Self-care for people with heart failure: the importance of tele-nursing in the COVID-19 pandemic.

OBJECTIVE: to describe factors of influence of telenursing on naturalistic decision making about self-care of people with heart failure during COVID-19. METHOD: this is a descriptive study with a qualitative approach, with 16 participants interviewed after hospitalization for decompensated heart failure. The data was collected using audio and video technology and submitted to content analysis, guided by the Situation-Specific Theory of Heart Failure Self-Care. RESULT: two thematic categories emerged from the analysis: Self-care as a decision-making process and Factors influencing decision-making, which describe tele-nursing as a support resource for people with heart failure, during changes in care in the pandemic period. CONCLUSION: it was possible to understand the relationship between telenursing and the establishment of a bond, in order to stimulate naturalistic decision-making by people with heart failure in their daily lives in a coherent way, leading to better health outcomes. HIGHLIGHTS: (1) Different barriers compromise the decision-making of people with heart failure.(2) Nursing theories can guide coherent self-care attitudes.(3) Continuity of care and a support network are necessary after hospitalization.(4) Emotional support for people with heart failure must go hand in hand with conventional treatment.(5) The bond through tele-nursing provides positive health outcomes.

In-hospital breastfeeding and predictive factors during the SARS-CoV-2 pandemic: A retrospective cohort study - Aleitamento materno hospitalar e fatores preditores durante a pandemia pelo SARS-CoV-2: Coorte retrospectiva.

PURPOSE: To analyze breastfeeding and the factors that positively influence the first hour of life, during hospitalization, and at discharge during the SARS-CoV-2 pandemic. DESIGN AND METHOD: This is a retrospective cohort study, with data collected from medical records. Consisting of 225 mother-newborn dyads with deliveries between 2020 and 2021. Breastfeeding in the first hour of life, during hospitalization, and at discharge was considered as the outcome variable. The independent variables were sociodemographic, obstetric, and neonatal data. The analysis was performed with bivariate and multivariate regression through a generalized linear model (Poisson family), with a 5% significance level. It was approved by the Institutional Review Board (IRB), under approval number 4,911,317. RESULT: Newborns of women without COVID-19 suspicion or diagnosis and who had skin-to-skin contact with their mother at birth are twice as likely to be breastfed in the first hour of life. Absence of complications in the newborn during hospitalization and no COVID-19 suspicion or diagnosis double the exclusive breastfeeding rate during hospitalization. Newborns exclusively breastfed during hospitalization present 1.6 times more chances of being exclusively breastfeeding at hospital discharge. CONCLUSION: It was evidence that women who gave birth without COVID-19 suspicion, and newborns who had skin-to-skin contact with their mother at birth represented a predictive factor for favoring exclusive breastfeeding. PRACTICE IMPLICATIONS: This research contributes to the innovation of evaluating breastfeeding in the newborn's first hour of life, during hospitalization, and at discharge in a pandemic context.

Self-care Level of Adults With Arterial Hypertension in Outpatient Follow-up in Brazil: A Cross-sectional Study.

BACKGROUND: Self-care is essential for minimizing the long-term progression of hypertension (HTN) and improving global health outcomes. However, little is known about the predictors of HTN self-care among adults with HTN in Brazil. OBJECTIVE: The aim of this study was to evaluate the self-care practices and the association of sociodemographic and clinical factors of adults with HTN in Brazil. METHODS: This was a cross-sectional study conducted by telephone with 120 adults with HTN monitored in a specialized outpatient clinic of a teaching hospital. Sociodemographic and clinical information was collected by a questionnaire survey. Self-care was assessed by the Self-care of Hypertension Inventory version 2. Multiple regression and Kendall's correlation analyses were performed to determine possible predictors. RESULTS: Low levels of self-care were observed across maintenance, management, and confidence measures. A weak correlation was observed between self-care maintenance and education (-0.13), the time of diagnosis (0.16), and the number of medications (0.15); self-care management and family income (0.13) and cognitive function (0.17); and self-care confidence and systolic (-0.15) and diastolic (-0.18) blood pressure values and time of diagnosis (0.16). In multiple regression analysis, self-care confidence was a predictor of self-care maintenance ( ß = 0.30; 95% confidence interval, 0.10-0.36) and management ( ß = 0.20; 95% confidence interval, 0.03-0.46). CONCLUSION: Confidence was essential in the maintenance and management of self-care and is central to the control of HTN. Self-care interventions must consider the different aspects that may affect self-care, highlighting improving self-care confidence as a main goal.

Self-care for people with heart failure: the importance of tele-nursing in the COVID-19 pandemic / Autocuidado de pessoas com Insuficiência Cardíaca: a importância da telenfermagem na pandemia da COVID-19 / El autocuidado de personas con insuficiencia cardíaca: la importancia de la teleenfermería en la pandemia de COVID-19

Abstract Objective: to describe factors of influence of telenursing on naturalistic decision making about self-care of people with heart failure during COVID-19. Method: this is a descriptive study with a qualitative approach, with 16 participants interviewed after hospitalization for decompensated heart failure. The data was collected using audio and video technology and submitted to content analysis, guided by the Situation-Specific Theory of Heart Failure Self-Care. Result: two thematic categories emerged from the analysis: Self-care as a decision-making process and Factors influencing decision-making, which describe tele-nursing as a support resource for people with heart failure, during changes in care in the pandemic period. Conclusion: it was possible to understand the relationship between telenursing and the establishment of a bond, in order to stimulate naturalistic decision-making by people with heart failure in their daily lives in a coherent way, leading to better health outcomes.

Resumo Objetivo: descrever fatores de influência da telenfermagem na tomada de decisão naturalista sobre o autocuidado de pessoas com insuficiência cardíaca durante a COVID-19. Método: estudo descritivo de abordagem qualitativa, com 16 participantes entrevistados após hospitalização pela descompensação da insuficiência cardíaca. Os dados foram coletados por tecnologia de áudio e vídeo e submetidos à análise de conteúdo, norteada pela Teoria de Situação Específica do Autocuidado da Insuficiência Cardíaca. Resultados: duas categorias temáticas emergiram da análise: Autocuidado como processo de tomada de decisão e Fatores que influenciam a tomada de decisão, as quais descrevem a telenfermagem como recurso de apoio à pessoa com insuficiência cardíaca, durante modificações de atendimento no período pandêmico. Conclusão: foi possível compreender a relação entre a telenfermagem e o estabelecimento de vínculo, de maneira a estimular a tomada de decisão naturalista pela pessoa com insuficiência cardíaca em seu cotidiano de forma coerente, impulsionando melhores resultados em saúde.

Resumen Objetivo: describir factores de influencia de la teleenfermería en la toma de decisión naturalista sobre el autocuidado de personas con insuficiencia cardíaca durante la pandemia de COVID-19. Método: estudio descriptivo de enfoque cualitativo, con 16 participantes entrevistados tras la hospitalización por la descompensación de la insuficiencia cardíaca. Los datos se recopilaron mediante tecnología de audio y vídeo y se sometieron a análisis de contenido, guiado por la Teoría de Situación Específica del Autocuidado de la Insuficiencia Cardíaca. Resultados: dos categorías temáticas surgieron del análisis: Autocuidado como proceso de toma de decisión y Factores que influyen en la toma de decisión, las cuales describen a la teleenfermería como recurso de apoyo a la persona con insuficiencia cardíaca, durante modificaciones de atención en el período pandémico. Conclusión: fue posible comprender la relación entre la teleenfermería y el establecimiento de vínculo, de manera a estimular la toma de decisión naturalista por la persona con insuficiencia cardíaca en su cotidianidad de forma coherente, impulsando mejores resultados en salud.

Analog neuromorphic circuit for spontaneous Ca2+ oscillations.

This study proposes an innovative analog neuromorphic circuit design to mimic spontaneous Ca2+ oscillations observed in astrocytes. Unlike traditional models, this approach does not rely on synaptic stimulation, suggesting that astrocytes may play a key role in generating neuronal activity. The circuit is built using transistor differential pairs to approximate the nonlinear sigmoidal biological functions, and its performance is validated through simulation and compared against mathematical models using phase diagram analysis. Results indicate a good fit between the circuit and the mathematical model. Finally, the circuit's ability to simulate the release of glutamate and ATP through spontaneous oscillations is demonstrated.

Symptoms of Depression in the Postpartum Period: Targeting Maternal Mental Health in the Perinatal Period.

This cross-sectional study aimed to examine the relationship between postpartum depression symptoms, anxiety, and stress during the postpartum period. A total of 101 women were assessed using the Depression, Anxiety and Stress Scale (DASS-21) and the Edinburgh Postnatal Depression Scale (EPDS) within 14 days after delivery. Multivariate regression analysis revealed that paid work, tobacco use, and stress symptoms were significantly associated with a higher incidence of postpartum depression symptoms. These results underscore the importance of comprehensive prenatal care and effective postpartum follow-up to address maternal mental health and prevent adverse outcomes for both mothers and children.

Educational intervention improves knowledge and adherence to treatment amongst puerperal women with syphilis: randomized clinical trial.

BACKGROUND: Gestational syphilis requires early detection and proper treatment to prevent negative maternal-fetal outcomes. This study aimed to evaluate the effectiveness of an educational intervention on treatment adherence and knowledge about syphilis in postpartum women with positive Treponema pallidum results. METHODS: A randomized, parallel, and open clinical trial was conducted with 64 postpartum women who tested positive for T. pallidum, assigned to two groups (1:1 ratio). The Intervention Group (IG) received an educational intervention on syphilis, including an explanatory leaflet and hands-on demonstrations, along with standard guidelines. The Control Group (CG) received standard guidelines alone. Pre-test and post-test assessments were conducted to measure knowledge and treatment adherence. Statistical analyses included descriptive and inferential methods, assessing group homogeneity using the Chi-square or Fishers exact test. The interventions effectiveness was determined using relative risk, and pre- and post-test scores were compared using the independent t test. RESULTS: The post-test revealed improvements in knowledge scores for general knowledge, treatment, and prevention domains (p < .05). The IG demonstrated an increase in post-test knowledge scores (p = .001), with association between post-test scores and treatment adherence (p = .001). CONCLUSION: The educational intervention on syphilis improved knowledge and treatment adherence in postpartum women with syphilis.

Cardiovascular risk factors in the elderly: a 10-year follow-up survival analysis.

AIMS: Cardiovascular risk factors present a high prevalence and have an impact on the morbimortality of the elderly; however, studies evaluating the impact of cardiovascular risk factors in the elderly have had short follow-up times and have not allowed specific analyses of the effects of these factors in the aged population, including how they affect the survival of the elderly. This study aimed to analyse the survival of elderly individuals living in the community, considering the presence of cardiovascular risk factors. METHODS AND RESULTS: A prospective 10-year follow-up was initiated in 2008 with a cohort of 418 elderly people living in a community in Central Brazil. The Kaplan-Meier method and the Cox proportional hazards model were used to examine the association between survival and cardiovascular risk factors. The mean age of the participants was 70.6 (±7.1) years; most participants were hypertensive (81.6%) and participated in irregular physical activity (44%), and 43.3% smoked. After a mean follow-up of 8.38 (±2.82) years, 59.3% had survived and 34.1% had died; among the deaths, 14.1% were due to cardiovascular causes. Age [hazard ratio (HR) 1.067, 95% confidence interval (CI) 1.027-1.109], hypertension (HR 3.178, 95% CI 1.144-8.826), and smoking (HR 2.235, 95% CI 1.253-3.987) were confirmed as risk factors for reduced survival, whereas physical activity was a protective factor (HR 0.456, 95% CI 0.206-1.007). CONCLUSION: The results from this study highlight the need for educational policies towards hypertension and smoking prevention among elderly people, and participation in physical activity needs to be encouraged.

Breast shells for pain and nipple injury prevention: A non-randomized clinical trial.

Objective: This study aimed to analyze the effectiveness of breast shells in preventing pain and nipple injury during breastfeeding. Method: A non-randomized clinical trial was carried out with blinding to the evaluators of the study results. The study included women with ≥35 weeks of singleton pregnancy, no nipple changes, and a desire to breastfeed. Resulting in 62 lactating women. The experimental group used breast shells and health education with clinical demonstration (n = 29), whereas the control group used no breast shells (n = 33). Pain and nipple injury were assessed three times, twice prenatally and once up to 14 days postpartum. Results: Nipple injury (50.0%) and nipple pain (67.7%) presented with similar frequency in both groups (p = 1). Breast engorgement (35,5%) was associated with nipple pain (p = 0.019) and its onset was delayed in the experimental group (p = 0.001). Health education contributes to breast and nipple care and increases favorable breastfeeding patterns. Conclusion: Breast shells do not prevent nipple pain or injury. Innovation: As far as we know, this is the first clinical research evaluating the use of breast shells since the antenatal care to prevent the occurrence of nipple pain and injury.

Síndromes hipertensivas específicas da gestação provocam desconforto respiratório agudo em recém-nascidos / Hypertensive gestational syndromes cause acute respiratory distress in newborns

Objetivo: Associar as síndromes hipertensivas específicas da gestação (SHEG) com desconforto respiratório agudo em recém-nascidos (RN). Metodologia: Estudo transversal, prospectivo, composto por 130 puérperas com SHEG e 142 RN. Os dados foram coletados através de questionário entre junho e setembro de 2018. Foram utilizados os testes de qui-quadrado de Yates e Exato de Fisher. Resultados: O diagnóstico de SHEG mais prevalente foi pré-eclâmpsia (48,46%). Predominou RN prematuro (62,68%), que necessitou de cuidados intensivos neonatais (61,36%). O diagnóstico de pré-eclâmpsia associou-se a prematuridade (0.01744), baixo peso (0.009306), desconforto respiratório (<0.0000001) e uso de suporte ventilatório (<0.0000001), e de pré-eclâmpsia sobreposta associou-se com desconforto respiratório (0.0006261) e uso de suporte ventilatório (0.0006261). Conclusão: É importante identificar precocemente as SHEG e oferecer uma assistência de qualidade durante o processo gravídico para reduzir os desfechos neonatais desfavoráveis e a taxa de mortalidade infantil. (AU)

Objective: To associate the hypertensive gestational syndromes (SHEG) with acute respiratory distress in newborns (RN). Methods: A prospective, cross-sectional study of 130 puerperal women with SHEG and 142 newborns. Data were collected by means of a questionnaire between June and September 2018. It was used the Yates chi-square test and Fisher's exact test. Results: The most prevalent diagnosis of SHEG was preeclampsia (48,46%). Premature newborns were predominating (62,68%), who needed neonatal intensive care (61,36%). The diagnosis of preeclampsia was associated with prematurity (0.01744), low weight (0.009306), respiratory distress (<0.0000001) and use of ventilatory support (<0.0000001), and overlapping preeclampsia was associated with respiratory distress (0.0006261) and the use of ventilatory support (0.0006261). Conclusion: It is important to identify early SHEG and provide quality care during the pregnancy process to reduce unfavorable neonatal outcomes and the infant mortality rate. (AU)

Objetivo: Asociar los síndromes hipertensivos específicos del embarazo (SHEG) con la dificultad respiratoria aguda en recién nacidos (RN). Metodos: Estudio transversal, prospectivo, compuesto por 130 puérperas con SHEG y 142 recién nacidos. Los datos fueron recolectados a través de un cuestionario entre junio y septiembre de 2018. Se utilizó las pruebas de chi cuadrado de Yates y Exacto de Fisher. Resultados: El diagnóstico de SHEG más prevalente fue preeclampsia (48,46%). Predominó recién nacidos prematuro (62,68%), que necesitó de cuidados intensivos neonatales (61,36%). El diagnóstico de preeclampsia se asoció a la prematuridad (0.01744), bajo peso (0.009306), dificultad respiratoria (<0.0000001) y uso de soporte ventilatorio (<0.0000001), y el de preeclampsia superpuesta se asoció con dificultad respiratoria (0.0006261) y uso de soporte ventilatorio (0.0006261). Conclusión: Es importante identificar precozmente el SHEG y ofrecer una asistencia de calidad durante el proceso gravídico para reducir los resultados neonatales desfavorables y la tasa de mortalidad infantil. (AU)

Lanolin and prenatal health education for prevention of nipple pain and trauma: Randomized clinical trial. / Lanolina y educación para la salud en la prevención de dolor y lesiones en los pezones: ensayo clínico aleatorizado.

OBJECTIVE: To investigate the effect of lanolin on nipple pain and trauma in breastfeeding after application of a health education. METHOD: Randomized controlled clinical trial, with two arms, open, with 66 participants during prenatal care in the primary health care network in Goiania - Goias, Brazil. Participants were randomized (1:1) using computer generated numbers in both experimental group (EG) and control group (CG). The EG received lanolin and health education on breastfeeding at two different times with clinical demonstration using cloth didactic breast and illustrative album as the intervention, while the CG received standard health education. Health education was carried out by the same researchers in both groups. Measurement of pain, nipple trauma, and breastfeeding technique occurred on postpartum day eight. The analysis included descriptive statistics and inferential analysis by means chi-square or Fisher test, and Student's t-test, significance level set at 0.05. RESULTS: A majority of the participants experienced no nipple trauma (59.1%) in both groups, and 60.6% of women experienced pain. In both groups, women showed favorable breastfeeding behaviors, except in the condition of the breasts. There were no significant differences between groups in pain prevention (p=0.61), nipple lesions (p=0.21), and breastfeeding technique (p>0.05). CONCLUSION: It is not clear whether the intervention, lanolin combined with health education, has a positive effect on the prevention of nipple pain and trauma. Further research is needed to elucidate this question. Registration number: RBR-7tvhq8. Registry website: http://www.ensaiosclinicos.gov.br/.

Demonstração clínica no pré-natal para o manejo da prevenção do ingurgitamento mamário: estudo quase-experimental / Demostración clínica prenatal para el manejo de la prevención de la ingurgitación de mama: estudio casi experimental / Prenatal clinical demonstration for the management of the breast engorgement prevention: quasi-experimental study

RESUMO Objetivo: investigar a efetividade da educação em saúde sobre amamentação no pré-natal para a adoção de medidas de prevenção do ingurgitamento mamário decorrente do aleitamento materno. Método: trata-se de um estudo quase-experimental com 136 participantes. No grupo experimental (n=91) foi realizada intervenção educativa com demonstração clínica sobre amamentação durante a gestação e reforço das orientações por telefone; o grupo-controle (n=45) recebeu as orientações habituais da unidade de saúde sem interferência da equipe de pesquisa. Para a análise dos dados foi realizada estatística descritiva inferencial, e risco relativo para associação das variáveis de interesse. Resultado: a adoção de medidas de manejo do ingurgitamento mamário foi superior no grupo experimental (p=0,026). A técnica adequada de amamentação foi prevalente entre as mulheres que receberam a intervenção (p=0,030), em especial na posição (RR: 1,39; IC 95%: 1,002-1,94) e pega (RR:20,03; IC 95%: 5,2-77,8). Além disso, o grupo experimental realizou a interrupção da mamada de forma adequada (p<0,001). Conclusão: a educação em saúde com utilização de demonstração clínica é efetiva no manejo do ingurgitamento mamário, na técnica adequada de amamentação e comportamentos de proteção ao aleitamento materno.

RESUMEN Objetivo: investigar la efectividad de la educación en salud sobre lactancia materna en la atención prenatal para la adopción de medidas para prevenir la ingurgitación de mama resultante de la lactancia materna. Método: se trata de un estudio casi-experimental con 136 participantes. En el grupo experimental (n = 91) se realizó una intervención educativa con demostración clínica sobre lactancia materna durante el embarazo y refuerzo de las guías telefónicas; el grupo control (n = 45) recibió las instrucciones habituales de la unidad de salud sin interferencia del equipo de investigación. Para el análisis de los datos se realizó estadística descriptiva inferencial y riesgo relativo para la asociación de las variables de interés. Resultado: la adopción de medidas para el manejo de la congestión mamaria fue superior en el grupo experimental (p = 0.026). La técnica de lactancia adecuada prevaleció entre las mujeres que recibieron la intervención (p = 0,030), especialmente en la posición (RR: 1,39; IC 95%: 1,002-1,94) y agarre (RR: 20,03; IC 95%: 5,2-77,8). Además, el grupo experimental realizó la interrupción de la lactancia de forma adecuada (p <0,001). Conclusión: la educación en salud con el uso de la demostración clínica es eficaz en el manejo de la congestión mamaria, en la técnica adecuada de lactancia materna y conductas protectoras frente a la lactancia materna.

ABSTRACT Objective: to investigate the effectiveness of health education on breastfeeding in prenatal care for the adoption of measures to prevent breast engorgement resulting from breastfeeding. Method: this is a quasi-experimental study with 136 participants. In the experimental group (n = 91) an educational intervention was carried out with clinical demonstration on breastfeeding during pregnancy and reinforcement of guidelines by telephone; the control group (n = 45) received the usual instructions from the Primary Health Care without interference from the research team. For the analysis of the data, inferential descriptive statistics and relative risk for the association of the variables of interest were performed. Result: the adoption of measures to manage breast engorgement was superior in the experimental group (p = 0.026). The adequate breastfeeding technique was prevalent among women who received the intervention (p = 0.030), especially in the position (RR: 1.39; 95% CI: 1.002-1.94) and latching on (RR: 20.03; 95% CI: 5.2-77.8). Also, the experimental group performed the interruption of breastfeeding appropriately (p <0.001). Conclusion: health education with the use of clinical demonstration is effective in the management of breast engorgement, in the appropriate technique of breastfeeding, and protective behaviors against breastfeeding.

Árvore da vida: projeto de impressão placentária em maternidades públicas estaduais do Centro-Oeste / Tree of life: placenta printing project in public maternities in the midwest state

Objetivo: relatar a experiência de residentes e enfermeiros obstétricos na implantação do projeto de impressão placentária em maternidades públicas do Estado de Goiás. Métodos: Trata-se de um relato de experiência acerca da realização de impressão placentária. A iniciativa ocorreu em Hospitais-Maternidades de Goiânia-GO. O projeto se iniciou em janeiro de 2019 e ficou vigente até março de 2020, devido à pandemia da Covid-19. O público-alvo consistiu em mulheres assistidas pela equipe de enfermagem obstétrica, sem exclusão de qualquer natureza. Resultados: As parturientes que receberam o carimbo da placenta expressaram face de surpresa e transmitiram sentimentos de gratidão, felicidade, empatia e sensibilidade. O momento do parto e nascimento é resgatado por meio de uma memória positiva, expressa, muitas vezes, pelo olhar direcionado ao recém-nascido. Ocorre o estreitamento do vínculo com a equipe de saúde, favorecendo uma comunicação facilitada, satisfação e confiança, além do estímulo profissional, aperfeiçoamento da técnica e promoção da humanização. Conclusão: O Carimbo da Placenta é um método de registro e de resgate do parto e nascimento que, somado às boas práticas, garantem não só a humanização na assistência, mas um vínculo afetivo e de segurança da paciente com a equipe de saúde. (AU)

Objective: To report the experience of residents and obstetric nurses in implementing the placenta printing project in public maternity hospitals in Goias State. Methods: This is an experience report about placenta printing. The initiative took place in Maternity Hospitals in Goiânia-GO. The project started in January 2019 and went on until March 2020, due to the Covid-19 pandemic. The target audience consisted of women assisted by the obstetric nursing team, without exclusion of any kind. Results: The parturients who received the placenta stamp were surprised and expressed feelings of gratitude, happiness, empathy and sensitivity. The childbirth moment is recovered through a positive memory, often expressed by looking at the newborn. Bonds are established with the health team, favoring open communication, satisfaction and trust, in addition to professional stimulation, technique improvement and promoting humanization. Conclusion: The Placenta Stamp is a method of registering and recovering labor and birth that, added to good practices, guarantee not only the humanization of assistance, but also the affective bond and safety feelings of the patient toward the health team. (AU)

Objetivo: Informar sobre la experiencia de residentes y enfermeras obstétricas en la implementación del proyecto de impresión placentaria en maternidades públicas en el Estado de Goiás. Métodos: Este es un informe de experiencia sobre la realización de la impresión de placenta. La iniciativa se pasó en los hospitales-maternidades de Goiânia-GO. El proyecto comenzó en enero de 2019 y siguió hasta marzo de 2020, debido a la pandemia de Covid-19. El público objetivo consistió en mujeres asistidas por el equipo de enfermería obstétrica, sin exclusión de ninguna naturaleza. Resultados: Las parturientas que recibieron el sello de placenta expresaron sorpresa y transmitieron sentimientos de gratitud, felicidad, empatía y sensibilidad. El momento del parto y el nacimiento se rescata a través de una memoria positiva, expresada, muchas veces, mirándose al recién nacido. Existe un estrechamiento del vínculo con el equipo de salud, lo que favorece a la comunicación, satisfacción y confianza, además de la estimulación profesional, la mejora de la técnica y la promoción de la humanización. Conclusión: El Sello de la Placenta es un método de registro y rescate del parto y del nacimiento que, sumado a las buenas prácticas, garantizan no solo la humanización de la asistencia, sino también el vínculo afectivo y de seguridad del paciente con el equipo de salud. (AU)

The effectiveness on health education to prevent nipple trauma from breastfeeding: a systematic review / A eficácia da educação em saúde na prevenção do trauma mamilar na amamentação: revisão sistemática

Abstract Objectives: to analyze the effectiveness on health education to prevent nipple trauma in breastfeeding compared to other interventions. Methods: systematic literature review was carried out in January 2019, according to PRISMA recommendations. The searches were conducted in Cinahl, PubMed, Web of Science, Scopus, and in the references cited in the selected articles. The studies were assessed for quality and level of evidence according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Results: twelve studies were selected, all conducted at the maternities. The interventions were classified in two categories: health education on breastfeeding and the use of nipple covers. Health education on breastfeeding presents a moderate level of evidence on the prevention of nipple trauma. There is a moderate to high level of evidence on the positive effects of guaiazulene, gel or peppermint water applied in the postpartum period to prevent nipple trauma. Conclusion: health education on breastfeeding with clinical demonstration is an important strategy to prevent nipple trauma and requires more than one educational approach. The use of nipple covers requires some consideration, since they must be removed prior to breastfeeding. All interventions were conducted in the postpartum period, which points out for the necessity of clinical research to prevent nipple trauma in prenatal care.

Resumo Objetivos: analisar a eficácia da educação em saúde para a prevenção do trauma mamilar na amamentação comparado a outras intervenções. Métodos: revisão sistemática realizada em janeiro de 2019, segundo recomendações PRISMA. As buscas foram realizadas na Cinahl, PubMed, Web of Science, Scopus e referências citadas nos artigos selecionados. Os estudos foram avaliados quanto à qualidade e nível de evidência conforme o sistema Grading of Recommendations, Assessment, Development and Evaluation. Resultados: foram selecionados 12 estudos, todos executados em maternidades. As intervenções foram representadas em duas categorias: educação em saúde sobre amamentação e uso de coberturas mamilares. A educação em saúde sobre amamentação apresenta moderada evidência na prevenção do trauma mamilar. As coberturas de gel ou água de hortelã-pimenta, de guaiazulene, aplicadas no pós-parto, têm efeito positivo na prevenção do trauma mamilar, com moderada a alta evidência. Conclusão: a educação em saúde sobre amamentação, com demonstração clínica, configura-se importante estratégia para prevenção do trauma mamilar, devendo ser realizada mais de uma abordagem educativa. A implementação de coberturas mamilares precisa ser ponderada, pois todas exigiram remoção antes da mamada. Todas as intervenções foram conduzidas no pós-parto, o que aponta para a necessidade de pesquisas clínicas sobre a prevenção do trauma mamilar no pré-natal.

Medium-chain triglyceride reinforce the hepatic damage caused by fructose intake in mice.

We aimed to investigate the effects of medium-chain triglyceride oil on the high fructose diet-provoked hepatic abnormalities in mice. We used C57bl/6 mice of 3-months-old divided into four groups for 12 weeks: control (C), control with MCT (C-MCT), fructose (F), and fructose with MCT (F-MCT). We investigated food and water intake, body mass, blood pressure, glucose tolerance, plasma and liver biochemistry, hepatic protein and gene expression. There were no changes in body mass, food intake and glucose tolerance among the groups. The F group presented increased water intake and blood pressure associated with hepatic steatosis and elevated de novo lipogenesis, beta-oxidation, mitochondrial biogenesis and inflammation in the liver. Surprisingly, the C-MCT group also showed hepatic steatosis and inflammation in the liver, and the F-MCT group had no exacerbations of fructose-induced abnormalities, showing marked hepatic steatosis, lipogenesis de novo and hepatic inflammation. The MCT oil groups also presented increased beta-oxidation and mitochondrial biogenesis. In conclusion, MCT oil showed detrimental hepatic effects and should be used with caution, especially in the presence of hepatic alterations.

Fadiga em Mulheres com Câncer de Mama Submetidas à Radioterapia / Fatigue in Women with Breast Cancer Submitted to Radiotherapy / Fatiga en Mujeres con Cáncer de Mama Sujeto a Radioterapia

Introdução: A fadiga em mulheres com câncer de mama após a radioterapia é um dos efeitos colaterais mais debilitantes, sendo um sintoma subjetivo, multidimensional e multifatorial. Objetivo: Caracterizar a fadiga em pacientes com câncer de mama em radioterapia que realizam o tratamento no Serviço de Radioterapia de um hospital de referência em tratamento oncológico do Estado de Goiás. Método: Trata-se de um estudo longitudinal. A Escala de Fadiga de Piper - revisada foi utilizada para avaliação de fadiga no início (T1), meio (T2) e final (T3) da radioterapia. Resultados: A amostra foi composta por 89 mulheres. A prevalência de fadiga em T1 foi de 26,9%. Houve aumento significativo da fadiga ao longo da radioterapia, sendo que, em T3, 50,8% das mulheres apresentavam fadiga. Houve predomínio da fadiga moderada em T2 e T3, e o aumento mais significativo da intensidade da fadiga foi verificado do momento T1 para T2. A dimensão afetiva da fadiga apresentou escore mais alto comparado às dimensões sensorial/psicológica. Conclusão: A presença e a intensidade da fadiga durante a radioterapia aumentaram significativamente, predominando a fadiga moderada na última semana do tratamento. A magnitude da fadiga exibiu escores mais altos na dimensão afetiva nas avaliações. Portanto, atenção maior à fadiga durante a radioterapia precisa ser dada pelos profissionais de saúde.

Introduction: Fatigue in women with breast cancer after radiotherapy is one of the most debilitating side effects, being a subjective, multidimensional, multifactorial symptom. Objective: To characterize fatigue in patients with breast cancer in radiotherapy who undergo treatment in the radiotherapy service of a reference hospital in cancer treatment in the State of Goiás. Method: This is a longitudinal study. The Piper Fatigue Scale - revised was used to evaluate fatigue at the beginning (T1), middle (T2) and final (T3) of the radiotherapy. Results: The sample consisted of 89 women. The prevalence of T1 fatigue was 26.9%. There was a significant increase in fatigue during radiotherapy, and in T3, 50.8% of the women presented fatigue. There was a predominance of moderate fatigue in T2 and T3, and the most significant increase in fatigue intensity was verified from T1 to T2. The affective dimension of fatigue presented a higher score compared to the sensorial/psychological dimensions. Conclusion: The presence and intensity of fatigue during radiotherapy increased significantly, with moderate fatigue predominating in the last week of treatment. The magnitude of fatigue exhibited higher scores in the affective dimension of the evaluations. Therefore, health professionals must focus more attention to fatigue during radiotherapy.

Introducción: La fatiga en mujeres con cáncer de mama después de la radioterapia es uno de los efectos colaterales más debilitantes, siendo un síntoma subjetivo, multidimensional, multifactorial. Objetivo: caracterizar la fatiga en pacientes con cáncer de mama en radioterapia que realizan el tratamiento en el servicio de radioterapia de un hospital de referencia en tratamiento oncológico del Estado de Goiás. Método: Se trata de un estudio longitudinal. La Escala de Fatiga de Piper - revisada fue utilizada para evaluación de fatiga al inicio (T1), medio (T2) y final (T3) de la radioterapia. Resultados: La muestra fue compuesta por 89 mujeres. La prevalencia de fatiga en T1 fue de 26,9%. Se observó un aumento significativo de la fatiga a lo largo de la radioterapia siendo que, en T3, el 50,8% de las mujeres presentaban fatiga. Se observó un predominio de la fatiga moderada en T2 y T3, y el aumento más significativo de la intensidad de la fatiga fue verificado del momento T1 para T2. La dimensión afectiva de la fatiga presentó una puntuación más alta en comparación con las dimensiones sensorial/psicológica. Conclusión: La presencia e intensidad de la fatiga durante la radioterapia aumentó significativamente, predominando la fatiga moderada en la última semana del tratamiento. La magnitud de la fatiga exhibió escores más altos en la dimensión afectiva en las evaluaciones. Por lo tanto, los profesionales de la salud deben prestar mayor atención a la fatiga durante la radioterapia.

Sífilis gestacional: fatores associados, comportamento de risco e repercussões neonatais / Gestational syphilis: associated factors, risk behavior and neonatal repercussions

Objetivo: analisar o comportamento de risco, os fatores associados e as repercussões neonatais em gestantes com sífilis. Método: estudo transversal, descritivo e retrospectivo, composto por 107 casos de sífilis gestacional em um hospital referência em gestação de alto risco, no período entre janeiro de 2016 e abril de 2017. Para análise estatística, foram aplicados os testes de qui-quadrado de Yates e Exato de Fisher. Resultados: maior ocorrência em mulheres jovens (56,1%), de cor não branca (81%), sem companheiro (53%), procedentes de outros municípios (65%), com menor escolaridade (62%) e sem exercer atividade remunerada (82%). Apesar de realizarem o pré-natal (95%), obtiveram um tratamento inadequado para a infecção (60%) e sem adesão dos parceiros sexuais (48%). Houve um predomínio de recém-nascidos pré-termos (51%), classificados com baixo peso ao nascer (35%) e vivos (90%). Houve uma associação estatisticamente significante entre o comportamento de risco com a escolaridade de até 8 anos de estudos (p<0.010), número de consultas de pré-natal <6 (p<0.001) e ocorrência de parto vaginal (p<0.032). Conclusão: as desigualdades sociais, aliadas às falhas na assistência pré-natal, corroboram para a persistência do quadro epidemiológico de sífilis no Brasil

Objective: to analyze the risk behavior, associated factors and neonatal repercussions in pregnant women with syphilis. Method: a cross-sectional, descriptive and retrospective study of 107 cases of gestational syphilis in a high-risk gestational hospital, in the period between January 2016 and April 2017. For statistical analysis, the chi-square Yates and Fisher's Exact test were applied. Results: greater occurrence in young women (56.1%), non-white skin color (81%), without companion (53%), coming from other municipalities (65%), lower schooling (62%) and without exercising paid activity (82%). Although they performed prenatal care (95%), they were inadequately treated for infection (60%) and without adherence of sexual partners (48%). There was a predominance of preterm newborns (51%), classified as having low birth weight (35%) and alive (90%). There was a statistically significant association between risk behavior with up to 8 years of schooling (p <0.010), number of prenatal consultations <6 (p <0.001), and vaginal delivery (p <0.032). Conclusion: social inequalities, together with failures in prenatal care, corroborate the persistence of the epidemiological presentation of syphilis in Brazil

Queixas de nutrizes que buscam atendimento em um banco de leite humano e fatores associados / Complaints from nursing mothers seeking care in a human milk bank and associated factors

O objetivo deste artigo é analisar as queixas de nutrizes que buscaram atendimento em um BLH e fatores associados. Trata-se de um estudo descritivo, analítico, transversal, retrospectivo, cuja população é composta por 1.709 nutrizes que buscaram atendimento no período de Janeiro a Dezembro de 2016. Para a coleta de dados, utilizaram-se as fichas de atendimento do BLH. As principais queixas que levaram as nutrizes a buscarem atendimento no BLH relacionam-se à dificuldade com a técnica de amamentação (41,9%) e a problemas mamários, como o ingurgitamento mamário (27,1%) e o trauma mamilar (18,1%). A necessidade de auxílio na técnica de amamentação esteve associada às seguintes condições relativas à nutriz: ser procedente da capital (p=0,001), apresentar mais de oito anos de estudo (p=0,040), ter uma ocupação (p=0,010), ser primípara (p=<0,001), optar pela realização de parto cesárea (p=<0,001) e ter experiência prévia com amamentação (p=0,004). Houve associação entre ingurgitamento mamário e primiparidade (p=0,038), além do fato de a nutriz ter contado com o apoio ao aleitamento materno na maternidade (p=0,021). O estudo possibilitou verificar a importância dos BLH no processo de lactação, um período em que as mulheres ficam ansiosas, necessitam de informações confiáveis e apresentam muitas queixas em relação à lactação

The aim of this article is to analyze the complaints of lactating mothers who sought care in a HMB and associated factors. It is a descriptive, cross-sectional, retrospective study, whose population is composed of 1.709 lactating mothers who sought care in the period from January to December the 2016. For the data collection, were used the service records of the HMB. The main complaints that led the lactating mothers to seek care at HMB were related to the difficulty with the breastfeeding technique (41.9%) and to breast problems, such as breast engorgement (27.1%) and nipple trauma (18,1%). The need for breastfeeding technique was associated to the following nutrient conditions: coming from the capital (p = 0.001), presenting more than eight years of study (p = 0.040), having an occupation (p = 0.010), being primiparous (p = <0.001), opt for cesarean (p = 0.001) and to have previous experience with breastfeeding (p = 0.004). There was an association between breast engorgement and primiparity (p = 0.038), in addition to the fact that the mother had support for breastfeeding in the maternity ward (p = 0.021). The study made it possible to verify the importance of HMBs in the lactation process, a period in which women become anxious, require reliable information and have many complaints about lactation

Fatores envolvidos na não realização dos exames de rastreamento para o câncer de mama / Factors involved in the non-performance of breast cancer screening tests

O objetivo foi analisar as evidências disponíveis na literatura sobre os fatores envolvidos na não realização dos exames de rastreamento para o câncer de mama. A coleta de dados foi realizada nas bases de dados LILACS, MEDLINE e Scopus. A estratégia de busca foi: (tw:("breast cancer screening")) AND (tw:("Health Knowledge, Attitudes, Practice")) AND (tw:(mammography)) OR (tw:(ultrasonography)) OR (tw:("clinical breast exam")). A amostra final constituiu-se de 10 artigos. Os fatores que demonstraram serem associados a não realização dos exames de rastreamento do câncer de mama foram: internos - medos, crenças/cultura, atitudes de vergonha/pudor, conhecimento sobre o câncer de mama e externos - serviços, profissionais de saúde, fatores sociopolíticos, organizacionais. Assim, estes fatores demonstram a necessidade de utilização do serviço de forma organizada e universal, com profissionais preparados a acolher e orientar as mulheres, proporcionando o enfrentamento de fatores que inviabilizam a realização do rastreamento do câncer de mama.

The objective ot this study was to analyze the evidence available in the literature on the factors involved in the non-performance of breast cancer screening tests. Data collection was performed in the LILACS, MEDLINE and Scopus databases. The search strategy was: (tw:("breast cancer screening")) AND (tw:("Health Knowledge, Attitudes, Practice")) AND (tw:(mammography)) OR (tw:(ultrasonography)) OR (tw:("clinical breast exam")). The final sample consisted of 10 articles. The factors that demonstrated to be associated with the non-performance of breast cancer screening tests were internal: fears, beliefs/culture, attitudes of shame/ embarrassment, knowledge about breast cancer; and external: health services, health professionals, sociopolitical factors, organizational factors. Thus, these factors demonstrate the need to use the service in an organized and universal way, with professionals prepared to welcome and guide women, coping with the factors that impede the performance of breast cancer screenings.

Scientific evidence on perineal trauma during labor: Integrative review.

OBJECTIVE: To assess the scientific evidence for management and preservation of perineal integrity during the expulsive stage of labor. STUDY DESIGN: Integrative review that employed the Population, Intervention, Comparison, Outcome strategy to formulate the research question: Which perineal measure(s) is(are) effective in maintaining perineal integrity during labor? The search was performed in the databases MEDLINE, LILACS, BDENF and SciELO. The ten selected studies were analyzed based on their level of evidence and grade of recommendation. RESULTS: Four categories of measures were located: antenatal perineal care, perineal massage during the expulsive phase of labor, manual perineal support during the expulsive phase of labor and perineal hyaluronidase injection. CONCLUSION: Based on its level of evidence, perineal massage with lubricants performed by the women or their partners at the end of pregnancy may be recommended as a measure favorable for perineal protection.