Maria Dalva de Barros Carvalho

Pregnancy After Bariatric Surgery: Implications for Mother and Newborn

BackgroundThe present study aimed to identify the implications for the mother and the newborn in pregnancies occurring after the bariatric surgery.MethodsThe present retrospective, exploratory cohort study was conducted to analyze the implications for the mother and the newborn in women of childbearing age (10 to 49xa0years) who became pregnant after undergoing bariatric surgery in Maringá, Paraná, Brazil, during the period from 1999 through 2008.ResultsThe study identified 32 women with the following characteristics: the majority of the women were Caucasian, slightly more than half were living with a partner, had some higher education, and most of them were without surgical complications. In addition, the mean weight loss post-surgery was 44.09xa0lbs, with an average interval of 40xa0months between the surgery and the pregnancy, with improvement of various comorbidities post-surgery. Conversely, they presented more neuropsychiatric disorders, post-surgery anemia, and higher prevalence of cesarean delivery. The majority of children were born at term with normal birth weight and no history of anemia. Hospitalization was required for 36.58% of the post-surgery pregnant women, while 17.07% of such cases required blood transfusion due to anemia. Lastly, there were fewer pregnancy-related hypertension cases than before the surgery.ConclusionsPregnancy after bariatric surgery has proven to be safe for both the mother and the newborn. The newborn birth weight was not compromised even though some of the pregnant women were anemic.

Causes of Organ Donation Failure in Brazil

INTRODUCTIONnThere has been a great improvement in transplantation medicine in Brazil in the last 2 decades. However, there remain several barriers regarding notification of brain and cardiac death as well as completion of the donation process.nnnMETHODSnThis retrospective study was performed between January 2008 and December 2010. We reviewed all deaths in a University Hospital, observing the causes of non-notification to the State Transplantation Authority and non-donations.nnnRESULTSnThere were 41 notifications of brain death resulting in donation in only 19.5% of those cases. Cardiac death was diagnosed in 21 patients, resulting in 52.4% donations. The main cause for non-donation were family refusal (37.2%), infectious diseases (30.2%), and clinical contraindications (32.6%). Most of the missed possible donors occurred during the night (54.8%) and in the emergency room (80.9%).nnnCONCLUSIONnThere is an urgent need for better education of the Brazilian population about organ donation and brain death definitions. Other identified problems include lack of uniformity in brain death determinations among hospitals, rigid contraindications to donation in the State of Parana, physician unawareness or disbelief about brain death diagnostic criteria, and lack of structure of our Hospital.

Pregnancy and Lactation-Associated Osteoporosis: Bone Histomorphometric Analysis and Response to Treatment with Zoledronic Acid.

Pregnancy and lactation-associated osteoporosis (PAO) is a rare condition with little known pathophysiology. Most cases are diagnosed in the third trimester of pregnancy or in the first weeks postpartum, particularly in first pregnancies. Vertebral fractures are most commonly observed and characterised by prolonged severe pain, functional limitations and a loss of height. Measurements of bone mineral density and biochemical markers of bone remodelling are the clinical methods most commonly used for the management of these patients. However, a bone biopsy with histomorphometric analysis has been considered to be the gold-standard. Few studies have evaluated the histomorphometry in patients with this clinical condition and none of them performed the procedure at the beginning of the clinical assessment. In this study, we report a case of PAO in a 31-year-old postpartum patient who had undergone a twin pregnancy. We describe the clinical, laboratory tests and imaging features. Bone histomorphometry showed a high resorption rate and excellent evolution after 1xa0year of treatment with intravenous zoledronic acid. Our data suggest that osteoclastogenesis plays a central role in the pathophysiological processes of this disease.

Tendência dos estudos sobre assédio moral e trabalhadores de enfermagem

Estudo de Revisao Integrativa da Literatura com o objetivo de analisar o conhecimento produzido sobre o assedio moral na enfermagem, apresentado em publicacoes nacionais e internacionais. Foram pesquisados artigos em bases de dados on-line entre os anos de 1999 e 2009, constituindo-se uma amostra de 18 publicacoes. Apos cuidadosa leitura, foram construidas sete categorias tematicas: avaliacao do assedio moral; comportamentos de assedio moral experimentados por enfermeiros; estrategias de coping adotadas por enfermeiros; consequencias do assedio moral; assedio moral na enfermagem como discriminacao de raca e genero; assedio moral entre profissionais de enfermagem; instituicoes como determinantes do assedio moral. Resultados dos estudos confirmam a presenca do assedio moral na enfermagem, contudo, apontam que estes profissionais tem aceitado e reproduzido este tipo de violencia, evidenciando a necessidade de conscientizacao desta populacao, como das instituicoes de saude, quanto ao assedio moral e seus prejuizos.This is an Integrative Literature Review that aims to analyze productions on moral harassment in nursing published in journals in Brazil and abroad. Articles from 1999 to 2009 were researched in online databases, comprising a sample of 18 publications. After careful reading seven thematic categories were built: evaluation of the moral harassment; behaviors of moral harassment on the part of male nurses; consequences of the moral harassment; coping strategies adopted by nurses; moral harassment in nursing as race and gender discrimination; moral harassment among nursing professionals; institutions as propagators of moral harassment. Results confirm the presence of moral harassment in nursing. However, they indicate that these professionals have been accepting and reproducing this kind of violence as part of the organizational culture, thus showing a need to educate this population and the health institutions themselves about moral harassment and its damages.

Organ and Tissue Donation for Transplantation From Fatal Trauma Victims

INTRODUCTIONnThe aim of this study was to analyze multiple aspects of organ donation after mortality owing to trauma-related causes.nnnMETHODSnWe completed a cross-sectional, retrospective, descriptive study that used data were extracted from monthly death reports and clinical records of fatal external injury victims 2-70 years of age who were assisted at 1 of 4 hospitals in the municipality of Maringá and the surrounding metropolitan area in Paraná state, Brazil, in 2012.nnnRESULTSnA total of 871 individuals within the age range for donation died, 15.4% owing to external causes of injury. Of these 134 cases, 80.6% were male and 52.23% were 18-40 years old. A total of 57% of deaths were owing to traffic accidents, 58% of which involved motorcycles. Aggression was a factor in 25% of deaths, with 55% owing to firearm wounds. Approximately 52% of families consented to organ donation when asked. A total of 58% of families who refused consent did not indicate a specific reason. At 62%, the majority of refusals involved brain-dead patients. Approximately 58% of the families did not receive a request for consent. Out of these 78 cases, 83% showed contraindications, 44% had sepsis, 40% hemodilution, and 10% logistical/infrastructural problems.nnnCONCLUSIONSnThe highest proportion of non donor cases was owing to the lack of a formal request for consent from the family. Thus, continued training for health care professionals on the donation-transplantation process and early identification of potential donors and appropriate organ maintenance is necessary.

Tendency of the studies on moral harassment and nurses

Estudo de Revisao Integrativa da Literatura com o objetivo de analisar o conhecimento produzido sobre o assedio moral na enfermagem, apresentado em publicacoes nacionais e internacionais. Foram pesquisados artigos em bases de dados on-line entre os anos de 1999 e 2009, constituindo-se uma amostra de 18 publicacoes. Apos cuidadosa leitura, foram construidas sete categorias tematicas: avaliacao do assedio moral; comportamentos de assedio moral experimentados por enfermeiros; estrategias de coping adotadas por enfermeiros; consequencias do assedio moral; assedio moral na enfermagem como discriminacao de raca e genero; assedio moral entre profissionais de enfermagem; instituicoes como determinantes do assedio moral. Resultados dos estudos confirmam a presenca do assedio moral na enfermagem, contudo, apontam que estes profissionais tem aceitado e reproduzido este tipo de violencia, evidenciando a necessidade de conscientizacao desta populacao, como das instituicoes de saude, quanto ao assedio moral e seus prejuizos.This is an Integrative Literature Review that aims to analyze productions on moral harassment in nursing published in journals in Brazil and abroad. Articles from 1999 to 2009 were researched in online databases, comprising a sample of 18 publications. After careful reading seven thematic categories were built: evaluation of the moral harassment; behaviors of moral harassment on the part of male nurses; consequences of the moral harassment; coping strategies adopted by nurses; moral harassment in nursing as race and gender discrimination; moral harassment among nursing professionals; institutions as propagators of moral harassment. Results confirm the presence of moral harassment in nursing. However, they indicate that these professionals have been accepting and reproducing this kind of violence as part of the organizational culture, thus showing a need to educate this population and the health institutions themselves about moral harassment and its damages.

Tendencia de los estudios sobre asedio moral y trabajadores de enfermería

Estudo de Revisao Integrativa da Literatura com o objetivo de analisar o conhecimento produzido sobre o assedio moral na enfermagem, apresentado em publicacoes nacionais e internacionais. Foram pesquisados artigos em bases de dados on-line entre os anos de 1999 e 2009, constituindo-se uma amostra de 18 publicacoes. Apos cuidadosa leitura, foram construidas sete categorias tematicas: avaliacao do assedio moral; comportamentos de assedio moral experimentados por enfermeiros; estrategias de coping adotadas por enfermeiros; consequencias do assedio moral; assedio moral na enfermagem como discriminacao de raca e genero; assedio moral entre profissionais de enfermagem; instituicoes como determinantes do assedio moral. Resultados dos estudos confirmam a presenca do assedio moral na enfermagem, contudo, apontam que estes profissionais tem aceitado e reproduzido este tipo de violencia, evidenciando a necessidade de conscientizacao desta populacao, como das instituicoes de saude, quanto ao assedio moral e seus prejuizos.This is an Integrative Literature Review that aims to analyze productions on moral harassment in nursing published in journals in Brazil and abroad. Articles from 1999 to 2009 were researched in online databases, comprising a sample of 18 publications. After careful reading seven thematic categories were built: evaluation of the moral harassment; behaviors of moral harassment on the part of male nurses; consequences of the moral harassment; coping strategies adopted by nurses; moral harassment in nursing as race and gender discrimination; moral harassment among nursing professionals; institutions as propagators of moral harassment. Results confirm the presence of moral harassment in nursing. However, they indicate that these professionals have been accepting and reproducing this kind of violence as part of the organizational culture, thus showing a need to educate this population and the health institutions themselves about moral harassment and its damages.