Continence App: Construction and validation of a mobile application for postnatal urinary incontinence prevention.

OBJECTIVE: Describing the Continence App development as an educational technology to promote adherence to pelvic floor muscle training and prevent urinary incontinence in postpartum women. STUDY DESIGN: Study of technological production carried out in two stages: construction and validation. The first happened in four steps: modeling, navigation project, abstract design of the interface and implementation. In the validation phase 22 experts (11 health experts and 11 from the information technology/computing/communication areas) and 22 puerperal women were invited to evaluate the content and appearance of the education application. The content validity was analyzed through the Content Validity Index and the appearance validity through 75% minimum agreement in the items evaluated. The study was conducted during 2016 and 2017. For the content validation, the judges evaluated the following aspects: concepts and definitions used in the application, possibility of comprehension by the target audience and form of presentation. In order to validate the appearance, the installation, execution of the functions, objectives, usability, interface, practicality and interaction with the user were evaluated. RESULTS: Most of health experts were physiotherapists (n = 07) and professionals with a PhD (n = 07). Regarding the CVI, 100% of the evaluated items obtained values of 0.86 or greater. Most of information technology/computing/communication experts were male (81.8%) and of the information technology area (63.6%). Except for "restart sessions", "ways of presenting suggestions", "user interaction" and "motivates questioning", all the other aspects received between 81.8% and 100% positive responses. All items evaluated by the target audience obtained a minimum of 94.3% positive responses from the participants. In this step, points for adjustment were identified in relation to the application content and interface, which were promptly corrected. CONCLUSIONS: The application has been validated for use in clinical practice as an educational technology to promote adherence to pelvic floor muscle training and prevention of urinary incontinence in postpartum women.

Early Childhood Diarrhea Predicts Cognitive Delays in Later Childhood Independently of Malnutrition.

Understanding the complex relationship between early childhood infectious diseases, nutritional status, poverty, and cognitive development is significantly hindered by the lack of studies that adequately address confounding between these variables. This study assesses the independent contributions of early childhood diarrhea (ECD) and malnutrition on cognitive impairment in later childhood. A cohort of 131 children from a shantytown community in northeast Brazil was monitored from birth to 24 months for diarrhea and anthropometric status. Cognitive assessments including Test of Nonverbal Intelligence (TONI), coding tasks (WISC-III), and verbal fluency (NEPSY) were completed when children were an average of 8.4 years of age (range = 5.6-12.7 years). Multivariate analysis of variance models were used to assess the individual as well as combined effects of ECD and stunting on later childhood cognitive performance. ECD, height for age (HAZ) at 24 months, and weight for age (WAZ) at 24 months were significant univariate predictors of the studies three cognitive outcomes: TONI, coding, and verbal performance (P < 0.05). Multivariate models showed that ECD remained a significant predictor, after adjusting for the effect of 24 months HAZ and WAZ, for both TONI (HAZ, P = 0.029 and WAZ, P = 0.006) and coding (HAZ, P = 0.025 and WAZ, P = 0.036) scores. WAZ and HAZ were also significant predictors after adjusting for ECD. ECD remained a significant predictor of coding (WISC III) after number of household income was considered (P = 0.006). This study provides evidence that ECD and stunting may have independent effects on children's intellectual function well into later childhood.

The maternal self-efficacy scale for preventing early childhood diarrhea: validity and reliability.

OBJECTIVE: This study aimed to develop and validate a psychometric scale for preventing early childhood diarrhea in endemic areas. DESIGN AND SAMPLE: Before applying to the field, the scale was subjected to content validity by a panel of experts and piloting. The final version was applied to 448 mothers of children 0- to 5-year-olds, living in Fortaleza, northeast Brazil. Structured interviews were conducted to identify diarrheal episodes in the study children. RESULTS: Significant negative correlations were found between higher maternal self-efficacy scores and previous childhood diarrhea (p = .001). In addition, positive correlations were found with maternal age (p = .018). The frequency of children (6-36 months old) with diarrhea was significantly lower when scale scores were higher (p = .015). The predictive validity revealed that high levels of maternal self-efficacy were a protective factor against childhood diarrhea. Cronbachs alpha was .84. CONCLUSIONS: The scale was found reliable. Cultural adjustments may be needed to extrapolate the scale to other endemic areas worldwide.

Psychometric assessment of the Brazilian version of the Breastfeeding Self-Efficacy Scale.

OBJECTIVES: The purpose of this study was to translate and psychometrically assess the Breastfeeding Self-Efficacy Scale (BSES) among women living in Fortaleza, CE, Brazil, and examine the relationship between breastfeeding self-efficacy (BSE) and maternal demographic variables. DESIGN AND SAMPLE: This methodological study is the first translation of BSES conducted in South America. The psychometric assessment of the original study was replicated. This methodological study enrolled a group (sample of judgment) of 117 pregnant women. MEASURES: BSES and maternal sociodemographic variables were studied. RESULTS: The Cronbach's alpha coefficient for the translated BSES was .88. Significant differences in BSES scores were found among mothers with a previous satisfactory breastfeeding experience (M = 145.81; SD = + or - 6.82, p = .0001). Significant relationships were found among prenatal BSE and maternal age (r = .228; p = .01), educational level (r = .234; p = .01), and marital status (r = .183; p = .04). No relationship was found among BSE and maternal occupation, family income, or number of pregnancies. CONCLUSIONS: Altogether, our findings suggest that BSES translated into Portuguese may be a reliable and valid measure to assess maternal BSE in Brazilian culture. Minor changes may be needed to use it in other Portuguese-speaking countries, such as Portugal and Mozambique.

Malnutrition as an enteric infectious disease with long-term effects on child development.

Malnutrition is a major contributor to mortality and is increasingly recognized as a cause of potentially lifelong functional disability. Yet, a rate-limiting step in achieving normal nutrition may be impaired absorptive function due to multiple repeated enteric infections. This is especially problematic in children whose diets are marginal. In malnourished individuals, the infections are even more devastating. This review documents the evidence that intestinal infections lead to malnutrition and that malnutrition worsens intestinal infections. The clinical data presented here derive largely from long-term cohort studies that are supported by controlled animal studies. Also reviewed are the mechanisms by which enteric infections lead to undernutrition and by which malnutrition worsens enteric infections, with implications for potential novel interventions. Further intervention studies are needed to document the relevance of these mechanisms and, most importantly, to interrupt the vicious diarrhea-malnutrition cycle so children may develop their full potential.

Fatores de risco para queimaduras e choque elétrico em crianças no ambiente domiciliar / Risk factor for burns and electric shock in children in the domestic setting / Factores de riesgo para las quemaduras y choques eléctricos en niños en el ambiente domiciliario

INTRODUÇÃO: Queimaduras e choque elétrico são acidentes graves que podem causar seqüelas irreversíveis ou a morte. OBJETIVO: Identificar a presença de fatores de riscos para queimaduras e choque elétrico, na opinião das mães e do pesquisador, em crianças da primeira infância, e verificar a associação com os dados sociodemográficos das mães. MÉTODO: Estudo descritivo e abordagem quantitativa. Foram realizadas visitas domiciliares a 87 famílias de crianças de entre 1 e 6 anos que freqüentavam creche, em Fortaleza-CE, no período de 2004-2006, utilizando um formulário sobre o tema. RESULTADOS: O fator de risco mais citado para queimaduras, observado pelas mães (34) e pelo pesquisador (64), foi: panelas ao alcance das crianças, observado pelas mães (34) e pelo pesquisador (64); para choque, o fator de risco mais observado pelas mães (33) e pelo pesquisador (53) foi tomada elétrica não protegida e ao alcance das crianças, observado pelas mães (33) e pelo pesquisador (53). CONCLUSÃO: A enfermagem deve orientar familiares na prevenção de acidentes, minimizando os riscos de acidentes na infância.

INTRODUCTION: Burns and electric shock are severe accidents that can cause irreversible results and death. OBJECTIVE: This study intended to identify mothers' opinions about risk factors in the household associated with burns and shock to which children are exposed. We also verified the correlation between demographic variables and risk factors for burns and shock. METHOD: This is a descriptive study, using a quantitative approach. We conducted household visits, involving 87 families with children aged 1 to 6 years old, who had attended the nursery care center, in Fortaleza, state of Ceará, Brazil, during 2004 to 2006, talking to them and filling out a thematic form. RESULTS: Saucepans within the reach of children were the most significant burn risk factor referred by mothers (34) and by the researcher (64). For electric shock, exposed electric outlets were said to be the most important risk factor by mothers (33) and by the researcher (53). CONCLUSION: Nurses should inform family members how to prevent accidents, therefore reducing accidents in childhood.

INTRODUCCIÓN: Las quemaduras y choques eléctricos son accidentes graves que pueden tener consecuencias irreversibles e incluso llevar a la muerte. OBJETIVO: Identificar la presencia de factores de riesgo para quemaduras y choques eléctricos, según las madres y el investigador, en niños de primera infancia y analizar si tales riesgos están vinculados a los datos sociodemográficos. MÉTODO: se trata de un estudio descriptivo con enfoque cuantitativo. Se visitaron 87 familias en sus domicilios con niños entre uno y seis años que iban a una guardería en Fortaleza, Estado de Ceará. El estudio se realizó entre los años 2004 y 2006 con un formulario que trataba del asunto. RESULTADOS: el factor de riesgo más mencionado, tanto por las madres como por el investigador, fue para quemaduras las ollas y para choques eléctricos las tomas eléctricas o enchufes no protegidos al alcance de los niños. CONCLUSIÓN: enfermería debe orientar a los familiares cómo prevenir accidentes, minimizando los riesgos de accidentes en la infancia.

Conhecimento das mães sobre o aleitamento materno: estudo descritivo / Mother's knowledge about breastfeeding: a descriptive study

Aims: Characterize the demographic profile of mothers who breastfeed exclusively or not, to verify the type of feeding offered to the infants and to inquire the mother's knowledge about important points concerning breastfeeding. Methods: Quantitative, descriptive study involving 102 mothers followed at the Center for Family Development whom were selected randomly, by adopting the following criteria: mothers of suckling infants up to 2 years of life, exclusively breastfed or not. The research was conducted using individual interviews; collected data were processed using the Software Package for the Social Sciences (SPSS 13.0). Results: 93 (91.2%) families had income between 1 to 3 minimum salaries; 70.6% of the mothers had ages between 18 and 30 years; 76.5% of the infants were breastfed and 31.4% were exclusively breastfed. In relation to the maternal knowledge on breastfeeding, it was observed that the previous breastfeeding experience and duration were significantly associated with the right answers on breastfeeding free demand (p=0.018), and water presence in the composition of maternal milk (p=0.031), as indicated correctly by 92 (90.1%) and 79 (77.5%) of the mothers, respectively. Conclusions: The study found that the mothers demonstrated a good knowledge level about breastfeeding issues; however, this finding is not indicative of awareness or self-confidence in the context of child health promotion, therefore mothers have not breastfed their children in the expected manner yet.

Objetivos: caracterizar o perfil sociodemográfico das mães que amamentaram exclusivamente ou não, verificar o tipo de alimentação oferecida aos lactentes e averiguar o conhecimento das mães sobre pontos importantes do aleitamento materno. Métodos: Estudo quantitativo, descritivo envolvendo 102 mães de lactentes acompanhados no Centro de Desenvolvimento Familiar selecionadas aleatoriamente, adotando os seguintes critérios: mães de lactentes até o segundo ano de vida e que amamentaram ou que ainda continuavam amamentando seus filhos exclusivamente ou não. A pesquisa foi realizada a partir de entrevistas individuais e os dados foram processados no Software Package for the Social Sciences (SPSS 13.0). Resultados: 93 (91,2%), famílias tinham renda de 1 a 3 salários mínimos; 70,6% das mães tinham idades entre 18 e 30 anos; 76,5% das mães estavam amamentando sendo que 31,4% o faziam exclusivamente. Em relação ao conhecimento materno sobre o amamentação, observou-se que a experiência e duração do aleitamento materno anterior apresentou associação estatística significante em relação às assertivas sobre a amamentação em livre demanda (p=0,018), e presença de água na composição do leite materno (p=0,031), apontadas como corretas por 92 (90,1%) e 79 (77,5%) mães respectivamente. Conclusões: O estudo evidenciou que as mães têm demonstrado bom nível de conhecimento sobre aleitamento, contudo essa sinalização não é indicativa de tranqüilidade ou de vitória no contexto da promoção à saúde infantil, pois as mães ainda não têm amamentado seus filhos do modo esperado.

Casal infértil em busca do filho desejado: estudo de caso clínico / Infertile couple pursuing for a desired child - a clinical case study

In the Northeast Brazil the pregnancy is culturally related to femininity (woman) and virility (man) therefore to be infertile can threaten the marriage union. To describe the infertile couple's experience who lives in Northeast Brazil and was submitted to in vitro fertilization (IVF), we conducted a clinical case study with qualitative approach using the Symbolic Interactionism (Blumer, 1969) and Thematic Analysis (Bardin, 1979) as theoretical and methodological framework, respectively. This study revealed that to submit to IVF is an experience full of conflict and uncertainty, requiring an especialized assistance in regards to human reproduction and a holistic nursing care considering the cultural issues.

No Nordeste do Brasil a gravidez está culturalmente relacionada à prova da feminilidade (mulher) e da virilidade (homem), pelo que, saber-se infértil pode abalar as bases estruturais da união conjugal. Descrever a experiência de um casal infértil inserido no ambiente cultural do Nordeste que se submete à fertilização in vitro (FIV). Para tanto, realizamos um estudo de caso clínico utilizando abordagem qualitativa utilizando o Interacionismo Simbólico (Blumer, 1969) e a Análise Temática (Bardin, 1977) como referencial teórico e metodológico, respectivamente. O estudo nos revelou que se submeter à FIV é uma experiência repleta de conflitos e incertezas para o casal nordestino exigindo não apenas uma assistência especializada relacionada à reprodução humana, mas um cuidado holístico e especializado por parte da Enfermagem, considerando, de forma particular, os aspectos culturais e sociais.

Perfil de famílias de crianças acidentadas no contexto domiciliar / Profile of children's families afflicted by an accident in the domiciliary context: a descriptive study

Accidents in the childhood, despite being potentially predictable and preventable, still can cause high child morbidity and mortality. This study aimed at defining a profile of their families, concerning family income, work status, maternal education and age, from which children had experienced domestic accidents. This is a descriptive study based on a quantitative approach. The sampling was 65 families of children currently attending two shelters in Fortaleza-CE, during 2004-2005. Parental interviews were conducted at their households, by using forms addressing socio-demographic characteristics and the occurrence of a previous domestic accident. Out of these 65, in 43 households, accidents had been reported. There was no statistical association between domestic accidents and family income, occupational status, maternal education and age. In 56 families, the monthly income was 02 minimum salaries at most, 27 mothers did not work outside their homes, 40 mothers did not complete the primary school and 15 mother's age ranged between 21 and 24 years old. Therefore, by knowing the real situation of the children's families whom experienced domestic accidents, the nurses can plan activities based on health education, which might prevent accidents and ultimately promoting child health.

Os acidentes na infância, apesar de potencialmente previsíveis e preveníveis, causam alta morbi-mortalidade infantil. O estudo teve como objetivo traçar o perfil das famílias quanto à renda familiar, ocupação, instrução e idade materna cujas crianças na primeira infância vivenciaram acidentes domésticos. Estudo descritivo com abordagem quantitativa. A amostra constituiu-se de 65 famílias de crianças matriculadas em duas creches, em Fortaleza-CE, em 2004-2005. Realizaram-se entrevistas com os pais, nos domicílios, utilizando-se formulários com assuntos referentes às condições sócio-demográficas e ocorrência de acidentes domésticos. Dos 65 domicílios, em 43 ocorreram acidentes. Não se verificou associação estatística significante entre renda familiar, ocupação, instrução, idade materna e a ocorrência dos acidentes domésticos. Em 56 famílias a renda total foi de no máximo 02 salários mínimos, 27 mães não trabalhavam fora do lar, 40 mães não concluíram o ensino fundamental e 15 mães tinham idade entre 21 e 24 anos. Desta forma, ao conhecer a real situação das famílias das crianças que experienciaram acidentes domésticos, a Enfermagem pode planejar atividades de educação em saúde, que proporcionem a prevenção dos acidentes e, conseqüentemente, promovam a saúde infantil.

Papilomavírus humano em homens e mulheres: enfocando o risco à esposição e prevenção / Men and women with human papilomavirus: focusing on the exposition risk and prevention

Objetiva abordar pacientes com HPV, destacando as diferenças de gênero em relação à exposição ao risco associada à prevenção