O papel do enfermeiro obstetra no empoderamento do companheiro para apoiar a mulher no trabalho de parto

Serve o presente relatório para descrever, analisar e refletir o percurso de aprendizagem para o desenvolvimento das competências do enfermeiro obstetra, no âmbito da unidade curricular “Estágio com Relatório”. Para a concretização das mesmas, foram delineados como objetivos a prestação de cuidados de enfermagem especializados à mulher/parturiente/feto/recémnascido inseridos na família e comunidade no período pré-natal, trabalho de parto, pós-parto e à mulher que vivencia processo de doença ginecológica. Também, na reflexão de um desejo consciente que proporcionasse um caminho para o desenvolvimento das competências do enfermeiro obstetra, a temática de interesse elegida foi: O papel do enfermeiro obstetra no empoderamento do companheiro para apoiar a mulher no trabalho de parto. Presentemente, a gestação não é exclusivamente vivida pela mulher grávida mas, pelo casal onde experienciam um conjunto de emoções e expectativas que irão ser relembradas. Atualmente atesta-se na evidência científica que a presença e a participação ativa do companheiro nos diferentes estádios do trabalho de parto, deve ser um reflexo de uma decisão consciente e decidida pelo casal, conferindo inúmeros benefícios para todos os envolvidos no processo de nascimento. Assim, considero a temática pertinente e atual, contribuindo para a autonomia e desenvolvimento de competências técnicas, científicas e relacionais, enquanto futura enfermeira obstetra, proporcionando ao companheiro uma aprendizagem adequada às suas necessidades e apoiando-o na aplicação das habilidades adquiridas para o apoio efetivo à mulher no trabalho de parto. O cuidado transpessoal de Jean Watson surge como modelo conceptual eleito para nortear o pensamento e o cuidado em enfermagem, contemplando a reciprocidade entre o enfermeiro obstetra, companheiro, mulher/grávida e parturiente, desenvolvendo no profissional competências pessoais, sociais e morais, em que o cuidado holístico está presente nas intervenções de enfermagem desenvolvidas

Plano de Negócios: Turismo em espaço rural na Serra de Tomar

O Plano de Negócios que se apresenta tem como principal objetivo a implementação e exploração de uma unidade de Casas de Campo – as “Casas de Santa Iria” – na região de Tomar. Sendo o Turismo sector fundamental para o desenvolvimento económico de um país, é pretendido através desta unidade de Turismo em Espaço Rural, estimular o desenvolvimento turístico da região, combatendo o abandono e a sazonalidade verificados nesta zona centro de Portugal. Através deste projeto empreendedor, que consiste na reabilitação casas rurais para utilização turística, é aspirado demonstrar o verdadeiro significado de ambiente rural em plena harmonia com a natureza, através da hospitalidade tipicamente portuguesa e atividades complementares oferecidas pelo estabelecimento de Turismo em Espaço Rural “Casas de Santa Iria”. Considerando o total de investimentos na ordem dos 220 mil euros, os fluxos de caixa previsionais e o custo de oportunidade do capital, o projeto apresenta um VAL de 913.749€, uma TIR de 57,41%% e um pay back period de quatro anos, critérios que garantem a sua viabilidade económico-financeira.The business plan here presented aims to implement a project of countryside houses, called "Casas de Santa Iria", in the Centro region of Portugal, Tomar Tourism emerges as a key sector for economic development of a country, so for is intended through the implementation of this unit of rural tourism, stimulate tourism development in the region, fighting abandonment and seasonality verified in this area. Through this entrepreneurial project, which consists in the rehabilitation of rural houses for tourist purpose, is drawn to show the true meaning of rural environment in harmony with nature, through the typical portuguese hospitality and complementary activities offered by the rural tourism unit "Casas de Santa Iria". Considering the total investment of 220 thousand euros, the forecast cash flows and the opportunity cost of capital, the project has an NPV of € 913,749, an IRR of 57.41% and a payback period of four years, criteria which ensures the project viability

Preeclampsia and syncytiotrophoblast membrane extracellular vesicles (STB-EVs)

Preeclampsia (PE) is a hypertensive complication of pregnancy that affects 2–8% of women worldwide and is one of the leading causes of maternal deaths and premature birth. PE can occur early in pregnancy (34 weeks gestation). Whilst the placenta is clearly implicated in early onset PE (EOPE), late onset PE (LOPE) is less clear with some believing the disease is entirely maternal whilst others believe that there is an interplay between maternal systems and the placenta. In both types of PE, the syncytiotrophoblast (STB), the layer of the placenta in direct contact with maternal blood, is stressed. In EOPE, the STB is oxidatively stressed in early pregnancy (leading to PE later in gestation- the two-stage model) whilst in LOPE the STB is stressed because of villous overcrowding and senescence later in pregnancy. It is this stress that perturbs maternal systems leading to the clinical manifestations of PE. Whilst some of the molecular species driving this stress have been identified, none completely explain the multisystem nature of PE. Syncytiotrophoblast membrane vesicles (STB-EVs) are a potential contributor to this multisystem disorder. STB-EVs are released into the maternal circulation in increasing amounts with advancing gestational age, and this release is further exacerbated with stress. There are good in vitro evidence that STB-EVs are taken up by macrophages and liver cells with additional evidence supporting endothelial cell uptake. STB-EV targeting remains in the early stages of discovery. In this review, we highlight the role of STB-EVs in PE. In relation to current research, we discuss different protocols for ex vivo isolation of STB-EVs, as well as specific issues involving tissue preparation, isolation (some of which may be unique to STB-EVs), and methods for their analysis. We suggest potential solutions for these challenges

Workaholism na advocacia: dimensões e preditores

O artigo analisa o workaholism na advocacia societária portuguesa, procurando medir este fenómeno através do Work Addiction Risk Test (wart) - um instrumento de autoavaliação sobre dimensões relativas a tendências compulsivas, falta de controlo, comunicação prejudicada e autoabsorção, incapacidade de delegar e autoestima. Tem por base um inquérito por questionário aplicado a uma amostra por conveniência de advogados com prática societária. Este estudo mostra que a falta de controlo e as tendências compulsivas contribuem para explicar o fenómeno em discussão. A análise de regressão permite concluir que o cargo ocupado, o tempo na sociedade e as horas de trabalho constituem preditores de workaholism.This article analyses workaholism in Portuguese corporate law firms, seeking to measure this phenomenon through the Work Addiction Risk Test (wart) - a self-assessment tool on dimensions related to compulsive tendencies, lack of control, impaired communication and self-absorption, inability to delegate and self-esteem. It is based on a survey applied to a convenience sample of corporate lawyers. The study shows the lack of control and compulsive tendencies contribute to explaining the phenomenon under discussion. It can be concluded through regression analysis that the position held, time at the office and working hours contribute as predictors for workaholism

Diplomados universitários e satisfação com o trabalho

Na atualidade a situação no mercado de trabalho dos diplomados universitários do ensino superior constitui um objeto de análise de interesse renovado para a sociologia e demais ciências sociais. Razões de natureza institucional e de curiosidade científica podem explicar tal fato. O presente artigo aborda precisamente a satisfação dos mestres da Universidade do Porto com o seu trabalho. Satisfação que constitui uma das dimensões relevantes da vida laboral. Elegemos analiticamente os indicadores, tipos e determinantes da satisfação do trabalho.The situation in the labor market of university graduates of higher education constitutes an object of analysis of renewed interest for sociology and other social sciences. Institutional reasons and scientific curiosity can explain this fact. This article addresses precisely the satisfaction of the masters of the University of Porto with their work. Satisfaction is one of the relevant dimensions of working life. We chose analytically the indicators, types and determinants of job satisfaction

A historical cohort study

OK Funding Information: Catarina R. Palma dos Reis acknowledges support from a Clarendon Fund Scholarship. Publisher Copyright: © 2023 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).Introduction: The velocity of fetal deterioration in fetal growth restriction is extremely variable, which makes monitoring and counseling very challenging. The soluble fms-like tyrosine kinase to placental growth factor (sFlt1/PlGF) ratio provides a readout of the vasoactive environment that correlates with preeclampsia and fetal growth restriction and that could be useful to predict fetal deterioration. Previous studies showed a correlation between higher sFlt1/PlGF ratios and lower gestational ages at birth, although it is unclear whether this is due to the increased incidence of preeclampsia. Our goal was to evaluate whether the sFlt1/PlGF ratio predicts faster fetal deterioration in early fetal growth restriction. Material and methods: This was a historical cohort study in a tertiary maternity hospital. Data from singleton pregnancies with early fetal growth restriction (diagnosed before 32 gestational weeks) confirmed after birth monitored between January 2016 and December 2020 were retrieved from clinical files. Cases of chromosomal/fetal abnormalities, infection and medical terminations of pregnancy were excluded. The sFlt1/PlGF ratio was acquired at diagnosis of early fetal growth restriction in our unit. The correlation of log10 sFlt1/PlGF with latency to delivery/fetal demise was assessed with linear, logistic (positive sFlt1/PlGF if >85) and Cox regression excluding deliveries for maternal conditions and controlling for preeclampsia, gestational age at time of ratio test, maternal age and smoking during pregnancy. Receiver-operating characteristic (ROC) analysis tested the performance of sFlt1/PlGF ratio in predicting delivery for fetal reasons in the following week. Results: 125 patients were included. Mean sFlt1/PlGF ratio was 91.2 (SD 148.7) and 28% of patients had a positive ratio. A higher log10 sFlt1/PlGF ratio predicted shorter latency for delivery/fetal demise in linear regression after controlling for confounders, β = −3.001, (−3.713 to −2.288). Logistic regression with ratio positivity confirmed these findings (latency for delivery 5.7 ± 3.32 weeks for ratios ≤85 vs 1.9 ± 1.52 weeks for ratios >85); β = −0.698 (−1.064 to −0.332). Adjusted Cox regression showed that a positive ratio confers a significantly positive hazard ratio (HR) for earlier delivery/fetal demise, HR 9.869 (5.061–19.243). ROC analysis showed an area under the curve of 0.847 (SE ± 0.06). Conclusions: sFlt1/PlGF ratio is correlated with faster fetal deterioration in early fetal growth restriction, independently of preeclampsia.publishersversionepub_ahead_of_prin

A cross-sectional analysis of syncytiotrophoblast membrane extracellular vesicles–derived transcriptomic biomarkers in early-onset preeclampsia

Background: Preeclampsia (PE) is a pregnancy-specific hypertensive disorder affecting 2%–8% of pregnancies worldwide. Biomarker(s) for the disorder exists, but while these have excellent negative predictive value, their positive predictive value is poor. Extracellular vesicles released by the placenta into the maternal circulation, syncytiotrophoblast membrane extracellular vesicles (STB-EVs), have been identified as being involved in PE with the potential to act as liquid biopsies. Objective: The objective of this study was to identify the difference in the transcriptome of placenta and STB-EVs between preeclampsia and normal pregnancy (NP) and mechanistic pathways. Methods/study design: We performed RNA-sequencing on placental tissue, medium/large and small STB-EVs from PE (n = 6) and NP (n = 6), followed by bioinformatic analysis to identify targets that could be used in the future for EV-based diagnostic tests for preeclampsia. Some of the identified biomarkers were validated with real-time polymerase chain reactions. Results: Our analysis identified a difference in the transcriptomic STB-EV cargo between PE and NP. We then identified and verified the differential expression of FLNB, COL17A1, SLC45A4, LEP, HTRA4, PAPP-A2, EBI3, HSD17B1, FSTL3, INHBA, SIGLEC6, and CGB3. Our analysis also identified interesting mechanistic processes via an in silico prediction of STB-EV-based mechanistic pathways. Conclusions: In this study, using comprehensive profiling of differentially expressed/carried genes of three linked sample subtypes in PE, we identified potential biomarkers and mechanistic gene pathways that may be important in the pathophysiology of PE and could be further explored in future studies

Plasma Concentrations of Soluble Endoglin versus Standard Evaluation in Patients with Suspected Preeclampsia

Background: The purpose of this study was to compare plasma soluble endoglin (sEng) levels with standard clinical evaluation or plasma levels of other angiogenic proteins [soluble fms-like tyrosine kinase 1 (sFlt1) and placental growth factor (PlGF)] in predicting short-term adverse maternal and perinatal outcomes in women with suspected preeclampsia presenting prior to 34 weeks. Methods and Findings: Data from all women presenting at <34 weeks for evaluation of preeclampsia with singleton pregnancies (July 2009−October 2010) were included in this analysis and sEng levels were measured at presentation. Data was analyzed for 170 triage encounters and presented as median {25−75th centile}. Thirty-three percent of patients (56 of 170) experienced an adverse outcome. sEng levels (ng/ml) were significantly elevated in patients who subsequently experienced adverse outcomes compared to those who did not (32.3 {18.1, 55.8} vs 4.8 {3.2, 8.6}, p<0.0001). At a 10% false positive rate, sEng had higher detection rates of adverse outcomes than the combination of highest systolic blood pressure, proteinuria and abnormal laboratory tests (80.4 {70.0, 90.8} vs 63.8 {51.4, 76.2}, respectively). Subjects in the highest quartile of sEng were more likely to deliver early compared to those in the lowest quartile (HR: 14.96 95% CI: 8.73−25.62, p<0.0001). Natural log transformed sEng correlated positively with log sFlt1 levels (r = 0.87) and inversely with log PlGF levels (r = −0.79) (p<0.0001 for both). Plasma sEng had comparable area under the curve for prediction of adverse outcomes as measurement of sFlt1/PlGF ratio (0.88 {0.81, 0.95} for sEng versus 0.89 {0.83, 0.95} for sFlt1/PlGF ratio, p = 0.74). Conclusions: In women with suspected preeclampsia presenting prior to 34 weeks of gestation, sEng performs better than standard clinical evaluation in detecting adverse maternal and fetal outcomes occurring within two weeks of presentation. Soluble endoglin was strongly correlated with sFlt1 and PlGF levels, suggesting common pathogenic pathways leading to preeclampsia

Lipidomic Assessment of Plasma and Placenta of Women with Early-Onset Preeclampsia

Introduction: Adipose tissue is responsible for triggering chronic systemic inflammatory response and these changes may be involved in the pathophysiology of preeclampsia. Objective: To characterize the lipid profile in the placenta and plasma of patients with preeclampsia. Methodology Samples were collected from placenta and plasma of 10 pregnant women with preeclampsia and 10 controls. Lipids were extracted using the Bligh–Dyer protocol and were analysed by MALDI TOF-TOF mass spectrometry. Results: Approximately 200 lipid signals were quantified. The most prevalent lipid present in plasma of patients with preeclampsia was the main class Glycerophosphoserines-GP03 (PS) representing 52.30% of the total lipid composition, followed by the main classes Glycerophosphoethanolamines-GP02 (PEt), Glycerophosphocholines-GP01 (PC) and Flavanoids-PK12 (FLV), with 24.03%, 9.47% and 8.39% respectively. When compared to the control group, plasma samples of patients with preeclampsia showed an increase of PS (p<0.0001), PC (p<0.0001) and FLV (p<0.0001). Placental analysis of patients with preeclampsia, revealed the PS as the most prevalent lipid representing 56.28%, followed by the main class Macrolides/polyketides-PK04 with 32.77%, both with increased levels when compared with patients control group, PS (p<0.0001) and PK04 (p<0.0001). Conclusion: Lipids found in placenta and plasma from patients with preeclampsia differ from those of pregnant women in the control group. Further studies are needed to clarify if these changes are specific and a cause or consequence of preeclampsia