The Determinants of Complementary Feeding Introduction Vary According to the Type of Food and Infants' Ages: A Cohort Study-ClaB, Brazil.

INTRODUCTION: Food inadequacies in the first 6 months of life are considered a global problem, with an emphasis on early complementary feeding introduction (CFI). This study aimed to identify the determinants of CFI. METHODS: A birth cohort study (N = 641). Data on infant feeding was collected before 30 days, and at 2, 4, and 6 months of age and, at baseline, data regarding socioeconomic status, demographics, maternal and infant health, obstetric history, and infant care. The hypothesis was that the risk determinants for early CFI vary according to the type of food and the age range of this introduction. Twelve Cox regression models were fit with four outcomes (formula; other types of milk; other beverages; and solid/semi-solid foods) considering three different age ranges of the infant at their introduction (< 2 months, 2-4 months, and 4-6 months). RESULTS: The introduction of the four food groups analyzed was early (median ages of introduction: formulas = 45 days; other milks = 135 days; other beverages = 120 days; solids and semi-solids = 135 days). The determinants that increased the risk of introducing formulas before 2 months were: primiparity, employed without maternity leave, mothers with unsatisfactory prenatal counseling and those who had cesarean sections. Not living with a partner, infant pacifier use at 2 months of age had a higher risk of introducing formula between 2 and 4 months of age. Non-white skin color, more than 35 years old, low maternal education, and lower family income increased the risk of introducing other types of milk between 2 and 4 months of age. Between 4 and 6 months of age, adolescent and low education level mothers had a higher risk of introducing other types of milk, unemployed was a protective factor against the introduction of other foods and beverages in this age group. CONCLUSIONS: The determinants of early CFI varied according to the type of food and the age of introduction.

Training and evaluation of professional competency in pediatric nursing: perspective of university professors.

OBJECTIVE: To analyze the training and evaluation of professional competency to work in the area of pediatric nursing based on the conceptions and experiences of university professors. METHOD: A qualitative study conducted with pediatric nursing professors from six public undergraduate courses in the state of São Paulo, Brazil. The data were collected by semi-structured interview and analyzed by the Content Analysis method. RESULTS: Sixteen professors participated. Five main themes emerged: competency definition, attributes to act with children, advances in the training of professional competency, challenges to enable training pediatric competency, and methods and instruments for evaluating competency acquisition to work in the area of pediatric nursing. CONCLUSION: The findings of this study point to the importance of a balanced approach in the cognitive, psychomotor and affective dimensions in training and evaluating professional competency in pediatric nursing, as well as extending the curricular valorization of this area of knowledge and practice.

Educational intervention regarding diet and physical activity for pregnant women: changes in knowledge and practices among health professionals.

BACKGROUND: The knowledge and practices of health professionals have a recognized role in behaviors related to the health of their patients. During pregnancy, this influence can be even stronger because there is frequent contact between women and doctors/nurses at periodic antenatal visits. When trained, supported and motivated, these professionals can act as health promoters. This study aimed to evaluate the effect of a focused educational intervention on improving the knowledge and practices of health professionals concerning diet and physical activity during pregnancy. METHODS: A controlled, non-randomized study was performed to assess the effects of an educational intervention on the knowledge and practices of nurses and doctors who provide primary care to pregnant women. The intervention group, doctors and nurses (n = 22) from the family health units in a medium-sized city of São Paulo State, Brazil, received 16 h of training comprising an introductory course and three workshops, whereas the control group, doctors and nurses (n = 20) from traditional basic health units in Botucatu, did not. The professionals' knowledge was assessed at two time points, 1 month prior to and 1 year after the beginning of the intervention, using an ad hoc self-report questionnaire. The increases in the knowledge scores for walking and healthy eating of the intervention and control groups were calculated and compared using Student's t-test. To analyze the professionals' practice, women in the second trimester of pregnancy were asked whether they received guidance on healthy eating and leisure-time walking; 140 of these women were cared for by professionals in the intervention group, and 141 were cared for by professionals in the control group. The percentage of pregnant women in each group that received guidance was compared using the chi-square test and the Prevalence Ratio (PR), and the corresponding 95 % confidence intervals (CI) were calculated. RESULTS: The intervention improved the professionals' knowledge regarding leisure-time walking (92 % increase in the score, p < 0.001). The women who were cared for by the intervention group were more likely to receive guidance regarding leisure-time walking (PR = 2.65; 95 % CI = 1.82-3.83) and healthy eating (PR = 1.76; 95 % CI = 1.34-2.31) when compared to the control group. CONCLUSION: It is possible to improve the knowledge and practices of health professionals through the proposed intervention aimed at primary health care teams providing antenatal care.

Service organization protocol for coping with undergraduate students' psychological distress: a collective construction.

OBJECTIVE: to report on the experience of the elaboration process of a service organization protocol for coping with public undergraduate students' psychological distress in the countryside of São Paulo. METHOD: experience report on protocol production, an action research product, carried out according to the health care and service organization protocol model, made possible by remote meetings with 33 professionals linked to the management and services of the university's health and social assistance departments. RESULTS: collective protocol production provided an opportunity for an institutional agreement on educational, therapeutic and support actions, to be developed in groups or individually with students, with provision for permanent education with civil servants. FINAL CONSIDERATIONS: this experience made it possible to list specific actions to face undergraduate students' psychological distress, bringing health professionals closer to those in management, promoting the exchange of concepts and practices to re-signify and transform the work developed.

Child health promotion from the perspective of family health strategy nurses.

OBJECTIVE: To apprehend nurses' conceptions and experiences about actions of child health promotion in family health units. METHODS: Exploratory study, with thematic content analysis of statements, obtained through semi-structured interviews with 11 nurses from a municipality in São Paulo. RESULTS: Three thematic categories emerged on child health promotion actions: they must be contextualized, provide for comprehensive care, and aim at self-care; they are carried out through health guidelines shared by professionals with children and their families, inside and outside the health units; present challenges to be overcome by health services, such as lack of involvement and appreciation of the family regarding child follow-up. CONCLUSIONS: The concepts apprehended approached the premises of official documents on health promotion; however, practical experiences included difficulties related to the life contexts of children, their families and health services, compromising the achievement of comprehensive care.

Health care in the first year of life of a prospective cohort of late-preterm and full-term infants, in Botucatu, state of São Paulo, Brazil, 2015-2017. / Atenção à saúde no primeiro ano de vida de uma coorte prospectiva de lactentes prematuros tardios e a termo de Botucatu, São Paulo, 2015-2017.

OBJECTIVE: To assess association between late-preterm birth and use of referral health services in the first year of life. METHODS: This was a prospective cohort study, with data collected from infants at 1, 3, 6, 9 and 12 months old. Maternal and birth characteristics were compared between full-term and late preterm infants. The effect of late preterm birth on the use of specialized outpatient clinic, emergency room/emergency care center, hospitalizations and intensive care unit (ICU) admissions was evaluated by calculating adjusted odds ratios. RESULTS: 41 late preterm and 540 full-term infants differed as to frequency of low birth weight and in not staying in joint accommodation, both of which were higher in late-preterm infants, who were also more likely to be admitted to the neonatal ICU (OR=6.85 - 95%CI 2.56;18.34). Late preterm birth was not associated with the use of other referral health services. CONCLUSION: late preterm birth was not associated with greater use of referral health services after discharge from maternity hospital.

Feelings and perceptions of women in the pregnancy-puerperal cycle who survived severe maternal morbidity.

This study aimed to understand severe maternal morbidity from the perspective of women who experienced it. The methodological precepts of qualitative research were adopted and the Collective Subject Discourse was the methodological framework chosen. A total of 16 women who experienced severe maternal morbidity were interviewed. Results were discussed based on four themes: describing the desire and plan for having a child; acknowledging the health problem and its influence on pregnancy and on the conceptus; overcoming the initial shock postpartum, and experiencing the risk situation: desires, frustration, and overcoming. This study will contribute to qualifying nursing care, specifically acknowledging the diversity and breadth of the needs presented by women in situations of severe morbidity during the pregnancy-puerperal cycle.

Breastfeeding knowledge and practice of health professionals in public health care services.

This study evaluated breastfeeding knowledge and practice of professionals who care for infants at health care services in a city in the interior of São Paulo, Brazil. This epidemiological study was carried out with a population of 89 nurses and physicians. Their answers to a structured questionnaire were analyzed in total and by place of work through the test for difference between proportions (Chi-square) with the level of significance at p<0.05. Data analysis was performed according to the Ministry of Health recommendations. The significant differences found for knowledge and practice, according to place of work, were restricted to certain aspects. Results of average scores were slightly better for professionals from the basic care units. Regular and poor performance were found in different studied aspects regardless of place of work, which suggest that potential educational interventions in this subject should include professionals at all levels of health care.

Health promotion by nursing technicians from the nurses' perspective.

OBJECTIVE: to analyze education and practice of nursing technicians in health promotion, from the perspective of teaching nurses of technical course and Primary Health Care nurses. METHOD: an exploratory study with qualitative data analysis, carried out in the city of São Paulo, through semi-structured interviews with nine public technical professors and 16 nurses from the basic health network. Data thematic analysis was carried out. RESULTS: three thematic categories have emerged: Conceptions and experiences on health promotion; Nursing technician's practice in health promotion; and Nursing technician education on health promotion. FINAL CONSIDERATIONS: it is necessary to review the centrality given to technicalism in the education and practice of nursing technicians, contemplating the health promotion and seeking the development of professional competence for the construction of transformative practices aimed at valuing the autonomy and proactivity of the people in health and quality of life production.

Perinatal results and first-year of life according to maternal skin color: a cohort study. / Resultados perinatais e do primeiro ano de vida segundo cor da pele materna: estudo de coorte.

OBJECTIVE: To analyze the maternal characteristics and perinatal and the first year outcomes of life according to the self-reported color of the mothers. METHOD: Cohort study with mothers and their babies developed in a city in the interior of São Paulo. Follow-up occurred from June 2015 to February 2017. Data were collected at five moments: in the first month and at three, six, nine and 12 months of the child's life. Sociodemographic variables related to prenatal and delivery were included in the study. Among the perinatal outcomes, we analyzed the birth weight and the need for hospitalization in neonatal units; for the outcomes of the first year of life, the occurrence of respiratory infection and the breastfeeding duration were measured. RESULTS: A total of 507 mothers participated in the study. Black/brown women presented an unfavorable socio-demographic situation when compared to white women. The only more favorable outcome among black/brown women was the breastfeeding duration. CONCLUSION: Despite the unfavorable socio-demographic situation considering the selected outcomes, black/brown women did not have worse results. The hypothesis that the quality of care may negate the negative effects of their sociodemographic conditions needs to be tested in future studies.

Perceptions and expectations of pregnant women about the type of birth.

OBJECTIVE: to understand the perceptions and expectations of pregnant women about the type of birth. METHOD: this is a qualitative research, based on the assumptions of the Humanization of Obstetric Care. 15 pregnant women were interviewed twice at the beginning and the end of gestation between October 2015 and May 2016. Data were analyzed according to the method of the Discourse of the Collective Subject. RESULTS: the discourses were associated with four themes: Advantages of vaginal birth over cesarean section; Fear and unpredictability of vaginal birth; Importance of the doctor in the definition of the type of birth; and Influence of family and friends in choosing the type of birth. FINAL CONSIDERATIONS: according to pregnant women, vaginal birth has more benefit compared to cesarean section. However, during gestation and birth, fear of pain and the unexpected, and medical opinions of friends and family against vaginal birth strongly influence the choice of cesarean section.

Service organization protocol for coping with undergraduate students' psychological distress: a collective construction / Protocolo de organización de servicios para el enfrentamiento del malestar psicológico de estudiantes universitarios: una construcción colectiva / Protocolo de organização de serviço para enfrentamento do sofrimento psíquico de universitários: uma construção coletiva

ABSTRACT Objective: to report on the experience of the elaboration process of a service organization protocol for coping with public undergraduate students' psychological distress in the countryside of São Paulo. Method: experience report on protocol production, an action research product, carried out according to the health care and service organization protocol model, made possible by remote meetings with 33 professionals linked to the management and services of the university's health and social assistance departments. Results: collective protocol production provided an opportunity for an institutional agreement on educational, therapeutic and support actions, to be developed in groups or individually with students, with provision for permanent education with civil servants. Final considerations: this experience made it possible to list specific actions to face undergraduate students' psychological distress, bringing health professionals closer to those in management, promoting the exchange of concepts and practices to re-signify and transform the work developed.

RESUMEN Objetivo: relatar la experiencia del proceso de elaboración colectiva de un protocolo de organización de servicios para el enfrentamiento del malestar psicológico de estudiantes de una universidad pública del interior de São Paulo. Método: relato de experiencia sobre la elaboración del protocolo, producto de investigación-acción, realizado según el modelo de protocolo de organización asistencial y de servicios de salud, posibilitado por encuentros a distancia con 33 profesionales vinculados a la gestión y servicios de los departamentos de salud y asistencia sociales universitarios. Resultados: la producción colectiva del protocolo brindó oportunidad para un acuerdo institucional sobre acciones educativas, terapéuticas y de apoyo, a ser desarrolladas en grupo o individualmente con los estudiantes, con previsión de educación permanente con los servidores públicos. Consideraciones finales: esta experiencia permitió enumerar acciones específicas para enfrentar el sufrimiento psíquico de estudiantes universitarios, acercando a los profesionales de la salud a los profesionales de la gestión, promoviendo el intercambio de conceptos y prácticas para resignificar y transformar el trabajo desarrollado.

RESUMO Objetivo: relatar experiência sobre o processo de elaboração coletiva de protocolo de organização de serviço para enfrentamento do sofrimento psíquico de estudantes de universidade pública do interior paulista. Método: relato de experiência da produção do protocolo, produto de pesquisa-ação, realizada conforme modelo de protocolo de cuidado à saúde e de organização de serviço, viabilizada por encontros remotos com 33 profissionais vinculados à gestão e aos serviços dos departamentos de saúde e assistência social da universidade. Resultados: a produção coletiva do protocolo oportunizou a pactuação institucional de ações educativas, terapêuticas e de apoio, para serem desenvolvidas em grupo ou individualmente com os estudantes, sendo previstas as de educação permanente com os servidores. Considerações finais: esta experiência possibilitou elencar ações específicas para o enfrentamento do sofrimento psíquico de estudantes universitários, aproximando profissionais da assistência aos da gestão, promovendo intercâmbio de concepções e práticas para ressignificar e transformar o trabalho desenvolvido.

[Representation of pregnant smokers on cigarette use: a study carried out at a hospital in the interior of the state of São Paulo]. / Representação de gestantes tabagistas sobre o uso do cigarro: estudo realizado em hospital do interior paulista.

This study sheds light on the smoking pregnant women's outlook on cigarette use. The Theory of Social Representations was used as a theoretical reference. For data analysis, the Collective Subject Discourse was constructed. Of the 27 women that were interviewed, 18 had finished elementary education, 8 had completed secondary education, and one had college level education; 14 had a stable union and 6 were married. Four themes emerged from the interviews: (1) starting to smoke: a natural, social practice; (2) satisfaction versus guilt; (3) shattering news: effects of smoking on pregnancy; and (4) quitting: between will and ability. Pregnant women revealed negative ideas about smoking, considering smoking the worst of addictions and a potential cause for complications to the fetus and the mother. Smoking was represented in a prejudicial manner, disregarding the existence of treatment and the need for it. Emerging difficulties were related to quitting, for which professionals, information and adequate approaches for treatment and support for achieving success are utmost necessities.

Nursing care in early childhood: contributions from intersubjective recognition.

OBJECTIVE: to understand the elements composing intersubjective recognition that are relevant for nursing care in early childhood in favor of comprehensive child development. METHOD: reflexive study based on the Honnethian concept of intersubjective recognition in the dimensions of affection, defense of rights, and social esteem. RESULTS: nursing knowledge and practices, permeated by the intersubjective recognition in the mentioned dimensions, contribute to the dynamism of interpersonal relations, the production of co-responsibility, and shared construction of health care in early childhood, with benefits to comprehensive development. CONCLUSION: a successful coordination of the three intersubjective dimensions enables the expansion of the understanding on childhood and nursing care in child health in the field of human development promotion, covering affection, defense of rights, and social esteem in the established relationships with future positive individual and social possibilities.

Child health promotion from the perspective of family health strategy nurses / Promoción de la salud infantil en la perspectiva de enfermeros de la estrategia de salud familiar / Promoção da saúde infantil na perspectiva de enfermeiros da estratégia saúde da família

ABSTRACT Objective To apprehend nurses' conceptions and experiences about actions of child health promotion in family health units. Methods Exploratory study, with thematic content analysis of statements, obtained through semi-structured interviews with 11 nurses from a municipality in São Paulo. Results Three thematic categories emerged on child health promotion actions: they must be contextualized, provide for comprehensive care, and aim at self-care; they are carried out through health guidelines shared by professionals with children and their families, inside and outside the health units; present challenges to be overcome by health services, such as lack of involvement and appreciation of the family regarding child follow-up. Conclusions The concepts apprehended approached the premises of official documents on health promotion; however, practical experiences included difficulties related to the life contexts of children, their families and health services, compromising the achievement of comprehensive care.

RESUMEN Objetivo Aprehender las concepciones y experiencias de enfermeros sobre las acciones de promoción de la salud del niño en las unidades de salud de la familia. Métodos Estudio exploratorio, con análisis de contenido temático de testimonios, obtenidos a través de entrevistas semiestructuradas con 11 enfermeros de un municipio de São Paulo. Resultados Emergieron tres categorías temáticas sobre las acciones de promoción de la salud del niño: deben ser contextualizadas, brindar atención integral y apuntar al autocuidado; se realizan a través de pautas de salud compartidas por los profesionales con los niños y sus familias, dentro y fuera de las unidades de salud; presentan desafíos a ser superados por los servicios de salud, como la falta de involucramiento y valorización de la familia en el cuidado del niño. Conclusiones Los conceptos aprehendidos se acercaron a las premisas de los documentos oficiales sobre promoción de la salud, sin embargo, las experiencias prácticas incluyeron dificultades relacionadas con los contextos de vida de los niños, sus familias y los servicios de salud, comprometiendo la consecución de una atención integral.

RESUMO Objetivo Apreender concepções e experiências de enfermeiros sobre ações de promoção da saúde infantil em unidades de saúde da família. Métodos Estudo exploratório, com análise de conteúdo temática de depoimentos, obtidos por entrevistas semiestruturadas com 11 enfermeiros de município paulista. Resultados Emergiram três categorias temáticas sobre ações de promoção da saúde infantil: devem ser contextualizadas, prever a integralidade do cuidado e visar o autocuidado; realizam-se por meio de orientações sobre saúde compartilhadas pelos profissionais com crianças e suas famílias, dentro e fora das unidades de saúde; apresentam desafios a serem superados pelos serviços da saúde, como falta de envolvimento e valorização da família quanto ao acompanhamento infantil. Conclusões As concepções apreendidas se aproximaram das premissas dos documentos oficiais sobre promoção da saúde, contudo, as experiências práticas incluíram dificuldades relativas aos contextos de vida das crianças, suas famílias e serviços de saúde, comprometendo a consecução da integralidade do cuidado.

[Adolescent pregnancy from a family perspective: sharing projects of life and care]. / A gravidez na adolescência sob a perspectiva dos familiares: compartilhando projetos de vida e cuidado.

This qualitative study aimed to apprehend the meaning of adolescents' pregnancy for their families, using semistructured interviews and collective subject discourse. Adolescent pregnancy is represented as a problem to be faced with family support. The families worry and are mobilized to solve adversities. Besides the shock about the news, impotence as to pregnancy prevention, conformism, happiness and improvement in family relationships due to the baby's arrival, participants evidenced frustration due to the interruption/change in the family life project in terms of the adolescent being pregnant without a stable relationship with the child's father. In valuing the family perspective on adolescent pregnancy, professional care to pregnant adolescents and their families can be delivered in partnership with the family and social context, making it easier to cope with conflicts and recognizing the family as an active subject in this process.

[Immunization coverage and associated factors of women who have recently given birth in a city in São Paulo state]. / Cobertura vacinal e fatores associados em puérperas de município paulista.

The importance of immunization among actions recommended in the prenatal period raises the possibility of protecting both the mother and the fetus against certain harmful diseases. The scope of this study was to assess the immunization coverage and associated factors of mothers whose deliveries occurred in the first half of 2012 in Botucatu, state of São Paulo. It is a cross-sectional study and data collection was performed in the two municipal maternity hospitals. Of the total births during the study period, 1318 mothers (90.3%) were included The data for the characterization of participants and their vaccination status (diphtheria, tetanus and hepatitis B) were obtained from the prenatal card, hospital records or interviews. For analysis of associated factors, the Chi-square test was used, with a 95% confidence interval and critical p of <0.05. Most of the study participants were 20 years old or more (84.4%), had seven years of schooling (69%), were monitored in prenatal care (99.2%) with seven or more appointments (88.9%). Miscarriage and infant death of 17.7% and 2.4% was recorded, respectively. Vaccination coverage was 68.4%. There was no association between sociodemographic and obstetric variables relating to prenatal care and vaccination of pregnant women.

Efeitos da cesárea eletiva sobre desfechos no primeiro ano de vida: estudo de coorte / Efectos de la cesárea electiva sobre los resultados en el primer año de vida: un estudio de cohort / Effects of elective cesarean section on outcomes in the first year of life: a cohort study

Resumo Objetivo verificar o efeito da cesárea eletiva, em comparação ao parto vaginal, sobre os desfechos no primeiro ano de vida da criança. Método estudo de coorte com 499 mães e seus bebês. Foram coletados dados sociodemográficos, relativos à história gestacional, ao parto e nascimento e sobre o primeiro ano de vida do bebê, em entrevista realizada na unidade de triagem neonatal, do registro do prontuário da maternidade e em entrevistas no domicílio. Avaliaram-se as associações de interesse mediante análises de regressão de Cox, ajustadas para as covariáveis identificadas, considerando-se resultados de análises bivariadas que apresentaram significância estatística em nível de p<0,20. Nas análises ajustadas, consideraram-se as relações significativas se p<0,05, tendo como medida de efeito o risco relativo. Resultados as cesáreas eletivas não se associaram aos desfechos estudados (interrupção do aleitamento materno, infecções respiratórias, atopias e sobrepeso/obesidade). Conclusão e implicações para a prática a ausência de associação da cesárea eletiva e os desfechos do primeiro ano de vida poderão ser confirmados em investigações futuras. Pelos achados, sugere-se que a equipe de saúde apoie as mães, com o intuito de aumentar sua confiança e empenho em relação à amamentação, prática que pode repercutir positivamente nos demais desfechos estudados.

Resumen Objetivo verificar el efecto de cesárea electiva, comparándolo con el producido por parto vaginal, en los resultados del primer año de vida del niño. Métodos estudio de cohorte en 499 madres y sus bebés. Fueron recogidos datos sociodemográficos relacionados a la historia gestacional, al parto, al nacimiento y al primer año de vida del bebé; los datos fueron obtenidos en entrevista realizada en la unidad de selección neonatal, en la ficha médica de la maternidad y en entrevistas en el domicilio. Las asociaciones fueron evaluadas con el análisis de regresión Cox, ajustadas para las covariables identificadas, considerando los resultados del análisis bivariado que presentaron significación estadística con un nivel de p<0,20. En los análisis ajustados, las relaciones fueron consideradas significativas si p<0,05, teniendo como medida de efecto el riesgo relativo. Resultados las cesáreas electivas no se asociaron con los resultados estudiados (interrupción del amamantamiento materno, infecciones respiratorias, atopias y exceso de peso/obesidad). Conclusión e implicaciones para la práctica la ausencia de asociación de la cesárea electiva con los resultados del primer año de vida podrá ser confirmada en investigaciones futuras. De acuerdo con los resultados, se sugiere que el equipo de salud apoye a las madres con la finalidad de aumentar su confianza y empeño para realizar el amamantamiento; esta práctica puede repercutir positivamente en los demás resultados estudiados.

Abstract Objective to verify the effect of elective cesarean section compared to vaginal delivery, on the outcomes of the child's first year of life. Methods cohort study with 499 mothers and their babies. Sociodemographic data were collected, related to the gestational history, birth and delivery, and about the baby's first year of life, in an interview carried out at the neonatal screening unit, from the maternity records and in home interviews. The associations of interest were evaluated with Cox regression analyses adjusted for the identified covariates, considering results of bivariate analyses that presented statistical significance at a p<0.20 level. In the adjusted analyses, associations were considered significant if p<0.05, having as effect measure the relative risk. Results elective cesarean sections were not associated with the outcomes studied (interruption of breastfeeding, respiratory infections, atopies and overweight/obesity). Conclusion and implications for practice the absence of association of elective cesarean sections and first year outcomes may be confirmed in future investigations. Based on the findings, it is suggested that the health team should support mothers in order to increase their confidence and commitment to breastfeeding, a practice that may have a positive impact on the other outcomes studied.

Atenção à saúde no primeiro ano de vida de uma coorte prospectiva de lactentes prematuros tardios e a termo de Botucatu, São Paulo, 2015-2017 / Atención a la salud en el primer año de vida de una cohorte prospectiva de bebés prematuros tardíos y a término, Botucatu, São Paulo, Brasil, 2015-2017 / Health care in the first year of life of a prospective cohort of late-preterm and full-term infants, in Botucatu, state of São Paulo, Brazil, 2015-2017

Objetivo: Avaliar associação entre prematuridade tardia e utilização de serviços de referência no primeiro ano de vida. Métodos: Estudo de coorte prospectiva, com dados coletados no 1º, 3º, 6º, 9º e 12º meses dos lactentes. Características maternas e de nascimento foram comparadas entre nascidos a termo e prematuros tardios. Avaliou-se o efeito da prematuridade tardia sobre a utilização de ambulatório especializado e unidade de pronto-socorro/pronto atendimento, internação em unidade de terapia intensiva (UTI) e hospitalização, calculando-se razões de chances ajustadas. Resultados: Os 41 prematuros tardios e 540 nascidos a termo diferiram nas frequências de baixo peso ao nascer e não permanência em alojamento conjunto, maiores nos prematuros tardios, estes também com mais chance de internação em UTI neonatal (OR=6,85 - IC95% 2,56;18,34), condição que não se associou à utilização dos demais serviços de referência. Conclusão: Prematuridade tardia não se associou à maior utilização de serviços de referência após alta da maternidade.

Objetivo: Evaluar la asociación entre nacidos prematuros tardíos y nacidos a término y la utilización de servicios de derivación. Métodos: estudio de cohorte prospectivo, con datos recolectados desde el primero hasta el duodécimo mes de vida de los lactantes. Se evaluaron características maternas y de nacimiento que fueron comparadas entre nacidos a término y prematuros tardíos. Fue evaluado el efecto de la prematuridad tardía sobre el uso de los servicios de derivación especializado y las unidades de Atención Temprana, internación en centro de terapia intensiva (CTI) y hospitalización calculando las razones de probabilidades ajustadas. Resultados: Los 41 nacidos prematuros tardíos y los 540 nacidos a término difirieron en la frecuencia de bajo peso al nacer y en no permanecer en alojamiento conjunto, mayor en los nacidos prematuros tardíos. Hubo más posibilidades de ingreso a la unidad de cuidados intensivos neonatales en nacidos prematuros tardíos (OR=6,85 - IC95% 2,56;18,34), condición que no se asoció con el uso de otros servicios de referencia. Conclusión: La prematuridad tardía no se asoció a una mayor utilización de los servicios de derivación luego del alta de la maternidad.

Objective: To assess association between late-preterm birth and use of referral health services in the first year of life. Methods: This was a prospective cohort study, with data collected from infants at 1, 3, 6, 9 and 12 months old. Maternal and birth characteristics were compared between full-term and late preterm infants. The effect of late preterm birth on the use of specialized outpatient clinic, emergency room/emergency care center, hospitalizations and intensive care unit (ICU) admissions was evaluated by calculating adjusted odds ratios. Results: 41 late preterm and 540 full-term infants differed as to frequency of low birth weight and in not staying in joint accommodation, both of which were higher in late-preterm infants, who were also more likely to be admitted to the neonatal ICU (OR=6.85 - 95%CI 2.56;18.34). Late preterm birth was not associated with the use of other referral health services. Conclusion: late preterm birth was not associated with greater use of referral health services after discharge from maternity hospital.

Child Health Surveillance: nurses perspective.

OBJECTIVE: to analyze conceptions of nurses on child health surveillance in family health units. METHOD: a qualitative study with thematic analysis of the data, based on the paradigm of Health Surveillance. Interviews were conducted with 13 nurses in a countryside city in the state of Sao Paulo. RESULTS: nurses conceived child health surveillance as an active monitoring, which should be comprehensive, identifying risks/vulnerabilities, through multidisciplinary and intersectoral actions that are dependent on maternal involvement. We found partial development of these assumptions in practice, due to difficulties such as lack of maternal involvement in the proposed actions, lack of time for discussion and adoption of measures in the units and disarticulation between levels and sectors of the city. CONCLUSION: a greater political and technical investment is needed to ensure the adoption of this model in different sectors and levels of care of the city.