Effects of Educational Interventions on Maternal Self-efficacy and Childhood Diarrhea: A Randomized Clinical Trial.

OBJECTIVE: Diarrhea still causes high morbidity and mortality in children under five, requiring constant interventions. Thus, the study aims to evaluate the effects of educational technologies on maternal self-efficacy to prevent childhood diarrhea. METHODS: Randomized clinical trial carried out in Fortaleza, Ceará, Brazil, with four randomized groups of mothers of children under 5 years of age, as follows: control group (n = 61), group A (booklet, n = 60), group B (video, n = 60), and group AB (booklet and video, n = 60). From June to October 2015, data collection was carried out in three moments (the first in person and the others by telephone monitoring). RESULTS: All groups improved their self-efficacy after the intervention, with higher scores in the group AB (booklet and video). A statistically significant association was found between the occurrence of diarrhea and maternal self-efficacy in groups A (booklet) (p = 0.023) and AB (booklet and video) (p = 0.042) at the second moment of data collection. From the second moment to the third moment, the risk of diarrhea decreased in group A, from 12.8 to 1.3, and in group AB, from 8.5 to 1.1. CONCLUSION: The technologies used, isolated or combined, were effective in improving maternal self-efficacy and decreasing the occurrence of childhood diarrhea; therefore, they can be used by nurses as health education tools.

Educational interventions using a primer and motivational interviewing: randomized clinical trial.

BACKGROUND: Many educational technologies have been used to promote the health of the population. Thus, the objective was to assess the effect of using an individual educational primer along with the Brief Motivational Interviewing (BMI) for increasing maternal self-efficacy for preventing childhood diarrhoea. METHODS: Randomized clinical trial, conducted in Fortaleza/Ceará-Brazil, composed of 181 mothers and/or guardians of children under five years, who were randomized into three groups: experimental group A (EG A)-who read the primer, experimental group B (EG B)-application of the primer and BMI and the control group (CG). The participants' assessment was based on the Maternal Self-Efficacy Scale for Preventing Childhood Diarrhoea and the diarrhoea Investigation Form at the beginning of the intervention and then 30 and 60 days after the first contact with the participants. RESULTS: There were 60 participants in EG A and CG and 61 in EG B. It was noted a greater incidence of participants with high self-efficacy in EG B after applying the technologies. All groups manifested diarrhoea among children after the interventions, although with a lower number in EG B, one-month post-intervention (P = 0.025). CONCLUSIONS: The combined use of the primer and the BMI contributed significantly over time to increase maternal self-efficacy in preventing childhood diarrhoea and reduce cases of this disease.

Application of a Bundle in the Prevention of Peri-Intraventricular Hemorrhage in Preterm Newborns.

The purpose of this study was to evaluate the impact of implementing a care bundle for preventing peri-intraventricular hemorrhage (PIVH) in preterm newborns. A longitudinal, quantitative, quasi-experimental study was conducted with preterm newborns from a neonatal unit. The study was divided into 2 stages: the first consisted of a retrospective cohort of newborns (control group) not exposed to the bundle, and the second consisted of 5 practical steps of implementing a care bundle for preventing PIVH in eligible newborns. The results show that a significant reduction in PIVH occurred, from 34.8% before the intervention to 26.3% after application of the bundle. Also, after implementation of the bundle, there was a reduction in the severe forms of PIVH in the newborns who presented with hemorrhage compared with the control group. The study shows how the use of a low-cost and easy operationalization tool can contribute to the health of preterm newborns. It was found that the bundle is directly related to the decrease in the incidence of PIVH. The results may contribute to the improvement in care quality, thus promoting safe care for premature newborns.

Factors Associated With Body Image Perception Among Brazilian Students From Low Human Development Index Areas.

This study aimed to evaluate sociodemographic, behavioral, and individual factors associated with body image perception in a sample of adolescents from schools in low Human Development Index areas in Brazil. This cross-sectional study included 609 boys and 573 girls (aged 11-17 years). Body image perception (nine-silhouettes scale) and sociodemographic, behavioral, and individual variables were included. Multinomial logistic regression analysis was used. Most boys (76.9%) and girls (77.5%) were dissatisfied with their body image. Body mass index status and healthy body image evaluation were significantly associated with body image dissatisfaction in both boys and girls ( p < .001), and daily fruit consumption was associated with body image dissatisfaction only in boys ( p = .035). Education and health care focused on body image can pay special attention to young people from vulnerable areas with unhealthy nutritional status and focus on strategies that enable improving the perception of a healthy body and a healthy diet.

Weight-Gain Velocity in Newborn Infants Managed with the Kangaroo Method and Associated Variables.

Objectives The Kangaroo method helps promote maternal breastfeeding and adequate growth of low birthweight preterm infants. The objective of this study was to analyze the association between weight-gain velocity during use of the Kangaroo method and maternal and infant variables. Methods A nested cross-sectional study in a cohort of newborn infants managed using the Kangaroo method was carried out at a reference center for the method in Brazil. Data on low birthweight and preterm infants managed using the Kangaroo Method (n = 78) and on their respective mothers (n = 70) was collected between January and July 2014. Maternal and infant variables were associated and correlated with weight-gain velocity (g/kg/day) at each phase of the method (p < 0.05). Results Mean weight-gain velocity increased from 0.12 ± 11.11 g/kg/day in the first phase to 13.47 ± 4.84 g/kg/day in the third phase (p < 0.001), and percentage of adequate weight increased at phase 3 (p < 0.001). Birthweight was inversely correlated with weight-gain velocity at phases 1 and 2 of the Kangaroo method. Birthweight of under 1500 g was associated with a lower likelihood of inadequate weight-gain velocity of the newborn at phase 1 (OR = 0.1; 95 % CI 0.01-0.78; p = 0.012). In phase 3, maternal age was directly correlated with weight-gain velocity. Conclusions Weight-gain velocity was associated with maternal (age) and infant (gestational age at birth, birthweight, weight for gestational age at birth, length of hospital stay and five-minute Apgar score) variables. Knowledge of the factors influencing weight-gain velocity and its behavior at each phase of the method can help guide conduct toward potentializing factors that promote adequate weight-gain.

Association Between Confidence in Smiling and Esthetic Characteristics.

OBJECTIVE: This study aimed to analyze which facial, gingival and dental characteristics are associated with confidence in smiling among 75 subjects seeking treatment in a northern Brazilian public dental university. MATERIALS AND METHODS: Clinical examinations and three standardized photographs of each subject were taken by one trained examiner. In addition, a questionnaire was applied to assess confidence in smiling. The subjects were dichotomized into two groups, non-confident (n = 36) and confident (n = 39) in smiling. Chi-square/Fischer exact test were used to associate the facial, gingival and dental characteristics between groups. RESULTS: The subjects that reported to be non-confident in smiling were statistically associated with smile type (p = 0.030) and wrongly positioned teeth (p = 0.047). On the other hand, gender (p = 0.491), marital status (p = 0.217), gum pigmentation (p = 0.930), midline (p = 0.176), volume of the upper (p = 0.380), and lower (p = 0.615) lips were not associated with self-reported confidence in smiling. CONCLUSION: In patients seeking dental treatment in a public dental university, non-confidence in smiling was associated only with some oral and intraoral characteristics and not with demographic characteristics. CLINICAL SIGNIFICANCE: This study showed that only smile type and wrongly positioned teeth were statistically associated with confidence in smiling. Dentists should pay attention to those intraoral characteristics, but the clinical decision making should always include the patients' perception. (J Esthet Restor Dent 29:E56-E66, 2017).

The use of educational video to promote maternal self-efficacy in preventing early childhood diarrhoea.

Diarrhoea is responsible for high rates of infant morbidity and mortality. It is multifactorial, manifested by socioeconomic, hygienic, and maternal factors. The aim of this study is to evaluate the effects of an educational video on maternal self-efficacy for the prevention of childhood diarrhoea. This was a randomized trial conducted in the state of Ceará, Brazil. Participants were 2 groups (comparison and intervention), composed of mothers of children under 5 years of age. Group membership was allocated by cluster randomization. Outcomes were maternal self-efficacy measured using the Maternal Self-efficacy Scale for Prevention of Early Childhood Diarrhoea; outcome data collectors were blinded to group allocation. Ninety participants were randomized to each group; 83 intervention group and 80 comparison group members were contained in the final analysis. Maternal self-efficacy in preventing childhood diarrhoea increased in both groups, but average scores of the intervention group were higher at all time than those of the comparison group. The educational video had a significant effect on maternal self-efficacy.

Factors associated with asthma in adolescents in the city of Fortaleza, Brazil.

OBJECTIVE: Asthma is a chronic inflammatory airway disease. In Brazil, little is known about factors associated with this disease. This study aimed to identify factors associated with asthma in 13- to 14-year-old adolescents in Fortaleza, Ceará, Brazil. METHODS: It is a cross-sectional population-based study, with a probability sample of 3015 students in 2006-2007. We used the questionnaires about asthma, rhinitis and socio-demographic/environmental factors from the International Study for Asthma and Allergies in Childhood (ISAAC) protocol. Current asthma was defined as physician-diagnosed asthma and wheezing in the previous 12 months. Bivariate analysis was performed between asthma and factors included in the study, using prevalence ratio and Chi-square test. Confidence intervals (95%) and odds ratio (OR) were also calculated. Factors associated with asthma in bivariate analysis were then assessed using logistic regression. RESULTS: Final sample was composed by 694 adolescents, 179 with asthma. Rhinoconjunctivitis and consumption of stuffed biscuits and fried snacks three or more times per week were independently and positively associated with asthma; consumption of fruits three or more times per week was negatively associated with asthma. CONCLUSIONS: Dietary factors were the most associated with asthma in this study. Besides rhinoconjunctivitis, consumption of stuffed biscuits and fried snacks (foods with high content of saturated fat) three or more times per week were independently associated with asthma as aggravating factors, while the consumption of fruits three or more times per week was associated with asthma as protective factor. Interventions acting on these factors may decrease the occurrence of asthma in this population.

[Knowledge, attitudes and practices for the prevention of diabetic foot]. / Conhecimento, atitudes e práticas de medidas preventivas sobre pé diabético.

The purpose of this study was to identify the knowledge, attitudes and practices for the prevention of diabetic foot in patients with diabetes mellitus type 2. This study was based on a cross-sectional survey conducted in two Family Health Units, in the city of Picos--PI, Brazil, with 85 diabetics of both sexes, by means of a semi-structured Knowledge, Attitude and Practice questionnaire. There was a predominance of females in the study (62.4%). On the topic of foot care, 49.4% had no knowledge on hygiene or what to observe in their feet. In relation to nail care, 56.5% were unaware of the correct way to cut nails. Regarding attitudes, 80% were willing to engage in self-care. In terms of practice, results showed that activities such as washing, drying, moisturizing and massaging were not executed together. It is therefore necessary to develop educational strategies to create awareness, both for diabetics and health professionals, on the effective prevention of diabetic foot.

[Quality of life in patients with spinal cord injury]. / Qualidade de vida em pacientes com lesão medular.

It was aimed to measure the quality of life of adults with spinal cord injury and identify domains that affect the quality of life of these individuals. Epidemiological study, conducted in 2007-2008 in Health Basic Units of Campina Grande/PB. There were 47 participants. It was used a questionnaire composed by: sociodemographic variables, etiology of injury; validated instrument to measure quality of life containing four domains: Physical Health, Environmental, Social Relationships and Psychological with their respective facets. The data collected were processed using descriptive and statistical analysis. The domains with lowest scores were: Environmental (55.20 points), Physical health (58.59 points). The facets that compromise the domains: mobility (55.3%), work capacity (55.3%), Financial resources (80.9%), Opportunities for acquiring new information and skills (51%), Participation in and opportunities for recreation/leisure activities (68.1%) and Sexual activity (34%). Results express the dissatisfaction of participants with quality of life. Nurses should contribute to rehabilitation and social reinsertion of those people, respecting their limitations, emphasizing the remaining potential and capacity for self-care.

Excessive Noise in Neonatal Units and the Occupational Stress Experienced by Healthcare Professionals: An Assessment of Burnout and Measurement of Cortisol Levels.

Excessive noise in the work environment has been associated with extra-auditory symptoms, which can have harmful long-term effects on individuals. The purpose of this study was to identify noise levels in neonatal intensive care units and investigate their impact on the occurrence of stress among healthcare professionals, using cortisol levels as a biomarker for Burnout Syndrome. This descriptive, observational, and cross-sectional study was conducted in four public teaching hospitals in Fortaleza, Ceará, Brazil. Sound pressure levels in the environment were measured, and questionnaires were administered to collect sociodemographic data and assess perceptions of the work environment and Burnout symptoms. Saliva samples were collected at the beginning and end of work shifts for cortisol quantification. The average sound pressure ranged from 59.9 to 66.4 dB(A), exceeding the recommended levels set by Brazilian and international legislation. Among the 256 participants, the average age was 39.4 years, with 95% being female. The majority (70.9%) were nurses, and 22.7% were physicians. There was no significant association found between noise and Burnout Syndrome, nor with changes in cortisol levels. However, a significant association was observed between the perception of excessive noise and the sensation of a stressful work shift (p = 0.012). All evaluated professionals displayed symptoms of Burnout. The high sound pressure levels indicated that the assessed environments did not meet the recommended standards for acoustic comfort, and this was associated with the participants' perception of stressful work shifts. While Burnout symptoms were evident in our participants, it was not possible to confirm a correlation with high noise levels.

Health Professionals' Chronotype Association with Salivary Cortisol and Occupational Stress in Neonatal Intensive Care Units.

Burnout syndrome has been reported among health workers, particularly those working in critical areas, and is considered a significant public health problem. This study aimed to investigate the relationship between chronotype and work-related stress, as measured by salivary cortisol levels and burnout, among health professionals working in neonatal intensive care units. A cross-sectional study was conducted across four public hospitals in Fortaleza, Ceará, Brazil. Two hundred and fifty-six health professionals were administered the brazilian version of the Burnout Characterization Scale, the morningness-eveningness questionnaire, for chronotype, a sociodemographic questionnaire that included lifestyle habits and a salivary cortisol test. The results indicated that morning chronotype workers were significantly associated with the following: advanced age (p < 0.001), female gender (p = 0.032), married status (p = 0.014), and having children (p = 0.030) compared to those with evening and intermediate chronotypes. However, no significant association was found between signs of burnout syndrome and chronotype (p = 0.316). Participants whose work shift did not match their chronotype had significantly higher initial salivary cortisol levels (p = 0.013). The findings suggest that adapting working hours to an individual's biological rhythm can help mitigate potential negative effects on physical and mental health. Thus, it is recommended that professionals' working hours be adjusted accordingly.

Prevalence of trachoma in the non-indigenous Baixo Jaguaribe micro-region, Ceará State, Northeast Brazil.

BACKGROUND: The aim of the current study was to estimate the population prevalence of trachoma in non-indigenous populations in the Baixo Jaguaribe micro-region, in the state of Ceará, northeast region of Brazil, 2021-2022. METHODS: A population-based prevalence survey focusing on detecting cases of trachomatous inflammation-follicular (TF) in children aged 1-9 y and trachomatous trichiasis (TT) 'unknown to the health system' in people aged ≥15 y, was conducted in rural areas of the Baixo Jaguaribe micro-region in the state of Ceará. Indigenous populations will be further researched. RESULTS: There was no detection of cases of TF and TT. In 900 households, 2234 people were examined. In the Baixo Jaguaribe micro-region, females (54.6%; 1219/2234) and the mixed/Pardo-Brazilian ethnicity (68.1%; 1521/2234) predominated. The most commonly reported educational level was elementary and middle school (41.8%; 702/1679). In 56.2% (506/900) of households, there was a source of water within the household. The monthly income range of 50%-100% of the minimum wage predominated in the families of the Baixo Jaguaribe micro-region (43.1%; 388/900). CONCLUSIONS: Although no cases of TF and TT were detected in the Baixo Jaguaribe micro-region in the state of Ceará during the study period, considering the historical endemicity, we emphasise the need for monitoring and sustainability of surveillance actions in areas at risk for trachoma, common contexts for neglected populations.

Postoperative bleeding after dental extraction in liver pretransplant patients.

PURPOSE: The aim of this prospective observational study was to evaluate the incidence of postoperative bleeding after dental extraction in candidates for liver transplantation and the efficacy of the association of tranexamic acid and absorbable hemostatic sponges. PATIENTS AND METHODS: All individuals referred for oral health evaluation requiring extraction were considered in this study. Patients were included in the analysis when the blood examinations showed a platelet count of 30,000/mm(3) or greater and an international normalized ratio (INR) of 3.0 or less. In group 1 local pressure was applied by use of gauze soaked with tranexamic acid, and in group 2 gauze without tranexamic acid was used. Absorbable hemostatic sponges and cross sutures were used as a standard hemostatic measure. RESULTS: In the 23 patients included in this study, 84 simple extractions were performed during 35 dental surgical procedures. The main preoperative blood tests found the following: a mean hematocrit level of 34.54% (SD, 5.84%; range, 21.7%-44.4%), platelet counts from 31,000/mm(3) to 160,000/mm(3), and a mean INR of 1.50 (SD, 0.39; range, 0.98-2.59). Postoperative bleeding occurred during only 1 procedure (2.9%), and local pressure with gauze was effective for achieving hemostasis. No statistically significant difference in the time to hemostasis was found between the 2 groups. CONCLUSIONS: This study found a low risk of bleeding for tooth extractions in patients with liver cirrhosis, INRs of 2.50 or less, and platelet counts of 30,000/mm(3) or greater. Blood transfusions were not needed, and in the case of postoperative bleeding, the use of local hemostatic measures was satisfactory.

[Hope in HIV-positive women]. / Esperança em mulheres portadoras da infecção pelo HIV.

The objective of this study was to assess the hope in the lives of HIV-positive women, using the Herth Hope Scale (HHS). Participants were 111 HIV-positive women who attended a referral outpatient clinic in Fortaleza-CE. From January to May 2009, interviews were held to collect biopsychosocial variables, and the HHS was applied. Data were analyzed using SPSS-8.0 and revealed an average hope index of 34.86, indicating that these women have little hope in life in view of their diagnosis of HIV. The scale item with the highest score was faith. This probably derives from the fact that Aids is incurable, transmissible and generates negative stigma, in addition to its relation with the idea of imminent death. In conclusion, measuring hope among HIV patients through the use of an instrument permits intervention assessment and planning, promoting assistance and motivation to live better and maintain a hopeful attitude.

[Maternal deaths at a public maternity Hospital in Fortaleza: an epidemiological study]. / Óbitos maternos em uma maternidade pública de Fortaleza: um estudo epidemiológico.

The objectives of this study were to analyze the maternal deaths, which occurred in a public maternity hospital in Fortaleza, Ceara State, Brazil and identify associations between time of death and the cases. An analysis was performed on the medical records, death certificates and notification forms regarding 96 maternal deaths that occurred between 2000 and 2008. The most prevalent delivery type was cesarean section (45, 46.8%) and the most prevalent causes of death were: hypertensive syndrome (27, 28.1%), infection (17, 17.7%) and hemorrhage (16, 16.7%). There was a statistically significant association between: cesarean section, hypertension syndrome and infection (x²=14.40, p=0.00; x²=4.02, p=0.04); deaths in the postpartum period and hypertensive syndrome (x²=6.13, p=0.01) and infection (x²=7.65, p=0.00). The characterization of these deaths helps in the recognition of groups at risk, and in developing preventive measures.

Antibacterial effects of chemomechanical instrumentation and calcium hydroxide in primary teeth with pulp necrosis.

PURPOSE: This study's purposes were to: evaluate the antibacterial effect of chemomechanical instrumentation and a calcium hydroxide-based dressing in primary teeth with pulp necrosis secondary to trauma; and detect the presence of Fusobacterium nucleatum and black-pigmented rods in the canals of these teeth. METHODS: Microbiological sample collections (MSCs) were obtained: after coronal access to the canals of primary incisors (in 18 teeth; MSC 1); after chemomechanical instrumentation (in 10 teeth; MSC 2); and 72 hours after removal of intracanal medication (in 18 teeth; MSC 3). These samples were sent for microbiological processing. The results were analyzed statistically via chi-square, analysis of variance, and Games-Howell tests (P<.05). RESULTS: Micro-organisms were isolated in approximately 94%, 10%, and 83% of canals, respectively, in MSCs 1, 2, and 3. There was a statistically significant difference only between MSCs 1 and 2 (P<.03). F nucleatum and black-pigmented rods were detected in approximately 56% and 11% of canals in MSC 1, respectively. CONCLUSION: Chemomechanical instrumentation and calcium hydroxide-based dressing have an anti-bacterial effect by significantly reducing the number of micro-organisms in the main root canal. They showed a limited efficacy, however, and did not prevent bacterial regrowth after endodontic therapy in primary teeth with pulp necrosis secondary to trauma.

[Pressure ulcers in the elderly: analysis of prevalence and risk factors]. / Ulcera por pressão em idosos institucionalizados: análise da prevalência e fatores de risco.

Studies on the prevalence of pressure ulcer and e.rperiences of living with elderly people with injuries during practice in long-stay institutions for the elderly have given rise to many concerns. This work aims to examine the prevalence and risk factors of pressure ulcer in the institutionalized elderly. This retrospective, quantitative study was held in a public long-stay institution for the elderly in Fortaleza, Ceará, Brazil. The sample consisted of 300 medical records of elderly from 2006 to 9009. It was used for data collection form. All ethical guidelines were followed. The most prevalent risk factors were: stroke (60%) and hypertension (74.3%). The average prevalence of pressure ulcers in the period was 18.8%, rangingfrom 11.1% to 23.2%. The recommendations for the prevention of pressure ulcers include the development of a prevention program to promote active aging

[The effectiveness of using semipermeable membrane in preterm infants to reduce transepidermal losses]. / Eficácia do uso de membrana semipermeável em neonatos pré-termo na redução de perdas transepidérmicas.

An investigation was made on the effectiveness of using semipermeable membrane on the skin of preterm infants on the evolution of weight loss and blood glucose values, water share, urine specific gravity and sodium. This is an experimental study, of the randomized clinical trial type, carried out from March to August 2008 in the Neonatal Intensive Care Unit of the Teaching Maternity Assis Chateaubriand (TMAC) in the city of Fortaleza-Ceará. The sample consisted of 42 preterm infants. The data were presented in tables and charts. In the application of the semipermeable membrane, the preterm infants of the intervention group (IG) had a decrease in the sodium levels and the daily flow demands, they also presented fewer hyperglycemia episodes and the urinary density was kept within normal patterns. The semipermeable membrane is, in fact, an effective therapeutic resource to minimize transepidermal water losses.

Non-verbal mother-child communication in conditions of maternal HIV in an experimental environment.

Non-verbal communication is predominant in the mother-child relation. This study aimed to analyze non-verbal mother-child communication in conditions of maternal HIV. In an experimental environment, five HIV-positive mothers were evaluated during care delivery to their babies of up to six months old. Recordings of the care were analyzed by experts, observing aspects of non-verbal communication, such as: paralanguage, kinesics, distance, visual contact, tone of voice, maternal and infant tactile behavior. In total, 344 scenes were obtained. After statistical analysis, these permitted inferring that mothers use non-verbal communication to demonstrate their close attachment to their children and to perceive possible abnormalities. It is suggested that the mothers infection can be a determining factor for the formation of mothers strong attachment to their children after birth.