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This pilot cross-sectional study was designed to determine the profile of obstetric violence in Ecuador in recent years. An online survey was conducted between March 2022 and April 2022, including women over 18 years who granted their informed consent to participate (n = 1598). We used non-probabilistic sampling to obtain our sample. Fisher's exact test was performed to assess the association between violence and type of birth, healthcare facility, and education level. Out of the women who participated in the study, 89.2% (n = 1426) identified themselves as Mestiza. Additionally, 88.3% (n = 1411) had completed university-level education. The majority of the participants, specifically 63.6% (n = 1017), received their care in public institutions, and 98.2% (n = 1569) reported structural negligence, while 74.5% (n = 1190) reported violation of their right to information. The entire sample affirmed to have experienced violation of the right of presence. This report shows that obstetric violence is present in Ecuador in different ways and that women experience negligence and violation of their right to receive ethical healthcare during childbirth.
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Nonspecific lower back pain is one of the main health issues experienced by nonprofessional caregivers of dependent individuals. The repetitive movements and efforts made by caregivers to assist dependent individuals are associated with the onset of this lower back pain. The main objective of this study was to assess the effectiveness of an educational intervention for the management of nonspecific lower back pain in nonprofessional caregivers of dependent individuals (TRANSFE program). The secondary objectives were to (i) evaluate the effectiveness of the TRANSFE program on other variables (caregiver burden, perceived social support, and health-related quality of life), (ii) obtain the sociodemographic profile of the sample, and (iii) determine the baseline of the study variables. A quasi-experimental study with post-intervention measurements at 3 months was conducted. Thirty-six nonprofessional caregivers of dependent individuals participated in this study. The presence of lower back pain (back pain index), low back pain (visual analogue scale), disability due to low back pain (Oswestry disability index), perceived social support (Duke-UNK scale), caregiver burden (Zarit burden scale), and health-related quality of life (EuroQol-5D) were assessed. The intervention significantly improved all the studied variables related to lower back pain (p < 0.001). The intervention was effective on other variables related to nonprofessional caregiving such as caregiver burden, perceived social support, and health-related quality of life, albeit with moderate results. An educational intervention for lower back pain experienced by caregivers of dependent individuals was effective in reducing lower back pain and addressing caregiver burden, perceived social support, and health-related quality of life. This study was registered retrospectively on the Open Science Framework platform on 20 June 2024, with the registration number 10.17605/OSF.IO/K7WTE.
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The issue of obstetric violence is internationally acknowledged as a serious violation of human rights. First identified by the Committee of Experts of the Inter-American Belém do Pará Convention in 2012, it is recognized as a form of gender-based violence that infringes upon women's rights during childbirth. Nations such as Argentina, Mexico, Venezuela, and certain regions in Spain have implemented laws against it, highlighting its severity and the need for protective legislation. Major international organizations, including WHO and the Council of Europe, advocate for the elimination of disrespectful and abusive treatment in maternity care. In 2019, the UN Special Rapporteur on violence against women called on states to protect women's human rights in reproductive services by enforcing laws, prosecuting perpetrators, and providing compensation to victims. However, despite advances, there remains institutional and systemic resistance to recognizing obstetric violence, which undermines trust in healthcare and impacts women's quality of life. Addressing this violence is imperative, requiring education and training in women's human rights for all healthcare professionals. As part of the coalition of experts from various organizations (InterOVO), we respond to the publication by EAPM, EBCOG, and EMA: "Joint Position Statement: Substandard and Disrespectful Care in Labor - Because Words Matter." We are committed to preventing and mitigating obstetric violence and improving care for women and newborns.
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Direitos da Mulher , Humanos , Feminino , Gravidez , Direitos da Mulher/legislação & jurisprudência , Europa (Continente) , América Latina , Violência de Gênero/prevenção & controle , Violência de Gênero/legislação & jurisprudência , Trabalho de Parto , Parto Obstétrico/legislação & jurisprudência , Qualidade da Assistência à Saúde/legislação & jurisprudência , Serviços de Saúde Materna/normas , Serviços de Saúde Materna/legislação & jurisprudênciaRESUMO
Numerous factors concerning early breastfeeding abandonment have been described, including health literacy (HL). This study's objective was to analyze factors related to early breastfeeding abandonment (<6 months). This prospective multicentric study examined the duration of breastfeeding at 6 months postpartum and was conducted in four different regions of Spain from January 2021 to January 2023. A total of 275 women participated in this study, which focused on maternal HL and obstetric practices. A decrease in the breastfeeding rate was observed from hospital discharge (n = 224, 81.5%) to the sixth month postpartum (n = 117, 42.5%). A Cox regression analysis revealed that inadequate HL levels, lack of mobilization during labour, and induced labour were significantly associated with early breastfeeding cessation (p = 0.022, p = 0.019, and p = 0.010, respectively). The results highlight that women with adequate HL had a 32% lower risk of early breastfeeding abandonment. In comparison, mobilization during labour and induction of labour were linked to a 32.4% reduction and a 53.8% increase in this risk, respectively. These findings emphasize the importance of considering obstetric and HL factors when addressing the breastfeeding duration, indicating opportunities for educational and perinatal care interventions.
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Letramento em Saúde , Trabalho de Parto , Gravidez , Feminino , Humanos , Aleitamento Materno , Estudos Prospectivos , Período Pós-Parto , MãesRESUMO
PROBLEM: It is necessary to continue promoting breastfeeding rates. BACKGROUND: Information and communication technologies have significantly impacted healthcare services and are transforming the sector. There is little evidence of the usefulness of mobile applications to support breastfeeding and increase its duration. AIM: To assess whether mobile application-LactApp® (Barcelona, Spain)-usage compared with standard care increases the 6-month postpartum breastfeeding rate. METHODS: A multicentre, randomised, controlled clinical trial of parallel groups was conducted. The study was conducted in four public hospitals in Spain from January 2022 to January 2023. 270 Women were randomly assigned to each parallel group. The women in the intervention group received free access to the mobile application LactApp®, which provides personalised and convenient support to women about BF. Women in the control group received standard care, which included individual counselling about the benefits of maintaining BF for the first 6 months of the baby's life. FINDINGS: The rate of breastfeeding abandonment at 15 days was 6.4 % in the control group vs 0.0 % in the intervention group (p = 0.105). LactApp® usage did not increase the 6-month postpartum breastfeeding rate compared with standard care (CG = 41.6% vs. IG = 43.6 %; p = 0.826). DISCUSSION: Further studies must explore how technologies can help improve long-term breastfeeding maintenance. The mobile app seems to reduce early weaning in the first 15 days slightly. CONCLUSION: Mobile application usage did not increase the breastfeeding rate compared with standard practice but may reduce breastfeeding abandonment in the first 2 weeks postpartum.
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Aleitamento Materno , Aplicativos Móveis , Lactente , Feminino , Humanos , Período Pós-Parto , Aconselhamento , ComunicaçãoRESUMO
Nomophobia is a phenomenon that describes the fear of not having one's mobile phone accessible. This study aimed to evaluate the presence of nomophobia among nursing students as well as its relationship with procrastination and social anxiety. METHODS: An observational, descriptive, cross-sectional study was conducted in a sample of 308 nursing students. Data were collected using the Nomophobia Questionnaire, Academic Procrastination Scale-Short Form, and Social Anxiety Questionnaire for Adults. Additionally, sociodemographic variables related to academic performance and smartphone use were collected. We performed a descriptive, bivariate, and multivariate analysis of the Nomophobia Questionnaire score. RESULTS: 19.5% (n = 60) of the students presented with or were at high risk of nomophobic behaviour. Moreover, nomophobic behaviour was positively correlated with high levels of social anxiety (p < 0.001), longer daily smartphone usage time (p < 0.001), and a high frequency of smartphone checking in class (p < 0.001). The predictive variables for nomophobic behaviour included age, variables related to smartphone use, social anxiety levels, work, procrastination tendency, sex, and self-reported average grade. CONCLUSION: One out of five students in the sample studied presented with or were at high risk of nomophobic behaviour. Additionally, nomophobic behaviour was associated with social anxiety and variables related to smartphone use. This study was not registered.
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INTRODUCTION: Changes to healthcare delivery organization that have occurred to protect people from the virus COVID-19 may have led to harmful consequences to pregnant women intensifying obstetric violence. Prevalence of obstetric violence in Ecuador is high with a range between 30 and 70% approximately. METHODS: This cross-sectional study was performed with the participation of 1298 women who answered EPREVO questionnaire from June 2021 to January 2022. Obstetrics characteristics' relationship before and during COVID-19 were examined using Fisher exact test. RESULTS: From 1598 respondents, 1284 (80.4%) gave birth before March 2020 Most of the participants (73.6%; CI:73.59-73.61) experienced obstetric violence during childbirth. Vaginal examination, enemas and genital shaving, episiotomy and cesarean section decreased significantly as well as rooming with the baby during the pandemic. Half of the women did not breastfeed the baby in the first hour but there were not statistically significant differences between giving birth before or during the infection from COVID-19. CONCLUSIONS: Levels of obstetric violence in Ecuador remains high but without major differences due to the COVID-19 pandemic, however some harmful medical practices considered as obstetric violence decreased but maybe to the fear to be infected by the virus.
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COVID-19 , Cesárea , Gravidez , Feminino , Humanos , Parto , Parto Obstétrico , Equador/epidemiologia , Estudos Transversais , Pandemias , COVID-19/epidemiologia , ViolênciaRESUMO
OBJECTIVE: To compare neonatal outcomes between water births, births with immersion only during labour, and births in which immersion was never used. METHODS: A retrospective cohort study was performed including mother-baby dyads attended between 2009 and 2019 at the Hospital do Salnés regional hospital (Pontevedra, Spain). These women were categorised into 3 groups: water birth; immersion only during dilation; and women who never used immersion. Several sociodemographic-obstetric variables were studied and the main outcome was the admission of the neonate to the intensive care unit (NICU). Permission was obtained from the responsible provincial ethics committee. Descriptive statistics were used and between-group comparisons were performed using variance for continuous variables and chi-square for categorical variables. Multivariate analysis was performed with backward stepwise logistic regression and incidence risk ratios with 95%CI were calculated for each independent variable. Data were analysed using IBM SPSS® statistical software. RESULTS: A total of 1191 cases were included. 404 births without immersions; 397 immersions only during the first stage of labor; and 390 waterbirths were included. No differences were found in the need to transfer new-borns to a NICU (p = .735). In the waterbirth cohort, neonatal resuscitation (p < .001, OR: 0,1), as well as respiratory distress (p = .005, OR: 0,2) or neonatal problems during admission (p < .001, OR: 0,2), were lower. In the immersion only during labor cohort, less neonatal resuscitation (p = .003; OR: 0,4) and respiratory distress (p = .019; OR: 0,4) were found. The probability of not breastfeeding upon discharge was higher for the land birth cohort (p < .001, OR: 0,4). CONCLUSIONS: The results of this study indicated that water birth did not influence the need for NICU admission, but was associated with fewer adverse neonatal outcomes, such as resuscitation, respiratory distress, or problems during admission.
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Parto Normal , Síndrome do Desconforto Respiratório , Gravidez , Lactente , Humanos , Recém-Nascido , Feminino , Parto Normal/efeitos adversos , Parto Normal/métodos , Estudos Retrospectivos , Ressuscitação , HospitalizaçãoRESUMO
PURPOSE: The primary aim of this study is to determine the influence of an intervention in women based on a free mobile application (LactApp®, Barcelona, Spain) in maintaining breastfeeding (BF) up to 6 months postpartum. The secondary aim is to assess the effect of health literacy (HL) on breastfeeding duration. METHODS: A multicenter, randomized controlled clinical trial of parallel groups will be carried out. Women will be randomly assigned to each of the parallel groups. In the control group, usual clinical practice will be followed from the third trimester of pregnancy to promote BF. In the intervention group, and in addition to usual clinical practice, the women will use a free mobile application (LactApp®) from the third trimester to 6 months postpartum. The type of BF at birth, at 15 days and at 3 and 6 months postpartum and the causes of cessation of BF in both groups will be monitored. The hypothesis will be tested using inferential analysis, considering an alpha of 5%. The study protocol was approved by the Clinical Research Ethics Committee of Hospital de la Ribera (Alzira, Valencia, Spain) in February 2021. A per protocol analysis and an intention-to-treat analysis will be performed. DISCUSSION: This study will identify the influence of a mobile application on improving BF rates. If the application proves effective, we will have a tool with free information available to any user at any time of day, which may be complemented by normal clinical practice and be integrated into our health care system. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT05432700.
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Breastmilk contains antibodies that could protect breastfed infants from infections. In this work, we examined if antibodies in breastmilk could neutralize SARS-CoV-2 in 84 breastmilk samples from women that were either vaccinated (Comirnaty, mRNA-1273, or ChAdOx1), infected with SARS-CoV-2, or both infected and vaccinated. The neutralization capacity of these sera was tested using pseudotyped vesicular stomatitis virus carrying either the Wuhan-Hu-1, Delta, or BA.1 Omicron spike proteins. We found that natural infection resulted in higher neutralizing titers and that neutralization correlated positively with levels of immunoglobulin A in breastmilk. In addition, significant differences in the capacity to produce neutralizing antibodies were observed between both mRNA-based vaccines and the adenovirus-vectored ChAdOx1 COVID-19 vaccine. Overall, our results indicate that breastmilk from naturally infected women or those vaccinated with mRNA-based vaccines contains SARS-CoV-2 neutralizing antibodies that could potentially provide protection to breastfed infants from infection.
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INTRODUCTION: Mobile applications (apps) are increasingly used during pregnancy, postpartum and lactation. To ensure the utility and usability of breastfeeding support apps, they need to be evaluated using a reliable scale specific to mHealth apps and breastfeeding users. OBJECTIVE: To translate the original the mHealth App Usability Questionnaire (MAUQ) questionnaire into Spanish and to adapt it to breastfeeding support apps environment. MATERIALS AND METHODS: The questionnaire was translated by one high English proficiency translator and was back translated. The items of the questionnaire were modified for Spanish readers and for breastfeeding users. The modified questionnaire was assessed for content validity with a panel of 5 experts and 12 users and the modified kappa statistic was used to determine the interrater agreement among the raters. The reliability of the questionnaire was assessed in a mobile application for breastfeeding support (LactApp) by 202 users. The structure of the questionnaire was validated using exploratory factor analysis. RESULTS: All items of the questionnaire were relevant, clear or comprehensible with content validity index values higher than 0.79. The modified kappa agreement for each item of the modified MAUQ (m-MAUQ) proved an excellent agreement (κ = 0.9-1.0). Factor analysis of the m-MAUQ showed four subscales. The internal consistency of the complete questionnaire was high (Cronbach α = 0.89). CONCLUSIONS: The Spanish and modified MAUQ demonstrated high reliability and validity and it might be used to evaluate the usability, utility and acceptability of mHealth apps aiming to support lactating women.
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Aplicativos Móveis , Telemedicina , Humanos , Feminino , Reprodutibilidade dos Testes , Aleitamento Materno , Lactação , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To measure the perception of obstetric violence among health sciences students. METHOD: Cross-sectional design in which the validated questionnaire PercOV-S (Perception of Student Obstetric Violence) was used. The questionnaire was offered to the students who participated in the I Congress of Feminist Medicine of the CEEM (State Councils of Medical Students) held on March 12, 2021. This questionnaire was sent online through Google Forms. RESULTS: The mean score obtained on the total scale was 3.83 scores (SD=0.61). For the dimension of protocolized-visible obstetric violence, the mean score is 2.79 points (SD=0.84) and for the dimension of non-protocolized-invisible obstetric violence, a mean of 4.16 points is obtained (SD=0.61). The global score of the displayed question differs statistically significantly with the variable scope (p=0.019), course (p=0.008), treatment according to ethnicity (p=0.008), treatment according to socioeconomic level, immigrant status (p<0.001), and prior knowledge about the concept of obstetric violence (p<0.001). CONCLUSIONS: The data show a marked generalised sensitivity of the sample to the issue of obstetric violence, especially with regard to the ethnic characteristics of the women. Likewise, the need to generate ethical-attitudinal training in the response to obstetric violence is observed.
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Estudantes de Medicina , Gravidez , Humanos , Feminino , Estudos Transversais , Violência , Feminismo , PercepçãoRESUMO
BACKGROUND: Despite international efforts to protect and promote exclusive breastfeeding (EBF) for infants up to six months of age, global rates of EBF continue to fall short of the targets proposed by the WHO for 2025. Previous studies have shown a relationship between the level of health literacy and the duration of EBF, although this relationship was not determinant, probably due to the use of a generic health literacy questionnaire. Therefore, this study aims to design and validate the first specific breastfeeding literacy instrument. METHODS: A Breastfeeding Literacy instrument was developed. Content validation was carried out by a group of 10 experts in health literacy, breastfeeding or instrument validation, obtaining a Content Validity index in Scale (S-CVI/Ave) of 0.912. A multicentre cross-sectional study was carried out in three Spanish hospitals to determine the psychometric properties (construct validity and internal consistency). The questionnaire was administered to 204 women during the clinical puerperium. RESULTS: The Kaiser-Meier-Oklin Test (KMO = 0.924) and Bartlett's Test of Sphericity (X2 = 3119.861; p ≤ 0.001) confirmed the feasibility of the Exploratory Factor Analysis, which explained 60.54% of the variance with four factors. CONCLUSIONS: The Breastfeeding Literacy Assessment Instrument (BLAI) consisting of 26 items was validated.
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Aleitamento Materno , Letramento em Saúde , Gravidez , Humanos , Feminino , Estudos Transversais , Reprodutibilidade dos Testes , Período Pós-Parto , Inquéritos e Questionários , PsicometriaRESUMO
The nursing assessment is the first step of the nursing process and fundamental to detecting patients' care needs and at-risk situations. This article presents the psychometric properties of the VALENF Instrument, a recently developed meta-instrument with only seven items that integrates the assessment of functional capacity, risk of pressure injuries and risk of falls with a more parsimonious approach to nursing assessment in adult hospitalization units. A cross-sectional study based on recorded data in a sample of 1352 nursing assessments was conducted. Sociodemographic variables and assessments of the Barthel, Braden and Downton instruments were included at the time of admission through the electronic health history. Thus, the VALENF Instrument obtained high content validity (S-CVI = 0.961), construct validity (RMSEA = 0.072; TLI = 0.968) and internal consistency (Ω = 0.864). However, the inter-observer reliability results were not conclusive, with Kappa values ranging between 0.213 and 0.902 points. The VALENF Instrument has adequate psychometric properties (content validity, construct validity, internal consistency and inter-observer reliability) for assessing the level of functional capacity, risk of pressure injuries and risk of falls. Future studies are necessary to establish its diagnostic accuracy.
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Úlcera por Pressão , Humanos , Adulto , Úlcera por Pressão/epidemiologia , Acidentes por Quedas , Estudos Transversais , Reprodutibilidade dos Testes , Hospitalização , Psicometria/métodos , Inquéritos e QuestionáriosRESUMO
BACKGROUND: The World Health Organization (WHO) recommends early initiation of breastfeeding (EIBF) within the first hour after birth. However, certain perinatal factors, namely caesarean section, may prevent this goal from being achieved. The aim of our study was to examine the relationship between EIBF (maternal lactation in the first hours and degree of latching before hospital discharge) and the maintenance of exclusive breastfeeding (MBF) up to the recommended 6 months of age (as advocated by the WHO). METHODS: This observational, retrospective cohort study included a random sample of all births between 2018 and 2019, characterising the moment of breastfeeding initiation after birth and the infant's level of breast latch (measured by LATCH assessment tool) prior to hospital discharge. Data were collected from electronic medical records and from follow-up health checks of infants up to 6 months postpartum. RESULTS: We included 342 women and their newborns. EIBF occurred most often after vaginal (p < 0.001) and spontaneous births with spontaneous amniorrhexis (p = 0.002). LATCH score <9 points was associated with a 1.4-fold relative risk of abandoning MBF (95%CI: 1.2-1.7) compared with a score of 9-10 points. CONCLUSIONS: Although we were unable to find a significant association between EIBF in the first 2 h after birth and MBF at 6 months postpartum, low LATCH scores prior to discharge were associated with low MBF, indicating the importance of reinforcing the education and preparation efforts of mothers in the first days after delivery, prior to the establishment of an infant feeding routine upon returning home.
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Aleitamento Materno , Cesárea , Lactente , Gravidez , Feminino , Recém-Nascido , Humanos , Estudos Retrospectivos , Mães , LactaçãoRESUMO
AIMS: To develop and validate an instrument that integrates functional capacity, risk of pressure ulcers and risk of falling with a more parsimonious approach towards nursing assessments in hospitalization units. DESIGN: Cross-sectional validation multicentre study. METHODS: Socio-demographic variables and assessments of Barthel Index, Braden Index and Downton Scale are included via electronic health records. Instrument's development process will include: (i) conceptual assessments; (ii) content validity; (iii) construct validity; (iv) internal consistency and (v) interobserver reliability. The analysis will consider possible differences in medical and surgical hospitalization units, hospitalization type or being a COVID-19 patient. This study was accepted for funding in November 2020 and approved by the Ethics and Research Committee in January 2021. RESULTS: An integrated instrument that lowers the administrative load of nursing assessments and allows at-risk patients to be detected with at least the same validity and reliability as the original instruments is expected to be obtained.
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COVID-19 , Humanos , Adulto , Reprodutibilidade dos Testes , Estudos Transversais , Hospitalização , Avaliação em Enfermagem , Estudos Multicêntricos como AssuntoRESUMO
BACKGROUND: Obstetric violence appears to be a worldwide concern and is defined as a type of gender-based violence perpetrated by health professionals. This violence undermines and harms women's autonomy. In Spain, 38.3 % of women have identified themselves as victims of this type of violence. AIM: To explore current information and knowledge about obstetric violence within the Spanish healthcare context, as well as to develop a theoretical model to explain the concept of obstetric violence, based on the experiences of healthcare professionals (midwives, registered nurses, gynaecologists and paediatricians) and nursing students. METHODS: A constructivist grounded theory study was conducted at Jaume I University in Spain between May and July 2021, including concurrent data collection and interpretation through constant comparison analysis. An inductive analysis was carried out using the ATLAS.ti 9.0 software to organise and analyse the data. RESULTS: Twenty in-depth interviews were conducted, which revealed that healthcare professionals and students considered obstetric violence a violation of human rights and a serious public health issue. The interviews allowed them to describe certain characteristics and propose preventive strategies. Three main categories were identified from the data analysis: (i) characteristics of obstetric violence in the daily routine, (ii) defining the problem of obstetric violence and (iii) strategies for addressing obstetric violence. Participants identified obstetric violence as structural gender-based violence and emphasised the importance of understanding its characteristics. Our results indicate how participants' experiences influence their process of connecting new information to prior knowledge, and they provide a connection to specific micro- and macro-level strategic plans. DISCUSSION: Despite the lack of consensus, this study resonates with the established principles of women and childbirth care, but also generates a new theoretical model for healthcare students and professionals to identify and manage obstetric violence based on contextual factors. The term 'obstetric violence' offers a distinct contribution to the growing awareness of violence against women, helps to regulate it through national policy and legislation, and involves both structural and interpersonal gender-based abuse, rather than assigning blame only to care providers. CONCLUSIONS: Obstetric violence is the most accurate term to describe disrespect and mistreatment as forms of interpersonal and structural violence that contribute to gender and social inequality, and the definition of this term contributes to the ongoing awareness of violence against women, which may help to regulate it through national policy and legislation.
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Pessoal de Saúde , Violência , Gravidez , Humanos , Feminino , Espanha , Teoria Fundamentada , Atitude do Pessoal de Saúde , Parto ObstétricoRESUMO
Catalan legislation, a pioneer in Europe, has defined obstetric violence (OV) as "preventing or hindering access to truthful information, necessary for autonomous and informed decision-making". The definition also states that OV can affect physical and mental health, as well as sexual and reproductive health. Some authors have expressed concern about an increase in OV during the SARS-CoV-2 pandemic. During the pandemic, recommendations were also openly offered on the non-establishment and/or early abandonment of breastfeeding without scientific evidence to support them. Experiencing a traumatic childbirth can influence breastfeeding outcomes. Here, we conducted a cross-sectional study using a self-administered online questionnaire. The sample consisted of women who gave birth in Spain between March 2020 and April 2021. The mean age was 34.41 (±4.23) years. Of the women, 73% were employed, 78.2% had a university education, and almost all were Caucasian. Among the subjects, 3.3% were diagnosed with SARS-CoV-2 during pregnancy and 1% were diagnosed during delivery. Some of the women (1.6%) were advised to stop breastfeeding in order to be vaccinated. Women diagnosed with SARS-CoV-2 during delivery (p = 0.048), belonging to a low social class (p = 0.031), with secondary education (p = 0.029), or who suffered obstetric violence (p < 0.001) perceived less support and that the health care providers were less inclined to resolve doubts and difficulties about breastfeeding. Breastfeeding has been significantly challenged during the pandemic. In addition to all the variables to be considered that make breastfeeding support difficult, we now probably need to add SARS-CoV-2 diagnosis and OV.
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COVID-19 , SARS-CoV-2 , Gravidez , Feminino , Humanos , Adulto , Teste para COVID-19 , Estudos Transversais , COVID-19/epidemiologia , Pandemias/prevenção & controle , Aleitamento MaternoRESUMO
Nursing assessment is the basis for performing interventions that match patient needs, but nurses perceive it as an administrative load. This research aims to develop and validate a meta-instrument that integrates the assessment of functional capacity, risk of pressure ulcers and risk of falling with a more parsimonious approach to nursing assessment in adult hospitalization units. Specifically, this manuscript presents the results of the development of this meta-instrument (VALENF instrument). A cross-sectional study based on recorded data was carried out in a sample of 1352 nursing assessments. Socio-demographic variables and assessments of Barthel, Braden and Downton indices at the time of admission were included. The meta-instrument's development process includes: (i) nominal group; (ii) correlation analysis; (iii) multiple linear regressions models; (iv) reliability analysis. A seven-item solution showed a high predictive capacity with Barthel (R2adj = 0.938), Braden (R2adj = 0.926) and Downton (R2adj = 0.921) indices. Likewise, reliability was significant (p < 0.001) for Barthel (ICC = 0.969; τ-b = 0.850), Braden (ICC = 0.943; τ-b = 0.842) and Downton (ICC = 0.905; κ = 7.17) indices. VALENF instrument has an adequate predictive capacity and reliability to assess the level of functional capacity, risk of pressure injuries and risk of falls.