Factors intervening in the childbirth experience: a mixed-methods study.

OBJECTIVE: To analyze the childbirth experience focusing on the intervening factors and on the delivery method. METHOD: A sequential and explanatory mixed-methods study guided by the World Health Organization document for positive childbirth experiences. The participants were puerperal women in a maternity teaching hospital from inland São Paulo (Brazil). The first quantitative stage involved descriptive analysis with Poisson regression of 265 answers to the "Termômetro da Iniciativa Hospital Amigo da Mulher e da Criança" ("Women- and Baby-Friendly Hospital Initiative Thermometer") questionnaire. The second stage, qualitative, thematically analyzed the interviews conducted with 44 puerperal women who took part in the first stage. Data integration was by connection. THE RESULTS AND DISCUSSION: The analysis by connection showed that among the factors that restricted the positive experience, C-section was predominant (61.9%), understood as an option due to fear of pain, the treatment modality and previous traumas. Restrictions referring to the presence of a companion (99.6%), not having privacy (83%), disrespectful situations (69.5%), too many touches (56.9%) and the absence of skin-to-skin contact (55%), among others, potentiated fear, loneliness, concern, shame, the perception of disrespect and insecurity with the assistance provided. The promoting factors were as follows: choosing the companion (95.4%) for collaborating in the safety perception, not having infections (83.9%), having continuous team monitoring (82.2%) and pain relief methods (78.9%), which were valued by the women. CONCLUSION: The intervening factors that promoted positive experiences were related to clinical and protocol-related issues and to service availability. The restrictive factors were associated with excess interventions, deprivation of rights and of choice, absence of privacy and restriction referring to the presence of a companion. Women with a normal postpartum period felt more insecure and disrespected when compared to those subjected to C-sections, whose choices were considered, although they had lower prevalence of skin-to-skin contact. There is an urgent need to apprehend women's experiences and turn them into actions that guarantee their lives in a safe and respectful way.

Experiences of interaction between teenage mothers and visiting nurses: a phenomenological study. / Vivências de interação entre mãe adolescente e enfermeira visitadora: um estudo fenomenológico.

OBJECTIVE: To understand the experiences of interaction between teenage mothers and visiting nurses in the Young Mothers Caregivers Program. METHOD: Qualitative research using the theoretical-methodological framework of Social Phenomenology, with phenomenological interviews with visiting nurses and teenage mothers. RESULTS: Three visiting nurses and nine teenage mothers participated. The understanding of the experiences led to the elaboration of three categories of contexts of meanings related to the past and present: "Experiences of participation in the PJMC"; "The interaction experienced by visiting nurses and teenage mothers"; "Parenting and maternal role". CONCLUSION: The interaction between visiting nurses and teenage mothers in the program was characterized as positive, as it provided the mother with greater security in her maternal and parental role. The attitudes of nurses and adolescent mothers were fundamental for establishing a positive interaction.

Vivências de interação entre mãe adolescente e enfermeira visitadora: um estudo fenomenológico / Vivencias de interacción entre madre adolescente y enfermera visitadora: un estudio fenomenológico / Experiences of interaction between teenage mothers and visiting nurses: a phenomenological study

RESUMO Objetivo Compreender as vivências de interação entre mães adolescentes e enfermeiras visitadoras no Programa Jovens Mães Cuidadoras. Método Pesquisa qualitativa, em que se utilizou o referencial teórico-metodológico da Fenomenologia Social, sendo realizadas entrevistas fenomenológicas com enfermeiras visitadoras e mães adolescentes. Resultados Participaram três enfermeiras visitadoras e nove mães adolescentes. A compreensão das vivências permitiu a elaboração de três categorias de contextos de significados relacionados ao tempo passado e presente: "As vivências de participação no Programa Jovens Mães Cuidadoras"; "A interação vivida por enfermeiras visitadoras e mães adolescentes"; "Parentalidade e papel maternal". Conclusão A interação entre enfermeiras visitadoras e mães adolescentes no programa foi caracterizada como positiva, por proporcionar à mãe maior segurança em desempenhar seu papel maternal e parental. As atitudes das enfermeiras e das mães adolescentes se mostraram fundamentais para o estabelecimento de interação positiva.

RESUMEN Objetivo Comprender las vivencias de interacción entre madres adolescentes y enfermeras visitadoras del Programa Jóvenes Madres Cuidadoras. Método Se trata de una investigación cualitativa, en la que se utilizó el referencial teórico-metodológico de la Fenomenología Social mediante entrevistas fenomenológicas entre enfermeras visitadoras y madres adolescentes. Resultados Participaron tres enfermeras visitadoras y nueve madres adolescentes. La comprensión de las vivencias posibilitó la elaboración de tres categorías de contextos significativos relacionados con el tiempo pasado y el presente: "Vivencias de la participación en el Programa Jóvenes Madres Cuidadoras"; "Interacción entre enfermeras visitadoras y madres adolescentes"; "Parentalidad y papel maternal". Conclusión La interacción entre las enfermeras visitantes y las madres adolescentes del programa se caracterizó por ser positiva, lo que proporcionó a la madre una mayor seguridad en el desempeño de su función materna y parental. Las actitudes de las enfermeras y las madres adolescentes fueron fundamentales para establecer una interacción positiva.

ABSTRACT Objective To understand the experiences of interaction between teenage mothers and visiting nurses in the Young Mothers Caregivers Program. Method Qualitative research using the theoretical-methodological framework of Social Phenomenology, with phenomenological interviews with visiting nurses and teenage mothers. Results Three visiting nurses and nine teenage mothers participated. The understanding of the experiences led to the elaboration of three categories of contexts of meanings related to the past and present: "Experiences of participation in the PJMC"; "The interaction experienced by visiting nurses and teenage mothers"; "Parenting and maternal role". Conclusion The interaction between visiting nurses and teenage mothers in the program was characterized as positive, as it provided the mother with greater security in her maternal and parental role. The attitudes of nurses and adolescent mothers were fundamental for establishing a positive interaction.

Adapted sport effect on postural control after spinal cord injury.

STUDY DESIGN: Cross-sectional study. OBJECTIVE: The aim of this study was to compare trunk muscle activation during anterior and lateral reach in athletic and sedentary individuals with spinal cord injury (SCI) and able-bodied people. SETTINGS: University Hospital-UNICAMP, Campinas, Brazil. METHODS: Individuals with complete traumatic SCI and thoracic neurological level were separated into two groups: sedentary (SSCI: n=10) and physically active (PASCI: n=10). The control group (C: n=10) without SCI was assessed. Trunk muscle activation was recorded during reach and grasp tasks. The significant level was set at P<0.05. RESULTS: The control group showed a highest mean activation for left longissimus muscle during all activities (P<0.05). The PASCI group presented significant highest activation for left iliocostalis muscles during all activities, except in the anterior reach task of 90% maximum reach (anterior reach (AR) 75: P=0.02; right lateral reach (RLR) 75: P=0.03; RLR90: P=0.01). The SSCI group presented highest activation for the left iliocostalis during the right lateral reach task of 75 and 90% maximum reach and right iliocostalis during the anterior reach task of 75% maximum reach (AR75: P=0.007; RLR75: P=0.02; RLR90: P=0.03). A different pattern of muscle activation between the control group and the groups with SCI was observed. CONCLUSION: Our results indicated that sports practice did not affect the trunk muscle activation in people with paraplegia. However, the pattern muscle activation in individuals with SCI is different compared with people without SCI during anterior reach tasks.

Influence of different types of seat cushions on the static sitting posture in individuals with spinal cord injury.

STUDY DESIGN: Cross-sectional study. OBJECTIVES: To evaluate the efficacy of the Postural Assessment Software PAS/SAPO in the posture analysis of individuals with spinal cord injury (SCI) during sitting position and to analyze if the use of different types of seat cushions-gel and foam, with no cushion-can interfere in the individual's posture during sitting position. SETTING: Centre of Rehabilitation at the University Hospital (FMRP-USP), Ribeirão Preto, Brazil. METHODS: Eight individuals, four paraplegics and four tetraplegics with SCI and 20 healthy individuals participated in the study. Photos were taken of individuals in the sitting position using foam, gel cushions and with no cushion. They were analyzed using the PAS/SAPO. The alignment of the anterior-superior iliac spine (ASIS) and the posterior pelvic tilt were evaluated from the angle formed between the ASIS and the greater trochanter of the femur. RESULTS: The group of healthy individuals presented the best postural alignment when compared with the group with SCI, both for the ASIS alignment (P<0.05) and for the degree of posterior pelvic tilt (P<0.05). No significant differences were found in the variables analyzed when the seat cushions were compared. CONCLUSION: The different types of cushions did not alter the sitting posture; however, individuals with SCI showed worse postural alignment than the healthy individuals. PAS/SAPO was demonstrated to be useful for postural assessment.

Season of birth and not vitamin D receptor promoter polymorphisms is a risk factor for multiple sclerosis.

Both genetic and environmental factors contribute to multiple sclerosis, the most common neurodegenerative disorder with onset in young adults. The objective of the current study is, based on the hypothesis that environmentally predisposed individuals are at risk for multiple sclerosis, to investigate whether they also carry genetic variants within the vitamin D machinery. Using medical files and DNA samples from 583 trios (a patient and both parents) of the French Multiple Sclerosis Genetics Group as well as data from the French Statistics Bureau, we aimed to assess whether: (1) a seasonality of birth was observed in French multiple sclerosis patients; (2) three single nucleotide polymorphisms within the promoter region of the vitamin D receptor were associated with multiple sclerosis susceptibility; and (3) the combination of a high risk month of birth and vitamin D receptor polymorphisms were correlated to multiple sclerosis incidence. We observed a significantly reduced number of individuals born in November who were later diagnosed as multiple sclerosis patients. However, we found no association between the three studied vitamin D receptor polymorphisms and multiple sclerosis. In conclusion, our data suggest that high levels of vitamin D during the third trimester of pregnancy could be a protective factor for multiple sclerosis.

Vitamin D, a neuro-immunomodulator: implications for neurodegenerative and autoimmune diseases.

It has been known for more than 20 years that vitamin D exerts marked effects on immune and neural cells. These non-classical actions of vitamin D have recently gained a renewed attention since it has been shown that diminished levels of vitamin D induce immune-mediated symptoms in animal models of autoimmune diseases and is a risk factor for various brain diseases. For example, it has been demonstrated that vitamin D (i) modulates the production of several neurotrophins, (ii) up-regulates Interleukin-4 and (iii) inhibits the differentiation and survival of dendritic cells, resulting in impaired allo-reactive T cell activation. Not surprisingly, vitamin D has been found to be a strong candidate risk-modifying factor for Multiple Sclerosis (MS), the most prevalent neurological and inflammatory disease in the young adult population. Vitamin D is a seco-steroid hormone, produced photochemically in the animal epidermis. The action of ultraviolet light (UVB) on 7-dehydrocholesterol results in the production of pre-vitamin D which, after thermo-conversion and two separate hydroxylations, gives rise to the active 1,25-dihydroxyvitamin D. Vitamin D acts through two types of receptors: (i) the vitamin D receptor (VDR), a member of the steroid/thyroid hormone superfamily of transcription factors, and (ii) the MARRS (membrane associated, rapid response steroid binding) receptor, also known as Erp57/Grp58. In this article, we review some of the mechanisms that may underlie the role of vitamin D in various brain diseases. We then assess how vitamin D imbalance may lay the foundation for a range of adult disorders, including brain pathologies (Parkinson's disease, epilepsy, depression) and immune-mediated disorders (rheumatoid arthritis, type I diabetes mellitus, systemic lupus erythematosus or inflammatory bowel diseases). Multidisciplinary scientific collaborations are now required to fully appreciate the complex role of vitamin D in mammal metabolism.

Relationship between median nerve somatosensory evoked potentials and spinal cord injury levels in patients with quadriplegia.

STUDY DESIGN: Cross-sectional study. OBJECTIVES: To observe if there is a relationship between the level of injury by the American Spinal Cord Injury Association (ASIA) and cortical somatosensory evoked potential (SSEP) recordings of the median nerve in patients with quadriplegia. SETTING: Rehabilitation Outpatient Clinic at the university hospital in Brazil. METHODS: Fourteen individuals with quadriplegia and 8 healthy individuals were evaluated. Electrophysiological assessment of the median nerve was performed by evoked potential equipment. The injury level was obtained by ASIA. N(9), N(13) and N(20) were analyzed based on the presence or absence of responses. The parameters used for analyzing these responses were the latency and the amplitude. Data were analyzed using mixed-effect models. RESULTS: N(9) responses were found in all patients with quadriplegia with a similar latency and amplitude observed in healthy individuals; N(13) responses were not found in any patients with quadriplegia. N(20) responses were not found in C5 patients with quadriplegia but it was present in C6 and C7 patients. Their latencies were similar to healthy individuals (P>0.05) but the amplitudes were decreased (P<0.05). CONCLUSION: This study suggests that the SSEP responses depend on the injury level, considering that the individuals with C6 and C7 injury levels, both complete and incomplete, presented SSEP recordings in the cortical area. It also showed a relationship between the level of spinal cord injury assessed by ASIA and the median nerve SSEP responses, through the latency and amplitude recordings.

[Differential mortality between metropolitan areas of Brazil, 1985-1995]. / Diferenciais de mortalidade entre as regiões metropolitanas de Belo Horizonte e Salvador, 1985-1995.

OBJECTIVE: To analyze differential changes of rates and stratification of mortality by gender and causes of death in the metropolitan area of Belo Horizonte (RMBH) and Salvador (RMS) between 1985 and 1995. METHODS: The Ministry of Health's Mortality Information System (SIM) provides data on death causes by age and sex that was used for this study. The groups of death causes were classified according to two major groups (preventable and non-preventable) and the decomposition method presented by Pollard was applied to analyze the contribution of each group of death causes in the changes in life expectation. RESULTS: There have been changes in the pace of the current mortality rate decline in RMBH and RMS, which have resulted in a reduction in the differences between the mortality rates in both areas. In both areas there was a substantial reduction in the mortality rates in the group of preventable causes, especially among women. CONCLUSIONS: There is still a structure of death causes, which seems to indicate that the improvement in mortality among the poor has been lower than it was expected.

[Reaction time to dichotic visual stimulation and its relationship to cerebral hemispheric specialization]. / Tiempo de reaccion a estimulacion visual dicotica y su relacion con la especializacion hemisferica cerebral.

There is a renewed interest in the study of the cerebral hemispheric specialization given its physiological, physiopathological, clinical and educational relevancy. According to this, a stimulus is better processed in one of the cerebral hemispheres. The visual dichotic stimulation allows to present a stimulus selectively to one of the hemispheres, and this was used in the present study for the measurement of the reaction time (TR) and for the establishment of its correlation with an objective and validated measure of the cerebral hemispheric specialization. Ninety eight persons with an average age of 22.2 +/- 0.7 (X +/- EE) years were studied by means of the Oldfield protocol for the determination of the Cerebral Hemispheric Lateralization Index (IL). Additionally, the age, the sex and the date of last menstruation in the case of females, were registered. The dichotic stimulation and the determination of the visual TR was accomplished by computer with a time resolution of 100 microseconds. The stimulus consisted of the random presentation of a white square on a black background in a computer monitor, to which the subject had to respond by pressing a key with his best hand. The reaction time was registered 10 times in each visual field for a total of 20 records per eye. The IL of the sample was predominantly right (66.32 +/- 4.64), and significantly smaller in males than in females (p < 0.05). The TR to stimuli in the left visual field was significantly greater (p < 0.05) than in the right visual field for both eyes. When analyzing the global results of each cerebral hemisphere, a TR significantly smaller for the left hemisphere (304.33 +/- 4.1 ms) than for the right (312.35 +/- 4.5 ms, p < 0.05) was observed. These results suggest that the cerebral hemispheric specialization, expressed as a smaller response time, cannot alone be only the product of a better intrinsic hemispheric processing of the information, but also of the anatomical relationships of the proximity of the hemisphere that receives the stimulus and the center or area that will generate the response, as is the case of the motor center located in the left hemisphere in the immense majority of the right-handed subjects in the sample and in the general population.

[Hospital morbidity for Chagas disease in Brazil]. / Morbidade hospitalar por doença de Chagas no Brasil.

The aim of this research was to describe the delivery and evolution of Chagas disease with in-patients in Brazil during the last decade. It also attempted to discuss the limits and possibilities of Internal Hospitalization Authorization (AIH) as a source of epidemiologist information. From 1984 to 1993, the number of in-patients diagnosed with "tripanossomiase" was about 1,700 yearly, declining in absolute numbers during the entire historic series. The majority concentration of in-patients occuring in this study was recorded in São Paulo, Goiás, Minas Gerais and Distrito Federal. The public sector importance increased and the university hospitals improved their participation with in-patients with "tripanossomiase". Concerning hospitals expenses for in-patients, this study has observed that a hegemony in São Paulo was strengthened. The average cost was varied: in São Paulo and Distrito Federal, the average cost was much higher than that of Minas Gerais and Goiás. Finally, this study concluded that the most suitable usefulness of the AIH forms would be for disease surveys that haven't been presented to many clinics, for which the SINTESE files would be sufficient.

Enhancement of Neurospora VS ribozyme cleavage by tuberactinomycin antibiotics.

Several examples of inhibition of the function of a ribozyme or RNA-protein complex have shown that certain antibiotics can interact specifically with RNA. There are, however, few examples of antibiotics that have a positive, rather than a negative, effect on the function of an RNA. We have found that micromolar concentrations of viomycin, a basic, cyclic peptide antibiotic of the tuberactinomycin group, enhance the cleavage of a ribozyme derived from Neurospora VS RNA. Viomycin decreases by an order of magnitude the concentration of magnesium required for cleavage. It also stimulates an otherwise insignificant transcleavage reaction by enhancing interactions between RNA molecules. The ability of viomycin to enhance some RNA-mediated reactions but inhibit others, including translation and Group I intron splicing, demonstrates the potential for natural selection by small molecules during evolution in the 'RNA world' and may have broader implications with respect to ribozyme expression and activity in contemporary cells.

Nucleotide sequence requirements for self-cleavage of Neurospora VS RNA.

We have used several complementary approaches to investigate the minimal contiguous sequence required for the in vitro self cleavage reaction performed by Neurospora VS RNA. Deletion analysis and site-directed mutagenesis revealed that only a single nucleotide is required upstream of the self-cleavage site, and that the identity of this nucleotide is not critical. This distinguishes VS RNA from all currently known ribozymes except hepatitis delta virus RNA. The shortest contiguous sequence capable of cleavage contains 153 nt downstream of the cleavage site. Linker insertion mutagenesis suggests that much of this downstream sequence is important for self-cleavage. Comparative sequence analysis of the VS plasmid from six natural isolates supports the importance in vivo of the minimal region determined by in vitro methods. Also, phylogenetic analysis raises the possibility of a recent horizontal transfer of the VS plasmid from Neurospora intermedia to Neurospora sitophila.