Atenção ao parto e nascimento em hospital universitário : comparação de práticas desenvolvidas após a adesão à Rede Cegonha

A partir da preocupação brasileira com a assistência ao parto, marcada pelo uso em excesso de tecnologia e medicalização, ocasionando intervenções desnecessárias e elevadas taxas de cesariana, o governo passou a adotar uma série de estratégias, a mais recente delas é a Rede Cegonha. Não foi encontrado nenhum estudo cuja finalidade fosse comparar as práticas assistenciais de uma mesma maternidade após a implementação da Rede Cegonha, no que se refere à capacidade dessa estratégia de modificar positivamente as práticas obstétricas ao longo dos anos. Assim, o objetivo desse estudo é analisar as práticas de atenção ao parto e nascimento em um hospital universitário no ano de implementação (2012) da Rede Cegonha e comparar com as práticas desenvolvidas quatro anos após (2016). Trata-se de um estudo transversal, realizado em um hospital universitário da cidade de Porto Alegre – RS, que abrange dados obtidos em dois períodos de tempo diferentes: 2012 e 2016. As variáveis do presente estudo foram divididas em sete blocos. As práticas de assistência avaliadas não demonstraram uma evolução contínua, como se supunha na hipótese desta pesquisa, visto que algumas apresentaram resultados melhores, e outras se mantiveram ou apresentaram resultados piores. Alguns resultados merecem destaque na comparação entre os anos de 2012 e 2016: venóclise rotineira (85,4% vs. 97,8%; p<0,001), restrição de movimentação no trabalho de parto (46,1% vs. 55,1%; p=0,008), episiotomia de rotina (63,6% vs. 55,0%; p=0,024), exames de toque acima do recomendado (69,5% vs. 76,8%; p=0,055), aspiração rotineira de vias aéreas do recém-nascido (65,6% vs. 56,8%; p=0,008) e administração de nitrato de prata antes da primeira hora após o parto (43,1% vs. 65,3%; p<0.001). Evidenciou-se também a manutenção de algumas práticas: internação fora do trabalho de parto (49,3% vs. 51,2%), posição de litotomia no expulsivo (99,3% vs. 98,7%), amniotomia rotineira (81,8% vs. 83,9%) e ocitocina rotineira (80,1% vs. 81,9%). Algumas boas práticas destacaram-se: aumento do acompanhante durante o parto (91,0% vs. 95,7%; p=0,004), do uso de métodos não-farmacológicos de alívio da dor (67,9% vs. 74,2%; p=0,040), do contato pele-a-pele (14,9% vs. 60,1%; p<0,001) e do estímulo à amamentação logo após o nascimento (22,1% vs. 45,0%; p<0,001). Modelos de atenção que mantêm práticas intervencionistas e obsoletas ignoram as evidências científicas e têm se mostrado falidos pois repercutem negativamente na morbimortalidade materna e neonatal. Um caminho já consolidado em outros lugares do mundo é a inserção de enfermeiras obstetras e obstetrizes na assistência direta ao parto. Os resultados encontrados neste trabalho são indicativos da necessidade da instituição, que é hospital universitário, rever suas práticas assistenciais, inclusive para adoção de um novo modelo de atenção.Based on the Brazilian preoccupation with childbirth care, marked by the excessive use of technology and medicalization, causing unnecessary interventions and high cesarean rates, the government started to adopt a series of strategies, the most recent being the Stork Network. We did not find any study whose purpose was to compare the care practices of the same motherhood after the implementation of the Stork Network, regarding the capacity of this strategy to positively modify obstetric practices over the years. Thus, the objective of this study is to analyze the practices of care for childbirth and birth in a university hospital in the year of implementation (2012) of the Stork Network and compare with the practices developed four years after (2016). This is a cross-sectional study carried out in a university hospital in the city of Porto Alegre, Brazil, which covers data obtained in two different time periods: 2012 and 2016. The variables of the present study were divided into seven blocks. The assistance practices evaluated did not show a continuous evolution, as assumed in the hypothesis of this research, since some presented better results, and others maintained or presented worse results. Some results are worthy of note in the comparison between the years 2012 and 2016: routine venoclysis (85.4% vs. 97.8%, p <0.001), movement restriction in labor (46.1% vs. 55.1% (P = .024), touch tests above the recommended rate (69.5% vs. 76.8%, p = 0.055), (65.6% vs. 56.8%, p = 0.008) and administration of silver nitrate within the first hour after delivery (43.1% vs. 65.3%; p <0.001). It was also evidenced the maintenance of some practices: hospitalization outside labor (49.3% vs. 51.2%), position of lithotomy in the expulsive (99.3% vs. 98.7%), routine amniotomy (81.8% vs. 83.9%) and routine oxytocin (80.1% vs. 81.9%). Some good practices were: increase of the companion during delivery (91.0% vs. 95.7%, p = 0.004), use of non-pharmacological methods of pain relief (67.9% vs. 74, (P = 0.040), skin-to-skin contact (14.9% vs. 60.1%, p <0.001) and stimulation of breastfeeding soon after birth (22.1% vs. 45.0% %, p <0.001). Models of care that maintain interventionist and obsolete practices ignore the scientific evidence and have proved bankrupt because they have a negative impact on maternal and neonatal morbidity and mortality. A path already consolidated in other parts of the world is the insertion of obstetricians and obstetricians in the direct care of childbirth. The results found in this study are indicative of the need of the institution, which is a university hospital, to review its care practices, including the adoption of a new model of care

The role of very fine particle sizes in the reflectance spectroscopy of plagioclase-bearing mixtures: New understanding for the interpretation of the finest sizes of the lunar regolith

The lunar surface consists of a regolith layer that covers the underlying bedrocks, and is generally char- acterized by particulates < 1 cm. Lunar soil is the fine fraction of the regolith, and is generally between 60 and 80 μm. Sizes < 10 μm, accounting for ca. 5–20% of the soil, were recognized and petrologically classified. The coarsest sizes of the regolith are chemically and mineralogically similar, while the finest fractions are more feldspathic, probably due to easier fracturing of plagioclase than mafic minerals. Due to the more feldspathic nature of the very fine lunar soils, in this paper, we quantitatively inves- tigate the influence of very fine ( < 10 μm) plagioclase on the absorption bands of mafic minerals using the Modified Gaussian Model. We considered two plagioclases with different iron content and two mafic end-members (1) 56% orthopyroxene and 44% clinopyroxene, and (2) 30% orthopyroxene and 70% olivine. We also compared our results with the deconvolution of the same mixtures at coarser sizes. Our results mainly show that: (1) fine sizes act principally on reflectance and on spectral contrast (with the former increasing and the latter decreasing); (2) very fine plagioclase has a blue slope in the Near Infrared and very shallow 1250 nm band depth, close to zero; (3) consequently, the plagioclase band is always shallower than mafic bands; (4) in mixtures with olivine, the composite band center always shows the typical olivine value, differently from coarser mixtures; and (5) mafic materials have a blue slope in the Short Wavelength Infrared Region, a more V-shaped 1 μm pyroxene absorption and the 1 μm mafic band centers are shifted by ca. 40 nm vs. coarse sizes, reflecting a different weight within the crystal field absorption of the mafic component in very fine size. We also evidenced that a coarse plagioclase could be overestimated, while a very fine one could be underestimated if compared with the 63–125 μm size

Atenção ao parto e nascimento em hospital universitário: comparação de práticas desenvolvidas após Rede Cegonha

Objetivo: comparar, após transcorridos quatro anos da implementação da Rede Cegonha, as práticas obstétricas desenvolvidas em um hospital universitário segundo classificação da Organização Mundial da Saúde. Método: estudo transversal realizado no ano de adesão à Rede Cegonha (377 mulheres) e replicado quatro anos após (586 mulheres). Dados obtidos mediante prontuário e questionário estruturado. Na análise, utilizou-se o Teste Qui-quadrado. Resultados: quatro anos após a Rede Cegonha, dentre as práticas da Categoria A (práticas comprovadamente úteis/ boas práticas), aumentou a frequência de acompanhante, de métodos não farmacológicos, de contato pele a pele e de estímulo à amamentação e diminuiu a liberdade de posição/ movimentação. Na Categoria B (práticas prejudiciais), houve redução de tricotomia e aumento de venóclise. Na Categoria C (práticas sem evidências suficientes), o Kristeller apresentou aumento. Na Categoria D (práticas utilizadas de modo inadequado), aumentou o percentual de toque vaginal acima do recomendado, de analgésicos e de analgesia e diminuiu a episiotomia. Conclusão: esses resultados indicam a manutenção de uma assistência tecnocrática e intervencionista e direcionam para a necessidade de mudanças no modelo de atenção obstétrica. Um caminho consolidado mundialmente é a incorporação de enfermeiras obstetras/obstetrizes na assistência ao parto pelo potencial de utilização apropriada de tecnologias e redução de intervenções desnecessárias.Objetivo: comparar, después de transcurridos cuatro años de la implementación de la Red Cigüeña, las prácticas obstétricas desarrolladas en un hospital universitario según clasificación de la Organización Mundial de la Salud. Método: estudio transversal realizado en el año de adhesión a la Red Cigüeña (377 mujeres) y replicado cuatro años después (586 mujeres). Datos obtenidos mediante prontuario y cuestionario estructurado. En el análisis, se utilizó el Test Chi-cuadrado. Resultados: cuatro años después de la Red Cigüeña, entre las prácticas de la Categoría A (prácticas demostradamente útiles/ buenas prácticas), aumentó la frecuencia de acompañante, de métodos no farmacológicos, de contacto piel a piel y de estímulo a la lactancia y disminuyó la libertad de posición/ movimiento. En la Categoría B (prácticas perjudiciales), hubo reducción de tricotomía y aumento de venoclisis. En la Categoría C (prácticas sin evidencias suficientes), el Kristeller presentó aumento. En la Categoría D (prácticas utilizadas de modo inadecuado), aumentó el porcentaje de toque vaginal más de lo recomendado, de analgésicos y de analgesia y disminuyó la episiotomía. Conclusión: esos hallazgos indican el mantenimiento de una asistencia tecnocrática e intervencionista y dirigida para la necesidad de cambios en el modelo de atención obstétrica. Un camino consolidado mundialmente es la incorporación de enfermeras obstetras/ parteras en la asistencia al parto por el potencial de utilización apropiada de tecnologías y reducción de intervenciones desnecesarias.Objective: to compare, after four years of the implementation of the Stork Network, the obstetric practices developed in a university hospital according to the classification of the World Health Organization. Method: cross-sectional study carried out in the year of adherence to the Stork Network (377 women) and replicated four years later (586 women). Data were obtained through medical records and a structured questionnaire. The Chi-square test was used in the analysis. Results: four years after the implementation of the Stork Network, in Category A practices (demonstrably useful practices/good practices), there was increased frequency of companions, non-pharmacological methods, skin-to-skin contact and breastfeeding stimulation, and decreased freedom of position/movement. In Category B (harmful practices), there was reduction of trichotomy and increased venoclysis. In Category C (practices with no sufficient evidence), there was increase of Kristeller’s maneuver. In Category D (improperly used practices), the percentage of digital examinations above the recommended level increased, as well as of analgesics and analgesia, and there was decrease of episiotomy. Conclusion: these findings indicate the maintenance of a technocratic and interventionist assistance and address the need for changes in the obstetric care model. A globally consolidated path is the incorporation of midwife nurses into childbirth for the appropriate use of technologies and the reduction of unnecessary interventions

Manual and semi-automated approaches to MIBG myocardial scintigraphy in patients with Parkinson’s disease

OBJECTIVE: This study investigates the effects of manual and semi-automatic methods for assessing MIBG semi-quantitative indices in a clinical setting. MATERIALS AND METHODS: We included (123)I-MIBG scans obtained in 35 patients with idiopathic Parkinson’s Disease. Early and late heart-to-mediastinum (H/M) ratios were calculated from (123)I-MIBG images using regions of interest (ROIs) placed over the heart and the mediastinum. The ROIs were derived using two approaches: (i) manually drawn and (ii) semi-automatic fixed-size ROIs using anatomical landmarks. Expert, moderate-expert, and not expert raters applied the ROIs procedures and interpreted the (123)I-MIBG images. We evaluated the inter and intra-rater agreements in assessing (123)I-MIBG H/M ratios. RESULTS: A moderate agreement in the raters’ classification of pathological and non-pathological scores emerged regarding early and late H/M ratio values (κ = 0.45 and 0.69 respectively), applying the manual method, while the early and late H/M ratios obtained with the semi-automatic method reached a good agreement among observers (κ = 0.78). Cohen-Kappa values revealed that the semi-automatic method improved the agreement between expert and inexpert raters: the agreement improved from a minimum of 0.29 (fair, for early H/M) and 0.69 (substantial, in late H/M) with the manual method, to 0.90 (perfect, in early H/M) and 0.87 (perfect, in late H/M) with the semi-automatic method. CONCLUSION: The use of the semi-automatic method improves the agreement among raters in classifying’ H/M ratios as pathological or non-pathological, namely for inexpert readers. These results have important implications for semi-quantitative assessment of (123)I-MIBG images in clinical routine

Reprodução, Partos, Maternidades e Paternidades: Perspectivas Contemporâneas em Antropologia e Saúde

A maternidade compulsória e a naturalização do amor materno enquanto instintivo são alguns dos papéis atribuídos às mulheres a partir da modernidade (BADINTER, 1985). No mesmo sentido, passaram a emergir uma série de normas, condutas e imposições sobre o corpo da mulher, que encontraram no campo científico seu instrumento legitimador, sendo a dinâmica dos sistemas de saúde e da própria ciência construídas segundo a dinâmica das relações de gênero impostas na sociedade. A ginecologia e a obstetrícia, enquanto campos da ciência e prática de cuidado com a saúde e o corpo, são parte desta dinâmica social de diferenciação de sexos e de gêneros, e, desde o século XIX, atuam desde uma materialização e “substancialização da diferença” (Rohden, 2001, p. 13). Portanto, além das mulheres serem compelidas a conduzirem suas vidas em conformidade com a ordem namorar, casar e ter filhos, quando elas os têm, ainda enfrentam uma série de desafios, os quais buscamos abordar e visibilizar neste número especial sobre Reprodução, Partos, Maternidades e Paternidades

Study of Detection Limits of Carbonate Phases in Mixtures with Basaltic-like Fine Regolith in the MIR (1–5.5 µm) Spectral Range

The presence of minerals formed under the occurrence of liquid water during the first billion years on Mars was a key discovery, but there is still a large number of open issues that make the study of these mineral deposits a main focus of remote sensing and laboratory studies. Moreover, even though there is extensive research related to the study of the spectral behavior of mixtures, we still lack a full understanding of the problem. The main goal of this work is the analysis of the detection limits of hydrated and carbonate phases within mixtures with basaltic-like fine regolith in the spectral region 1.0–5.5 µm (1818–10,000 cm−1). We selected two different basalt samples and mixed them with two carbonate phases: a dolomite and a calcite. Spectral features have been investigated isolating the main carbonate absorption features and overtones; deriving trends of spectral parameters such as band depth, band area, full-width-half-maximum; percentage and grain size variations. The results obtained in this work show how the presence of a basaltic component can strongly influence the appearance of the hydrated and carbonate features showing different trends and intensities depending on the grain size and percentage of the carbonate components

Two-Phase Stefan Problem as the Limit Case of Two-Phase Stefan Problem with Kinetic Condition

AbstractBoth one-dimensional two-phase Stefan problem with the thermodynamic equilibrium condition u(R(t),t)=0 and with the kinetic rule uε(Rε(t),t)=εRε′(t) at the moving boundary are considered. We prove, when ε approaches zero, Rε(t) converges to R(t) in C1+δ/2[0,T] for any finite T>0, 0<δ<1

A contaminação do rio Guaraguaçu (Litoral do Paraná): limites e riscos ao desenvolvimento territorial regional

Este estudo diagnostica um impacto ambiental de grande magnitude que ocorre na Bacia do Rio Guaraguaçu, importante rio de planície costeira, tanto pela sua rica biodiversidade e estado de conservação, quanto pelos serviços ambientais que oferece ao território. Trata-se da contaminação do rio Pery, afluente que recebe a maior parte da carga orgânica dos esgotos e do aterro dos municípios de Pontal do Paraná e Matinhos. Dados de qualidade das águas superficiais evidenciaram o alto grau de contaminação que determina alteração do contínuo fluvial, com grandes consequências ecossistemas, e grande risco à saúde ambiental das populações humanas que ali vivem. Os resultados são discutidos em função da magnitude deste impacto, e dos cenários futuros determinados pelos principais planos de desenvolvimento territorial e políticas públicas propostos para a região

Dissolved oxygen dynamics under ice: three winters of high-frequency data from Lake Tovel, Italy

Under-ice dissolved oxygen (DO) metabolism and DO depletion are poorly understood, limiting our ability to predict how changing winter conditions will affect lake ecosystems. We analyzed under-ice DO dynamics based on high-frequency (HF) data at two depths (5 and 25 m) for three winters (January-March 2014, 2015, and 2016) in oligotrophic Lake Tovel (1178 m above sea level; maximum depth 39 m). Specifically, we assessed diel metabolic rates based on HF data of DO, temperature, and light for winter 2016 and seasonal DO depletion rates based on HF data of DO for all three winters. For 2016, calculations of metabolic rates were possible only for 34% and 3% of days at 5 and 25 m, respectively; these metabolic rates generally indicated net heterotrophy at both depths. Low success in modeling metabolic rates was attributed to low diel DO variability and anomalous diel DO patterns, probably linked to under-ice physical processes. Seasonal DO patterns for the three winters showed increasing, decreasing, or stable DO trends at 5 m while at 25 m patterns always showed decreasing DO trends but with different rates. Our multiyear study permitted us to hypothesize that the observed intraannual and interannual differences in DO depletion can be attributed to variable snow cover determining the penetration of radiation and thus photosynthesis. This study brings new insights to DO dynamics in ice-covered systems, highlights the challenges linked to under-ice lake metabolism, and advocates for a modeling approach that includes physical processes

The detector control unit of the fine guidance sensor instrument on-board the ARIEL mission: design status

ARIEL is an ESA mission whose scientific goal is to investigate exoplanetary atmospheres. The payload is composed by two instruments: AIRS (ARIEL IR Spectrometer) and FGS (Fine Guidance System). The FGS detection chain is composed by two HgCdTe detectors and by the cold Front End Electronics (SIDECAR), kept at cryogenic temperatures, interfacing with the F-DCU (FGS Detector Control Unit) boards that we will describe thoroughly in this paper. The F-DCU are situated in the warm side of the payload in a box called FCU (FGS Control Unit) and contribute to the FGS VIS/NIR imaging and NIR spectroscopy. The F-DCU performs several tasks: drives the detectors, processes science data and housekeeping telemetries, manages the commands exchange between the FGS/DPU (Data Processing Unit) and the SIDECARs and provides high quality voltages to the detectors. This paper reports the F-DCU status, describing its architecture, the operation and the activities, past and future necessary for its development