Right ventricular myocardial performance index (Tei) in premature infants.

OBJECTIVE: The objective of this study was to evaluate the right ventricular myocardial performance index) based on echocardiography in very low birth weight premature neonates, close to hospital discharge. METHODS: This was a prospective cross-sectional study that included premature neonates with birth weight <1,500 g and gestational age <37 weeks at the Intermediate Neonatal Unit of Bonsucesso Federal Hospital from July 2005 to July 2006. The infants underwent two-dimensional color Doppler echocardiography, being the right ventricular myocardial performance index evaluated close to hospital discharge. We compared the neonatal and echocardiographic variables in neonates with and without bronchopulmonary dysplasia. RESULTS: A total of 81 exams were analyzed. The mean birth (standard deviation) weight and gestational age were 1,140 (235) g and 30 (2.2) weeks, respectively. The incidence of bronchopulmonary dysplasia was 32%. The mean right ventricle myocardial performance index (standard deviation) of the sample was 0.13 (0.06). We found a significant difference in aortic diameter [non-bronchopulmonary dysplasia 0.79 (0.07) vs. bronchopulmonary dysplasia 0.87 (0.11) cm, p=0.003], left ventricle in diastole [non-bronchopulmonary dysplasia 1.4 (0.19) vs. bronchopulmonary dysplasia 1.59 (0.21) cm, p=0.0006], ventricular septal thickness [non-bronchopulmonary dysplasia 0.23 (0.03) vs. bronchopulmonary dysplasia 0.26 (0.05) cm, p=0.032], and "a" measurement [(= sum of the isovolumetric contraction time, ejection time, and isovolumetric relaxation time) when calculating the myocardial performance index (p=0.01)]. CONCLUSION: Higher "a" interval in neonates with bronchopulmonary dysplasia suggests right ventricle diastolic dysfunction. We conclude that the right ventricle myocardial performance index is an important indicator both of ventricular function and for serial follow-up testing of very low birth weight premature neonates, especially those with bronchopulmonary dysplasia.

[Assessment of the impact of the NGO Refazer on medical care for children at social risk]. / Avaliação de impacto da ONG Refazer no tratamento médico de crianças em risco social.

OBJECTIVE: Assess the impact of activities by the nongovernmental organization Refazer in support of medical care for children at social risk. METHODS: A longitudinal study was conducted of 77 patients from Rio de Janeiro in treatment at the Fernandes Figueira Institute and supported by Refazer. The assessment period was two years, one before and the other during the intervention period while being supported by the NGO. The percentage of hospitalizations, average length of stay, severity of the illness, use of technology, number of outpatient consultations, and clinical conditions involved were compared. RESULTS: The indicators linked with the hospitalizations revealed changes during the intervention period. There was a reduction in the average time and percentage of hospitalization. The most common pathologies were congenital malformations, chromosomal anomalies, and diseases of the nervous system. These diseases and HIV/AIDS were more prevalent in children that remained hospitalized even after receiving support from the NGO. CONCLUSIONS: Analysis of the indicators showed that the outcomes are adequate to the NGO's mission and that the population helped benefits from participation in the social support network. Although it cannot be stated that the benefits found are due exclusively to the activities of the NGO, a simple and easy-to-use evaluation of adequacy was developed that NGOs themselves can use, representing progress toward the institutional use of evaluations by NGOs working in health.

Right ventricular myocardial performance index (Tei) in premature infants

SUMMARY OBJECTIVE: The objective of this study was to evaluate the right ventricular myocardial performance index) based on echocardiography in very low birth weight premature neonates, close to hospital discharge. METHODS: This was a prospective cross-sectional study that included premature neonates with birth weight <1,500 g and gestational age <37 weeks at the Intermediate Neonatal Unit of Bonsucesso Federal Hospital from July 2005 to July 2006. The infants underwent two-dimensional color Doppler echocardiography, being the right ventricular myocardial performance index evaluated close to hospital discharge. We compared the neonatal and echocardiographic variables in neonates with and without bronchopulmonary dysplasia. RESULTS: A total of 81 exams were analyzed. The mean birth (standard deviation) weight and gestational age were 1,140 (235) g and 30 (2.2) weeks, respectively. The incidence of bronchopulmonary dysplasia was 32%. The mean right ventricle myocardial performance index (standard deviation) of the sample was 0.13 (0.06). We found a significant difference in aortic diameter [non-bronchopulmonary dysplasia 0.79 (0.07) vs. bronchopulmonary dysplasia 0.87 (0.11) cm, p=0.003], left ventricle in diastole [non-bronchopulmonary dysplasia 1.4 (0.19) vs. bronchopulmonary dysplasia 1.59 (0.21) cm, p=0.0006], ventricular septal thickness [non-bronchopulmonary dysplasia 0.23 (0.03) vs. bronchopulmonary dysplasia 0.26 (0.05) cm, p=0.032], and "a" measurement [(= sum of the isovolumetric contraction time, ejection time, and isovolumetric relaxation time) when calculating the myocardial performance index (p=0.01)]. CONCLUSION: Higher "a" interval in neonates with bronchopulmonary dysplasia suggests right ventricle diastolic dysfunction. We conclude that the right ventricle myocardial performance index is an important indicator both of ventricular function and for serial follow-up testing of very low birth weight premature neonates, especially those with bronchopulmonary dysplasia.

Cognitive performance of premature infants: association between bronchopulmonary dysplasia and cognitive skills. Cross-sectional study.

CONTEXT AND OBJECTIVE:: Children born prematurely often have worse cognitive performance than those born at term regarding skills such as memory, attention and processing speed. Bronchopulmonary dysplasia may compromise cognitive development. The aims here were: a) To describe the cognitive performance of preterm infants with very low birth weight; b) To investigate its association with bronchopul-monary dysplasia adjusted for sociodemographic, neonatal and post-neonatal factors. DESIGN AND SETTING:: Cross-sectional study developed in a public tertiary-care hospital. METHODS:: To evaluate cognition among 112 children, we applied an intelligence scale (Wechsler scale). The average scores for children with and without bronchopulmonary dysplasia were compared across the fve domains of the scale. Associations with bronchopulmonary dysplasia were investigated for domains that showed signifcant diferences between the two groups. Associations between exposure and outcome were estimated via multivariate logistic regression. RESULTS:: There were no diferences in averages for the full-scale intelligence quotient, verbal intelligence quotient, performance intelligence quotient and general language composite domains. The processing speed quotient was the only domain that presented a signifcant diference between the two groups (P = 0.02). Among the children with bronchopulmonary dysplasia, low full-scale intelligence quotient was observed in 28.1%. In the multivariate analysis, bronchopulmonary dysplasia (odds ratio: 3.1; 95conf-dence interval: 1.1-8.7) remained associated with the outcome of processing speed quotient. CONCLUSION:: Bronchopulmonary dysplasia was an independent risk factor for alteration of the processing speed quotient.

Neonatal risk factors for respiratory morbidity during the first year of life among premature infants.

CONTEXT AND OBJECTIVE: There have been dramatic increases in very low birth weight infant survival. However, respiratory morbidity remains problematic. The aim here was to verify associations between pulmonary mechanics, pulmonary structural abnormalities and respiratory morbidity during the first year of life. DESIGN AND SETTING: Prospective cohort study at Instituto Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro. METHODS: Premature infants with birth weight < 1500 g were studied. Lung function tests and high-resolution chest tomography were performed before discharge. During the first year, infants were assessed for respiratory morbidity (obstructive airways, pneumonia or hospitalization). Neonatal lung tests and chest tomography and covariables potentially associated with respiratory morbidity were independently assessed using relative risk (RR). RR was subsequently adjusted via logistic regression. RESULTS: Ninety-seven newborn infants (mean birth weight: 1113 g; mean gestational age: 28 weeks) were assessed. Lung compliance and lung resistance were abnormal in 40% and 59%. Tomography abnormalities were found in 72%; respiratory morbidity in 53%. Bivariate analysis showed respiratory morbidity associated with: mechanical ventilation, prolonged oxygen use (beyond 28 days), oxygen use at 36 weeks, respiratory distress syndrome, neonatal pneumonia and patent ductus arteriosus. Multivariate analysis gave RR 2.7 (confidence interval: 0.7-10.0) for simultaneous lung compliance and chest tomography abnormalities. Adjusted RR for neonatal pneumonia and mechanical ventilation were greater. CONCLUSIONS: Upon discharge, there were high rates of lung mechanism and tomography abnormalities. More than 50% presented respiratory morbidity during the first year. Neonatal pneumonia and mechanical ventilation use were statistically significant risk factors.

Learning difficulties in schoolchildren born with very low birth weight.

OBJECTIVES: To investigate the relationship between very low birth weight and learning difficulties at school by means of a systematic review of the literature, identifying patterns of learning difficulties among these schoolchildren, possible cognitive correlations, peculiarities of the lowest birth weight ranges and any interference with outcomes by socioeconomic and/or clinical factors. SOURCES OF DATA: Bibliographic search (MEDLINE, LILACS, Excerpta Medica, reference lists of original articles, periodicals related to the subject, information from experts in the area and thesis and dissertation databases) on the keywords: prematurity/very low birth weight, learning difficulties/academic achievement/school performance, follow-up/results/cohort. SUMMARY OF THE FINDINGS: The search returned 114 articles and the 18 of these were selected as having investigated learning difficulties in schoolchildren born with very low birth weights using appropriate methodology. The academic performance of these children was observed to be inferior the whole study population was compared with those born full term. The subject most compromised was mathematics. The risk of suffering from learning difficulties increased in inverse proportion to birth weight. An association was identified between very low birth weight and cognitive compromise. CONCLUSIONS: The systematic approach corroborated the results obtained by published studies: schoolchildren born with very low birth weights exhibited increased risk of learning difficulties when compared with those born at full term. There was a predominance of children with multiple academic subjects compromised and mathematics was the most affected. Risk was observed to follow an ascending gradient as birth weight reduced. There was an association between very low birth weight and cognitive compromise.

Representações sociais de pessoas vivendo com HIV: autopercepção da identidade egoecológica / The social representations of people living with HIV: self-perception of the ego-ecological identity

RESUMO Este artigo objetivou compreender a identidade ego-ecológica da pessoa vivendo com HIV e analisar as influências exercidas pelo profissional de saúde sobre esses indivíduos. A pesquisa é de abordagem qualitativa, com base teórico-metodológica na Teoria das Representações Sociais. Foram realizadas entrevistas com complementação de frases com 20 pessoas vivendo com HIV que recebem atendimento no laboratório de imunologia de um hospital universitário. O perfil populacional do estudo influenciou positivamente no lidar com o agravo, dada a maior idade e tempo de tratamento. Apesar disso, os estigmas sociais negativos ainda se fizeram presentes. Enfatizou-se o profissional de saúde com potencial de transformação, sendo este vinculado à oferta qualificada de cuidado. Por fim, concluiu-se que ainda há preconceitos e tabus direcionados a pessoas vivendo com HIV, indicando assim a necessidade de um olhar atencioso às vulnerabilidades biopsicossociais dessa população.

ABSTRACT The aim of this paper is to understand the ego-ecological identity of the person living with HIV and to analyze the influences exerted by the health professional on these individuals. The research has a qualitative approach, with theoretical and methodological basis on the Theory of Social Representations. Phrase-complementing interviews were conducted with 20 people living with HIV who receive care at the immunology laboratory of a university hospital. The population profile of the study had a positive influence on dealing with the problem, given the older age and treatment time; despite that, negative social stigmas were still present. The health professional with transformation potential was emphasized, being linked to the qualified offer of care. Finally, it was concluded that there are still prejudices and taboos directed at people living with HIV, thus indicating the need for a careful look at the biopsychosocial vulnerabilities of this population.

Residentes de enfermagem e a terapia pela arte / Residentes de enfermería y terapia de arte / Nursing residents and art therapy

Objetivo relatar os resultados da terapia pela arte por meio de oficinas expressivas aos enfermeiros residentes. Método estudo descritivo exploratório, de abordagem qualitativa, com análise temática, que apresenta a experiência sentida e vivenciada por sete profissionais enfermeiros do primeiro ano de residência, que participaram das oficinas expressivas em um hospital de grande porte localizado na cidade do Rio de Janeiro, Brasil. Resultados surgiram os seguintes temas: o ambiente hospitalar como fator estressante; a arte como mecanismo catártico em meio ao sofrimento emocional; olhando para dentro e encontrando equilíbrio; o uso da arte como instrumento para relaxar, descontrair e adquirir novas experiências; conceito ampliado de saúde e doença. Considerações finais a arte por meio das oficinas expressivas trouxe impactos positivos aos residentes de Enfermagem. A pesquisa mostra que é possível promover saúde por meio da arte.

Objetivo reportar los resultados de la arteterapia a través de talleres expresivos a enfermeros internes. Método estudio descriptivo exploratorio, con abordaje cualitativo, con análisis temático, que presenta la experiencia sentida y experimentada por siete profesionales de enfermería del primer año de residencia, que participaron de talleres expresivos en un gran hospital ubicado en la ciudad de Río de Janeiro, Brasil. Resultados surgieron los siguientes temas: el ambiente hospitalario como factor estresante; el arte como mecanismo catártico en medio del sufrimiento emocional; mirar hacia adentro y encontrar el equilibrio; el uso del arte como instrumento para relajarse, relajarse y adquirir nuevas experiencias; concepto ampliado de salud y enfermedad. Consideraciones finales el arte a través de talleres expresivos trajo impactos positivos a los internes de enfermería. Las investigaciones demuestran que es posible promover la salud a través del arte.

Objective to report the results of art therapy through expressive workshops to intern nurses. Method exploratory descriptive study, with a qualitative approach, with thematic analysis, which presents the experience felt and live by seven nursing professionals of the first year of residence, who participated in expressive workshops in a large hospital located in the city of Rio de Janeiro, Brazil. Results the following themes emerged: the hospital environment as a stressful factor; art as a cathartic mechanism in the midst of emotional suffering; looking inward and finding balance; the use of art as an instrument to relax, relax and acquire new experiences; expanded concept of health and disease Final considerations art through expressive workshops brought positive impacts to nursing interns. Research shows that it is possible to promote health through art

Longitudinal assessment of the lung mechanics of very low birth weight preterm infants with and without bronchopulmonary dysplasia.

CONTEXT AND OBJECTIVE: Prematurity has been correlated with altered lung mechanics. Some infants develop lung injury as a consequence of lung immaturity, invasive mechanical ventilation and exposure to oxygen, thus resulting in bronchopulmonary dysplasia. The aim here was to compare the lung mechanics of preterm infants with and without bronchopulmonary dysplasia during the first year of life. DESIGN AND SETTING: Prospective cohort study in a tertiary-level hospital. METHODS: This study included premature infants at a public hospital who underwent two pulmonary function tests: one at discharge and the other at the corrected age of 4 to 8 months. Tidal volume, lung compliance and lung resistance were measured. Statistical tests were used for comparisons between infants with and without bronchopulmonary dysplasia. RESULTS: 102 children with mean gestational age of 29 ± 2.0 weeks were studied; 17 with bronchopulmonary dysplasia. Lung compliance (0.84 ± 0.29 versus 1.28 ± 0.46; P < 0.001) and tidal volume (6.1 ± 0.94 versus 7.2 ± 1.43; P < 0.01) at discharge were significant lower in children with bronchopulmonary dysplasia than in those without the disease, but no differences were observed at the second test (compliance: 1.53 ± 0.77 versus 1.94 ± 1.01; P = 0.12; and tidal volume: 6.9 ± 1.4 versus 7.3 ± 1.6; P = 0.42). CONCLUSION: Differences in lung mechanics were observed between infants with and without bronchopulmonary dysplasia at hospital discharge but these differences were no longer detected at the final follow-up. The lung mechanics of all the infants improved over this period of time.

Lung mechanics and high-resolution computed tomography of the chest in very low birth weight premature infants.

CONTEXT: Premature infant lung development may be affected by lung injuries during the first few weeks of life. Lung injuries have been associated with changes in lung mechanics. OBJECTIVE: To evaluate an association between lung mechanics and lung structural alterations in very low birth weight infants (birth weight less than 1500 g). DESIGN: A cross-sectional evaluation of pulmonary mechanics (lung compliance and lung resistance) and high resolution computed tomography of the chest at the time of discharge, in 86 very low birth weight infants born at Instituto Fernandes Figueira, a tertiary public healthcare institution in Rio de Janeiro, Brazil. Lung compliance and resistance were measured during quiet sleep. High resolution computed tomography was performed using Pro Speed-S equipment. MAIN MEASUREMENTS: Statistical analysis was performed by means of variance analysis (ANOVA/Kruskal Wallis). The significance level was set at 0.05. RESULTS: Abnormal values for both lung compliance and lung resistance were found in 34 babies (43%), whereas 20 (23.3%) had normal values for both lung compliance and lung resistance. The mean lung compliance and lung resistance for the group were respectively 1.30 ml/cm H2O/kg and 63.7 cm H2O/l/s. Lung alterations were found via high-resolution computed tomography in 62 (72%) infants. Most infants showed more than one abnormality, and these were described as ground glass opacity, parenchymal bands, atelectasis and bubble/cyst. The mean compliance values for infants with normal (1.49 ml/cm H2O/kg) high resolution computed tomography, 1 or 2 abnormalities (1.31 ml/cm H2O/kg) and 3 or more abnormalities (1.16 ml/cm H2O/kg) were significantly different (p=0.015). Our data were insufficient to find any association between lung resistance and the number of alterations via high-resolution computed tomography. CONCLUSION: The results show high prevalence of lung functional and tomographic abnormalities in asymptomatic very low birth weight infants at the time of discharge. They also show an association between lung morphological and functional abnormalities.

[Respiratory morbidity in the first year of life of preterm infants discharged from a neonatal intensive care unit]. / Morbidade respiratória no primeiro ano de vida de prematuros egressos de uma unidade pública de tratamento intensivo neonatal.

OBJECTIVE: The objective of this study was to verify the incidence of respiratory morbidity in the first year of life in very low birth weight preterm infants and also to compare the presence of respiratory morbidity in the first year of life according to neonatal risk factors. METHODS: This is a prospective cohort study. We studied preterm newborn infants weighing less than 1,500 g and with gestational age less than 34 weeks who were born between 1998 and 2000. During the first year of life, the infants received monthly medical follow-up and during each visit we evaluated the patients considering the presence of obstructive airway syndrome and/or pneumonia and/or hospital admission due to respiratory conditions. The incidence rate of respiratory morbidity in the first year of life was measured. Chi-squared test was used to compare proportions. RESULTS: The cohort was constituted of 97 preterm infants with mean birthweight of 1,113 g and mean gestational age of 28 weeks. The incidence rates of obstructive airway syndrome, pneumonia and hospital admission were 28, 36 and 26%, respectively. The incidence rate of respiratory morbidity was 53%. There was a significant difference between the incidence rates of respiratory morbidity among infants who had a prolonged use of oxygen (83%) and those who did not (43%). CONCLUSION: More than 50% of the infants presented respiratory morbidity in the first year of life and there was a high percentage of pneumonia and hospitalization due to respiratory conditions. Infants who had a prolonged use of oxygen presenting with higher respiratory morbidity incidence rate than infants who did not use oxygen for a long period.

Neonatal sepsis as a risk factor for neurodevelopmental changes in preterm infants with very low birth weight.

OBJECTIVE: to evaluate neonatal sepsis as a risk factor for abnormal neuromotor and cognitive development in very low birth weight preterm infants at 12 months of corrected age. METHODS: this was a prospective cohort study that followed the neuromotor and cognitive development of 194 very low birth weight preterm infants discharged from a public neonatal intensive care unit. The Bayley Scale of Infant Development (second edition) at 12 months of corrected age was used. The outcomes were the results of the clinical/neurological evaluation and the scores of the psychomotor development index (PDI) and mental development index (MDI) of the Bayley Scale of Infant Development II. The association between neonatal sepsis and neuromotor development and between neonatal sepsis and cognitive development was verified by logistic regression analysis. RESULTS: mean birth weight was 1,119g (SD: 247) and mean gestational age was 29 weeks and 6 days (SD: 2). Approximately 44.3%(n=86) of the infants had neonatal sepsis and 40.7% (n=79) had abnormal neuromotor development and/or abnormal psychomotor development index (PDI < 85) at 12 months of corrected age. On the mental scale, 76 (39.1%) children presented abnormal cognitive development (MDI<85). Children with neonatal sepsis were 2.5 times more likely to develop changes in neuromotor development (OR: 2.50; CI: 1.23-5.10). There was no association between neonatal sepsis and cognitive development impairment. CONCLUSION: neonatal sepsis was an independent risk factor for neuromotor development impairment at 12 months of corrected age, but not for mental development impairment.

A sintomatologia depressiva entre lésbicas, gays, bissexuais e transexuais: um olhar para a saúde mental / Symptoms of depression among lesbians, gays, bisexuals, and transsexuals: a look at mental health / La sintomatología depresiva entre lesbianas, gays, bisexuales y transexuales: una mirada hacia la salud mental

Objetivo: analisar a incidência da sintomatologia depressiva entre lésbicas, gays, bissexuais e transexuais (LGBT), de dois cenários distintos, e sua relação com a sexualidade desses indivíduos. Método: pesquisa quantitativa, mediante análise estatística, realizada entre os anos de 2016 a 2018, e que aplicou o Inventário de Depressão de Beck - II (BDI- II) do Hospital Uiversitário Gaffrée e Guinle (HUGG) e na Escola de Enfermagem Alfredo Pinto (EEAP), ambos localizados no município do Rio de Janeiro. Participaram 76 pessoas. A pesquisa foi aprovada por Comitê de Ética. Resultados: No HUGG foi observado indicativo de depressão mínima. Na EEAP, foi observado indicativo de depressão moderada. As disparidades podem ser justificadas pela diferença de idade, os impactos do processo de disclosure e estigmas do portador de HIV. Conclusão: observouse que a família é fundamental na saúde mental entre LGBT e que é necessário mais pesquisas sobre o tema.

Objective: to examine the incidence of symptoms of depression among lesbian, gay, bisexual, and transgender (LGBT) people from two different scenarios, and their relationship with these individuals' sexuality. Method: this quantitative study, using statistical analysis was conducted between 2016 and 2018 by applying the Beck Depression Inventory - II (BDI-II) to 76 participants at the Gaffrée e Guinle University Hospital and the Alfredo Pinto School of Nursing, both in Rio de Janeiro city. The study was approved by the research ethics committee. Results: indications of minimal depression were found at the hospital, while at the school of nursing, indications of moderate depression were observed. These disparities may be explained by the age difference, the impacts of the disclosure process, and stigmas attached to people with HIV. Conclusion: the family was found to be fundamental in mental health among LGBT people, and further research on the subject is needed.

Objetivo: analizar la incidencia de sintomatología depresiva entre lesbianas, gays, bisexuales y transexuales (LGBT), en dos escenarios distintos, y la relación de esos individuos con su sexualidad. Método: investigación cuantitativa por medio de un análisis estadístico, realizada entre 2016 y 2018, con la aplicación del Inventario de Depresión de Beck-II (BDI-II) del Hospital Universitario Gaffrée e Guinle (HUGG) y en la Escuela de Enfermería Alfredo Pinto (EEAP), ambos ubicados en la ciudad de Río de Janeiro. Participaron 76 personas en total. La investigación fue aprobada por el Comité de Ética. Resultados: En el HUGG, se observó un indicativo de depresión mínima. En la EEAP, se observó un indicativo de depresión moderada. Las disparidades pueden estar justificadas por las diferencias de edad, los impactos del proceso de divulgación y los estigmas del portador del VIH. Conclusión: Se observó que la familia es fundamental para la salud mental LGBT y que hace falta más investigación sobre dicho tema.

Assessment of factors that interfere on breastfeeding within the first hour of life.

OBJECTIVE: To investigate how the 4thStep of the Baby-Friendly Hospital Initiative was applied, assess the prevalence of breastfeeding (BF) within the first hour after birth and analyze factors associated with non-BF in this period of life. METHODS: Cross-sectional study conducted in a high-risk maternity-hospital in Rio de Janeiro City, Brazil, with interview to a sample of 403 rooming-in mothers. The prevalence ratio with its respective 95% confidence interval was estimated by the use of SPSS 15® from a model with complementary log log link function. RESULTS: The prevalence of BF in the first hour of life was 43.9%. Multivariate analysis showed that were protected against non-BF in the first hour after birth non-black women (PR = 0.62, 95% CI: 0.42-0.90), multiparous women (PR = 0.66, 95% CI: 0.47-0.93), prenatal care (PR = 0.23, 95% CI: 0.08-0.67), vaginal delivery (PR =0 .41, 95% CI: 0.28-0.60), newborn with birthweight ≥ 2,500g (PR = 0.31, 95% CI: 0.11-0.86) and women who received help from the health team to BF in the delivery room (PR = 0.51, 95% CI: 0.36-0.72). CONCLUSION: Help provided by the health team to breastfeeding at birth, Step 4 of the Baby-Friendly Hospital Initiative, as well as non black women, multiparous women, receiving pre-natal care, vaginal delivery and appropriate birthweight contributed to breastfeeding in the first hour of life.

Isolation of a phylogenetically distinct rabies virus from a tufted capuchin monkey (Cebus apella) in Brazil.

A rabies virus isolate (BRmk1358 strain) was discovered from a rabid tufted capuchin monkey in Brazil. The present study determined the nucleotide sequence of the BRmk1358 strain and compared with the rabies viruses isolated from marmosets and other animals in the Americas. Phylogenetic analyses showed that the BRmk1358 strain formed a lineage distant from that of marmoset rabies virus within the Chiroptera-related rabies virus cluster. This result suggests that the source of rabies infection in the tufted capuchin monkey may have been bat, and that they have a risk to act as rabies reservoir in Brazil.

Cognitive performance of premature infants: association between bronchopulmonary dysplasia and cognitive skills. Cross-sectional study / Desempenho cognitivo de prematuros: associação da displasia broncopulmonar com as habilidades cognitivas. Estudo transversal

ABSTRACT CONTEXT AND OBJECTIVE: Children born prematurely often have worse cognitive performance than those born at term regarding skills such as memory, attention and processing speed. Bronchopulmonary dysplasia may compromise cognitive development. The aims here were: a) To describe the cognitive performance of preterm infants with very low birth weight; b) To investigate its association with bronchopul-monary dysplasia adjusted for sociodemographic, neonatal and post-neonatal factors. DESIGN AND SETTING: Cross-sectional study developed in a public tertiary-care hospital. METHODS: To evaluate cognition among 112 children, we applied an intelligence scale (Wechsler scale). The average scores for children with and without bronchopulmonary dysplasia were compared across the fve domains of the scale. Associations with bronchopulmonary dysplasia were investigated for domains that showed signifcant diferences between the two groups. Associations between exposure and outcome were estimated via multivariate logistic regression. RESULTS: There were no diferences in averages for the full-scale intelligence quotient, verbal intelligence quotient, performance intelligence quotient and general language composite domains. The processing speed quotient was the only domain that presented a signifcant diference between the two groups (P = 0.02). Among the children with bronchopulmonary dysplasia, low full-scale intelligence quotient was observed in 28.1%. In the multivariate analysis, bronchopulmonary dysplasia (odds ratio: 3.1; 95conf-dence interval: 1.1-8.7) remained associated with the outcome of processing speed quotient. CONCLUSION: Bronchopulmonary dysplasia was an independent risk factor for alteration of the processing speed quotient.

RESUMO CONTEXTO E OBJETIVO: Crianças nascidas prematuras com frequência apresentam pior desempenho cognitivoque as nascidas a termo em habilidades como memória, atenção, velocidade de processamento. A displasia broncopulmonar pode comprometer o desenvolvimento cognitivo. Os objetivos aqui foram: a) Descrever o desempenho cognitivo de crianças nascidas prematuras com muito baixo peso; b) Investigar sua associação com a displasia broncopulmonar ajustada para fatores sócio-demográfcos, neonatais e pós-neonatais. TIPO DE ESTUDO E LOCAL: Estudo transversal desenvolvido em hospital público de cuidados terciários. MÉTODOS: Para a avaliação cognitiva de 112 crianças, aplicamos a escala de inteligência (Wechsler scale). Foram comparadas as médias dos escores das crianças com e sem displasia broncopulmonar nos cinco domínios da escala. A associação com a displasia broncopulmonar foi investigada para os domínios que apresentaram diferença signifcativa entre os dois grupos. A associação entre a exposição e o desfecho foi estimada por regressão logística multivariada. RESULTADOS: Não houve diferença entre as médias dos domínios do quociente de inteligência total, quociente de inteligência verbal, quociente de inteligência de execução e composto de linguagem geral. O quociente de velocidade de processamento foi o único domínio que apresentou diferença signifcativa entre os dois grupos (P = 0,02). Entre as crianças com displasia broncopulmonar, quociente de inteligência total baixo ocorreu em 28,1%. Na análise multivariada, a displasia broncopulmonar (odds ratio: 3,1; intervalo de confança: 1,1-8,7) permaneceu associada ao desfecho quociente de velocidade de processamento. CONCLUSÃO: A displasia broncopulmonar foi um fator de risco independente para alteração no quociente de velocidade de processamento.

Tecnologias educacionais na assistência de enfermagem em educação em saúde: revisão integrativa / Educational technologies in nursing assistance in health education: integrating review

Objetivos: identificar, nas publicações acadêmicas, os modelos de Tecnologias Educacionais (TE) utilizados na assistência de enfermagem em educação em saúde e analisar os modelos de tecnologias educacionais quanto ao tipo, alcance, praticidade, desafios e validação. Método: revisão integrativa com a questão: “Quais modelos de tecnologia educacionais são utilizados em Educação em Saúde?”, nas bases de dados LILACS,MEDLINE e BDEnf, no período de 2002 a 2014, usando como descritores: ‘tecnologia educacional’, ‘assistência de enfermagem’, ‘cuidados de enfermagem’ e ‘educação em saúde’. Pela de matriz de análise, coletou-se: título, periódico, local, ano, público-alvo, método, TE, resultado e análise dos artigos. Resultados: analisaram-se seis artigos, sendo um internacional. As TEs utilizadas foram: cartilhas, jogo e software educativo, com diferentes assuntos e públicos. Conclusão: os estudos tiveram desafios para elaborar as TEs em relação ao público, mas essas tecnologias se mostraram práticas, eficientes e acessíveis.

Mental performance of very low birth weight preterm infants: assessment of stability in the first two years of life and factors associated with mental performance.

The aim of this study was to investigate the stability of mental performance of very low birth weight premature infants during the first two years of life, and to identify factors associated with mental performance.The study included 109 children. The Mental Scale of Bayley Scales of Infant Development - Second Edition was administered at 6, 12 and 18-24 months of corrected age. The stability of the scores between assessments was verified by the analysis of variance for repeated measures.The association of the major social and neonatal characteristics with mental development was confirmed using multivariate analysis by linear regression, considering the following outcomes: mental development indices at 6 months, 12 months and between 18-24 months of corrected age. The mean Mental Developmental Index (MDI) was 83.4 (SD: 12.4) at 6 months, 86.4 (SD: 13.9) at 12 months, and 73.4 (SD: 14.5) at 18-24 months. A significant decrease in the mental developmental index (13 points) at 18-24 month corrected age was observed. The Mental development index did not show stability during the first two years of life in this population of preterm infants, except for children with neonatal pneumonia whose performance was unsatisfactory in all assessments. Among the risk factors investigated only male gender and neonatal pneumonia were associated with outcomes.

Risk factors for cognitive impairment in school-age children born preterm: application of a hierarchical model.

The purpose was to analyze factors associated with cognitive impairment in very low birth weight (VLBW) children born preterm. A prospective cohort of 65 VLBW children was assessed at the age of eight years using the Wechsler Intelligence Scale for Children. A model for the relationship of variables with the cognitive impairment outcome attributed hierarchical levels: distal (socioeconomic variables), intermediate I and II (perinatal and neonatal variables, post-neonatal variables) and proximal (child health and psychosocial stimulation). A multivariate logistic regression was performed. In the multivariate hierarchical logistic regression, the maternal education (OR=0.77, 95%CI 0.63-0.94) and number of prenatal visits (OR=0.73, 95%CI 0.54-0.99) showed a protective association, but the male (OR=7.3, 95%CI 1.54-35.3) was associated with worse results. The VLBW children cognitive performance in the age of eight years benefits from more educated mothers, better prenatal care, and the baby gender as female.

Síndrome de Burnout entre profissionais de enfermagem de unidades intensivas em um hospital público / Burnout syndrome among nursing professionals of intensive units in a public hospital / Síndrome de Burnout entre los profesionales de enfermería de unidades intensivas en un hospital público

Objetivos: determinar a prevalência da Síndrome de Burnout entre profissionais de enfermagem das unidades intensivas de um hospital público e identificar fatores estressores no ambiente de trabalho. Método: pesquisa de campo, com caráter descritivo e exploratório, e abordagem quantitativa. A coleta de dados foi realizada a partir do Maslach Burnout Inventory. A pontuação de cada sujeito foi comparada com os valores de referência para diagnóstico da Síndrome. Resultados: dois profissionais apresentaram a Síndrome de Burnout. Foi possível perceber que os enfermeiros sofrem mais com a exaustão emocional, enquanto os auxiliares apresentam reduzida realização profissional. Os fatores estressores mais mencionados na pesquisa foram as faltas de recursos humanos e materiais, falta de sistematização do trabalho, o relacionamento interpessoal e o excesso de ruídos no ambiente. Conclusão: a sobrecarga relativa ao trabalho representa um risco à saúde dos profissionais que atuam em unidades intensivas.(AU)

Objectives: determining the prevalence of Burnout Syndrome among nursing professionals of the intensive units of a public hospital and identifying stressors in the workplace. Method: a field research with a descriptive and an exploratory character and a quantitative approach. Data collection was carried out from the Maslach Burnout Inventory. The score of each subject was compared to the reference values for diagnosis of the Syndrome. Results: two professionals presented the Burnout Syndrome. It could be observed that nurses suffer more from emotional exhaustion, while auxiliaries showed reduced professional accomplishment. The stressors most frequently mentioned in the research were lack of human and material resources, lack of systematization of work, interpersonal relationships and the excess noise in the environment. Conclusion: the relative workload represents a risk to the health of those professionals who work in intensive care units.(AU)

Objetivos: determinar la prevalencia del Síndrome de Burnout entre los profesionales de enfermería en las unidades de cuidados intensivos de un hospital público e identificar los factores de estrés en el lugar de trabajo. Método: esta es una investigación de campo con carácter descriptivo y exploratorio y el enfoque cuantitativo. La recolección de datos se llevó a cabo desde el Maslach Burnout Inventory. La puntuación de cada sujeto se comparó con los valores de referencia para el diagnóstico del Síndrome. Resultados: dos profesionales presentaron el Síndrome de Burnout. Se pudo observar que las enfermeras sufren más de agotamiento emocional, mientras que los auxiliares presentaran reducida realización profesional. Los factores de estrés más frecuentemente mencionados en la encuesta fueron la falta de recursos humanos y materiales, la falta de sistematización del trabajo, las relaciones interpersonales y el exceso de ruido en el medio ambiente. Conclusión: la carga en relación con el trabajo representa un riesgo para los profesionales de la salud que trabajan en unidades de cuidados intensivos.(AU)