Effect of mode of delivery on neonatal outcome of monochorionic diamniotic twin pregnancies: a retrospective cohort study.

OBJECTIVE: To assess whether vaginal delivery increases the risk of adverse neonatal outcome among uneventful monochorionic diamniotic twin pregnancies. STUDY DESIGN: We conducted a retrospective controlled cohort study on 112 uneventful monochorionic diamniotic twin pregnancies at > or = 34 weeks' gestation. The outcomes of 52 monochorionic diamniotic twins delivered vaginally were compared with those of 172 monochorionic diamniotic twins delivered by cesarean section. RESULTS: Five babies (2.9%) in the cesarean section group had a 5-minute Apgar score < 7 and needed orotracheal intubation, whereas in the vaginal delivery group no 5-minute Apgar score < 7 or orotracheal intubation occurred (p = 0.002). Delivery by cesarean section presented higher rates of admission to neonatal intensive care unit (62 out of 172 babies delivered by cesarean section compared to 3 out of 52 babies delivered vaginally, p < 0.001). There were no cases of intrapartum twin-to-twin transfusion syndrome or neonatal death at time of hospital discharge in either group. CONCLUSION: Vaginal delivery appears to be a good management option in uneventful monochorionic diamniotic twin pregnancies after 34 weeks' gestation.

[Single health system and nursing undergraduation in Paraná]. / Sistema Unico de Saúde e a graduação em enfermagem no Paraná

This research aimed to analyze the curriculum of 'paranaense' nursing graduation identifying if it has occurred the orientation development for Unique System of Health. It was proved that there is a proposal of formation that overcomes the hospital-centered model, focused in the preventive and collective aspects and demands of the work market. It was observed equivalent schedule distribution of biological disciplines and disciplines that approach biological sciences and collective health. It was noticed a reducing in the credit hours of the collective health which appeared lately; the curricular supervision traineeship appears as a moment that allows to narrow the learning knowledge with real situations of the professional life. Concluding, there is a signal for reorienting the formation, but it is still a slow process, in a construction phase, which demands problems.

Organizational flow chart of home care for children with special health care needs.

OBJECTIVE: To develop a workflow protocol for Home Care (HC) services in the HC2 modality for children with special health care needs (CSHCN) in the state of Parana. METHOD: Quantitative, descriptive, exploratory, multiple case studies. Data was collected with professionals from the eight home care services in Parana. Data were analyzed using the Strengths, Weaknesses, Opportunities and Threats (SWOT) methodology, from which a 5W2H method of action plan was developed, resulting in a flow chart. RESULTS: Considering the strategies found in Home Care services, such as planned hospital discharge, caregiver training, organized transportation and singular therapeutic project, a flow organization protocol for children with special health care needs in Home Care services was developed. CONCLUSION: The protocol developed makes it possible to organize the care provided to children with special health care needs in home care.

[The education in graduate nursing in the State of Paraná, Brazil]. / Formação na Graduação em Enfermagem no Estado do Paraná.

We approach the implementation of the Curricular Guidelines of degree in nursing in Paraná identifying the curricular changes triggered, analyzing changes made and identifying pedagogical principles that were effectively materialized with the new proposals. We found a growth around 80% of private courses/schools of nursing. We analyze 9 political pedagogical projects showing that some courses have their own constructions from the curricular guidelines. Others are suited to them literally. The data relating to education focused on the student; the role of the professor; the pedagogy of skills; the learning to learn; the Unified Health System as a focus of the training; a licenciature/education in nursing; the research in the graduation; the times in training and the methodological approach of the course testify this assertion.

[Movements in high education, in health and nursing education]. / Movimentos na educação superior, no ensino em saúde e na enfermagem.

We present data about the higher education from a review of the national context to particularize the higher education in health and nursing and teaching trends in this field. We systematize data on education in Lula's government, noting the continuity and deepening of politics for higher education in Brazil, especially in regard to privatization and the transfer of resources to the private sector. In higher education in health we found that the official politic points to the adoption of innovative/active methodologies; the methodology of problematization as the only way to propose innovative curricular changes and acceptable when you receive the state incentive for the initiatives of change that are also observed in the experiences of curricular reforms of Brazilian nursing.

[Curricular change: a challenge for an undergraduate nursing course]. / Mudança curricular: desafio de um curso de graduação em enfermagem.

This work presents a research that intended to contribute with the evaluation of the Pedagogic Political Project (PPP) of an undergraduate nursing course. The objective is to analyze and to argue the curricular reformularization; contributing to the process of discussion and evaluation. The used methodology was the comparative analysis between the PPP of 1995 and 2003 and the data collected with professors and students concerning the theoretical presuppositions of the course that it was the identified innovative element in the PPP of 2003. The data revealed that the theoretical presuppositions, inyour majority guided the formation process, but there are concepts that still little incorporate like the interdisciplinarity. Another raised data was the non-effective participation of students and professors in the process of implantation and evaluation of the PPP.

Assessment of the essential attributes of Primary Health Care for children.

OBJECTIVE: To identify the presence and extent of essential attributes in primary health care services for children, focusing on the evaluation of structure and process. METHOD: Evaluative, quantitative study carried out in 23 traditional basic health units in a city in Parana State, with 548 caregivers of children under 12 years old, using the Primary Care Assessment Instrument (PCATool Brazil), child version. Essential and general scores of the primary care were calculated according to the methodology proposed, with a cut-off score ≥6.6. RESULTS: The scores of the essential attributes in relation to structure are: Accessibility (5.5), Kinship (6.9), Integrality of care - Services Available (6.0) and Coordination - System information (7.4). As for the Process, the following results were obtained: First visit - Use (8.6), Longitudinally (6.1), Integrality - Services Provided (6.1) and Coordination - Integration of Care (6.9). CONCLUSION: The essential score was 6.6 and the general score was 6.3, showing weak focus on primary health care.

Conhecimentos e práticas de profissionais da saúde sobre fake news / Knowledge and practices of health professionals about fake news / Conocimientos y prácticas de los profesionales de la salud acerca de las noticias falsas

Fake news é a propagação de notícias falsas disseminadas de forma intencional, que buscam induzir ao erro. Na saúde, suas repercussões são negativas devido a consequências que podem gerar no enfrentamento de condições de saúde dos indivíduos.Objetivo: Identificar os conhecimentos e práticas de profissionais de saúde com relação à fake news.Metodologia:Trata-se de pesquisa exploratória, quantitativa, cujos participantes foram profissionais de saúde de um município de médio porte no Oeste do Paraná, que responderam à instrumento de coleta de dados on-line. Os dados foram sistematizados e analisados pela estatística descritiva.Resultados:Participaram 169 profissionais que entendem Fake news como notícias falsas; se utilizam de programas jornalísticos de televisão para se informar; recebem, mais frequentemente, notícias falsas pelo whatsapp; verificam em sites confiáveis as informações; entendem que fake News trazem riscos à saúde; já atenderam pessoas acreditando em notícias falsas; sabem que criar e divulgar fake News é crime e sabem identificar notícias falsas. Conclusões:Diante da infodemia vivenciada, sugere-se a apropriação das mídias sociais para a divulgação científica comprometida com a saúde, a fim de que a sociedade possa acessar informações confiáveis baseadas em evidências científicas (AU).

Fake news is the propagation of false news spread intentionally, which seeks to mislead. In health, its repercussions are negative due to consequences that may not generate coping with the health conditions of patients.Objective:To identify the knowledge and practices of health professionals regarding fake news.Methodology:This is an exploratory, quantitative research, whose participants were health professionals from a medium-sized city in western Paraná, who responded to the online data collection instrument. Data were systematized and analyzed using descriptive statistics. Results: 169 professionals understand Fake news as misleading information; they keep informed through television news programs; they more often receive fake news via WhatsApp; verify information on trusted sites; understand that fake news brings health risks; they have already served people who believe in fake news; they know that creating and disseminating fake news is a crime and they know howto identify fake news.Conclusions:In view of the infodemic experienced, it is suggested the appropriation of social media for scientific dissemination is committed to health so that society can access reliable information based on scientific evidence (AU).

Las fake news son la propagación de noticias falsas difundidas de forma intencionada, que pretenden inducir a error. En salud, sus repercusiones son negativas por las consecuencias que puede generar el no afrontar las condiciones de salud de los pacientes.Objetivo:Identificar los saberes y prácticas de los profesionales de la salud frente a las fake news.Metodología:Se trata de una investigación cuantitativa, exploratoria, cuyos participantes fueron profesionales de la salud de una ciudad de mediano porte del oeste de Paraná, que respondieron al instrumento de recolección de datos en línea. Los datos fueron sistematizados y analizados mediante estadística descriptiva.Resultados:169 profesionales entienden las fake news como información engañosa; se mantienen informados a través de programas de noticias televisivos; reciben más a menudo noticias falsas a través de WhatsApp; verificar información en sitios confiables; comprender que las noticias falsas conllevan riesgos para la salud; ya han servido a personas que creen en noticias falsas; saben que crear y difundir noticias falsas es un delito y saben identificar las noticias falsas.Conclusiones:Ante la infodemia vivida, se sugiere la apropiación de las redes sociales para la divulgación científica comprometida con la salud para que la sociedad pueda acceder a información confiable basada en evidencia científica (AU).

[Curricular Guidelines for Nursing Graduate Course: contexts, changes and perspectives]. / Diretrizes Curriculares da Graduação de Enfermagem: pensando contextos, mudanças e perspectivas.

Research focusing the curricular guidelines for Nursing Faculty in Brazil as approved in 2001 by the Resolution no 03/2001-CNE. The study aimed at contextualizing and rescueing the historical elaboration process of these guidelines, to discuss the approved content supporting elements to guide the construction of politician-pedagogical projects. Bibliographical sources, documents and interviews were used. Pedagogical principles present in the guidelines were verified; the discussion on the research were approached; the nursery licentiature degree, the Unique System of Health as focus of the formation and the performance of the United Net. The context of the private higher education and health, the economic changes (financial globalization, the performance of international agencies) had conformed the scenery of changes in the graduation in Brazil in the 90' and beginning of the 21st century.

Programa Saúde na Escola: desafios e possibilidades para promover saúde na perspectiva da alimentação saudável / School Health Program: challenges and possibilities for health promotion from the perspective of healthy eating

RESUMO O Programa Saúde na Escola elege a promoção da saúde como diretriz para o desenvolvimento de ações de saúde na escola. O objetivo foi identificar e analisar fortalezas, oportunidades, fragilidades e ameaças ao programa para implementar ações de promoção da saúde que promovem hábitos alimentares saudáveis. Esta revisão, de abordagem qualitativa, selecionou 29 artigos de avaliação do programa, publicados entre 2015 e 2021. Pela Matriz Fofa, a análise agrupou os resultados em: Fortalezas, Oportunidades, Fraquezas e Ameaças. Entre as fortalezas, destacaram-se a proximidade dos setores de saúde e educação e a integração entre escola, unidade de saúde e família. Como oportunidades, observou-se a possibilidade de planejamento intersetorial para promoção da saúde. As fragilidades referem-se à desarticulação intersetorial, à falta de formação e à predominância de ações biomédicas. As ameaças encontradas demonstram a centralização do poder na saúde e a aproximação dos escolares ao serviço de saúde sem uma compreensão ampliada da promoção da saúde, oportunizando a medicalização. Conclui-se que é possível desenvolver ações educativas intersetoriais para promoção da alimentação saudável nos serviços básicos envolvendo os escolares e suas famílias. Essas ações devem ser priorizadas nas agendas públicas a fim de viabilizar sua prática cotidiana nos serviços.

ABSTRACT The School Health Program (PSE) elects health promotion as a guideline for developing health actions at school. The aim is to identify and analyze the program's strengths, opportunities, weaknesses, and threats to implement health-promoting actions that promote healthy eating habits. This review, of qualitative approach, comprises 29 articles of evaluation of the program published between 2015 and 2021. By the SWOT matrix, the analysis grouped the results into Strengths, Opportunities, Weaknesses, and Threats. Among the strengths, the proximity of the health and education sectors and the integration between the school, health unit, and family stood out; as opportunities, the possibility of intersectoral planning for health promotion was observed. The weaknesses refer to the intersectoral disarticulation, the lack of training, and the predominance of biomedical actions. The threats found demonstrate the centralization of power in health and the schoolchildren's approach to the health service without a broader understanding of health promotion, providing opportunities for medicalization. It is concluded that it is possible to develop intersectoral educational actions to promote healthy eating in basic services involving schoolchildren and their families. This practice should be prioritized in public agendas in order to enable its daily practice in services.

Health in School Program in the view of managers in five towns of the Western Paraná, Brazil / Programa Saúde na Escola na visão de gestores, em cinco municípios do Oeste Paranaense, Brasil

INTRODUCTION: In school, education and health should be related to promoting health and turning the Health in School Program (HSP) into an effective cross-sector policy. The managers' view about the implementation of the Program in towns of the 10th Health Regional Office of Paraná, Brazil, and the Regional Education Center from the city of Cascavel was questioned. OBJECTIVE: To analyze the managers' understanding of the implementation and development of the Health in School Program. METHODS: This is an exploratory study of a qualitative approach, with data from interviews with managers of five towns in the Western Parana region from the 10th Health Region and the Regional Education Center of Cascavel. These towns have implemented the Program by 2012. Fifteen managers (eight from the health area and seven fromthe education area) participated in the interviews conducted in July, August, and September 2015. The data were systematized and based on thematic content analysis. RESULTS: The theme "The managers' perception about the implementation of the HSP" was systematized and unfolded into the subthemes: motivations for participation, planning, evaluation and monitoring, developed actions, the cross-sector policies, and financial resources. CONCLUSION: The HSP was implemented in the studied towns, however, in differentiated stages, although the developing actions aimed at its integration. The cross-sector policy has become an important strategy for the development of health and education. The program needs to improve actions for health promotion and training of the subjects involved.

INTRODUÇÃO: Na escola, a educação e a saúde devem se relacionar para implementar ações favoráveis à promoção da saúde, de forma que o Programa Saúde na Escola (PSE) efetiva-se como política intersetorial. Questiona-se a respeito da visão de gestores em relação à implantação do Programa em municípios da 10ª Regional de Saúde/PR e do NRE de Cascavel/PR. OBJETIVO: Analisar a compreensão dos gestores acerca da implantação e desenvolvimento do Programa Saúde na Escola. Métodos: Trata-se de estudo exploratório de abordagem qualitativa, com dados extraídos de entrevistas com gestores de cinco municípios da região Oeste Paranaense, que integram a 10ª Regional de Saúde e o Núcleo Regional de Educação de Cascavel/PR; que fizeram adesão ao Programa Saúde na Escola e o implantaram até o ano de 2012. Participaram quinze gestores (oito da área da saúde e sete da educação), entrevistados nos meses de julho, agosto e setembro de 2015. Os dados foram sistematizados e fundamentados conforme a análise de conteúdo temática. RESULTADOS: Sistematizou-se a temática "A percepção dos gestores acerca da implantação do PSE", que se desdobrou nas subtemáticas: motivações para adesão, planejamento, avaliação e monitoramento, ações desenvolvidas, intersetorialidade observada e recursos financeiros. CONCLUSÃO: O PSE está implantado nos municípios estudados, porém, com estágios diferenciados, mas desenvolvendo ações que visam à sua integralidade. A intersetorialidade tornou-se estratégia importante para o desenvolvimento de ações pertinentes à saúde e educação. O programa carece de fortalecer as ações de promoção da saúde e formação dos sujeitos envolvidos.

Estágio Curricular Supervisionado e Trabalho de Conclusão de Curso em Enfermagem: bacharelado e licenciatura / Pasantía Curricular Supervisada y Trabajo de Finalización de Curso en Enfermería: bachillerato y licenciatura / Supervised Curricular Internship and Course Completion Work in Nursing: bachelor and degree

Objetivo: avaliar a formação recebida nas atividades de Estágio Curricular Supervisionado e Trabalho de Conclusão de Curso de graduação em enfermagem. Método: pesquisa quanti-qualitativa, com dados coletados nos anos de 2018 e 2019, com alunos da Enfermagem que responderam a um questionário on-line assíncrono, pela ferramenta Limesurvey. Os dados quantitativos foram submetidos à analise descritiva e os qualitativos à análise de conteúdo. Resultados: 11 eram concluintes em 2018 e 25, em 2019 e responderam ao questionário 7 e 10, respectivamente. Avaliaram positivamente o ensino-aprendizagem vivenciado, elencaram desafios, mas visualizaram o desenvolvimento de autonomia, autoconfiança, crescimento profissional e pessoal; superação de inseguranças e empenho do serviço em acolhe-los. Na monografia, exercício das normas e definição de critérios de avaliação seriam positivos e papel dos professores. Conclusões: a conclusão da graduação pelo estágio e monografia é momento insubstituível, viabilizando o exercício da autonomia e apoiados pelo enfermeiro do serviço e professor supervisor.(AU)

Objective: to evaluate the training received in the activities of the Supervised Curricular Internship and Work Completion of the Undergraduate Course in Nursing. Method: quantitative-qualitative research with data collected in 2018 and 2019 with Nursing students who completed online questionnaire. The quantitative data were subjected to descriptive analysis and the qualitative data to content analysis. Results: there were 11 senior students in 2018, and 25 in 2019; from them, 7 and 10 respectively. They positively evaluated the teaching-learning experience, listed challenges, but visualized the development of autonomy, self-confidence, professional and personal growth, overcoming insecurities, and the service's commitment to welcome them. In the Work, students reported that exercising the standards and definition of evaluation criteria would be positive and the role of the professors. Conclusions: the practice and Work are an irreplaceable moment, enabling the exercise of autonomy and supported by nurses and the supervising professor.(AU)

Objetivo: evaluar la formación recibida en las actividades de formación en Pasantía Curricular Supervisada y Trabajo de Finalización de Curso de pregrado en enfermería. Método: investigación cuantitativa-cualitativa con datos recolectados en 2018 y 2019 con estudiantes de Enfermería con cuestionario online. Los datos fueron sometidos a análisis descriptivo y de contenido. Resultados: hubo 11 estudiantes de último curso en 2018, y 25 en 2019; de ellos, 7 y 10 respectivamente completaron el cuestionario. Evaluaron positivamente la enseñanza-aprendizaje, enumeraron desafíos, pero visualizaron el desarrollo de autonomía, confianza en sí mismos, crecimiento profesional y personal, superación de inseguridades y compromiso del servicio de acogerlos. En Trabajo, los estudiantes informaron que ejercicio de las normas y definición de criterios de evaluación serían positivos y papel de los profesores. Conclusiones: la práctica y el trabajo es un momento insustituible, permitiendo ejercicio de autonomía y apoyado por servicio de enfermería y profesor supervisor.(AU)

Repercussões da prática educativa no autocuidado e manejo do Diabetes Mellitus tipo 1 na infância / Repercusiones de la práctica educativa sobre el autocuidado y manejo de la Diabetes Mellitus tipo 1 en la infancia / Effects of educational practice on self-care and management of Type 1 Diabetes Mellitus in childhood

Objetivo: apresentar as repercussões de uma prática de educação em saúde para o autocuidado e manejo da Diabetes Mellitus tipo 1 entre crianças. Método: estudo qualitativo com grupo focal e descrição do perfil glicêmico das crianças. As atividades de educação em saúde, lúdica e com cartilha educativa, foram desenvolvidas com quatro crianças com diabetes e seus familiares, em ambulatório de hospital universitário. Análise de conteúdo do tipo temática. Resultados: a atividade física mostrou-se como alternativa eficaz para prática de autocuidado, porém, houve resistência à adoção de hábitos alimentares direcionados ao diabetes, relacionados ao controle glicêmico inadequado e aumento de complicações. Observou-se mudanças no manejo da doença comparando-se o antes e após as atividades educativas. Conclusões: recursos lúdicos e cartilha educativa repercutiram positivamente no manejo da família e no autocuidado da criança com Diabetes Mellitus.

Objetivo: presentar las repercusiones de una práctica de educación para la salud sobre el autocuidado y manejo de la Diabetes Mellitus tipo 1 en niños. Método: estudio cualitativo con grupo focal y descripción del perfil glicémico de los niños. Las actividades de educación para la salud, lúdicas y con cartilla didáctica, se desarrollaron con cuatro niños con diabetes y sus familiares, en el ambulatorio de un hospital universitario. Análisis de contenido de tipo temático. Resultados: la actividad física demostró ser una alternativa eficaz para la práctica del autocuidado, sin embargo, hubo resistencia a la adopción de hábitos alimentarios dirigidos a la diabetes, relacionados con un control glucémico y aumento de complicaciones. Se observaron cambios en el manejo de la enfermedad comparándose el antes y después de las actividades educativas. Conclusiones: los recursos lúdicos y la cartilla educativa repercutieron positivamente en el manejo de la familia y en el autocuidado de los niños con Diabetes Mellitus.

Objective: to present the effects of health education for the self-care and management of type 1 Diabetes Mellitus among children. Method: a qualitative study with a focus group and description of the children's glycemic profile. The health education activities, of a playful type and with an educational booklet, were carried out with four children with diabetes and their families, in an outpatient clinic of a university hospital. Thematic content analysis was performed. Results: physical activity proved to be an effective option for the practice of self-care, however, there was non-compliance to the adoption of dietary habits aimed at diabetes, concerning inadequate glycemic control, and increased complications. Changes in the management of the disease were observed when comparing the before and after of educational activities. Conclusions: playful resources and an educational booklet had a positive impact on family management and the self-care of children with Diabetes Mellitus.

Pregnancy after uterine artery embolization: a case report in a woman with leiomyomata.

Background. Several pregnancies have been reported after embolization of uterine artery. This procedure is an accepted nonsurgical treatment for symptomatic uterine fibroids but its safety in women desiring future childbearing is not well established. Case Report. We present a 40-year-old woman with leiomyomata who became pregnant after previously undergone uterine artery embolization for three times. The placenta was previa and the fetus was in transverse position. She had a cesarean delivery of an appropriately grown fetus at 37 weeks, which was followed by uterine atony requiring hysterectomy. Conclusion. Although pregnancy-related outcomes remain understudied, the available reports evidence that pregnancies after uterine artery embolization may be at significantly increased risk for postpartum hemorrhage, cesarean delivery, abnormal placentation, and malpresentation. In patients who are undergoing this type of treatment and contemplating pregnancy, the possibility of adverse complications should be taken in consideration and women should be appropriately advised.

Organizational flow chart of home care for children with special health care needs / Organigrama de atención domiciliaria a niños con necesidades de salud especiales / Fluxograma organizativo de atenção domiciliar às crianças com necessidades especiais de saúde

ABSTRACT Objective: To develop a workflow protocol for Home Care (HC) services in the HC2 modality for children with special health care needs (CSHCN) in the state of Parana. Method: Quantitative, descriptive, exploratory, multiple case studies. Data was collected with professionals from the eight home care services in Parana. Data were analyzed using the Strengths, Weaknesses, Opportunities and Threats (SWOT) methodology, from which a 5W2H method of action plan was developed, resulting in a flow chart. Results: Considering the strategies found in Home Care services, such as planned hospital discharge, caregiver training, organized transportation and singular therapeutic project, a flow organization protocol for children with special health care needs in Home Care services was developed. Conclusion: The protocol developed makes it possible to organize the care provided to children with special health care needs in home care.

RESUMEN Objetivo: Desarrollar un protocolo de organigrama en los servicios de atención domiciliaria (AD) de la modalidad AD2 para niños con necesidades de salud especiales (CRIANES), en el estado de Paraná. Método: Se trata de una investigación cuantitativa, descriptiva, exploratoria, con estudio de casos múltiples. La recolección de datos se llevó a cabo con profesionales de los ocho servicios de atención domiciliaria paranaenses. Los datos se analizaron con la metodología DAFO (Debilidades, Amenazas, Fortalezas y Oportunidades), de la cual se elaboró el plan de acción con el método 5W2H que produjo el organigrama normativo. Resultados: Considerando las estrategias encontradas en los servicios de atención domiciliaria, como alta hospitalaria programada, preparación del cuidador, transporte sanitario organizado y proyecto terapéutico singular, se desarrolló el protocolo del organigrama para niños con necesidades de salud especiales en los servicios de atención domiciliaria. Conclusión: El protocolo desarrollado posibilita organizar el diagrama de flujo de atención a niños con necesidades especiales de saluden atención domiciliaria.

RESUMO Objetivo: Desenvolver protocolo de organização de fluxo nos serviços de atenção domiciliar (AD) para o cuidado na modalidade AD2a crianças com necessidades especiais de saúde (CRIANES), no estado do Paraná. Método: Pesquisa quantitativa, descritiva, exploratória, estudo de casos múltiplos. Coleta de dados com profissionais dos oito serviços de atenção domiciliar paranaenses. Os dados foram analisados com a metodologia Strengths, Weaknesses, Opportunities e Threats (SWOT), a partir da qual foi elaborado plano de ação pelo método 5W2H, originando fluxograma normativo. Resultados: Considerando as estratégias encontradas nos serviços de atenção domiciliar, como alta hospitalar programada, preparo do cuidador, transporte sanitário organizado e projeto terapêutico singular, foi desenvolvido protocolo de organização de fluxo para crianças com necessidades especiais de saúde nos serviços de atenção domiciliar. Conclusão: O protocolo desenvolvido possibilita organizar o fluxo de atenção às crianças com necessidades especiais de saúde na atenção domiciliar.

Organizational flow chart of home care for children with special health care needs / Organigrama de atención domiciliaria a niños con necesidades de salud especiales / Fluxograma organizativo de atenção domiciliar às crianças com necessidades especiais de saúde

ABSTRACT Objective: To develop a workflow protocol for Home Care (HC) services in the HC2 modality for children with special health care needs (CSHCN) in the state of Parana. Method: Quantitative, descriptive, exploratory, multiple case studies. Data was collected with professionals from the eight home care services in Parana. Data were analyzed using the Strengths, Weaknesses, Opportunities and Threats (SWOT) methodology, from which a 5W2H method of action plan was developed, resulting in a flow chart. Results: Considering the strategies found in Home Care services, such as planned hospital discharge, caregiver training, organized transportation and singular therapeutic project, a flow organization protocol for children with special health care needs in Home Care services was developed. Conclusion: The protocol developed makes it possible to organize the care provided to children with special health care needs in home care.

RESUMEN Objetivo: Desarrollar un protocolo de organigrama en los servicios de atención domiciliaria (AD) de la modalidad AD2 para niños con necesidades de salud especiales (CRIANES), en el estado de Paraná. Método: Se trata de una investigación cuantitativa, descriptiva, exploratoria, con estudio de casos múltiples. La recolección de datos se llevó a cabo con profesionales de los ocho servicios de atención domiciliaria paranaenses. Los datos se analizaron con la metodología DAFO (Debilidades, Amenazas, Fortalezas y Oportunidades), de la cual se elaboró el plan de acción con el método 5W2H que produjo el organigrama normativo. Resultados: Considerando las estrategias encontradas en los servicios de atención domiciliaria, como alta hospitalaria programada, preparación del cuidador, transporte sanitario organizado y proyecto terapéutico singular, se desarrolló el protocolo del organigrama para niños con necesidades de salud especiales en los servicios de atención domiciliaria. Conclusión: El protocolo desarrollado posibilita organizar el diagrama de flujo de atención a niños con necesidades especiales de saluden atención domiciliaria.

RESUMO Objetivo: Desenvolver protocolo de organização de fluxo nos serviços de atenção domiciliar (AD) para o cuidado na modalidade AD2a crianças com necessidades especiais de saúde (CRIANES), no estado do Paraná. Método: Pesquisa quantitativa, descritiva, exploratória, estudo de casos múltiplos. Coleta de dados com profissionais dos oito serviços de atenção domiciliar paranaenses. Os dados foram analisados com a metodologia Strengths, Weaknesses, Opportunities e Threats (SWOT), a partir da qual foi elaborado plano de ação pelo método 5W2H, originando fluxograma normativo. Resultados: Considerando as estratégias encontradas nos serviços de atenção domiciliar, como alta hospitalar programada, preparo do cuidador, transporte sanitário organizado e projeto terapêutico singular, foi desenvolvido protocolo de organização de fluxo para crianças com necessidades especiais de saúde nos serviços de atenção domiciliar. Conclusão: O protocolo desenvolvido possibilita organizar o fluxo de atenção às crianças com necessidades especiais de saúde na atenção domiciliar.

[Nursing research in Brazil: the problem of knowledge creation]. / Pesquisa em enfermagem no Brasil: problematizando a produção de conhecimentos.

This research analyses aspects from articles published over the last five years, in three nation-wide periodicals divulging the most part of Nursing knowledge produced; it identifies priviledged and silenced points, raising problems around the main issues in knowledge creation. We worked on 811 abstracts and their footnotes. Data were approached and organized in tables. Most researches are in the assistance area: themes around hospital subjects, such as child health, and some others not concerning the hospital field, such as women's health, HIV/AIDS, and Psychiatry and Mental Health Nursing; production is usually made by doctors and Postgraduate students, as public universities are the main locus for scientific production to receive financial support from Federal governmental organs.

[A reading of the recent socialized scientific production of REBEn]. / Uma leitura da recente produção científica socializada pela REBEn.

The article results in a first approach to the state-of-the-art research in nursing in Brazil. It is part of a research that will analyze other two indexed periodicals. It is based on 250 summaries and footnotes of Revista Brasileira de Enfermagem REBEn (Brazilian Periodical of Nursing) in the last five years, beginning in 1997. The information was segmented and distributed into tables. Our tentative conclusion is that there was a predominance of research articles with certain homogeneity on the themes covered, a tendency toward collective production, predominance of the public universities in the production of knowledge, as well as public organs in the financing of the studies. In our evaluation, REBEn has become an important means of socialization of knowledge production in nursing.

[Evaluation and design of a political-pedagogical project for nursing undergraduate programs]. / Avaliação e construção de um projeto político pedagógico para a graduação em enfermagem.

This work presents the results of an experience which aimed primarily at the evaluation of the Political-Pedagogical Project--PPP of the nursing undergraduate program from UNIOESTE (Cascavel town Campus) and at pondering on a new curricular proposal for that program. Thus, a research project was designed to be used by all professors teaching that program, with the participation of students, former students, and professionals working on the health care delivery network, where field work can be carried out through practical activities and training periods for the students. The data gathered by them have been used as subsidies for a proposal to build a new political-pedagogical project, that was took effect in the year 2003. Besides designing a new pedagogical proposal, strategies for a continued evaluation of the PPP implantation process have been defined. This evaluation is to be performed at the end of each term.