Aleitamento Materno: O Porquê do Abandono

Sendo o aleitamento materno um momento único e privilegiado na comunhão mãe - filho, este deve ser sentido como um acto natural. No entanto, o abandono precoce é uma realidade. O presente estudo tem como objectivo principal conhecer as razões que levam ao abandono do aleitamento materno exclusivo, em crianças com menos de quatro meses. Para responder a esta questão, foram entrevistadas 23 mães que abandonaram o aleitamento materno antes do quarto mês da vida do seu filho. Como objectivos específicos, pretendeuse conhecer as vantagens e desvantagens do aleitamento materno, sentidas pelas mães, assim como os sentimentos vivenciados no momento do abandono. Pretendeu-se, ainda, conhecer alguns factores institucionais que influenciaram o sucesso do aleitamento materno. Tratou-se de um estudo exploratório - descritivo, onde se analisou o conteúdo das entrevistas efectuadas às mães. Os resultados do estudo mostram que as razões principais para o abandono precoce do aleitamento materno exclusivo, apontadas pelas mães, foram o choro intenso do bebé e o leite insuficiente da mãe. A maior vantagem apontada relativamente ao aleitamento natural foi a comodidade e a maior desvantagem foi a dependência mãe-bebé, ou seja, o facto da mãe não se poder afastar, durante muito tempo, do bebé. Esta forma de amamentar provoca na mãe sentimentos positivos e de proximidade

Temperature assessment in the drilling of ex vivo bovine and porcine cortical bone tissue

The drilling bone process is a common surgical procedure on medicine. The main concern in these surgeries is the thermal damage of the bone tissue induced by inappropriate parameters [1]. Objectives: Analyze the optimum cutting conditions that generate the lower temperature. Drill speed and the feed-rate effects were studied during the drilling of animal bones. Experimental tests were performed in laboratory and clinical environment

A Importância da Paisagem para o Desenvolvimento Turístico – O Caso da Ilha de São Jorge

Dissertação apresentada para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Gestão do Território – área de especialização em: Ambiente e Recursos NaturaisCom esta dissertação, pretende-se ressalvar a importância da paisagem para o desenvolvimento turístico, considerando-a como recurso endógeno de extrema importância para as opções em termos de desenvolvimento e ordenamento do território. Assim, partindo da paisagem da ilha de S. Jorge nos Açores, pretende-se estudar e projectar linhas propositivas e estratégicas que sirvam o território, sobretudo do ponto de vista turístico, e que assentem no garante de um desenvolvimento o mais sustentável possível da ilha. Acredita-se que a sustentabilidade na utilização dos recursos endógenos desta Ilha de São Jorge será o garante da sua preservação, servindo para o desenvolvimento e estabilidade económica com usufruto do turismo. Só com a melhoria dos recursos endógenos, como é a paisagem, é possível uma melhoria da qualidade de vida da população. Só mantendo e preservando o que existe é que se consegue desenvolver sem danificar, permitindo um desenvolvimento promissor e duradouro

Temperature assessment in the drilling of composite materials and ex-vivo porcine bones

This study presents different experimental methodologies for analysis and temperature evaluation during the drilling process of composite materials and ex-vivo porcine bones. In the experimental methodologies were evaluated the influence of different parameters on the bone temperature rise. The combinations of different parameters produced temperatures far below the critical values. It was concluded that drill temperature decreases when the feed-rate is higher and, independently, increases with the increasing of hole depth. The influence of drill speed is not clear. In the composite materials the temperature decreases in the drill bit when the drill speed is higher, and in ex-vivo porcine bones happens the opposite. The animal models recorded lower temperature values than composite materials.The author of this paper acknowledges the support of the Project "Biomechanics: Contributions to the healthcare" co-financed by the Regional Operational Programme of North (ON.2 -The New North), the National Strategic Reference Framework (NSRF), through the European Development Fund (ERDF) and also to the project UID/EM/50022/2013 of LAETA financed by FCT

Effect of Intimate Partner Violence on Children of Puerto Rican Women

Intimate partner violence [IPV] is a preventable and costly societal issue that has reached epidemic proportions. Women are often the victims of IPV, and millions of children are exposed to it annually. The purpose of this study was to explore experiences of Puerto Rican mothers and their perceptions of how IPV exposure may have impacted their children using resilience theory. Data were collected via audiotaped individual interviews with 9 Puerto Rican mothers who endured an array of escalating IPV, often exacerbated by the perpetrators use of alcohol or drugs, and had IPV-exposed children aged 6 -11 years. Data analysis integrated content and thematic procedures. Interview data was transcribed, read, audited and coded based on compelling statements, quotes, and sentences made by the participants. The coded clusters were further evaluated, reduced to significant statements, then grouped into themes that captured the essence of the participants lived experiences and of the group. The mothers separated because they feared for their lives and the effect of IPV on the children. Once separated the mothers felt isolated, lived in shelters which were unconducive to childrearing, and had challenges navigating the system. They perceived their IPV-exposed children exhibited a multitude of behaviors including PTSD but that most were showing signs of resilience. Their IPV was perpetrated by males who were mostly the biological fathers of their children who used controlling behaviors towards the kids. The potential positive social change impact of this study is to empower Puerto Rican mothers to disclose IPV and to better inform health care providers regarding the impact of IPV on children aged 6 -11 years in an effort to increase the health, well-being, and resiliency of this vulnerable population

Facilitators and obstacles to implementing the practical approach to the care kit/pack Brazil / Facilitadores e obstáculos para implementar a abordagem prática do kit de cuidados/ pacote Brasil

Contextualization and objective: Clinical protocols are instruments that can be used to keep professionals up to date and to improve the quality of healthcare. In 2016, the implementation process of the Practical Approach to Care Kit/PACK Brazil began, a protocol developed in South Africa that trains primary care doctors and nurses to diagnose and deal with common adult conditions. This study aimed to explore the factors that interfered in the implementation of PACK Brazil with health professionals who had been trained in the protocol.Methodology: Semi-structured interviews were carried out with an intentional sample of doctors and nurses from primary healthcare centres in the city where the protocol was implemented. The thematic matrix technique was used to analyze the information collected.Results: 14 interviews were conducted; 6 of the interviewees were doctors and 8 were nurses; 13 were female. The thematic matrix divided the interview data into two themes: facilitators for the implementation of the PACK; and obstacles to implementing the PACK. The implementation of the PACK Brazil revealed facilitators related to the intervention process itself, such as the methodology used in training for the protocol. Although the acceptance of the PACK Brazil has been positive among health professionals, difficulties related to the individual characteristics of doctors and nurses and organizational obstacles were encountered when using the protocol.Final Considerations: The implementation of protocols in primary care can be a challenge, especially when it is intended to adapt materials from different socio-cultural environments. This study showed that the efforts made by the PACK Brazil implementation team were reflected in the high level of acceptance of the protocol by the interviewees. However, individual and organizational aspects of the studied context proved to be obstacles to the use of the PACK Brazil.

Correlation between Lumbar Lordosis Angle and Degree of Gynoid Lipodystrophy (Cellulite) in Asymptomatic Women

INTRODUCTION: Gynoid lipodystrophy (cellulite) has been cited as a common dermatological alteration. It occurs mainly in adult women and tends to gather around the thighs and buttocks. Its presence and severity have been related to many factors, including biotype, age, sex, circulatory changes, and, as some authors have suggested, mechanical alterations such as lumbar hyperlordosis. OBJECTIVE: To correlate the degree of cellulite with the angle of lumbar lordosis in asymptomatic women. METHODS: Fifty volunteers were evaluated by digital photos, palpation, and thermograph. The degree of cellulite was classified on a scale of 1-4. Analyses were performed on the superior, inferior, right and left buttocks (SRB, IRB, SLB, ILB), and the superior right and left thighs (SRT, SLT). The volunteers underwent a lateral-view X-ray, and the angle of lumbar lordosis was measured using Cobb's method (inferior endplate of T12 and the superior endplate of S). The data were statistically analyzed using ANOVA and Spearman's correlation. A significance level of 5% was adopted. RESULTS: Volunteers had a mean age of 26.1 ± 4.4 years and a mean body mass index of 20.7 ± 1.9 kg/m². There was no significant difference in lumbar lordosis angle between those with cellulite classes 2 and 3 (p > 0.297). There was also no correlation between lumbar lordosis angle and the degree of cellulite (p > 0.085 and r > 0.246). CONCLUSIONS: The analysis suggests that there is no correlation between the degree of cellulite and the angle of lumbar lordosis as measured using Cobb's method

High dose-rate endobronchial brachytherapy: a dosimetric study

OBJETIVO: Avaliar a distribuição de dose em diferentes situações de braquiterapia endobrônquica de alta taxa de dose, com foco principalmente nos volumes de altas doses, e tentar definir situações de melhor ou pior distribuição de dose que possam servir de guia na prática clínica. MATERIAIS E MÉTODOS: Estudo teórico, simulando braquiterapia endobrônquica de alta taxa de dose utilizando dois cateteres, com variação da extensão de carregamento, angulação entre os cateteres, profundidade de cálculo e o intervalo entre as paradas da fonte. Com prescrição de 7,5 Gy, foram calculados os volumes englobados pelas isodoses correspondentes a 100%, 150% e 200% da dose prescrita (V100, V150 e V200, respectivamente) e as razões V150/V100 e V200/V100. RESULTADOS: Os volumes aumentaram com o aumento da extensão de carregamento dos cateteres, profundidade de cálculo e angulação, com tendência a um aumento proporcionalmente menor para angulações maiores. As relações V150/V100 e V200/V100 foram, em geral, homogêneas, ao redor de 0,50 e 0,30, respectivamente. CONCLUSÃO: A distribuição de dose na situação considerada padrão é em geral adequada. Nenhum parâmetro específico que pudesse ser relacionado à maior toxicidade foi identificado. Recomendamos uma avaliação rápida da qualidade do implante por meio da análise das relações V150/V100 e V200/V100.OBJECTIVE: To evaluate the dose distribution in different situations of high dose-rate endobronchial brachytherapy, focusing especially on high-dose volumes, and try to identify better or worse situations in terms of dose distribution to aid as guidance in the clinical practice. MATERIALS AND METHODS: Theoretical study simulating high dose-rate endobronchial brachytherapy utilizing two catheters, varying the loading extent, angle between the catheters, prescription depth, and source step. With a prescription dose of 7.5 Gy, the volumes involved by the 100%, 150% and 200% isodoses (V100, V150 and V200, respectively) and V150/V100 and V200/V100 ratios were calculated. RESULTS: There was a volume enhancement with larger loaded lengths, increase in prescription depth and angles, with a tendency towards a proportionally smaller increase with larger angulations. In general, the V150/V100 and V200/V100 ratios were homogeneous, respectively around 0.50 and 0.30. CONCLUSION: Overall, the dose distribution in the standard situation was appropriate. No specific parameter that could be related to a higher toxicity was identified. The authors recommend a swift evaluation of the treatment quality through the analysis of the V150/V100 and V200/V100 ratios

Autochthonous malaria notified in the State of São Paulo: clinical and epidemiological characteristics from 1980 to 2007

INTRODUÇÃO: A malária autóctone no Estado de São Paulo caracteriza-se por surtos esporádicos na região oeste e transmissão persistente na região leste onde ocorrem casos oligossintomáticos com baixa parasitemia pelo Plasmodium vivax. Os objetivos deste estudo foram: analisar a completitude das fichas de notificação de malária autóctone; estimar a tendência da incidência de casos autóctones no ESP de 1980 a 2007; analisar o comportamento clínico e epidemiológico dos casos em duas regiões de autoctonia neste período. MÉTODOS: Foi realizado um estudo descritivo com 18 variáveis das FIN de malária do ESP, analisadas em duas regiões e em dois períodos (1980-1993 e 1994-2007). Fontes de dados: SUCEN/SES/SP, SINAN/CVE/SES/SP e DATASUS. RESULTADOS: A completitude foi superior a 85% em 11 variáveis. A tendência da incidência foi decrescente. Foram notificados 821 casos autóctones, 91,6% na região leste, predominando Plasmodium vivax. A infecção assintomática teve maior porcentagem no segundo período (p<0,001). CONCLUSÕES: A completitude das informações foi considerada satisfatória. As diferenças clínicas encontradas merecem atenção da vigilância epidemiológica que deve lidar com o desafio da infecção assintomática por Plasmodium.INTRODUCTION: Autochthonous malaria in the State of São Paulo is characterized by sporadic outbreaks in the western region and by persistent transmission in the eastern region, where oligosymptomatic cases with low parasitemia due to Plasmodium vivax occur. The objectives of this study were to assess the completeness of autochthonous malaria notification forms; to estimate the incidence trends of autochthonous cases in the State of São Paulo from 1980 to 2007; and to analyze the clinical and epidemiological patterns of cases in two autochthonous regions over this period. METHODS: This was a descriptive study that analyzed 18 variables on the notification form for malaria in the State of São Paulo, comparing these two regions over two periods (1980-1993 and 1994-2007). The data sources were SUCEN/SES/SP, SINAN/CVE/SES/SP and DATASUS. RESULTS: The completeness was greater than 85% for 11 variables. The incidence trend was decreasing. There were 821 autochthonous cases: 91.6% occurred in the eastern region, predominantly due to Plasmodium vivax. Asymptomatic infection had a higher percentage in the second period (p < 0.001). CONCLUSIONS: The completeness of the information was satisfactory. The clinical differences observed deserve attention from epidemiological surveillance agencies, which need to deal with the challenge of asymptomatic infection by Plasmodium

The Effect of Digital Marketing and Brand Awareness on Decisions to Purchase Internet Service Provider Products

In today's generation, increasing technological advances have made developments in marketing strategies have evolved into the era of digitalization. One of the companies that has the largest telecommunication network system in Indonesia, namely PT Nugraha Utama Teknologi, focuses on its marketing strategy through social media on PT Nugraha Utama Teknologi. The purpose of this study is to determine whether digital marketing and brand awareness have a significant effect on purchasing decisions partially and determine whether digital marketing and brand awareness have a significant effect on purchasing decisions simultaneously. The research design is survey research using quantitative methods. The sampling technique used in this study was accidental sampling with a sample of 100 people. The results of this study indicate that the first digital marketing variable has a partially significant effect on purchasing decisions. Second, the brand awareness variable has a significant effect on purchasing decisions partially. Third, digital marketing and brand awareness variables have a significant effect on purchasing decisions simultaneously