Construção do papel materno a partir da vivência de internação em UTI neonatal em dois modelos assistenciais / The formation of the maternal role from experience of hospitalization in the Neonatal Intensive Care Unit in two models of care

Introdução: O nascimento de um recém-nascido pré-termo que necessita de internação em Unidade de Terapia Intensiva (UTI) Neonatal representa uma crise na família. Os sentimentos maternos são contraditórios, envolvendo medo, culpa e negação. Objetivo: Analisar a construção do papel materno a partir do nascimento de um filho pré-termo internado em UTI Neonatal. Métodos: Estudo qualitativo realizado em quatro maternidades, duas no Rio de Janeiro e duas em São Luís. Em cada estado uma unidade utilizava o cuidado tradicional e a outra o Método Canguru. Foram realizadas 20 entrevistas semi-estruturadas, onze em unidades convencionais e nove em unidades canguru. A amostra foi definida pelo critério de saturação. Foram entrevistadas mães de bebês com internação de um a três meses. Realizada análise de conteúdo na modalidade temática. Resultados: Foram identificadas diferenças nos dois modelos assistenciais. Nos locais que utilizavam o Método Canguru, o contato pele a pele e a participação nos cuidados foram fundamentais para a construção da auto-imagem como mãe, influenciando na expectativa materna em relação ao período pós-alta e na construção de projetos de vida para o bebê. As mães do modelo tradicional tinham falas mais influenciadas pelo medo do bebê adoecer e preocupações como medo de visitas, de morte súbita e de doenças incuráveis. Conclusão: O Método Canguru facilita o desempenho do protagonismo materno, privilegiando a utilização de recursos próprios na compreensão e condução do que se passa com a mãe e com seu filho, levando ao seu empoderamento. Essa nova tecnologia de cuidado é facilitadora da construção do papel materno.Palavras-chave: Cuidados intensivos. Método mãe canguru. Recém-nascido de baixo-peso.AbstractIntroduction: The birth of a preterm baby who needs hospitalization in the Neonatal Intensive Care Unit (NICU) represents a crisis for the family. The maternal feelings are contradictory, involving fear, guilt and denial. Objective: To analyze the maternal role formation after the birth of preterm infants hospitalized in the NICU. Methods: This is a qualitative study conducted in four neonatal intensive care units, two in Rio de Janeiro and two in São Luís. In each State one of the units used the traditional care and the other one the Kangaroo care method. Twenty semi-structured interviews were conducted, being eleven in conventional units and nine in kangaroo units. The number of interviews was defined by the saturation criterion. We interviewed mothers of hospitalized infants of one to three months of age. Data were analyzed by thematic approach. Results: There were differences in the two care models. At those units where the Kangaroo method was used, the skin contact between the mother and child as well as the participation in the care were essential to build their self-image as a mother, influencing the maternal expectations in relation to post-discharge period and to the planning of life projects for the baby. Mothers who experienced the traditional model had reported to be more influenced by fear of infant to be sick and concerns such as fear of visits, sudden death and incurable diseases. Conclusion: Kangaroo care facilitates the performance of maternal protagonism, favoring the use of their own resources in understanding and dealing with problems that are happening with her and her child, leading to their empowerment. This new technology facilitates the formation of the maternal role.Keywords: Neonatal intensive care. Kangaroo mother method. Low birth weight infant

Lack of EGFR-activating mutations in European patients with triple-negative breast cancer could emphasise geographic and ethnic variations in breast cancer mutation profiles

INTRODUCTION: Triple-negative breast cancers (TNBCs) are characterised by lack of expression of hormone receptors and epidermal growth factor receptor 2 (HER-2). As they frequently express epidermal growth factor receptors (EGFRs), anti-EGFR therapies are currently assessed for this breast cancer subtype as an alternative to treatments that target HER-2 or hormone receptors. Recently, EGFR-activating mutations have been reported in TNBC specimens in an East Asian population. Because variations in the frequency of EGFR-activating mutations in East Asians and other patients with lung cancer have been described, we evaluated the EGFR mutational profile in tumour samples from European patients with TNBC. METHODS: We selected from a DNA tumour bank 229 DNA samples isolated from frozen, histologically proven and macrodissected invasive TNBC specimens from European patients. PCR and high-resolution melting (HRM) analyses were used to detect mutations in exons 19 and 21 of EGFR. The results were then confirmed by bidirectional sequencing of all samples. RESULTS: HRM analysis allowed the detection of three EGFR exon 21 mutations, but no exon 19 mutations. There was 100% concordance between the HRM and sequencing results. The three patients with EGFR exon 21 abnormal HRM profiles harboured the rare R836R SNP, but no EGFR-activating mutation was identified. CONCLUSIONS: This study highlights variations in the prevalence of EGFR mutations in TNBC. These variations have crucial implications for the design of clinical trials involving anti-EGFR treatments in TNBC and for identifying the potential target population

Platinum–rhodium–tin/carbon electrocatalysts for ethanol oxidation in acid media: effect of the precursor addition order and the amount of tin

Carbon-supported Pt x –Rh y –Sn z catalysts (x:y:z = 3:1:4, 6:2:4, 9:3:4) are prepared by Pt, Rh, and Sn precursors reduction in different addition order. The materials are characterized by X-ray diffraction, transmission electron microscopy, and X-ray photoelectron spectroscopy techniques and are evaluated for the electrooxidation of ethanol in acidic media by cyclic voltammetry, chronoamperometry, and anode potentiostatic polarization. The influence of both the order in which the precursors are added and the composition of metals in the catalysts on the electrocatalytic activity and physico-chemical characteristics of Pt x –Rh y –Sn z /C catalysts is evaluated. Oxidized Rh species prevail on the surface of catalysts synthesized by simultaneous co-precipitation, thus demonstrating the influence of synthesis method on the oxidation state of catalysts. Furthermore, high amounts of Sn in composites synthesized by co-precipitation result in very active catalysts at low potentials (bifunctional effect), while medium Sn load is needed for sequentially deposited catalysts when the electronic effect is most important (high potentials), since more exposed Pt and Rh sites are needed on the catalyst surface to alcohol oxidation. The Pt3–Rh1–Sn4/C catalyst prepared by co-precipitation is the most active at potentials lower than 0.55 V (related to bifunctional effect), while the Pt6–Rh2–Sn4/C catalyst, prepared by sequential precipitation (first Rh and, after drying, Pt + Sn), is the most active above 0.55 V.The authors thank the Brazilian National Council of Technological and Scientific Development-CNPq (Grants: 402243/2012-9, 303630/2012-4, 474261/2013-1, 407274/2013-8, and 310282/2013-6) for the scholarships and financial support for this work

Perinatal and early life factors associated with symptoms of depression in Brazilian children

Background: Few studies have been conducted on the association between perinatal and early life factors with childhood depression and results are conflicting. Our aim was to estimate the prevalence and perinatal and early life factors associated with symptoms of depression in children aged 7 to 11 years from two Brazilian birth cohorts. Methods: The study was conducted on 1444 children whose data were collected at birth and at school age, in 1994 and 2004/2005 in Ribeirao Preto, where they were aged 10-11 years and in 1997/98 and 2005/06 in Sao Luis, where children were aged 7-9 years. Depressive symptoms were investigated with the Child Depression Inventory (CDI), categorized as yes (score >= 20) and no (score < 20). Adjusted and non-adjusted prevalence ratios (PR) were estimated by Poisson regression with robust estimation of the standard errors. Results: The prevalence of depressive symptoms was 3.9% (95% CI = 2.5-5.4) in Ribeirao Preto and 13.7% (95% CI = 11.0-16.4) in Sao Luis. In the adjusted analysis, in Ribeirao Preto, low birth weight (PR = 3.98; 95% CI = 1.72-9.23), skilled and semi-skilled manual occupation (PR = 5.30; 95% CI = 1.14-24.76) and unskilled manual occupation and unemployment (PR = 6.65; 95% CI = 1.16-38.03) of the household head were risk factors for depressive symptoms. In Sao Luis, maternal schooling of 0-4 years (PR = 2.39; 95% CI = 1.31-4.34) and of 5 to 8 years (PR = 1.80; 95% CI = 1.08-3.01), and paternal age < 20 years (PR = 1.92; 95% CI = 1.02-3.61), were independent risk factors for depressive symptoms. Conclusions: The prevalence of depressive symptoms was much higher in the less developed city, Sao Luis, than in the more developed city, Ribeirao Preto, and than those reported in several international studies. Low socioeconomic level was associated with depressive symptoms in both cohorts. Low paternal age was a risk factor for depressive symptoms in the less developed city, Sao Luis, whereas low birth weight was a risk factor for depressive symptoms in the more developed city, Ribeirao Preto.CNPq (Conselho Nacional de Desenvolvimento Cientifico e Tecnologico - Brazilian National Research Council) [523474/96-2, 520664/98-1]FAPEMA (Fundacao de Amparo a Pesquisa e ao Desenvolvimento Cientifico e Tecnologico do Maranhao)FAPESP (Fundacao de Amparo a Pesquisa do Estado de Sao Paulo - Sao Paulo Research Foundation) [93/0525-0, 97/09517-1, 00/0908-7

Social inequality and perinatal health: comparison of three Brazilian cohorts

The objective of the present study was to estimate and compare social inequality in terms of three indicators, i.e., low birth weight (LBW), preterm birth (PTB) and small for gestational age (SGA) birth, in three birth cohorts. Two cohorts were from the city of Ribeirão Preto, where data were collected for all 6748 live born singletons in 1978/79 and for one third of live born singletons (2846) in 1994. The third cohort consisted of 2443 singletons born in São Luís over a period of one year (1997/98). In Ribeirão Preto, LBW and PTB rates increased in all social strata from 1978/79 to 1994. Social inequalities regarding LBW and PTB disappeared since the increase in these rates was more accelerated in the groups with higher educational level. The percentage of SGA infants increased over the study period. Social inequality regarding SGA birth increased due to a more intense increase in SGA births in the strata with lower schooling. In São Luís, in 1997/98 there was no social inequality in LBW or PTB rates, whereas SGA birth rate was higher in mothers with less schooling. We speculate that the more accelerated increase in medical intervention, especially due to the increase in cesarean sections in the more privileged groups, could be the main factor explaining the unexpected increase in LBW and PTB rates in Ribeirão Preto and the decrease or disappearance of social inequality regarding these perinatal indicators in the two cities