos neonatais no Departamento Regional de Saúde VI - Bauru / ». Botucatu : [s.n.], 2011. http://hdl.handle.net/11449/106049.

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Orientador: Cristina Maria Garcia de Lima Parada
Banca: Maria Antonieta de Barros Leite Carvalhaes
Banca: Luana Carandina
Banca: Marilisa Barros
Banca: Maria José Clapis
Resumo: Investigar os óbitos neonatais pode ser uma importante estratégia para redução da mortalidade infantil e fetal, pois contribui para melhorar a qualidade da informação sobre esse evento adverso e possibilita a adoção, pelos serviços de saúde, de medidas para a prevenção de óbitos evitáveis. Objetivo Geral: avaliar os óbitos neonatais investigados no Departamento Regional de Saúde VI - Bauru, considerando-se os Colegiados de Gestão Regional, no ano de 2009. Metodologia: estudo descritivo e transversal, que analisou 162 óbitos investigados, a partir das informações digitadas no Sistema de Informações sobre Mortalidade Neonatal (SIM-Neo). Os resultados são apresentados de forma descritiva e a partir de escore síntese que considerou a qualidade da atenção ao pré-natal, ao parto e ao recém-nascido; fatores de risco pré-natal, no parto e com relação ao recém-nascido e situação sociodemográfica materna. Para análise dos escores foi ajustado um modelo para proporções do tipo logístico, considerando Colegiados e categorias como efeitos principais e a interação Colegiados versus categorias. Resultados: passaram por alguma investigação 88,5% dos óbitos ocorridos e 67,3% tiveram investigação completa. A análise dos escores relativos à qualidade da atenção pré-natal evidenciou diferença quando se consideraram os piores resultados (escore menores que cinco), sendo o Colegiado Vale do Jurumirim diferente e melhor que o de Bauru e o de Lins. Com relação à qualidade da assistência ao parto, houve diferença quando se compararam os Colegiados Vale do Jurumirim, Bauru e Cuesta Botucatu com Lins, sendo pior a situação de Lins. Para a qualidade da atenção ao neonato, os Colegiados de Bauru e Jaú diferiram e foram melhores que o Vale do Jurumirim. Quanto ao risco do neonato, o Colegiado Vale do Jurumirim... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Introduction: Investigating neonatal deaths can be an important strategy to reduce child and fetal mortality as it contributes to improve the quality of information on such adverse event and allows for the adoption of measures for prevention of evitable deaths by health care services. Objective: To evaluate neonatal deaths investigated at the Regional Health Department VI (DRS VI) - Bauru by taking into account the Regional Management Collegiates in 2009. Methodology: This is a descriptive crosssectional study that analyzed 162 deaths investigated from the information entered on the Neonatal Mortality Information System (SIM-Neo). Results are presented in a descriptive fashion and based on a synthesis score which considered the quality of prenatal care, the care to delivery and the care to newborns; prenatal risk factors, delivery risks and those related to newborns as well as maternal sociodemographic conditions. For score analysis, a logistic model was fitted for proportions by taking into account Collegiates and categories as main effects and the Collegiate-versuscategory interaction. Results: 88.5% of the occurring deaths underwent some investigation, and 67.3% were completely investigated. The analysis of the scores related to the quality of prenatal care showed difference when the worse scores (scores lower than five) were considered, and Vale do Jurumirim Collegiate was different and better than those in Bauru and Lins. As regards the quality of care to delivery, difference was found when comparing the Collegiates in Vale do Jurumirim, Bauru and Cuesta Botucatu with that in Lins, and Lins showed the worst situation. As for the quality of care to neonates, the Collegiates in Bauru and Jau differed and were better than that in Vale do Jurumirim. Concerning risk to neonates, the Collegiate... (Complete abstract click electronic access below)
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Campos, Jocileide Sales. « Integralidade da atenção e evitabilidade de óbitos perinatais no Município de Fortaleza - Ceará ». Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/6/6132/tde-20042011-133706/.

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Introdução: Conquistar a integralidade, a mais complexa diretriz do SUS, se constitui um permanente desafio, visto que, ao contrário da universalidade do acesso e da descentralização, parece, ainda, distante de ser alcançada. Objetivo: Caracterizar óbitos perinatais ocorridos em residentes em Fortaleza, 2006, para compreender o potencial da integralidade da atenção no sistema local de saúde. Métodos: Foram utilizados métodos complementares de pesquisa - quantitativa e qualitativa. Na abordagem qualitativa realizaram-se entrevistas individuais às mães de crianças que sobreviveram ao período neonatal e mães que perderam seus conceptos no período perinatal. Estudo transversal que incluiu o universo dos óbitos perinatais, a partir de dados dos sistemas oficiais de informação sobre mortalidade e sobre nascidos vivos e do relacionamento de dados entre os mesmos, consubstanciou a pesquisa quantitativa. Resultados e Discussão: A taxa de mortalidade perinatal foi 17,0/1000 nascidos totais - 8,2 para óbitos fetais e 8,8 para neonatais precoces. As principais causas encontradas foram: asfixia (24por cento ) - 4 vezes maior entre natimortos; baixo peso ao nascer cuja mortalidade foi 30 vezes maior entre os 25por cento com menos de 2500g; prematuridade (32,4por cento ); malformações congênitas (9,5por cento ) e infecções (7,0por cento ) inclusive 03 casos de sífilis congênita. Fatores de risco potenciais, como idade da mãe de 10 -14 anos, mais freqüente entre óbitos neonatais precoces, e de 35 e mais anos entre os fetais. A mortalidade foi mais alta (98,0/1000 nascidos totais) entre filhos de mães com nenhuma escolaridade - risco potencial importante - cuja elevada freqüência foi também percebida nas entrevistas que, por sua vez, evidenciaram uma categoria acrescentada ao estudo: a relação médico-paciente, considerada falha e desatenciosa, na percepção das mães, quanto aos esclarecimentos sobre alto risco na gestação e no parto. Destacou-se, ainda, o sentimento das mães sobre a falta da visita domiciliar na gravidez e de acompanhante no parto. Conclusões e algumas considerações: A baixa escolaridade pareceu um critério de 9 evitabilidade mais apropriado para uso em países em desenvolvimento, como o Brasil, do que aqueles da classificação de Wigglesworth, inclusive de acesso mais complexo nestes países. Para gestantes com baixa ou nenhuma escolaridade, o sistema de saúde poderia ofertar atenção especial, fortalecendo atividades educativas, adotando a interconsulta especializada e acompanhante no parto
Introduction - To achieve the integrality (comprehensive health care), the more complex SUS guideline, is an ongoing challenge, because, unlike the universality of access and decentralization, it still seems very far. Objective - To characterize perinatal deaths occurred among residents in Fortaleza, 2006, in order to understand the potential of the integrality of the care in the health system. Methods - It was adopted both, quantitative and qualitative methodologies that are complementary one to another. In the qualitative approach, individual interviews were carried out to mothers of children who survived the neonatal period and mothers who lost their babies in the perinatal period. A cross-sectional study that included the universe of perinatal deaths, based on data from official systems of information on births and deaths and also using the relationship of data between them, embodied quantitative research. Results and discussion - The perinatal mortality rate was 17.0 / 1,000 births - 8.2 to 8.8 for stillbirths and early neonatal deaths, respectively. The main causes were: asphyxia (24per cent ) - four times higher among stillbirths; low birth weight whose mortality was 30 times higher among the 25per cent weighting less than 2500g; prematurity (32.4per cent ); congenital malformations (9.5per cent ) and infections (7.0per cent ) including three cases of congenital syphilis. Potential risk factors such as maternal age of 10 -14 years old, more frequent among early neonatal deaths, while the fetal deaths occurred more among mothers are 35 and more. Mortality was highest (98.0/1,000 births) among children of mothers with no education - important potential risk factor which high frequency was also seen among the interviewee that, in turn, added a new category to the study as doctor-patient relationship considered failure and disrespectful on the perception of mothers regarding the details of high risk in pregnancy and childbirth. Was highlighted, too, the feeling of mothers about the lack of home visit by community health work during pregnancy and, also, of companion at childbirth. Conclusion and considerations - The low 11 educational level seemed a criterion more suitable for use in developing countries like Brazil, to avoid perinatal deaths, than those of Wigglesworth\'s classification, which is more difficult to obtain in these countries. For pregnant women with low/no education, the health system could strength health educational activities, adopt specialized attention and companion at hospital

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Stephansson, Olof. « Epidemiological studies of stillbirth and early neonatal death / ». Stockholm, 2002. http://diss.kib.ki.se/2002/91-7349-143-8.

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Devlin, Rosemary. « Miscarriage, stillbirth and neonatal death : a midwifes perspective ». Thesis, Queen's University Belfast, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.324953.

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Carter, Ashley. « Fetal and early neonatal death : Do the determinants vary ? » VCU Scholars Compass, 2008. http://scholarscompass.vcu.edu/etd/1659.

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Purpose: To compare the determinants and distribution of fetal and early neonatal deaths in the Commonwealth of Virginia. Background: Much attention is devoted to reducing the infant mortality rate which was declining up until 2002. The recent rise was parsed and found to stem from an increase in deaths during the early neonatal period. Fetal deaths are not well understood and are not routinely included when evaluating infant mortality. Methods: Using data collected from 2001 to 2006 fetal death and linked infant birth and death certificates by the Virginia Department of Health, crude mortality rates and leading causes of death were calculated for fetal and early neonatal mortality. Rates were calculated for each period of death by locality and mapped to determine if the distribution differed. Logistic regression was also used to evaluate sociodemographic and pregnancy risk factors and chi-square analyses were used to determine if the determinants varied significantly by timing of death outcome. Results: During the study period, the fetal death rate was 5.4 per 1,000 fetal deaths plus live births, the early neonatal death rate was 2.5 deaths per 1,000 live births and perinatal mortality rate was 7.9 deaths per 1,000 fetal deaths plus live births. Trends over time, gestational age specific mortality, geographic distribution, cause of death and many determinants were comparable between both death periods. Extremely low birth weight was the most significant risk factor for early neonatal death (OR = 1747.06). Congenital anomalies of the child were the leading predictor of fetal death (OR = 26.24, 95% CI: 19.62, 35.10) and second highest for early neonatal death (OR = 52.26, 95% CI: 35.21, 77.56). Conclusions: Because of the similarities in geographic distribution, sociodemographic factors, pregnancy risk factors and causes of death, analyzing neonatal and infant mortality rates in isolation from fetal deaths does not accurately depict the burden of adverse pregnancy outcomes.

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Nichols, Lee Anne 1957. « The hardest moment : How nurses adapt to neonatal death ». Thesis, The University of Arizona, 1987. http://hdl.handle.net/10150/291853.

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Thirteen nurses were interviewed over an eight week period to explore their adaptive responses to neonatal death. A process of adaptation was identified that included several phases through which these nurses proceeded before they finalized the death experience for themselves. These phases included responses to the resuscitation of the infant; the measures taken to console the bereaved parents; feelings associated with difficult moments during the dying process; the behaviors utilized to strengthen themselves before and after the death; reactions to the silence in the unit that occurred afterwards; the values they discovered when reflecting on how the death was handled; and the development of a philosophical meaning from their experiences. Data were collected and analyzed using grounded theory methodology.

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Biswas, Animesh. « Maternal and Neonatal Death Review System to Improve Maternal and Neonatal Health Care Services in Bangladesh ». Doctoral thesis, Örebro universitet, Institutionen för hälsovetenskap och medicin, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-46379.

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Bangladesh has made encouraging progress in reducing maternal and neonatal mortality over the past two decades. However, deaths are much higher than in many other countries. The death reporting system to address maternal, neonatal deaths and stillbirths is still poor. Moreover, cause identification for each of the community and facility deaths is not functional. The overall objective of this thesis is to develop, implement and evaluate the Maternal and Neonatal Death Review (MNDR) system in Bangladesh. The study has been conducted in two districts of Bangladesh. A mixed method is used in studies I and II, whereas a qualitative method is used in studies III-V, and cost of MNDR is calculated in study VI. In-depth interviews, focus group discussions, group discussions, participant observations and document reviews are used as data collection techniques. Quantitative data are collected from the MNDR database. In study I, community death notification in the MNDR system was found to be achievable and acceptable at district level in the existing government health system. A simple death notification process is used to capture community-level maternal and neonatal deaths and stillbirths. It was useful for local-level planning by health managers. In study II, death-notification findings explored dense pocket areas in the district. The health system took local initiatives based on the findings. This resulted in visible and tangible changes in care-seeking and client satisfaction. Death numbers in 2012 were reduced in comparison with 2010 in the specific area. In study III, verbal autopsies at community level enabled the identification of medical and social causes of death, including community delays. Deceased family members cordially provided information on deaths to field-level government health workers. The health managers used the findings for a remedial action plan, which was implemented as per causal findings. In study IV, social autopsy highlights social errors in the community, and promotes discussion based on a maternal or neonatal death, or stillbirth. This was aneffective means to deliver some important messages and to sensitize the community. Importantly, the community itself plans and decides on what should be done in future to avert such deaths. In study V, facility death review of maternal and neonatal deaths was found to be possible and useful in upazila and district facilities. It not only identified medical causes of death, but also explored gaps and challenges in facilities that can be resolved. The findings of facility death reviews were helpful to local health mangers and planners in order to develop appropriate action plans and improve quality of care at facility level. Finally, in study VI, the initial piloting costs required for MNDR implementation were estimated, including large capacity development and other developmental costs. However, in the following year, costs were reduced. Unit cost per activity was 3070 BDT in 2010, but, in the following years, 1887 BDT and 2207 BDT, in 2011 and 2012 respectively.

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Howat, William James. « The pulmonary immunopathology of sudden infant death syndrome ». Thesis, University of Southampton, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.241962.

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Conry, Jennifer Robyn. « Mothers' experiences of accessing services following the death of a baby through stillbirth or neonatal death ». Diss., Pretoria : [s.n.], 2006. http://upetd.up.ac.za/thesis/available/etd-04172007-122705.

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Jones, Kerry Sian. « Parental perspectives on grief and loss following stillbirth and neonatal death ». Thesis, University of Bristol, 2010. http://hdl.handle.net/1983/b7f9dfed-a7a0-45f3-89be-eefdbc1ab356.

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This research explores men and women's experience of grief and loss following stillbirth and neonatal death. Utilising existing literature and empirical research with twenty-seven bereaved parents, I argue that stillbirth and neonatal death represents a tragedy to these men and women, yet, its impact has been sequestered both practically and theoretically by medical and psychological and other scholarly discourses of bereavement. Such notions of grief are characterised by their rationality and represented as a series of stages, each comprising of tasks and goals for the bereaved to work through. The data collected about experiences of loss suggests that a way of understanding the impact of such deaths must go beyond professional approaches to grief and instead focus upon the way men and women narrate their experience. I suggest that the meaning given to the experience of loss can be deconstructed by taking account of the varying forms of expressing such experience (such as writing, talking, art, poetry). I demonstrate that men and women experience not only the emotional pain of loss but also struggle with their embodied identity as a parent. I argue that this is mediated by the social networks to which bereaved parents belong and according to the dominant discourses (such as medicine and expected notions of motherhood and fatherhood) and wider political and social structures (such as employment) to which bereaved parents' relate. These findings constitute an understanding of loss which reflects and conflicts with the findings of other research. In so doing, this study contributes to more succinct knowledge concerning perinatal loss, embodied lived experiences and women as well as men's accounts which I argue is overlooked in the literature. The thesis concludes with policy recommendations which include ongoing bereavement training for health professionals, the development of specialist bereavement midwives and for the provision of care which reflects bereaved parent's gendered socio economic and cultural needs.

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Pahal, Narinder Kaur. « A morphometric study of the phrenic nerve and diaphragm during late gestational and neonatal development ». Thesis, Liverpool John Moores University, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.361503.

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Fortney, Christine A. « Evaluating Quality of Death at the End of Life in Neonates in the NICU ». The Ohio State University, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=osu1354656849.

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Almeida, Marcia Furquim de. « Mortalidade neonatal em Santo André ». Universidade de São Paulo, 1995. http://www.teses.usp.br/teses/disponiveis/6/6132/tde-24102014-152306/.

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O objetivo da tese é descrever uma coorte de nascidos vivos e os óbitos neonatais dela derivados e estimar as probabilidades de morte segundo características do recém-nascido, da gestação, do parto e da mãe, bem como das causas de morte. Utilizou-se como fonte de obtenção de dados as Declarações de Nascido Vivo (DN) e de Óbito (DO),documentos básicos dos Sistemas Oficiais de Informação do país. A coorte foi formada por 3225 nascimentos vivos de mães residentes e ocorridos no Munícipio de Santo André, no 1º semestre de 1992. Para a identificação dos óbitos neonatais foi empregada a técnica de \"linkage\", pareando-se as DO com as respectivas DN, obtendo-se 55 óbitos neonatais. A proporção de nascidos vivos de baixo peso ao nascer foi de 6,8 por cento . Obteve-se associação estatisticamente significativa para os nascidos vivos de baixo peso e a presença de gestações de pré-termo, parto normal e cujo nascimento havia ocorrido no hospital público do SUS. Este hospital é referência para as gestações de risco do municipio. Essa associação estava presente também nos recém-nascidos de mães adolescentes e idosas e nos de mães prímiparas ou grandes multíparas. Não se encontrou associação entre o baixo peso ao nascer e sexo, bem como com a variável anotação do nome do pai na DN. Os óbitos concentraram-se no 10 dia de vida (54,5 por cento ).Verificou-se que 94,6 por cento das crianças morreram sem que estas tivessem deixado o hospital após o nascimento. Com relação às causas básicas de morte, as mais frequentes foram as afecções perinatais. A análise das causas múltiplas permitiu uma melhor avaliação da participação da imaturidade/prematuridade e das infecções perinatais no processo que levou a morte. Estas causas estiveram presentes como causa básica ou associada em 63,6 por cento e 25,5 por cento dos óbitos, respectivamente. Os fatores de risco para os óbitos neonatais foram baixo peso ao nascer, gestações de pré-termo e a ausência do registro do nome do pai. Os partos cesareanos foram considerados como fator de confusão para o risco de morte neonatal, o efeito protetor destes partos desapareceu ao se controlar o peso ao nascer. O maior risco de morte encontrado nos nascimentos no hospital público do SUS também deixou de existir ao se controlar a variável peso. Observou-se um risco de morte significativamente maior para os nascidos vivos de baixo peso do sexo masculino que nos do sexo feminino. A categoria de recém-nascidos de baixo peso e de pré-termo apresentou risco de morte 82 vezes maior que os de termo com peso igual ou superior a 2500 gramas. Não se encontrou um risco de morte significativo para os nascidos vivos de mães primíparas ou grandes multíparas e de mães adolescentes ou idosas em relação aos recém-nascidos de mães multíparas e com idade entre 20 e 34 anos. Foram considerados como nascidos vivos de risco os nascimentos de baixo peso. Observou-se um risco de morte significativamente maior por anomalias congênitas e afecções perinatais nos nascimentos de baixo peso que entre aqueles que tinham peso igual ou acima de 2500 gramas. O risco de morte por infecções perinatais foi 94,0 vezes maior nesse grupo de recém-nascidos. Os nascidos vivos de baixo peso do sexo masculino apresentaram uma chance 3,6 vezes mais elevada de morrer por afecções respiratórias que os do sexo feminino deste grupo. Os dados obtidos sugerem que muitos destes óbitos poderiam ter sido evitados se houvesse uma melhor identificação das gestações de risco no pré-natal e fosse assegurada uma adequada atenção ao parto e aos recém-nascidos, bem como indicam que nem todos recém-nascidos de risco receberam os cuidados nescessários após o parto.
A cohort of live births was analysed and the risk of death according to some variables was estimated. The data was obtained from the birth and death certificates. The records were linked, and each death was matched with the birth certificate, in order to identify the neonatal deaths and the survivals of the cohort. It was studied 3,225 live borns of resident mothers of the Santo André Municipality. The births occurred in this area from 01/101/1992 to 06/30/1992. The incidence of low birthweight was 6.8 per cent and the proportion of preterm infants was 5.3 per cent . The low birthweight was associated to the preterm gestation, vaginal deliveries, and to the births which occurred on the SUS public hospital. There was also an association between the low birthweight and the live borns from adolescent and older mothers. The low and high parity were risk factors to the low birthweight. The abscence of notation of the father\'s name on the birth certificate was not associated to the low birthweight. The deaths occurred mainly in the first day of the life (54.5 per cent ) . The data showed that 94.6 per cent of the infant deaths occurred before hospital discharge . The perinatal afections were the leading cause of death. The prematurity/imaturity was assigned as underlying or associated cause in 63.6 per cent of the deaths and the perinatal infections in 25.5 per cent of these deaths. It was found a higher risk of death in low birthweight and preterm newborns and in infants with abscence of the father\'s name on the birth certificate. The cesarean section deliveries showed to be a confounding factor to the neonatal deaths, as well as, the type of the hospital in which the infants were deliveried. The male low birthweight infants presented higher risk of death than the female infants. The low birthweight and preterm babies showed a 82 times higher risk of dying than the normal weight and term infants. The low birthweight newborn showed a higher risk of death from congenital anommalies and perinatal afections. This group of live births, also presented a risk of death from perinatal infections 94.0 times higher than the normal weight babies. The male low birthweigth infants presented 3.6 times higher chance of dying from perinatal respiratory afections than the female newborns of this group. These results suggest that some deaths could be avoided by adequate prenatal, delivery and neonatal care in the maternity wards. The high risk death found in the preterm and very low birth weight infants also suggest that some of these high risk newborns did not had access to neonatal intensive care.

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Shi, Ruoyang. « BNIP3 regulates excessive mitophagy in the delayed neuronal death in stroke ». Springer, 2012. http://hdl.handle.net/1993/23688.

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Autophagy is a physiological process by which the cell eliminates damaged organelles, toxic agents, and long-lived proteins by degradation through lysosomal system. Mitophagy, the specific autophagic elimination of mitochondria, regulates mitochondrial number to match metabolic demand and is a core machinery of quality control to remove damaged mitochondria. A neuroprotective role of physiological autophagy/mitophagy has been discovered. However, recent studies suggested that highly accelerated autophagy/mitophagy might contribute to neuronal death in various pathological situations including cerebral ischemia. In this study, we aimed to investigate the activation of excessive autophagy, particularly, the more specific mitophagy, in neuronal tissues and its contribution to ischemia/hypoxia (I/H)-induced delayed neuronal death. I/H injury was induced by oxygen and glucose deprivation (OGD) followed by reperfusion (RP) on primary cortical neurons in vitro. Cerebral ischemia was induced by unilateral common carotid artery occlusion and hypoxia in neonatal mice in vivo. In order to determine the extent to which autophagy contributes to neuronal death in cerebral ischemia, we performed multiple methods and found that in both primary cortical neurons and SH-SY5Y cells exposed to OGD for 6 h and RP for 24, 48, and 72 h, respectively, an increase of autophagy was observed as determined by the increased ratio of LC3-II to LC3-I and Beclin 1 expression. Using Fluoro-Jade C and monodansylcadaverine double-staining, and electron microscopy we found the increment in autophagy after OGD/RP was accompanied by increased autophagic cell death, and this increased cell death was inhibited by the specific autophagy inhibitor, 3-methyladenine. The presence of large autolysosomes and numerous autophagosomes in cortical neurons were confirmed by electron microscopy. Autophagy activities were increased dramatically in the ischemic brains 3-7 days postinjury from a rat model of neonatal cerebral I/H as shown by increased punctate LC3 staining and Beclin-1 expression. We thus obtained the conclusion that excessive activation of autophagy contributes to neuronal death in cerebral ischemia. BNIP3 (Bcl-2/adenovirus E19 kD interacting protein 3), a member of a unique subfamily of death-inducing mitochondrial proteins, is highly associated with mitochondrial dysfunction and delayed neuronal death in stroke. It is known that BNIP3-induced neuronal death is caspase-independent and characterized by early mitochondrial damage. Recent evidence suggested that the BNIP3 family of proteins might be important regulators of mitophagy. Here, using both stroke models, we found that homodimer (60 kD) of BNIP3/NIX (BNIP3L) were highly expressed in a ‘delayed’ manner. Particularly, significant mitophagic activation was confirmed by electron microscopy. In contrast, both neonatal mitophagy and apoptosis were significantly inhibited in the BNIP3 knockout (KO) mice after I/H, which was also accompanied by a significantly increased autophagic response. In addition, the infarct volume in the BNIP3 KO mice was significantly reduced as compared to wild-type (WT) mice after 7 or 28 days recovery, showing a prominent neuroprotection of BNIP3 gene silencing. A protein-to-protein interaction of mitochondria-localized BNIP3 (60 kD) with the autophagosome marker, LC3, was confirmed by co-ip, immunocytochemistry and further quantified by ELISA, indicating BNIP3 was an effective LC3-binding target on damaged mitochondria. These data demonstrated a novel role of BNIP3 in regulating neuronal mitophagy and cell death during ischemic stroke.

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Stefanus, Frieda N. « Understanding the perceptions of women who experienced any delay in accessing appropriate health care services during childbirth in Otjiwarongo district hospital, Namibia ». University of Western Cape, 2019. http://hdl.handle.net/11394/7646.

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Master of Public Health - MPH
Access to appropriate health care service during childbirth is a great challenge to many women in Africa and Namibia is no exception. More than 70% of women in Otjozondjupa region experienced some form of delay during childbirth, and while maternal mortality continued to rise over the years in Namibia it is currently at about 265/100 000, which is too high for a middle-income country. Hence, this study aimed to get a deeper understanding of the perceptions of women who experienced any of the three delays in accessing appropriate health care during childbirth in Otjiwarongo hospital.

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Stanley, Leisa J. « Association among neonatal mortality, weekend or nighttime admissions and staffing in a Neonatal Intensive Care Unit ». [Tampa, Fla.] : University of South Florida, 2008. http://purl.fcla.edu/usf/dc/et/SFE0002421.

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Thompson, Susannah Ruth. « Birth pains : changing understandings of miscarriage, stillbirth and neonatal death in Australia in the Twentieth Century ». University of Western Australia. School of Humanities, 2008. http://theses.library.uwa.edu.au/adt-WU2008.0150.

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Feminist and social historians have long been interested in that particularly female ability to become pregnant and bear children. A significant body of historiography has challenged the notion that pregnancy and childbirth considered to be the acceptable and 'appropriate' roles for women for most of the twentieth century in Australia - have always been welcomed, rewarding and always fulfilling events in women's lives. Several historians have also begun the process of enlarging our knowledge of the changing cultural attitudes towards bereavement in Australia and the eschewing of the public expression of sorrow following the two World Wars; a significant contribution to scholarship which underscores the changing attitudes towards perinatal loss. It is estimated that one in four women lose a pregnancy to miscarriage, and two in one hundred late pregnancies result in stillbirth in contemporary Australia. Miscarriage, stillbirth and neonatal death are today considered by psychologists and social workers, amongst others, as potentially significant events in many women's lives, yet have received little or passing attention in historical scholarship concerned with pregnancy and motherhood. As such, this study focuses on pregnancy loss: the meaning it has been given by various groups at different times in Australia's past, and how some Australian women have made sense of their own experience of miscarriage, stillbirth or neonatal death within particular social and historical contexts. Pregnancy loss has been understood in a range of ways by different groups over the past 100 years. At the beginning of the twentieth century, when alarm was mounting over the declining birth rate, pregnancy loss was termed 'foetal wastage' by eugenicists and medical practitioners, and was seen in abstract terms as the loss of necessary future Australian citizens. By the 1970s, however, with the advent of support groups such as SANDS (Stillbirth and Neonatal Death Support) miscarriage and stillbirth were increasingly seen as the devastating loss of an individual baby, while the mother was seen as someone in need of emotional and other support. With the advent of new prenatal screening technologies in the late twentieth century, there has been a return of the idea of maternal responsibility for producing a 'successful' outcome. This project seeks to critically examines the wide range of socially constructed meanings of pregnancy loss and interrogate the arguments of those groups, such as the medical profession, religious and support groups, participating in these constructions. It will build on existing histories of motherhood, childbirth and pregnancy in Australia and, therefore, also the history of Australian women.

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Goggin, Mary. « The lived experience of parents following the death of a twin in the perinatal neonatal period ». Thesis, University of Brighton, 2011. https://research.brighton.ac.uk/en/studentTheses/090ff076-bee3-4b7a-bc3f-2ec43498736e.

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This thesis reports a phenomenological study of seven parents’ lived experience following the death of a twin in the perinatal/ neonatal period. It gives consideration to the issues important to the study. It provides a literature search to situate the study in the field of evolving bereavement theory and in the context of twin loss. A number of questions have been raised that led to the formulation of the research question (page 63). The descriptive phenomenological methodology adopted provides a framework for my ontological and epistemological positions. Through the method of analysis of the data from semi-structured interviews, the essence of the phenomenon was elicited and the fundamental structure was established.

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Williamson, Melissa Grace. « Exploring midwives' experiences of managing patients' perinatal loss at a maternity hospital in the Western Cape, South Africa ». University of the Western Cape, 2016. http://hdl.handle.net/11394/5645.

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Magister Curationis - MCur
Perinatal deaths are emotion-laden events not only for the mothers, but also for physicians and midwives. Hence, mothers experiencing the phenomenon need support to overcome the experience. If the loss occurs in a health institution, the responsibility of supporting the woman is borne by healthcare providers, particularly midwives. However, limited information exists on how midwives manage patients who experience perinatal loss in health institutions. Consequently, this study on midwives' experiences of managing patients' perinatal loss at a maternity hospital in the Western Cape, South Africa was conducted. The aim of the study was to explore midwives' management of patients with perinatal loss. The study utilised a qualitative research design and employs a phenomenological approach. Purposive sampling was used to select eight registered midwives to participate in the study. Data was collected by means of in-depth unstructured interviews, which were audio-recorded. It was then analysed by utilising Colaizzi's (1978) steps of phenomenological data analysis. Four themes emerged from the data, namely, knowledge of perinatal loss, challenges when managing patients, managing perinatal loss, and getting emotionally involved. Themes were informed by several subthemes. In addition, implication on practice indicates that improving support to mothers with pregnancy loss requires a multi-disciplinary approach or teamwork from various professionals in order to enhance mutual collaboration between families and healthcare workers. The study concludes that nursing education programmes should be reviewed to ensure that they include midwives' needs in the area of managing clients experiencing a perinatal loss. Hence, student midwives should be given more clinical experience of caring for bereaved couples under supervision, as well as compassionate support, which would assist them to develop these skills before they graduate.

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Silva, Laura Pedroza da. « Mortalidade neonatal evitável, Espírito Santo, Brasil, 2007 a 2009 ». Universidade Federal do Espírito Santo, 2012. http://repositorio.ufes.br/handle/10/5678.

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Introdução: A investigação dos óbitos neonatais por causas evitáveis pode ser compreendida como um indicador sensível da qualidade da assistência à saúde de recém-nascidos. Objetivo: Avaliar a qualidade das informações e investigar os óbitos neonatais evitáveis segundo peso ao nascer, no estado do Espírito Santo, no período de 2007 a 2009, utilizando os bancos de dados do Sistema de Informação sobre Mortalidade e do Sistema de Informação sobre Nascidos Vivos. Metodologia: Estudo observacional descritivo; população estudada composta por nascidos vivos e óbitos neonatais. A qualidade dos dados foi avaliada em três dimensões: acessibilidade, oportunidade e completude. Utilizou-se critério de evitabilidade por intervenção do Sistema Único de Saúde e ponto de corte no peso em ≤ 1500g. Resultados: Os dados foram acessíveis e apresentaram defasagem de três anos em relação ao início do estudo. O Sistema de Informação sobre Mortalidade apresentou elevado percentual de dados faltantes nas variáveis, número da Declaração de Nascido Vivo, assim como escolaridade, idade e história reprodutiva da mãe. Os óbitos evitáveis responderam por 63% dos quais os associados a causas reduzíveis por atenção ao recém-nascido somaram 37%. Entre os óbitos com peso 1501g a 2499g destacaram-se os associados a causas evitáveis por atenção ao recém (42%) e a mulher na gestação (41%); e entre os óbitos com peso ≥ 2500g as causas evitáveis por atenção à mulher no parto (47%). Conclusões: Apesar das deficiências encontradas no Sistema de informação sobre Mortalidade, a utilização de dados secundários possibilitou compreender o cenário dos óbitos neonatais no Espírito Santo
Introduction: The investigation of avoidable neonatal deaths can be understood as a sensitive indicator of the quality of health care for newborns babies. Objective: Evaluate the quality of the information and investigate avoidable neonatal deaths according to birth weight in Espírito Santo state in the period from 2007 to 2009 using banks of Mortality Information System and System of Information on Live Births. Methodology: Descriptive observational study, the population was live births and neonatal deaths. The quality of data was evaluated in three dimensions: accessibility, timeliness and completeness. Used downward trend avoidable death by intervention of Brazilian Health System, and weight cutting point ≤ 1500g. Results: The data was accessible and presented three-year lag in relation to the beginning of the study. The SIM had high percentage of missing data presented on the number of DN, mother s age and schooling, and reproductive history. The avoidable deaths were 63%; the mean preventable cause was attention to newborn 37%. The deaths with weight 1501g to 2499g had avoidable causes by attention to newborn (42%) and women in pregnancy (41%); and deaths with weight ≥ 2500g had preventable by attention to the woman in childbirth (47%). Conclusions: Despite the weaknesses found in the Mortality information system, the use of secondary data made it possible to understand the scenario of neonatal deaths in the State of Espírito Santo

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Sidler, Daniel. « Medical futility as an action guide in neonatal end-of-life decisions ». Thesis, Stellenbosch : Stellenbosch University, 2004. http://hdl.handle.net/10019.1/50017.

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Thesis (MPhil)--University of Stellenbosch, 2004.
ENGLISH ABSTRACT: This thesis discusses the value of medical futility as an action guide for neonatal endof- life decisions. The concept is contextualized within the narrative of medical progress, the uncertainty of medical prognostication and the difficulty of just resource allocation, within the unique African situation where children are worse off today than they were at the beginning of the last century. parties actively engage in an interactive deliberation for a plan of action. Both parties ought to accept moral responsibility. Such a model of deliberation has the added advantage of transcending the limitations of the participants to arrive at a higher-level solution, which is considered more than just a consensus. It has been argued that medical progress has obscured the basic need for human compassion for the dying and for their loved ones. The literature furthermore reports that the quality of end-of-life care is unsatisfactory for both patients and their families. It is within this context that the concept of medical futility is positioned as a useful action guide. As we do not have the luxury of withdrawing from the responsibility to engage in the deliberation of end-of-life decisions, such responsibility demands an increasing awareness of ethical dilemmas and a model of medical training where communication, conflict-resolution, inclusive history taking, with assessment of patient values and preferences, is focussed on. The capacity for empathetic care has to be emphasized as an integral part of such approach. Finally, in this thesis, the concept of medical futility is tested and applied to clinical case scenarios. It is argued that the traditional medical paradigm, with its justification of an 'all out war' against disease and death, in order to achieve utopia for all, is outdated. Death in the neonatal intensive care unit is increasingly attributed to end-of-life decisions. Futile treatment could be considered a waste of scarce resources, contradicting the principle of nonmaleficence and justice, particularly in an African context. The ongoing confidence in, and uncritical submission to the technological progress in medicine is understood as a defence and coping mechanism against the backdrop of the experience of life's fragility, suffering and the inevitability of death. Such uncritical acceptance of the technological imperative could lead to a harmful fallacy that cure is effected by prolonging life at all cost. What actually occurs, instead, is the prolongation of the dying process, increasing suffering for all parties involved. The historical development of the concept of medical futility is discussed, highlighting its applicability to the paradigmatic scenario of cardio-pulmonary resuscitation. Particular attention is given to ways in which the concept could endanger patient-autonomy by allowing physicians to make unilateral, paternalistic decisions. It is argued that the informative model of the patient-physician relationship, where the physician's role is to disclose information in order for the patient to indicate her preferences, ought to be replaced by a more adequate deliberative model, where both
AFRIKAANSE OPSOMMING: Hierdie tesis bespreek die waarde van mediese futiliteit as 'n maatstaf vir aksie in gevalle van neonatale 'einde-van-lewe' besluite. Die konsep word gekontekstualiseer binne die wêreldbeskouing van mediese vooruitgang, die onsekerheid van mediese prognostikering en die probleme wat geassosieer IS met regverdige hulpbrontoekenning; spesifiek binne die unieke Afrika-situasie. Dit word aangevoer dat die tradisionele mediese paradigma, met regverdiging vir voorkoming van siekte en dood ten alle koste, verouderd is. Sterftes in neonatale intensiewe sorgeenhede word toenemend toegeskryf aan 'einde-van-lewe' besluite Futiele behandeling sou dus beskou kon word as 'n vermorsing van skaars hulpbronne, wat teenstrydig sou wees met die beginsels nie-skadelikheid ('nonmaleficence') en regverdigheid. Die volgehoue vertroue in en onkritiese aanvaarding van aansprake op tegnologiese vooruitgang lil geneeskunde, kan beskou word as verdediging- en hanteringsmeganisme in die belewenis van lewenskwesbaarheid, lyding en die onafwendbaarheid van die dood. Sodanige onkritiese aanvaarding van die tegnologiese imperatief kan tot 'n onverantwoordbare denkfout, naamlik dat genesing plaasvind deur verlenging van lewe ten alle koste, lei. Wat hierteenoor eerder mag plaasvind, is 'n verlenging die sterwensproses en, gepaard daarmee, toenemende lyding van all betrokke partye. Die historiese ontwikkeling van die konsep van mediese futiliteit word bespreek met klem op die toepaslikheid daarvan op die paradigmatiese situasie van kardiopulmonêre resussitasie. Spesifieke aandag word gegee aan maniere waarop die konsep pasiënte se outonomie in gevaar stel, deur die betrokke medici die reg te gee tot eensydige, paternalistiese besluitneming. Die argument is dan dat die informatiewe model, waar die verhouding tussen die dokter en pasiënt gebasseer is op die beginsel dat die dokter inligting moet verskaf aan die pasiënt sodat die pasiënt 'n ingeligte besluit kan neem, vervang moet word met 'n meer toepaslike beraadslagende model, waar sowel die dokter as die pasiënt aktief deelneem aan interaktiewe beraadslaging oor 'n aksieplan. Albei partye word dan moreel verantwoordbaar. So 'n model van beraadslaging het die bykomende voordeel dat dit die beperkings van die deelnemers kan transendeer. Sodoende word 'n hoër-vlak oplossing - iets meer as 'n blote consensus - te weeg gebring. Die argument word ontwikkel dat mediese vooruitgang meelewing met die sterwendes en hul geliefdes mag verberg. Verder dui die literatuur daarop dat die kwaliteit van einde-van-lewe-sorg vir sowel die pasiënte as hul familie onaanvaarbaar is. Dit is binne hierdie konteks dat die konsep van mediese futiliteit kan dien as 'n maatstaf vir aksie. Medici kan nie verantwoordelikheid vir deelname aan beraadslaging rondom eindevan- lewe beluitneming vermy nie, en as sodanig vereis die situasie toenemende bewustheid van sowel die etiese dilemmas as 'n mediese opleidingsmodel waann kommunikasie, konflikhantering, omvattende geskiedenis-neming, met insluiting van die pasient se waardes en voorkeure, beklemtoon word. Die kapasiteit vir empatiese sorg moet weer eens beklemtoon word as 'n integrale deel van hierdie benadering. Ten slotte, hierdie tesis poog om die konsep van mediese futiliteit te toets en toe te pas op kliniese situasies.

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Anunciação, Patricia Sampaio da. « REVÉS DE UM PARTO : MODELOS EXPLICATIVOS DE MULHERES QUE PERDERAM O FILHO NO PERÍODO NEONATAL ». Universidade Federal do Maranhão, 2015. http://tedebc.ufma.br:8080/jspui/handle/tede/1018.

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Infant mortality is an indicator of the levels of social and economic development and health of the population. Although the infant mortality rate has decreased in the post-neonatal, neonatal period still has the largest number of deaths. This component is difficult because reduction depends primarily on actions directed to improve care provided in prenatal care and health services that perform deliveries. Thus, understanding how mothers interpret and explain the death of his son in the neonatal period may unveil a face of child mortality not revealed in official documents of death or the socio-demographic indicators. Therefore, we sought to analyze the models to the death of newborns in the perspective of women who have lost infants at birth. We adopted a descriptive and analytical research, qualitative type, with women living in São Luis, who gave birth in maternity hospitals in the capital. Semi-structured interviews for data collection were used. Data were analyzed by thematic analysis technique and Categorization. The results show that women build their own models to the death of their children. Thus the explanations and interpretations given by women show some aspects whose categories are objects of analysis of this study: Realizing the danger, explaining the causes of death and Facing the process of mourning. Accounts, the situations that represent the weakness in the service network and the lack of information during the prenatal monitoring and even at delivery were identified. This is evident both in relation to the monitoring of pregnant women as well as in neonatal mourning situations. The results show a scenario in which the neonatal mourning situations go unnoticed in health team work routine in maternity wards.
A mortalidade infantil é um indicador dos níveis de desenvolvimento social e econômico e de condições de saúde da população. Embora a taxa de mortalidade infantil tenha decrescido no componente pós-neonatal, o período neonatal ainda concentra o maior número de óbitos. Esse componente é de difícil redução porque depende principalmente de ações dirigidas à qualificação da atenção prestada no pré-natal e nos serviços de saúde que realizam partos. Dessa forma, entender como as mães interpretam e explicam a morte do seu filho no período neonatal pode desvendar uma face da mortalidade infantil não revelada nos documentos oficiais de óbito ou nos indicadores sócio demográficos. Sendo assim, buscou-se analisar os modelos explicativos para o óbito de recém-nascidos na perspectiva das mulheres que perderam os filhos no período neonatal. Adotou-se pesquisa descritiva e analítica, do tipo qualitativa, com mulheres residentes no município de São Luís, que tiveram partos nas maternidades da capital. Foram utilizadas entrevistas semiestruturadas para a coleta de dados. Os dados foram analisados pela técnica de Análise Temática e Categorização. Os dados evidenciaram que as mulheres constroem modelos explicativos próprios para a morte de seus filhos. Dessa forma as explicações e interpretações atribuídas pelas mulheres evidenciam alguns aspectos cujas categorias são objetos de análise deste estudo: Percebendo o perigo, Explicando as causas da morte e Encarando o processo de Luto. Dos relatos, foram identificadas as situações que representam a fragilidade na rede de atendimento, bem como a falta de informação durante o acompanhamento de pré- natal e até no momento do parto. Isto se evidencia tanto em relação ao acompanhamento da mulher grávida como também em situações de luto neonatal. Os resultados revelam um cenário em que a situações de luto neonatal passam despercebidas no cotidiano de trabalho da equipe de saúde nas maternidades.

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Silva, Laureana Cartaxo Salgado Pereira da. « Sentimentos de profissionais de enfermagem diante da morte de rec?m-nascidos em uma unidade de terapia intensiva ». Universidade Federal do Rio Grande do Norte, 2006. http://repositorio.ufrn.br:8080/jspui/handle/123456789/14631.

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To understand the feelings of nursing professionals when faced with the death of newborn babies in an intensive care unit is the purpose of this investigation. Motivation was triggered by the countless hardships we go through everyday, as professionals, and the scarcity of publications in this specific area of knowledge. The aim is to describe the experience of the nursing professionals and identify their feelings when faced with the death of newborn babies in an intensive care unit. As a methodological procedure, this research is based on a qualitative, phenomenology-focused approach and on the following leading question addressed to the interviewed nurses and nursing technicians who work at the unit: How do you feel when you are faced with the death of a newborn baby in the ICU at which you work? Answers to this question on such phenomenon revealed a diversity of feelings, such as, loss, guilt, failure, negation, compassion, and sorrow, coupled with anguish, fear, and anxiety, resulting in an experience of the sensitive world of everyone. Theoretical support to this analysis was based on works by authors who discuss phenomenology, as well as authors who study the theme of death. An understanding of the phenomenon thus studied enables us to affirm that the death of a newborn baby is, for the nursing professional who takes care of the baby in the space of the ICU, an experience of conflicting, sometimes painful feelings, on account of their complexity. This is true not only in respect of their feelings for the baby, but for the family as well, especially the parents
Compreender os sentimentos dos profissionais de enfermagem diante da morte de rec?m-nascidos em uma unidade de terapia intensiva constitui o objeto desta investiga??o. A motiva??o para realiz?-la decorreu das in?meras dificuldades por n?s vivenciadas no cotidiano profissional e da escassez de publica??es nesta ?rea espec?fica do conhecimento. Tem como objetivos descrever a viv?ncia de profissionais de enfermagem e identificar seus sentimentos diante da morte de rec?m-nascidos em unidade de terapia intensiva. Como procedimento metodol?gico, a pesquisa se pauta em uma abordagem qualitativa com enfoque fenomenol?gico, tendo como pergunta norteadora da entrevista realizada com enfermeiros e t?cnicos de enfermagem, da referida unidade, a seguinte indaga??o: Como voc? se sente diante da morte do rec?m-nascido na UTI em que voc? trabalha? Emergiram do questionamento, acerca deste fen?meno, uma diversidade de sentimentos, como perda, culpa, fracasso, nega??o, compaix?o, tristeza, acompanhados de ang?stia, medo, ansiedade o que resulta numa experi?ncia do mundo sens?vel de cada um. A an?lise teve como aporte te?rico tanto os autores que tratam da fenomenologia, como estudiosos do tema da morte. A partir da compreens?o do fen?meno estudado, podemos afirmar ser a morte do rec?m-nascido para os profissionais de enfermagem, que com ela lidam no espa?o de uma UTI, uma viv?ncia de sentimentos conflituosos, por vezes dolorosos, pela complexidade que encerra. Isto n?o somente em rela??o ? crian?a, mas, sobretudo diante dos familiares, em particular, dos pais

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Galdino, Cíntia Valéria. « Análise da mortalidade perinatal na região do Médio Paraíba, Estado do Rio de Janeiro, de 2005 a 2009 ». Universidade do Estado do Rio de Janeiro, 2012. http://www.bdtd.uerj.br/tde_busca/arquivo.php?codArquivo=4498.

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A taxa de mortalidade perinatal (TMP) é um dos importantes indicadores de saúde que refletem a qualidade da assistência prestada durante a gestação, o parto e ao recém nascido. A TMP possui dois componentes: a taxa e mortalidade fetal e a taxa de mortalidade infantil neonatal precoce. O objetivo do presente estudo foi analisar a mortalidade perinatal na região do Médio Paraíba, estado do Rio de Janeiro, Brasil no período de 2005 a 2009, segundo causa básica dos óbitos, componentes do período perinatal e critérios de evitabilidade. Foram utilizados os dados referentes aos óbitos fetais e infantis neonatais precoces e de nascidos vivos, registrados, respectivamente, nos Sistemas de Informações sobre Mortalidade (SIM) e Nascidos Vivos (SINASC). A TMP na região foi de 18,4 óbitos por mil nascimentos totais. As taxas de mortalidade fetal e infantil neonatal precoce no período alcançaram, espectivamente 10,7 óbitos por mil nascimentos totais e 7,7 óbitos por mil nascidos vivos. A TMP apresentou redução ao longo do quinquênio analisado associada à queda do componente neonatal precoce, mantendo-se estável o componente fetal. As principais causas básicas dos óbitos perinatais, segundo a lista de mortalidade CID BR, foram as afecções originadas no período perinatal (89%) e as malformações congênitas, deformidades e anomalias cromossômicas (10,5%). Utilizando os critérios de evitabilidade segundo Ortiz, para os óbitos infantis neonatais precoces foi observado que mais de 41% eram reduzíveis por diagnósticos e tratamento precoces. Ressalta-se a necessidade da implementação de ações de assistência à saúde da gestante e de cuidados com o recémnascido com vistas à redução da mortalidade perinatal na região do Médio Paraíba.
The perinatal mortality rate (PMR) is an important health indicator that reflects the quality of health care provided during pregnancy, childbirth and to the newborns. The PMR has two components: the fetal mortality rate and the early neonatal mortality rate. The objective of this study was to analyze the perinatal mortality in the Médio Paraíba region, Rio de Janeiro state, Brazil between 2005 and 2009, according to the underlying cause of deaths, components of the perinatal period and criteria of avoidability. Data regarding fetal and early neonatal deaths and live births was provided by the National Death (SIM) and Live Birth (SINASC) Information Systems, respectively. The PMR in the region was 18.4 deaths per thousand total births. Fetal and early neonatal mortality rates reached 10.7 deaths per thousand total births and 7.7 deaths per thousand live births, respectively. The PMR declined during the five year period, associated with the fall of its early neonatal component, remaining stable the fetal component. The main underlying causes of perinatal deaths, according to the ICD Mortality List for use in Brazil - ICD BR, were certain conditions originating in the perinatal period (89%) and congenital malformations, deformations and chromosomal abnormalities (10,5%). Using the criteria of avoidability according to Ortiz, for early neonatal infant deaths was observed that over 41% were avoidable through early diagnosis and treatment . Efforts aimed at improving health care during pregnancy and childbirth are needed in order to reduce perinatal mortality levels in the Médio Paraíba region.

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Nardello, Daniele Marin. « Características epidemiológicas dos óbitos fetais e neonatais precoces de filhos de pacientes com near mis ». Universidade Federal de Sergipe, 2016. https://ri.ufs.br/handle/riufs/4997.

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Objective: To identify the epidemiological characteristics of early fetal and neonatal deaths in maternal near miss patients and the associated elements to this outcome. Method: Cross-sectional study including 79 women with features near miss, identified in a one-year period, and their newborns. Semi-structured interviews and the study of patients’ records were conducted. The variables were analyzed through simple frequency and percentage. To evaluate the association between those variables, the Fisher’s Exact Test was used. For the multivariate analysis the perceptual map constructed from the multiple correspondence examination was used, using the variables that were significant to 20%. Results: Amongst the near miss mothers, hypertensive disorders (severe pre-eclampsia, eclampsia, hypertension) totalized 32 cases (40,5%) and, of those, 14 (58,3%) had fetal and neonatal adverse outcome (p 0,046). The highest prevalence of fetal and neonatal adverse outcome was derived from cesarean delivery (20, 83,3%), of women with 2 or 3 children (11, 45,8%), and without previous stillbirths (17, 70,8%), this last variable with significance p 0,038. In the fetal and neonatal adverse outcome analysis significant levels were verified in newborns admitted in Neonatal Intensive Care Unit (17, 70,8%, p < 0,001); children with gestational age < 32 weeks (10, 41,6%, p < 0,001); birth weight < 2500 (16, 66,7%, p 0,001); APGAR score at 5 minutes < 7 (9, 52,9%, p < 0,001); neonatal asphyxia, 9 (50,00%, p < 0,001); and early respiratory distress syndrome, 13 (72,2%, p 0,002). Conclusion: The characteristic of early fetal and neonatal deaths in maternal near miss patients had a close association with fetal and neonatal adverse outcome. Among the mothers with hypertensive disorders the significant characteristics to the outcome in newborns were prematurity, neonatal asphyxia and early respiratory distress syndrome.
Objetivo: Identificar as características epidemiológicas dos óbitos fetais e neonatais precoces em pacientes com near miss materno e os fatores associados a este desfecho. Método: Estudo transversal, cuja população foi composta por 79 mulheres com características de near miss (NM), identificadas no período de um ano, e dos seus respectivos recém-nascidos. Foram realizadas entrevistas semiestruturadas e investigação dos prontuários. As variáveis foram analisadas por meio de frequências simples e percentual. Para avaliar associação entre as variáveis, utilizou-se o teste Exato de Fisher. Para análise multivariada, foi usado o mapa perceptual construído a partir da análise de correspondência múltipla e utilizadas as variáveis que foram significativas a 20%. Resultados: Entre as mães classificadas com NM, as desordens hipertensivas (pré-eclâmpsia grave, eclâmpsia, hipertensão) totalizaram 32 casos (40,5%) e, destes, 14 (58,3%) tiveram desfecho fetal e neonatal adverso (DFNA) com p-valor =0,046. A maior prevalência de DFNA foi proveniente de parto cesáreo (20, 83,3%), de mulheres com dois a três filhos (11, 45,8%) e sem natimortos anteriores (17, 70,8%), verificando-se significância para esta última variável p =0,038. Na análise dos DFNA, foi observada significância estatística para os recém-nascidos admitidos na UTIN (17, 70,8%, p <0,001); crianças com idade gestacional < 32 semanas (10, 41,6%, p <0,001); peso ao nascer < 2500 (16, 66,7%, p =0,001); APGAR de 5 minutos < 7 contabilizaram 9 (52,9%, p <0,001); asfixia neonatal, 9 (50%, p <0,001); e desconforto respiratório precoce, 13 (72,2%, p =0,002). Conclusão: As características dos óbitos fetais e neonatais precoces em pacientes com near miss materno tiveram associação forte com o desfecho fetal e neonatal adverso. Nas mães com desordens hipertensivas, as características estatisticamente significantes para o desfecho entre os recém-nascidos foram a prematuridade, asfixia neonatal e desconforto respiratório precoce.

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Zetterström, Karin. « Chronic Hypertension and Pregnancy : Epidemiological Aspects on Maternal and Perinatal Complications ». Doctoral thesis, Uppsala University, Department of Women's and Children's Health, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-7755.

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These studies were undertaken to investigate risks of maternal and perinatal complications in pregnant women with chronic hypertensive disease, and to investigate future risk of preeclampsia in women born small for gestational age (SGA). Population based cohort studies using the Swedish Medical Birth Register from different years were performed.

The maternal complications mild and severe preeclampsia, gestational diabetes and abruptio placenta were studied in a population of 681 515 women, with a prevalence of 0,5% for chronic hypertension. Risk estimates were adjusted for differences in maternal characteristics as age, parity, BMI, ethnicity and smoking habits. Chronic hypertensive women wore found to have significantly increased risks of all complications.

The perinatal complication SGA was studied in a population of 560 188, with a prevalence of 0,5% for chronic hypertension. Risk estimates were adjusted for differences in maternal characteristics and for the secondary complications mild and severe preeclampsia. Chronic hypertensive women were found to suffer a significantly increased risk of giving birth to an offspring that is SGA.

The perinatal complication fetal/infant mortality was studied in a population of 1 222 952 with a prevalence of 0,6% for chronic hypertension. Risk estimates were adjusted for differences in maternal characteristics and for the complications mild and severe preeclampsia, gestational diabetes, abruptio placenta and offspring being SGA In the analysis an effect modification by gender was included. Chronic hypertensive women were found to have a significantly increased risk for stillbirth and neonatal death in male, but not in female, offspring. Thus a clear gender difference in mortality was revealed. The risk of mortality of offspring was mediated by severe preeclampsia, abruptio placenta and offspring being SGA. Mild preeclampsia and gestational diabetes did not affect the risk. No increased risk of post neonatal mortality was found.

A generation study was performed in 118 634 girls of which 5.8% were born SGA. Their future risk for mild and severe preeclampsia in first pregnancy was analysed. Risk estimates were adjusted for age, smoking, BMI and for preeclampsia in the mothers while pregnant with the study population. Women who were born SGA were shown to have a significantly increased risk for severe preeclampsia, but not for mild preeclampsia.

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Rosa, Andréa Pereira. « Estresse oxidativo como um mecanismo dos efeitos deletérios causados pela hiperglicemia neonatal em cérebro de ratos ». reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2018. http://hdl.handle.net/10183/183005.

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A diabetes é um distúrbio endócrino do metabolismo dos carboidratos, clinicamente caracterizada por hiperglicemia, resultante da incapacidade do organismo em secretar insulina, defeitos na sua ação ou ambos. Na última década, houve um crescente aumento no número de trabalhos sobre a múltipla hereditariedade de um tipo de diabetes rara e não imunológica diagnosticada antes dos 6 meses de vida, a diabetes neonatal (DN). A maioria dos estudos, existentes na literatura referentes à DN, foi realizada em pacientes e aborda principalmente aspectos clínicos, etiológicos e terapêuticos. No entanto, existe uma deficiência de estudos realizados em modelos animais, a fim de avaliar danos moleculares em tecidos submetidos à hiperglicemia neonatal. Recentemente, as consequências da diabetes no sistema nervoso central (SNC) têm recebido maior atenção, uma vez que os recentes estudos mostram que a hiperglicemia é capaz de promover a ruptura da homeostase redox no cérebro de ratos. Neste sentido, o estresse oxidativo (EO) parece representar um dos mecanismos pelos quais a hiperglicemia danifica o tecido cerebral em um período crucial de desenvolvimento. Diante disso, o presente trabalho objetivou estudar não só a relação do EO com a hiperglicemia neonatal em cérebro de ratos, mas também avaliar se os danos oxidativos promovidos pelas espécies reativas de oxigênio (ERO) na condição hiperglicêmica podem estar envolvidos no processo de morte celular neuronal. Para isso, foram utilizados ratos Wistar de 5 dias de vida, divididos em dois grupos: controle e diabético. O modelo de diabetes foi induzido pela administração intraperitoneal de estreptozotocina (STZ) em uma única dose de 100 mg/Kg peso corporal, sendo que foram considerados diabéticos os ratos com glicemia >200mg/dL. Os animais foram sacrificados com 10 dias de vida, ou seja, 5 dias após a administração de STZ. O cérebro total dos animais foi homogeneizado, centrifugado e o homogeneizado utilizado para as medidas de parâmetros de EO e expressão proteica. Além disso, o cérebro total foi utilizado em cortes histológicos para análise do parâmetro de morte celular neuronal, avaliada pela técnica FluoroJade C. Os parâmetros de EO analisados foram o metabolismo da glutationa, que engloba a atividade das enzimas glutationa S-transferase (GST), glutationa redutase (GR), glutamato-cisteína ligase (GCL) e a 8 determinação da concentração de glutationa total e reduzida (GSH/GSSG). A medida do peróxido de hidrogênio (H2O2) também foi avaliada, juntamente com a quantificação proteica por “Western Blot” do fator nuclear eritroide relacionado ao fator 2 (Nrf2), da superóxido dismutase (SOD), da catalase (CAT), da glutationa peroxidase (GPx), da heme oxigenase 1 (HO-1) e da tiorredoxina (TRX). Os parâmetros relativos à sobrevivência e morte celular avaliados foram a quantificação proteica por “Western Blot” da proteína cinase B (AKT), da proteína cinase B fosforilada (p-AKT), da glicogênio sintase cinase 3 β (GSK3β), da p38 proteína cinase ativada por mitógenos (p38), proteína cinase c-Jun N-terminal (JNK), da célula-B de linfoma 2 (Bcl2) e da proteína X associada a Bcl2 (Bax). Os ratos submetidos ao modelo de hiperglicemia neonatal não apresentaram diferenças significativas nos parâmetros relacionados ao metabolismo da glutationa (GST, GR, GCL e GSH/GSSG), tampouco nas concentrações de H2O2 quando comparados ao grupo controle. A expressão proteica do Nrf2 foi diminuída no grupo diabético, enquanto que a expressão da CAT, HO-1 e TRX se apresentaram aumentadas no grupo diabético quando comparado ao grupo controle. Não foram encontradas diferenças significativas nas expressões proteicas da SOD e GPx. As expressões proteicas das proteínas p38 e Bcl2 foram aumentadas, enquanto a expressão da p-AKT se mostrou reduzida no grupo diabético. Já com relação à expressão das proteínas JNK, GSK3β e Bax não houve diferença significativa nos grupos analisados. Finalmente, com relação à técnica que avaliou morte celular neuronal, o grupo diabético apresentou três vezes mais marcações de neurônios fluorescentes, ou seja, com morte celular quando comparado com o grupo controle. Portanto, esses resultados sugerem que o EO pode representar um mecanismo envolvido nos efeitos da hiperglicemia no SNC de ratos neonatos. Além disso, as alterações na expressão de proteínas envolvidas em vias de sobrevivência/morte celular colaboram para o resultado de morte celular verificado no cérebro de animais com hiperglicemia neonatal e mostram os efeitos nocivos da DN em um período crucial de desenvolvimento cerebral.
Diabetes is an endocrine disorder of the carbohydrates metabolism clinically characterized by hyperglycemia, resulting from the inability of the body to secrete insulin, defeats in its action and both. In the last decade, there has been an increasing number of studies about neonatal diabetes (DN), a type of diabetes non-immunological diagnosed before 6 months of life. The most studies related to DN was developed in patients and mainly deal with clinical, etiological and therapeutic aspects. However, there is a few of studies in animal models in order to assess molecular damage in tissues submitted to neonatal hyperglycemia. Recently, the consequences of diabetes in the central nervous system (CNS) have received increased attention, as recent studies show that hyperglycemia is capable of promoting the rupture of redox homeostasis in the rat brain. Wherefore, the present work aimed to study not only the relationship between EO and neonatal hyperglycemia in rat brain, but also evaluate if the oxidative damage promoted by reactive oxygen species (ROS) in the hyperglycemic condition may be involved in the neuronal cell death process. For this, 5-day-old Wistar rats were used to promote the induction of diabetes, which was done with a single intraperitoneal streptozotocin (STZ) administration (100 mg/kg body weight). Rats with glycemia> 200 mg/dL were considered diabetic. The rats were sacrificed in 10 days of life, wherefore five days after STZ adiminstration. The whole brain of the rats was homogenized, centrifuged and homogenized used for EO techniques and protein expression measurements. In addition, total brain was used in histological sections for analysis of the neuronal cell death. The EO parameters evaluated were the activity of the glutathione S-transferase (GST), glutathione reductase (GR), glutamate-cystein ligase (GCL) and the determination of total and reduced glutathione concentration (GSH/GSSG). Hydrogen peroxide (H2O2) was evaluated along with Western Blot protein quantification of catalase (CAT), glutathione peroxidase (GPx), heme oxygenase (HO-1) and thioredoxin (TRX). Relative to cell survival and death were evaluated protein kinase B (Akt), phosphorylated protein kinase B (p-Akt), glycogen synthase kinase 3β (GSK3β), p38 mitogen-activated protein kinase (p38), c-Jun amino-terminal kinases (JNK), phosphorylated c-Jun amino-terminal kinases (p-JNK), B-cell 10 lymphoma 2 (Bcl2) and Bcl2-associated protein X (Bax) by western blot. The neonatal hyperglycemia was not able to promote significant differences in the glutathione metabolism (GST, GR, GCL and GSH / GSSG) nor in the H2O2 measurement when compared to the control group. Nrf2 protein expression was decreased whereas CAT, HO-1 and TRX protein expression were increased in the diabetic group when compared to the control group. No significant differences were found in the protein expression of SOD and GPx. Also, p38 and Bcl2 protein expression was increased, whereas p-Akt was decreased in the diabetic group, already regarding the expression of JNK, p-JNK, Jsk3β and Bax proteins there were no significant difference in the analyzed groups. Finally, relative to neuronal cell death technique, the diabetic group presented three fold more neuronal cell death with fluorescent marking characteristic, when compared to the control group. Therefore, these results suggest that OE may represent a mechanism involved in the effects of hyperglycemia in the central nervous system of neonatal rats. In addition, changes in the expression of proteins involved in survival/death cell pathways contribute to the outcome of cell death, result found in the brain of animals with neonatal hyperglycemia and finally show the harmful effects of neonatal diabetes in a crucial period of brain development.

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Hawthorne, Dawn M. « The Influence of Spirituality, Race/Ethnicity and Religion on Parent Grief and Mental Health at one month and three months after their Infant's/Child's death in the Neonatal or Pediatric Intensive Care Unit ». FIU Digital Commons, 2012. http://digitalcommons.fiu.edu/etd/591.

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The death of an infant/child is one of the most devastating experiences for parents and immediately throws them into crisis. Spiritual and religious coping strategies may help parents with their loss. The purposes of this longitudinal study were to: 1) describe differences in bereaved parents’ use of spiritual coping strategies across racial/ethnic and religious groups, mother/father dyads, and time – one (T1) and three (T2) months after the infant’s/child’s death in the neonatal (NICU) or pediatric intensive care unit (PICU), and 2) test the relationship between spiritual coping strategies and grief, mental health, and personal growth for mothers and fathers at T1 and T2. A sample of 126 Hispanic, Black/African American, and White parents of 119 deceased children completed the Spiritual Coping Strategies scale, Beck Depression Inventory-II, Impact of Events-Revised, Hogan Grief Reaction Checklist, and a demographic form at T1 and T2. Controlling for race and religion, spiritual coping was a strong predictor of lower grief, better mental health, and greater personal growth for mothers at T1 and T2 and lower grief for fathers at T1. The findings of this study will guide bereaved parents to effective strategies to help them cope with their early grief.

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Ferrari, Rosangela Aparecida Pimenta. « Mortalidade neonatal no município de Londrina - Paraná : características maternas, dos recém-nascidos e uso do sistema de saúde, de 2000 a 2009 ». Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/7/7141/tde-19042012-080259/.

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A mortalidade neonatal, em sua maioria, ocorre por causas que poderiam ser evitadas se houvesse oferta de serviços qualificados durante o pré-natal, parto e puerpério. De modo geral, estão associadas às condições biológicas, às disparidades socioeconômicas e de acesso aos serviços de saúde. Assim, mesmo em municípios com melhores índices de desenvolvimento econômico, a elucidação dos elementos que compõem a trama de causalidade dos óbitos neonatais é fundamental. Dessa forma, o objetivo do estudo foi analisar os fatores associados aos óbitos neonatais no Município de Londrina-PR, no período de 2000 a 2009. Foram investigados os óbitos neonatais, segundo características maternas, do recém-nascido e relativas ao uso do sistema municipal de saúde, por meio de estudo retrospectivo descritivo do tipo ecológico. Os dados foram extraídos da Declaração de Nascido Vivo, da Declaração de Óbito e das Fichas de Investigação do Óbito Infantil do Comitê Municipal de Prevenção de Mortalidade Materno-Infantil do Núcleo de Informação de Mortalidade (NIM) da Secretaria de Saúde Municipal. No que se refere à caracterização materna, mais de 60,0% das mães eram jovens adultas (12 a 27 anos) e a média de idade 25,8 anos. Ao longo dos 10 anos, o número de mães adolescentes diminuiu de 22,9% para 8,5%. Do total, 83,5% tinham companheiro, 73,9% de oito a onze anos de estudo e 52,7% não trabalhavam. Tiveram acompanhamento no pré-natal 91,4% das mulheres, 55,1% das quais se consultaram de uma a seis vezes. Quase a totalidade apresentou algum tipo de afecção durante a gestação: 82,7% trabalho de parto prematuro e 36,7% doenças renais e de vias urinárias. Pouco mais de 51,0% evoluiu para o parto vaginal. Ao longo dos anos, o parto cirúrgico aumentou de 35,4% para 61,5%. Quanto às características dos recém-nascidos que foram a óbito, 56,9% eram do sexo masculino e 86,0% da raça branca. Aproximadamente 60,0% nasceram entre 22 e 31 semanas de gestação e 60,7% tinham peso inferior a 1.500 gramas e 73,0% apresentaram asfixia no 1º minuto de vida. Ao longo dos anos, a prematuridade se manteve elevada. A média de idade do óbito foi de 4,9 dias. A maioria das mortes ocorreu no período neonatal precoce (73,9%) e o Coeficiente de Mortalidade Neonatal passou de 21,2 para 14,8, entre 2000 e 2009. A causa básica foram, predominantemente, afecções perinatais (77,6%), seguidas das anomalias congênitas (20,0%). Do total das mortes evitáveis, 77,1% ocorreram por causas redutíveis por adequado controle na gravidez e atenção ao parto. Quanto ao uso do sistema municipal de saúde pelas mães dos neonatos observou-se que 62,3% realizaram o pré-natal no serviço público de saúde. A quase totalidade dos partos ocorreu no hospital (96,5%), sendo 63,7% em hospitais que ofereciam atendimento obstétrico e de unidade de terapia intensiva neonatal (UTIN). Ao longo dos 10 anos de estudo, o uso do serviço hospitalar com maternidade e UTIN, aumentou de 39,2% para 66,6%. O período do óbito neonatal apresentou associação estatisticamente significativa com: trabalho de parto prematuro (p<0,01), infecção do trato urinário (p<0,05), hipertensão arterial/pré-eclâmpsia (p<0,01), peso ao nascer (p<0,01), idade gestacional (p<0,01), Apgar no 1º e 5º minuto (p<0,01), local do parto (p<0,01) e local do óbito (p<0,05). Por outro lado, não houve associação estatística com as características demográficas e socioeconômicas maternas. Ainda que as mortes neonatais tenham sido reduzidas, ao longo dos anos, no Município de Londrina, a sua ocorrência requer atenção para a reorganização do sistema de saúde, particularmente no que se refere à qualificação da assistência pré-natal e parto. Conclui-se ser necessária a operacionalização da integralidade de forma a abordar as necessidades materno-infantis que recorrerem ao serviço municipal de saúde.
Neonatal mortality mostly occurs due to avoidable causes which could be prevented if quality health services were available at prenatal, delivery and postnatal periods. In general, these causes are related to biological conditions, socioeconomic disparities and health services accessibility. Hence, even in cities where the economic development is high, it is fundamental to elucidate factors that contribute to the causality of neonatal deaths. The aim of this study was to analyze the factors associated to neonatal deaths in Londrina - PR, from 2000 to 2009. Neonatal deaths were investigated according to characteristics of mothers, newborns and health system city services through an ecological study with a retrospective and descriptive approach. Data were obtained from Birth Certificates, Death Certificates and Infant Death Investigation Forms provided by the Municipal Committee for Prevention of Maternal and Infant Death obtained from the Mortality Information Center assigned under the City Health Department. Regarding maternal characteristics, more than 60.0% were young adults (aged from 12 to 27), mean age of 25.8. Over this ten-year period, the number of teenager mothers decreased from 22.9% to 8.5%. Out of the total, 83.5% were married, 73.9% had 8-11 schooling years and 52.7% did not have a job. Most women (91.4%) received prenatal care and 55.1% of them attended to 1-6 prenatal care appointments. Almost all mothers had some sort of health problems during pregnancy: 82.7% presented with premature labor and 36.7% had renal and urinary conditions. Slightly more than 51,0% led to natural deliveries. Over the years, surgical deliveries increased from 35.4% to 61.5%. As for characteristics of newborns who died, 56.9% were male and 86.0% were caucasian. About 60.0% were born with 22-31 weeks of gestational age and 60.7% weighted under 1500 grams and 73.0% presented with asfixiation at the first minute. Over the studied period, prematurity rates remained elevated. Mean death age was 4.9 days. Most deaths occured at early neonatal period (73.9%) and the Neonatal Mortality Rate decreased from 21.2 to 14.8 between 2000 to 2009. The leading death causes were perinatal conditions (77.6%) followed by congenital anomalies (20.0%). Out of all avoidable deaths, 77.1% occured due to causes that could be prevented if adequate control over pregnancy and labor care were available. As for the city health services attended by the newborns\' mothers, 62.3% used the public health system. Almost all labors took place in hospitals (96.5%), and 63.7% of these facilities provided obstetric and neonatal intensive care. In the studied period, the use of hospital facilities with maternity/nursery and neonatal intensive care wards increased from 39.2% to 66.6%. The neonatal death period was statistically associated to premature labor (p<0.01), urinary tract infeccion (p<0.05), arterial hypertension/pre-eclampsia (p<0.01), birth weight (p<0.01), gestational age (p<0.01), Apgar score at 1st and 5th minutes (p<0.01), place of delivery (p<0.01) and place of death (p<0.05). On the other hand, there was no statistical association between maternal demographic and socioeconomical characteristics. Even though neonatal deaths have decreased over the years, in Londrina, this number still requires attention in order to reorganize the health system, specifically regarding qualified assitance for prenatal care and delivery. In conclusion, it is necessary to implement integrative care as to address the maternal-infant needs of the population who attends the city health services.

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Sousa, Marilia Cordeiro de. « Características maternas e neonatais relacionadas ao óbito em recém-nascidos com cardiopatia congênita ». Universidade Federal de Goiás, 2017. http://repositorio.bc.ufg.br/tede/handle/tede/7329.

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All over the world, in several regions, the congenital anomalies have stood out as one of the main causes of death in their first year of life, specially in the newborn period. Among these anomalies, congenital cadiopathies, with a prevalence of 8:1000 live births. This study aimed to analyse newborn and maternal characteristics related to newborn deaths with congenital cardiopathy. It is a transversal, retrospective study with a quantitative approach. For that purpuse, it was used secondary collected data from puerperal and their live newborn children patient records diagnosed with congenital cardiopathies in a Public Hospital in Goiania, Goias State, Brazil, from 2005 to 2015. It was included 43 newborn children diagnosed with congenital cardiopathies which fit the criteria adopted, including diagnosis by post-natal echocardiogram. Considering the sociodemographic maternal variables, 63% were from 15 to 35 years old, 63% were from Goias State countryside, 35% had 8 years or less of formal education, 40% were in a relationship and 37% were unnemployed. Among the obstetric variables, the mothers who had more than one child were 60%, 44% had live births, 79% had cesarean sections, 91% were single pregnancy and 46% had less than 6 pre-natal consults. The average number of pre-natal consults was 2/2,5. Considering the neonatal variables of the newborn children who had congenital cardiopathies, most of them were female (54%), 51% had Apgar & or below in the first minute and 51% had Apgar 7 or above in the fifth minute; 93% had complications in birth and 56% had related congenital anomalies (specially Down Syndrome). The gestational age for the 43 pregnancies varied between 34,3 to 38,1 weeks. The newborns weight varied from 700g to 5.410g, average 2.598g ± 134,5g. 81% of the newborns had acyanotic congenital cardiopathies while only 19% of them had the cianotic type (8 cases). The general mortality rate was 39,5%, i.e., 17 deaths. Acyanotic congenital cardiopathies were responsible for 11 deaths (65%), while the cyanotic ones were responsible for 6 deaths (35%). The avegare of living days before death was 8,5 ± 1 days during the early neonatal period. It was observed that the death by congenital cardiopathy showed significant difference in relation to the maternal variables: parity (0,014) and type of pregnancy (0,025), multiple pregnancies and single gestation, respectively. And there was also an association estatistically significant between neonatal death and cyanotic congenital cardiopathy (0,045). It is concluded that congenital cardiopathies are more prevalent in young women, from the countryside, who had more than one child, with single gestation, being the death more common in newborn children with cyanotic congenital cardiopathies. Therefore, the reduction of death by congenital cardiopathy depends on high quality pré-natal care, early diagnosis and post-natal timely intervention.
No mundo, em diversas regiões, as anomalias congênitas têm se destacado como uma das principais causas de óbito no primeiro ano de vida, principalmente no período neonatal. Entre elas, destacam-se as cardiopatias congênitas, com prevalência de 8:1000 nascidos vivos. O objetivo deste estudo foi analisar as características neonatais e maternas relacionadas ao óbito em recém-nascidos com cardiopatia congênita. Trata-se de um estudo transversal, retrospectivo e com abordagem quantitativa. Utilizou-se dados secundários coletados dos prontuários das puérperas e de seus RN vivos diagnosticados com anomalias congênitas em um Hospital Público em Goiânia-GO, no período de 2005 a 2015. Foram incluídos 43 recém-nascidos diagnosticados com cardiopatias congênitas, os quais preencheram os critérios adotados, incluindo o diagnóstico através de ecocardiograma pós-natal. Em relação às variáveis sociodemográficas maternas, 63% apresentaram idade entre 15 e 35 anos, 63% eram procedentes do interior do Estado de Goiás, 35% com nível de escolaridade maior ou igual a 8 anos, 40% com companheiro e 37% sem ocupação. Dentre as variáveis obstétricas, as multíparas representaram 60%, gestação a termo em 44%, cesárea em 79%, gestação única em 91% e 46% realizaram menos de 6 consultas de pré-natal. A média do número de consultas de pré-natal foi de 2,0 ± 2,5 consultas. Em relação às variáveis neonatais dos RN acometidos por cardiopatias congênitas, a prevalência foi do sexo feminino com 54%, com Apgar menor ou igual 7 no 1º minuto em 51% e maior ou igual a 7 no 5º minuto em 51%, 93% apresentaram intercorrências no nascimento e 56% possuíam anomalias congênitas associadas (prevalecendo a Síndrome de Down). A idade gestacional ao nascimento das 43 gestações variou de 34,3 a 38,1 semanas. O peso do RN variou de 700g a 5.410g, sendo a média de 2.598g ±134,5g. As cardiopatias congênitas acianóticas acometeram 81% (35) dos RN, enquanto as cianóticas representaram 19% (8) casos. A taxa geral de mortalidade foi de 39,5%, ou seja, 17 óbitos. As cardiopatias congênitas acianóticas foram responsáveis por 11 (65%) óbitos, enquanto as cianóticas por 6 (35%) óbitos. A média de dias de vida antes do óbito foi 8,5 ± 1dia, no período neonatal precoce. Observou-se que o óbito por cardiopatia congênita se apresentou significativo em relação às variáveis maternas: paridade (0,014) e tipo de gravidez (0,025), multíparas e gestação única, respectivamente. Houve uma associação estatisticamente significante entre o óbito neonatal e cardiopatia congênita cianótica (0,045). Conclui-se que as cardiopatias congênitas são mais prevalentes em mulheres jovens, procedentes do interior, multíparas, com gestação única, sendo o óbito mais comum em RN com cardiopatias congênitas cianóticas. Assim sendo, a redução do óbito por cardiopatia congênita parece depender de um acompanhamento pré-natal de qualidade, com diagnóstico precoce e intervenções oportunas no período pós-natal.

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Newitt, Mark Julian. « Ritual, pastoral presence, and character virtues in healthcare chaplaincy : a study of chaplains' support to bereaved parents following the in utero or neonatal death of their baby ». Thesis, Durham University, 2013. http://etheses.dur.ac.uk/7283/.

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This thesis sets out to understand better how chaplains can support bereaved parents following the death of their baby. Running parallel to this, with increasing demand for evidence-based practice, it aims to evidence the benefit of chaplaincy support and the unique skills of chaplains. The thesis is based on twelve semi-structured interviews with sixteen parents. These were analysed using a form of grounded theory and compared with the findings of related research. I argue that the root of all other spiritual need is the loss of control parents experienced. Alongside this theme I identify a loss of meaning, a loss of self worth, and a desire to do something in response to their loss. Although there is not a one size fits all response, the liturgy and ritual provided by chaplains helped counter spiritual distress. I propose that, alongside the ability to perform liturgy and ritual, chaplains are viewed as having authority in both religious and spiritual matters. As liturgy and ritual was appreciated in conjunction with the presence of the chaplain, I explore a virtue-based approach to chaplaincy and recommend the increased use of shadowing and mentoring. Drawing on Fowler’s Stages of Faith, I describe how some parents found greater religious faith or increased spiritual awareness as a result of their experience. I speculate that, in order to provide the best possible support to parents, chaplains need to exhibit the characteristics of Fowler’s stage 5. Chaplains have a richness of reflection and experience and I appeal to churches to engage more profoundly with them. I also recommend the continued employment of chaplains within hospitals and argue for the narrative voice to be valued in research. Contra to current NICE guidelines, I contend that parents should be offered the opportunity to see and hold their dead baby.

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Zanini, Roselaine Ruviaro. « Modelos multiníveis aplicados ao estudo da mortalidade infantil no Rio Grande do Sul, Brasil, de 1994 a 2004 ». reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2007. http://hdl.handle.net/10183/10589.

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CONTEXTO: O Coeficiente de Mortalidade Infantil (CMI), que expressa o risco de um nascido vivo morrer antes de completar um ano de vida, é considerado um dos mais eficientes sensores de desenvolvimento social, econômico e ético, e seu acompanhamento permite inferir sobre a qualidade de vida de uma população. No Rio Grande do Sul, esse coeficiente vem apresentando tendência decrescente, permanecendo abaixo da média nacional. Entretanto, ampliar a compreensão dos determinantes da mortalidade infantil pode contribuir na elaboração de políticas e programas de saúde específicos. São inúmeros os fatores de risco citados na literatura, e a maioria deles é evidenciada em estudos que desconsideram a hierarquia existente nos dados. Porém, crianças que vivem em determinadas regiões podem apresentar características similares, quando comparadas a outras que vivem em regiões diferentes. Assim, as técnicas clássicas de análise, que pressupõem independência entre as observações, podem produzir estimativas viesadas. OBJETIVOS: O objetivo deste estudo foi utilizar os dados de sistemas de informações para analisar a evolução e os determinantes da mortalidade infantil e seus componentes no Rio Grande do Sul, de 1994 a 2004, assim como identificar os fatores associados à mortalidade neonatal, em 2003, considerando características individuais e contextuais. MÉTODO: Para a análise da evolução, foi realizado um estudo ecológico longitudinal, considerando-se medidas repetidas e regressão linear multinível, com microrregiões no nível 2 e tempo no nível 1. Para identificar os determinantes associados ao óbito neonatal, foi utilizada uma coorte retrospectiva que vinculou os nascimentos registrados no período de 01/01/2003 a 03/12/2003 aos óbitos neonatais originados desses nascimentos. Esses fatores foram estimados e comparados por meio da análise dos modelos de regressão logística clássica e multinível. RESULTADOS: Verificou-se que a taxa de mortalidade infantil reduziu de 19,2 para 15,2 por mil nascidos vivos, e as principais causas de óbitos infantis, nos últimos cinco anos, foram as afecções perinatais (54,10%). Aproximadamente 47% da variação nas taxas de mortalidade ocorreu no nível das microrregiões, sendo que 10% de acréscimo na cobertura do Programa Saúde da Família esteve associado à redução de 1‰ na mortalidade infantil, e um acréscimo de 10% na taxa de pobreza esteve associado com uma redução de 2,1‰ nos óbitos infantis. Também, encontrou-se associação positiva com a proporção de baixo peso e a taxa de leitos hospitalares na população e, negativa, com a proporção de partos cesáreos e a taxa de hospitais. As variáveis associadas ao óbito neonatal, no modelo clássico, foram: baixo peso ao nascer, Apgar no 1º e 5º minuto inferiores a 8, presença de anomalia congênita, parto cesáreo, prematuridade e perda fetal anterior. No modelo multinível, essa variável não se manteve significativa, mas a inclusão da variável contextual indicou que 15% da variação da mortalidade neonatal pode ser explicada pela variabilidade nas taxas de pobreza em cada microrregião. CONCLUSÕES: Este estudo evidenciou a predominância dos fatores individuais na mortalidade infantil e neonatal, mas demonstrou que a análise multinível foi capaz de identificar efeitos contextuais, possibilitando ações públicas direcionadas aos grupos vulneráveis.
CONTEXT: The Infant Mortality Coefficient (IMC), that express the risk of a bornalive baby die before completing one year of life, is considered one of the most efficient sensors of social, economic and ethical development, and its following allows to infer on the population life quality. In Rio Grande do Sul this coefficient has presented a decreasing trend, remaining below national average. However, to extend the understanding determinants of infant mortality can contribute in the elaboration of policies and specific health programs. Several risk factors are mentioned in literature, and the majority of them are evidenced in studies that disrespect the existing hierarchy in data. However, children who live in certain regions can present similar characteristics, when compared to others who live in different regions. Thus, classical techniques of analysis that estimate independence between comments, can produce biased estimates. OBJECTIVES: The objective of this study was to use the systems of information data to analyze the evolution and determinants of infant mortality and their components in Rio Grande do Sul from 1994 to 2004, as well as to identify the factors associated to neonatal mortality, in 2003, considering individual and contextual characteristics. METHOD: For the evolution analysis a longitudinal ecologic study was carried out, considering repeated-measures and multilevel linear regression, with microregions in level 2 and time in level 1. To identify the determinants associated to neonatal death, a historic cohort was used to link births recorded from 01/01/2003 to 12/03/2003 with the originated neonatal deaths of these births. These factors were estimated and compared by classic and multilevel logistic regression models. RESULTS: It was verified that the infant mortality rate decreased from 19.2 to 15.2 per thousand live births, and the main causes of infant deaths in the last five years has been perinatal affections (54.10%). Approximately 47% of the variation in mortality rates occurred at a microregion level, being that 10% increase in Family Health Program coverage was associated to the reduction of 1‰ in infant mortality, and an increase of 10% in poverty rate was associated to an increase of 2.1‰ in infant deaths. Also, there was positive association with the proportion of low weight and hospital bed rates in the population and, negative, with the proportion of caesarean sections and hospital rates. Low birthweight, Apgar scores at 1 and at 5 minutes lower 8, presence of congenital abnormality, caesarean section, pre-term birth and previous fetal loss were associated to neonatal deaths in the classical model. In the multilevel model, previous fetal loss did not remain significant, but the inclusion of contextual variable indicated that 15% of neonatal mortality variation can be explained by the variability in rates of poverty in each microregion. CONCLUSIONS: This study evidenced the predominance of individual factors in infant and neonatal mortality, but it demonstrated that the multilevel analysis was capable of identifying contextual effects, making directed actions to the susceptible groups possible.

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Tsang, Hing-wai, et 曾慶威. « In vitro studies of hypoxic ischemic down-regulated 1 (HID-1) protein encoded by a novel gene down-regulated in neonatal hypoxic-ischemicencephalopathy in different cell death paradigms ». Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B45608192.

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Wrammert, Johan. « Surviving birth : Studies of a simplified neonatal resuscitation protocol in a low-income context using a mixed-methods approach ». Doctoral thesis, Uppsala universitet, Internationell mödra- och barnhälsovård (IMCH), 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-316728.

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United Nations has lately stated ambitious health targets for 2030 in the Sustainable Development Goal agenda, following the already achieved progress between 1990 and 2015 when the number of children dying before the age of five was reduced by more than half. However, the mortality reduction in the first month of life after birth has not kept the same pace. Furthermore, a large number of stillbirths have previously not been accounted for. The aim of this thesis was to evaluate the impact of clinical training in neonatal resuscitation, and to identify strategies for an effective implementation at a maternal health facility in Nepal. Focus group discussions were used to explore the perceptions of teamwork among staff working closest to the infant at the facility. A prospective cohort study with nested referents was applied to determine effect on birth outcomes after an intervention with Helping Babies Breathe, a simplified protocol for neonatal resuscitation. Sustainability of the acquired skills after training was addressed by employing a quality improvement cycle. Video recordings of health workers performance were collected to analyse adherence to protocol. Midwives described the need for universal protocols in neonatal resuscitation and management involvement in clinical audit and feedback. There was a reduction of intrapartum stillbirth (aOR 0.46, 95% CI 0.32–0.66) and neonatal mortality within 24 hours of life (aOR 0.51, 95% CI 0.31–0.83) after the intervention. Ventilation of infants increased (OR 2.56, 95% CI 1.67–3.93) and potentially harmful suctioning was reduced (OR 0.13, 95% CI 0.09–0.17). Neonatal death from intrapartum-related complications was reduced and preterm infants survived additional days in the neonatal period after the intervention. Low birth weight was not found to be a predictor of deferred resuscitation in the studied context. This study confirmed the robustness of Helping Babies Breathe as an educational tool for training in neonatal resuscitation. Accompanied with a quality improvement cycle it reduced intrapartum stillbirth and mortality on the day of delivery in a low-income facility setting. Improved postnatal care is needed to maintain the gains in survival through the neonatal period. Increased management involvement in audit and quality of care could improve clinical performance among health workers.

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Subutzki, Larissa Spies. « VALIDAÇÃO DE CONSTRUTO TEÓRICO-PRÁTICO SOBRE O PROCESSO DE MORTE E MORRER EM UNIDADE DE TERAPIA INTENSIVA NEONATAL, À LUZ DO PENSAMENTO COMPLEXO ». Centro Universitário Franciscano, 2017. http://www.tede.universidadefranciscana.edu.br:8080/handle/UFN-BDTD/617.

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Submitted by MARCIA ROVADOSCHI (marciar@unifra.br) on 2018-08-22T12:43:51Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_LarissaSpiesSubutzki.pdf: 1833489 bytes, checksum: 94804ae8e0e46ca3f593185fa023dbc3 (MD5)
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The present paper is based on the thought that there can be no simplified way of understanding and analyzing the facts surrounding human existence and, therefore, a linear approach to exercising multiprofessional care in the process of death and dying. Thus, investing in studies on the phenomenon of death and dying from the perspective of complexity thinking will contribute to the establishment of a "new professional order", motivated by an extended and systemic understanding of care throughout the existential cycle. The purpose of this study was to validate the theoretical-practical construct on the multiprofessional care of neonates in the process of death and dying in neonatal intensive care units, following a complexity thinking. And, as specific objectives: To analyze the scientific productions on multiprofessional care in the process of death and dying in neonatal intensive care units; To know the perception of the multiprofessional team of neonatal intensive care units on the process of death and dying of neonates, and To describe the stages of construction on the process of death and dying in neonatal and pediatric intensive care units . In order to meet the first objective, an integrative research was carried out in PubMed, Lilacs and Bdenf Databases, which resulted in the inclusion of 13 productions, which were decoded into three categories of analysis: the perception of the multiprofessional team about the process of death and dying, strategies of care in the face of neonatal death and family reaction to the process of death and dying. To meet the second objective, a qualitative exploratory-descriptive study was carried out through a focus group technique with 35 professionals from the multiprofessional team who work in a neonatal and pediatric intensive care unit from May to July. A third specific objective was reached through a methodological research, which sought to describe the construction and validation stages of a construct on the process of death and dying in neonatal intensive care units, following a complexity thinking. In response to the latter objective, on the analysis of renowned specialists, a return of twelve instruments were evaluated in the first round and eleven instruments in the second Delphi round. In the first round, suggestions were made for changes in relation to the conceptual and formative dimensions of the construct. The construct was considered valid, both in content and appearance and will contribute to the expanded and multiprofessional understanding of the process of death and dying of neonates and children locally and nationally. It is concluded, therefore, that the process of death and dying of neonates and children constitutes a singular and complex process, both for the multiprofessional team and for the family members. In this direction, the validation of a theoretical-practical construct on the process of death and dying, in the perspective of complex thinking, constitutes a proactive strategy for the (re) thinking of human existence itself, in addition to enabling theoretical-practical reflections among professionals of the multiprofessional team that contributes to the confrontation of the adversities and the uncertainties inherent to existential and caring dynamics. Complex thinking corroborates, in this direction, with the bet that it is not possible to escape the uncertainties and adversities of life, but that it is necessary to assume death and dying as a phenomenon that is part of the existential dynamics.
O presente estudo sustenta-se no pensamento de que não pode haver uma forma simplificada de compreender e analisar os fatos que envolvem a existência humana e, tão pouco, uma abordagem linear no exercício do cuidado multiprofissional no processo de morte e morrer. Assim, investir em estudos sobre o fenômeno de morte e morrer na perspectiva do pensamento da complexidade contribuirá para o estabelecimento de uma nova ordem profissional, motivada pela compreensão ampliada e sistêmica do cuidado em todo o ciclo existencial. Com base nesta aposta, o presente estudo teve como objetivo geral: Validar construto teórico-prático sobre o cuidado multiprofissional de neonatos no processo de morte e morrer em unidade de terapia intensiva neonatal, à luz do pensamento da complexidade. E, como objetivos específicos: Analisar as produções científicas sobre o cuidado multiprofissional no processo de morte e morrer em unidade de terapia intensiva neonatal; Conhecer a percepção da equipe multiprofissional da unidade de terapia intensiva neonatal sobre o processo de morte e morrer de neonatos e, Descrever as etapas de construção e validação de um construto sobre o processo de morte e morrer em unidade de terapia intensiva neonatal. Para atender o primeiro objetivo foi realizada uma pesquisa integrativa nas Bases de Dados PubMed, Lilacs e Bdenf, a qual resultou na inclusão de 13 produções, as quais foram decodificadas em quatro categorias de análise: percepção da equipe multiprofissional sobre o processo de morte e morrer, estratégias de cuidados diante da morte neonatal e reação da família face ao processo de morte e morrer. Para atender o segundo objetivo, foi realizada uma pesquisa qualitativa exploratório-descritiva, por meio da técnica de grupo focal, com 35 profissionais da equipe multiprofissional que atuam em uma unidade de terapia intensiva neonatal, no período de maio a julho de 2016. O terceiro objetivo específico foi alcançado a partir de uma pesquisa metodológica, que buscou descrever as etapas de construção e de validação de um construto sobre o processo de morte e morrer em unidade de terapia intensiva neonatal, à luz do pensamento da complexidade. Em resposta a este último objetivo obteve-se, na análise dos especialistas em âmbito nacional, um retorno de doze instrumentos avaliados na primeira rodada e, onze instrumentos, na segunda rodada Delphi. Na primeira rodada foram realizadas sugestões de mudanças em relação as dimensões conceitual e formativa do construto. O construto foi considerado válido tanto em conteúdo quanto em aparência e, certamente, contribuirá para a compreensão ampliada e multiprofissional do processo de morte e morrer de neonatos em âmbito local e em território nacional. Conclui-se, portanto, que o processo de morte e morrer de neonatos se constitui em processo singular e complexo, tanto para a equipe multiprofissional, quanto para os familiares. Nessa direção, a validação de um construto teórico-prático sobre o processo de morte e morrer, na perspectiva do pensamento complexo, se constitui em estratégia proativa para o (re)pensar da própria existência humana, além de possibilitar reflexões teórico-práticas entre os profissionais da equipe multiprofissional que contribuam para o enfrentamento das adversidades e das incertezas inerentes à dinâmica existencial e cuidativa. O pensamento complexo corrobora, nessa direção, com a aposta de que não é possível fugir das incertezas e das adversidades da vida, mas de que é preciso assumir a morte e o morrer como fenômeno integrante da dinâmica existencial.

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Lu, Simin. « Calcium Dependent Regulatory Mechanism in Wolfram Syndrome : A Dissertation ». eScholarship@UMMS, 2015. https://escholarship.umassmed.edu/gsbs_diss/733.

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Wolfram syndrome is a genetic disorder characterized by diabetes and neurodegeneration. Two causative genes have been identified so far, WFS1 and WFS2, both encoding endoplasmic reticulum (ER) localized transmembrane proteins. Since WFS1 is involved in the ER stress pathway, Wolfram syndrome is considered an ER disease. Despite the underlying importance of ER dysfunction in Wolfram syndrome, the molecular mechanism linking ER to the death of β cells and neurons has not been elucidated. The endoplasmic reticulum (ER) is an organelle that forms a network of enclosed sacs and tubes that connect the nuclear membrane and other organelles including Golgi and mitochondria. ER plays critical functions in protein folding, protein transport, lipid metabolism, and calcium regulation. Dysregulation of ER function disrupts normal cell metabolism and activates an array of anti-survival pathways, eventually leading to disease state. Here we show that calpain is involved in both prototypes of Wolfram syndrome. Calpain 2 activity is negatively regulated by WFS2 protein, and hyper-activation of calpain 2 by WFS2-knockdown leads to cell death. Calpain hyper-activation is also present in WFS1 loss of function cells due to the high cytosolic calcium. Extensive calpain activation exists in the Wolfram syndrome mouse model as well as in patient cells. A compound screen targeting ER homeostasis reveals that dantrolene, a ryanodine receptor inhibitor, can prevent cell death in cell models of Wolfram syndrome. Our results demonstrate that the pathway leading to calpain activation provides potential therapeutic targets for Wolfram syndrome and other ER diseases.

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Lu, Simin. « Calcium Dependent Regulatory Mechanism in Wolfram Syndrome : A Dissertation ». eScholarship@UMMS, 2002. http://escholarship.umassmed.edu/gsbs_diss/733.

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Wolfram syndrome is a genetic disorder characterized by diabetes and neurodegeneration. Two causative genes have been identified so far, WFS1 and WFS2, both encoding endoplasmic reticulum (ER) localized transmembrane proteins. Since WFS1 is involved in the ER stress pathway, Wolfram syndrome is considered an ER disease. Despite the underlying importance of ER dysfunction in Wolfram syndrome, the molecular mechanism linking ER to the death of β cells and neurons has not been elucidated. The endoplasmic reticulum (ER) is an organelle that forms a network of enclosed sacs and tubes that connect the nuclear membrane and other organelles including Golgi and mitochondria. ER plays critical functions in protein folding, protein transport, lipid metabolism, and calcium regulation. Dysregulation of ER function disrupts normal cell metabolism and activates an array of anti-survival pathways, eventually leading to disease state. Here we show that calpain is involved in both prototypes of Wolfram syndrome. Calpain 2 activity is negatively regulated by WFS2 protein, and hyper-activation of calpain 2 by WFS2-knockdown leads to cell death. Calpain hyper-activation is also present in WFS1 loss of function cells due to the high cytosolic calcium. Extensive calpain activation exists in the Wolfram syndrome mouse model as well as in patient cells. A compound screen targeting ER homeostasis reveals that dantrolene, a ryanodine receptor inhibitor, can prevent cell death in cell models of Wolfram syndrome. Our results demonstrate that the pathway leading to calpain activation provides potential therapeutic targets for Wolfram syndrome and other ER diseases.

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Rydvall, Anders. « Withhold or withdraw futile treatment in intensive care : arguments supported by physicians and the general public ». Doctoral thesis, Umeå universitet, Anestesiologi och intensivvård, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-128863.

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Background: Since the 60s and with increasing intensity a discussion have continued about balance between useful and useless/harmful treatment. Different attempts have been done to create sustainable criteria and recommendations to manage the situations of futile treatment near the end of life. Obviously, to be able to withhold (WH) or withdraw (WD) treatment which is no longer appropriate or even harmful and burdensome for the patient, other processes than strict medical (or physiological) assessments are necessary. Aim. To shed light on the arguments regarding to WH or WD futile treatment we performed two studies of physicians’ and the general populations’ choice and prioritized arguments in the treatment of a 72-year-old woman suffering from a large intra-cerebral bleeding with bad prognosis (Papers I and II) and a new born boy with postpartum anoxic brain damage (Papers III and IV). Methods. Postal questionnaires based on two cases presented above involving severely ill patients were used. Arguments for and against to WH or WD treatment, and providing treatment that might hasten death were presented. The respondents evaluated and prioritized arguments for and against withholding neurosurgery, withdrawing life-sustaining treatment and providing drugs to alleviate pain and distress. We also asked what would happen to physicians’ own trust if they took the action described, and what the physician estimated would happen to the general publics’ trust in health services (Paper IV). Results. Approximately 70% of the physicians and 46% of the general public responded in both surveys. The 72-year-old woman: A majority of doctors (82.3%) stated that they would withhold treatment, whereas a minority of the general public (40.2%) would do so; the arguments forwarded and considerations regarding quality of life differed significantly between the two groups. Quality-of-life aspects were stressed as an important argument by the majority of both neurosurgeons and ICU-physicians (76.8% vs. 54.0%); however, significantly more neurosurgeons regarded this argument as the most important. A minority in both groups, although more ICU-physicians, supported a patient’s previously expressed wish of not ending in a persistent vegetative state as the most important argument. As the case clinically progressed, a consensus evolved regarding the arguments for decision making. The new born child: A majority of both physicians [56 % (CI 50–62)] and the general population [53 % (CI 49–58)] supported arguments for withdrawing ventilator treatment. A large majority in both groups supported arguments for alleviating the patient’s symptoms even if the treatment hastened death, but the two groups display significantly different views on whether or not to provide drugs with the additional intention of hastening death, although the difference disappeared when we compared subgroups of those who were for or against euthanasia-like actions. Conclusions. There are indeed considerable differences in how physicians and the general public assess and reason in critical care situations, but the more hopelessly ill the patient became the more the groups' assessments tended to converge, although they prioritized different arguments. In order to avoid unnecessary dispute and miscommunication, it is important that health care providers are aware of the public's views, expectations, and preferences. Our hypothesis—physicians’ estimations of others’ opinions are influenced by their own opinions—was corroborated. This might have implications in research as well as in clinical decision-making.

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Zlot, Renata. « Anomalias congênitas em natimortos e neomortos : o papel do aconselhamento genético ». Instituto Fernandes Figueira, 2008. https://www.arca.fiocruz.br/handle/icict/3635.

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Fundação Oswaldo Cruz. Instituto Fernandes Figueira. Departamento de Ensino. Programa de Pós-Graduação em Saúde da Criança e da Mulher. Rio de Janeiro, RJ< Brasil
Este estudo objetivou analisar o entendimento das informações fornecidas e as opções reprodutivas de mulheres que passaram pelo aconselhamento genético (AG) no Instituto Fernandes Figueira (IFF)/Fundação Oswaldo Cruz (FIOCRUZ). Muitos artigos mostram que a lembrança dos riscos de recorrência e a interpretação dos riscos de forma correta são fundamentais para o planejamento reprodutivo. Primeiramente foi feito uma análise quantitativa, através de freqüências simples, para o levantamento do perfil das mulheres atendidas durante os anos de 2002 e 2003 (160 mulheres), quanto à idade, escolaridade e estado civil. Avaliamos também o fluxograma do atendimento durante o pré-natal e nas consultas de AG.Posteriormente foi realizada uma pesquisa, através de entrevistas estruturadas (35 perguntas), enviadas pelo correio para as 101 mulheres atendidas no período de 2002 a 2004, que se enquadravam nos critérios de inclusão ( filho natimorto ou neomorto com anomalia congênita e que foi submetido a necrópsia, avaliação genética, ou estudo citogenético). Recebemos 34 respostas ( com termo de consentimento livre e informado assinado), que foram analisadas fazendo-se uso das abordagens quantitativa e qualitativa, para verificar o entendimento das clientes em relação ao diagnóstico, risco de recorrência, interpretação de riscos e suas opções reprodutivas após o AG.Encontramos respostas condizentes com as informações fornecidas em relação à lembrança do risco numérico e à interpretação do risco em torno de 53 por cento e 56 por cento , respectivamente. Percebemos, entretanto, que em nosso estudo o desejo de ter filhos esteve mais fortemente ligado às decisões reprodutivas do que os riscos de recorrência fornecidos.
This study aimed to analyze how the information provided to women through genetic counselling (GC) in Instituto Fernandes Figueira (IFF) / Oswaldo Cruz Foundation (FIOCRUZ) was understood and their reproductive options thereafter. Many authors point out that recalling the recurrence risks and their correct interpretation are extremely important for reproductive planning. A quantitative analysis was performed using simple frequencies to characterize the profile of the women who sought GC in the years 2002 and 2003 (160 women). Data such as age, education level and marital status were collected. The flowchart of care during prenatal and GC consultations was studied. After the profile analysis, a structured interview comprising 35 questions was sent by mail to 101 women who underwent GC in the years 2002 to 2004 and fullfilled the inclusion criteria (whose babies had congenital anomalies and werestillborn or died in the neonatal period and underwent autopsy, genetic evaluation or chromosomal investigation). The 34 responses (with signed informed consent to participate in the study) were received and underwent both quantitative and qualitative analyses, where the clients´ understanding was verified regarding diagnosis,recurrence risks, risk interpretation and their reproductive options after the conclusion of GC. Responses were in accordance to the information provided in GC, regarding remembrance of the numerical recurrence risk and its interpretation in 53% and 56%, respectively. Our study showed, however, that the desire to have children was more strongly related to the reproductive decisions than the informed recurrence risks.

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