[Successful treatment of the diverticular lesion of the colon via EMR with over-the-scope clip (OTSC):a case report].

A 65-year-old woman presented with a flat elevated lesion of about 1cm in the cecal diverticulum during a lower gastrointestinal endoscopy that was performed previously by another physician during a medical checkup. The patient was referred to our department for resection. Considering the risk of perforation owing to the diverticular lesion, positive nonlifting sign, and Group 5 diagnosis on the previous biopsy, EMR with over-the-scope clip (OTSC) (EMRO) was selected, and complete resection was achieved without complications.

Vision-threatening lesions developing with longer-term follow-up after treatment of neovascular age-related macular degeneration.

PURPOSE: To assess the development of vision-threatening lesions at least 3.5 years after initiating anti-vascular endothelial growth factor (VEGF) for choroidal neovascularization (CNV) in eyes with age-related macular degeneration (AMD). DESIGN: Retrospective cohort study. PARTICIPANTS: A total of 75 patients (81 eyes) with CNV secondary to AMD who received intravitreous anti-VEGF treatment and were followed for at least 3.5 years after initiating treatment. METHODS: Retrospective record review of patients initiating anti-VEGF treatment between November 2005 and June 2008 at a university-based institution for whom at least 3.5 years of follow-up was available at the same institution. MAIN OUTCOME MEASURES: Predominantly hemorrhagic lesions or geographic atrophy (GA). RESULTS: Among 75 patients (81 eyes; 59% were women; median age, 78 years), mean follow-up was 4.9 years and at least 6 years for 40%. Median visual acuity (VA) was 20/80 (interquartile range [IQR], 20/50-20/100) initially, 20/63 (IQR, 20/40-20/160) at 2 years, 20/80 (IQR, 20/40-20/200) at 3.5 years, and 20/63 (IQR 20/32-20/200) at 6 years. Six eyes (7%) had predominantly hemorrhagic lesions initially, whereas this developed in an additional 3 eyes (4%, 95% confidence interval [CI], 1% to 10%) in 3.5 years and in 1 additional eye (1%, 95% CI, 0.03% to 7%) at more than 3.5 years of follow-up. Initially, GA within or overlapping the boundary of the entire CNV was present in 4 eyes (5%) and outside this boundary in 8 eyes (10%). Geographic atrophy enlarged in each eye over time. The only eyes that developed GA outside the CNV boundary were those that had GA outside the lesion at baseline. Additional atrophy within the boundary of CNV defined at baseline, termed "atrophic disciform scars," developed in 5 eyes (6%), all within 4 years of treatment initiation. CONCLUSIONS: Longer-term follow-up of neovascular AMD managed with anti-VEGF therapy suggests that predominantly hemorrhagic lesions may develop within 3.5 years of initiating therapy and more than 3.5 years after initiating therapy. In contrast, new areas of GA beyond the boundaries of the CNV lesion as defined at initiation of anti-VEGF therapy seem unlikely to develop if there is no GA outside of the CNV lesion initially.

Understanding How Health Providers Identify Women with Postpartum Hemorrhage: A Qualitative Study.

OBJECTIVE: To identify how health providers recognize postpartum hemorrhage early and the difficulties involved in it. METHODS: An exploratory, descriptive study using a qualitative approach through a semi-structured interview technique. In total, 27 health professionals (nursing technicians, nurses, medical residents in Gynecology and Obstetrics, hired medical doctors, and medicine professors) working in a tertiary-level hospital of reference in women's health care in the State of São Paulo, Brazil, participated in the study through an invitation. After they accepted the invitation, they signed the free and informed consent form. All interviews were recorded and transcribed, and a thematic analysis was conducted. We found three analysis categories: a) perception of the severity: "there is something wrong with the women"; b) difficulties in the early diagnosis of postpartum hemorrhage; and c) the process to improve obstetrical care. RESULTS: Caregivers believe teamwork and communication should be improved. Besides the visual estimation of blood loss, the nursing team is attentive to behavioral symptoms like irritability, while the medical staff follow protocols and look for objective signs, such as altered vital signs. CONCLUSION: Besides the objective evaluations, the subjective perceptions of the providers are involved in the clinical judgement regarding the diagnosis of postpartum hemorrhage, and this should be included in a broader diagnosis strategy.

OBJETIVO: Identificar como os profissionais de saúde reconhecem precocemente os casos de hemorragia pós-parto e as suas dificuldades. MéTODOS: Realizou-se um estudo exploratório, descritivo, com uma abordagem qualitativa por meio da técnica de entrevista semiestruturada. Por meio de um convite, participaram do estudo 27 profissionais saúde (técnicas de enfermagem, enfermeiras, residentes de Ginecologia e Obstetrícia, e médicos contratados e docentes) que trabalhavam em um hospital de nível terciário de referência no atendimento à saúde da mulher no estado de São Paulo. Depois que os participantes aceitaram o convite, eles assinaram o termo de consentimento livre e esclarecido. Todas as entrevistas foram gravadas, transcritas, e realizou-se uma análise temática. Identificaram-se três categorias de análise: a) percepção da gravidade: "há algo de errado com as mulheres"; b) dificuldades no diagnóstico precoce da hemorragia pós-parto; e c) o processo para melhorar a atenção em obstetrícia. RESULTADOS: Os profissionais de saúde acreditavam que o trabalho em equipe e a comunicação deviam ser aperfeiçoados. Além da estimativa visual da perda de sangue, a equipe de enfermagem estava atenta a sintomas comportamentais como irritabilidade, ao passo que o pessoal médico seguia protocolos e procurava sinais objetivos, como sinais vitais alterados. CONCLUSãO: Além das avaliações objetivas, as percepções subjetivas dos provedores estão envolvidas no julgamento clínico do diagnóstico de hemorragia pós-parto, e isto deve ser incluído em uma estratégia de diagnóstico mais ampla.

Good prenatal care practices in teenage pregnancy from the perspective of healthcare professionals / Buenas prácticas en la atención prenatal a adolescentes embarazadas: perspectivas de profesionales de la salud

Objective: To systematize good prenatal care practices in a referral center for pregnant teenagers in Campinas, São Paulo, Brazil, from the perspective of healthcare professionals. Materials and Methods: Qualitative study conducted between June and July 2017 using semi-structured interviews and a focus group with 10 healthcare professionals providing care to pregnant teenagers in a public hospital in the region of Campinas, São Paulo, Brazil. Data were examined using the thematic content analysis technique, which gave rise to new analytical categories. Triangulation of the results was used for validation. The theoretical and practical applicability of the main findings was identified. Results: The study looked into three categories arising from the discourse of the professionals and the evidence found in the literature: 1) comprehensive analysis of pregnant teenagers; 2) professional experiences related to the care of pregnant teenagers reflecting service quality; and 3) strengths and improvement opportunities potentially replicable as a care model. Good practices in prenatal care are those which prioritize comprehensive care for pregnant teenagers, are coordinated by a multidisciplinary team and result in a multidimensional approach, valuing the complexity of motherhood in the teenage years. Conclusions: It is advisable to develop education strategies, strengthen group care and involve the teenager's support network as part of sexual and reproductive health services in order to promote a positive experience during prenatal care when the process of becoming a mother takes place during adolescence.

Objetivo: sistematizar buenas prácticas de atención prenatal en un servicio de referencia para adolescentes embarazadas en Campinas, São Paulo, Brasil, desde la perspectiva de profesionales de la salud. Materiales y métodos: estudio cualitativo desarrollado entre junio y julio de 2017, se emplearon entrevistas semiestructuradas y se realizó un grupo focal con 10 profesionales de la salud que prestaban atención a adolescentes embarazadas en una unidad hospitalaria del sistema público de la región de Campinas, São Paulo, Brasil. Los datos fueron examinados mediante la técnica de análisis de contenido temático de donde surgieron nuevas categorías de análisis. Se hizo validación a través de triangulación de los resultados. Se identificó la aplicabilidad teórica y práctica de los principales hallazgos. Resultados: fueron elaboradas tres categorías emergentes del discurso de los profesionales y de las evidencias en la literatura: 1) análisis integral de las adolescentes en situación de embarazo; 2) experiencias profesionales en la atención a las adolescentes embarazadas que evidencian calidad en el servicio; 3) fortalezas y oportunidades del servicio con posibilidades de replicación como modelo asistencial. Son consideradas buenas prácticas durante el cuidado prenatal aquellas que priorizan la atención integral a las adolescentes embarazadas; estas son coordinadas por un equipo multidisciplinario, y consiguen tener un abordaje multidimensional, sobre todo, valorando la complejidad que supone la maternidad en la adolescencia. Conclusiones: dentro de los servicios de salud sexual y reproductiva es recomendable el desarrollo de estrategias educativas, el fortalecimiento de la atención en grupos y la inclusión de la red de apoyo de las adolescentes en la atención, con el fin de favorecer una experiencia positiva durante el cuidado prenatal cuando el proceso de volverse madre acontece durante la adolescencia.

Effects of 660 and 780 nm low-level laser therapy on neuromuscular recovery after crush injury in rat sciatic nerve.

BACKGROUND AND OBJECTIVE: Post-traumatic nerve repair is still a challenge for rehabilitation. It is particularly important to develop clinical protocols to enhance nerve regeneration. The present study investigated the effects of 660 and 780 nm low-level laser therapy (LLLT) using different energy densities (10, 60, and 120 J/cm²) on neuromuscular and functional recovery as well as on matrix metalloproteinase (MMP) activity after crush injury in rat sciatic nerve. MATERIALS AND METHODS: Rats received transcutaneous LLLT irradiation at the lesion site for 10 consecutive days post-injury and were sacrificed 28 days after injury. Both the sciatic nerve and tibialis anterior muscles were analyzed. Nerve analyses consisted of histology (light microscopy) and measurements of myelin, axon, and nerve fiber cross-sectional area (CSA). S-100 labeling was used to identify myelin sheath and Schwann cells. Muscle fiber CSA and zymography were carried out to assess the degree of muscle atrophy and MMP activity, respectively. Statistical significance was set at 5% (P≤0.05). RESULTS: Six hundred sixty nanometer LLLT either using 10 or 60 J/cm² restored muscle fiber, myelin and nerve fiber CSA compared to the normal group (N). Furthermore, it increased MMP-2 activity in nerve and decreased MMP-2 activity in muscle and MMP-9 activity in nerve. In contrast, 780 nm LLLT using 10 J/cm² decreased MMP-9 activity in nerve compared to the crush group (CR) and N; it also restored normal levels of myelin and nerve fiber CSA. Both 60 and 120 J/cm² decreased MMP-2 activity in muscle compared to CR and N. 780 nm did not prevent muscle fiber atrophy. Functional recovery in the irradiated groups did not differ from the non-irradiated CR. CONCLUSION: Data suggest that 660 nm LLLT with low (10 J/cm²) or moderate (60 J/cm²) energy densities is able to accelerate neuromuscular recovery after nerve crush injury in rats.

Validation of an Instrument to guide Nursing Staffing in Obstetric Rooming in.

OBJECTIVES: to construct and validate an instrument for the classification of mother-baby binomials that subsidizes personnel Staffing in in-rooming units. METHOD: methodological study. The construction was based on theoretical and legal references. Content validity was performed by experts through the content validity index measurement. Then, the instrument was applied to a sample of 122 binomials, and exploratory factor analysis was performed using the principal components analysis. RESULTS: the instrument consisted of seven care indicators: Birth route; Maternal morbidity; Neonatal morbidity; Breastfeeding; Social aggravating factors; Care guidance; and interaction and bonding. All with content validity index of 1. The construct was composed of 3 domains, with Cronbach's alpha of 0.62, 0.85 and 0.89. CONCLUSIONS: the classification instrument of mother-baby binomials allows the classification of mother-baby binomials and may support personnel Staffing in in-rooming units.

Knowledge of Pregnant Adolescents about Human Papillomavirus.

OBJECTIVE: To evaluate the level of information possessed by pregnant adolescents regarding the human papillomavirus (HPV). METHODS: Descriptive study developed in the adolescent prenatal outpatient clinic of a tertiary hospital from the state of São Paulo, Brazil. Data were collected between June and December 2017 following approval from the ethics and research committee (CAAE: 1.887.892/2017). Pregnant adolescents, ≤18 years old, who attended the abovementioned outpatient section, composed the sample. Those diagnosed with a psychiatric disorder and those with hearing or cognitive disabilities were excluded. After acceptance to participate in the present study, the pregnant adolescents signed an Informed Consent Form. Regarding the statistical analysis, the chi-squared test and the Fisher exact test were used. RESULTS: Regarding the knowledge about HPV, 123 (80.92%) of the participants had already heard about the subject; for 77 (50.66%), their schools had been the source of the information; 101 (66.45%) did not know how they could be infected by the virus. Age variation did not influence their knowledge on how to prevent themselves from HPV (p = 0.2562). The variable vaccine is associated with HPV prevention (p < 0.0001). CONCLUSION: The pregnant adolescents composing the sample have shown to have knowledge about HPV. However, they do not prevent themselves from it appropriately, given that little more than half of the sample was vaccinated, had not reported an understanding that the use of preservatives and vaccination are effective means of prevention, and did not correlate HPV with uterine cervical cancer.

OBJETIVO: Avaliar o nível de informação que as adolescentes gestantes possuem em relação ao papilomavírus humano (HPV). MéTODOS: Estudo descritivo desenvolvido no ambulatório pré-natal adolescente de um hospital terciário do estado de São Paulo, Brasil. Os dados foram coletados entre junho e dezembro de 2017, após a aprovação do comitê de ética e pesquisa (CAAE: 1.887.892/2017). A amostra foi composta por adolescentes gestantes com ≤ 18 anos que frequentaram o ambulatório. Foram excluídas as com transtorno psiquiátrico diagnosticado e as portadoras de deficiência auditiva ou de cognição. Após aceitarem participar do presente estudo, as adolescentes grávidas assinaram o termo de assentimento e consentimento livre e esclarecido. Para as análises estatísticas, foram utilizados os testes de qui-quadrado e exato de Fisher. RESULTADOS: Em relação ao conhecimento sobre o HPV, 123 (80,92%) já tinham ouvido falar sobre o assunto; destas adolescentes, 77 (50,66%) receberam as informações que tinham através de suas escolas, e 101 (66,45%) pacientes não sabiam como poderiam contrair o vírus. A variação da idade das adolescentes entrevistadas não influenciou se estas sabiam ou não como se prevenir contra o HPV (p = 0,2562). A variável vacina está associada à prevenção contra o HPV (p < 0,0001). CONCLUSãO: As gestantes avaliadas possuem conhecimento sobre o HPV, mas não fazem a prevenção adequada, visto que um pouco mais da metade se vacinaram, não relataram o preservativo e a vacina como métodos eficazes de prevenção, e não relacionaram o HPV com o câncer de colo de útero.

Circulating tumor cell number and prognosis in progressive castration-resistant prostate cancer.

PURPOSE: The development of tumor-specific markers to select targeted therapies and to assess clinical outcome remains a significant area of unmet need. We evaluated the association of baseline circulating tumor cell (CTC) number with clinical characteristics and survival in patients with castrate metastatic disease considered for different hormonal and cytotoxic therapies. EXPERIMENTAL DESIGN: CTC were isolated by immunomagnetic capture from 7.5-mL samples of blood from 120 patients with progressive clinical castrate metastatic disease. We estimated the probability of survival over time by the Kaplan-Meier method. The concordance probability estimate was used to gauge the discriminatory strength of the informative prognostic factors. RESULTS: Sixty-nine (57%) patients had five or more CTC whereas 30 (25%) had two cells or less. Higher CTC numbers were observed in patients with bone metastases relative to those with soft tissue disease and in patients who had received prior cytotoxic chemotherapy relative to those who had not. CTC counts were modestly correlated to measurements of tumor burden such as prostate-specific antigen and bone scan index, reflecting the percentage of boney skeleton involved with tumor. Baseline CTC number was strongly associated with survival, without a threshold effect, which increased further when baseline prostate-specific antigen and albumin were included. CONCLUSIONS: Baseline CTC was predictive of survival, with no threshold effect. The shedding of cells into the circulation represents an intrinsic property of the tumor, distinct from extent of disease, and provides unique information relative to prognosis.

Treatment patterns and healthcare resource utilization and costs in heavy menstrual bleeding: a Japanese claims database analysis.

AIMS: Heavy menstrual bleeding (HMB) is a highly prevalent condition, characterized by excessive menstrual blood loss and cramping, that interferes with activities of daily life. The aim of this study was to investigate treatment patterns in HMB in Japan, and to assess healthcare resource utilization and costs among women newly-diagnosed with the condition. MATERIALS AND METHODS: This study retrospectively analyzed health insurance data available in the Japan Medical Data Center (JMDC) database on women aged 18-49 years who were newly-diagnosed with primary or secondary HMB. Treatment patterns were analyzed, and healthcare utilization and costs were evaluated and compared to matched controls. RESULTS: The study included a total of 635 patients, 210 with primary HMB and 425 with secondary HMB. In the primary HMB cohort, 60.0% of patients received one or more pharmacological or surgical treatments, compared with 76.2% in the secondary HMB cohort. The most commonly prescribed medications in all patients were hemostatic agents (28.7%), traditional Chinese medicine (TCM) (12.1%), and low-dose estrogen progestins (LEPs) (10.1%). After adjustment for patient baseline characteristics, healthcare costs were 1.93-times higher in primary HMB cases (p < .0001) and 4.44-times higher in secondary HMB cases (p < .0001) vs healthy controls. Outpatient care was the main cost driver. LIMITATIONS: The main limitations of this study are related to its retrospective nature, and the fact that only reimbursed medications were captured in the source database. CONCLUSIONS: A substantial proportion of HMB patients did not receive the recommended treatments. Healthcare costs were considerably increased in the presence of an HMB diagnosis.

Evaluation of the treatment patterns and economic burden of dysmenorrhea in Japanese women, using a claims database.

PURPOSE: This study aimed to describe treatment patterns and estimate health care resource utilization and associated costs among Japanese women with dysmenorrhea, using a claims database. METHODS: This was a retrospective analysis using health insurance data from the Japan Medical Data Center, assessing female patients aged 18-49 years with newly diagnosed primary or secondary dysmenorrhea. Treatment pattern analyses focused on hormonal medications, analgesics, hemostatic agents, traditional Chinese medicine (TCM), and gynecological surgeries. Data were collected on health care resource utilization and costs associated with medications, imaging procedures, and inpatient and outpatient care in both patients and matched controls. RESULTS: The analysis included 6,315 women with dysmenorrhea (3,441 primary; 2,874 secondary). The most commonly prescribed initial therapies were low-dose estrogen progestins (LEPs, 37.7%) and TCM (30.0%), with substantial differences between primary (LEPs: 27.4%, TCM: 38.8%) and secondary (LEPs: 50.2%, TCM: 19.5%) dysmenorrhea cohorts. Surgery was conducted in <5% of all patients. Both primary and secondary cohorts of dysmenorrhea had significantly higher mean total health care costs compared to controls within the 1-year period following diagnosis (Case-primary: 191,680 JPY [1,916 USD]; secondary: 246,488 JPY [2,465 USD], Control-primary: 83,615 JPY [836 USD]; secondary: 90,711 JPY [907 USD]) (p<0.0001). After adjusting for baseline characteristics, these costs were 2.2 and 2.9 times higher for primary and secondary dysmenorrhea cohorts, respectively, compared with matched controls, (both p<0.0001). The main driver of these excess costs was outpatient care, with eight additional physician visits per year among dysmenorrhea patients compared to controls (p<0.0001). CONCLUSION: Considerable heterogeneity in treatment patterns was observed, with relatively low utilization of LEPs in patients with primary dysmenorrhea and those treated by internal medicine physicians. Total annual health care costs were approximately 2-3 times higher in patients with dysmenorrhea compared to women without the condition.

Nursing students' knowledge about obstetric violence / Conhecimento de acadêmicos de Enfermagem sobre a violência obstétrica

INTRODUCTION: Obstetric violence is a worldwide multifactorial phenomenon. It is characterized by the disrespectful treatment of women at health institutions, during the pregnancy-puerperal period. Identifying future health professionals´ knowledge on this theme can be useful to design teaching strategies that support professional training for the prevention and coping of obstetric violence. OBJECTIVE: To evaluate the knowledge of nursing undergraduate students on Obstetric Violence. METHODS: This is descriptive and exploratory research with a quantitative approach and a sample of 115 students from a public university. The data were collected by a structured questionnaire. The questions were analyzed by applying statistical tests and Poisson regression models with robust variance. RESULTS: About 99.1% of the students stated some approach to the theme, and 56.3% know someone who suffered obstetric violence. The university and social media were cited as the main sources of information. Only 10.5% were able to estimate how many women currently suffer from obstetric violence; 13% know the available legislation and 33.04% said they know how to make a report of violence. CONCLUSION: The findings indicate that students have superficial knowledge about the investigated topic, ignoring epidemiological aspects, as well as related legislation in Brazil and available instances for reporting. These results justify the teaching improvement about obstetric violence in the educational process of these future professionals, as a strategy to prevent and struggle with obstetric violence.

INTRODUÇÃO: A violência obstétrica é um fenômeno multifatorial mundial. É caracterizada pelo tratamento desrespeitoso no contexto das instituições de saúde, durante o ciclo gravídico-puerperal. Dessa forma, identificar o conhecimento dos futuros profissionais de saúde sobre esse tema é uma maneira de contribuir para o desenho de estratégias de ensino que favoreçam uma formação profissional consciente e comprometida com a prevenção e enfrentamento da violência obstétrica. OBJETIVO: Avaliar o nível de conhecimento de estudantes de enfermagem sobre Violência Obstétrica. MÉTODOS: Pesquisa descritiva e exploratória, com abordagem quantitativa, com amostra de 115 acadêmicos de uma universidade pública. Os dados foram coletados com aplicação de instrumento estruturado. As questões foram analisadas utilizando testes estatísticos e modelos de regressão de Poisson com variância robusta. RESULTADOS: Cerca de 99,1% dos estudantes tiveram contato com o tema e 56,3% conhecem alguém que sofreu violência obstétrica. A universidade e as redes sociais foram citadas como as principais fontes de informação. Apenas 10,5% foram capazes de estimar quantas mulheres atualmente sofrem violência obstétrica; 13% conhecem a legislação disponível e 33,04% disseram saber como fazer uma denúncia. CONCLUSÃO: Os achados indicam que os acadêmicos possuem conhecimento superficial sobre o tema investigado, ignorando os aspectos epidemiológicos, a legislação vigente no Brasil e os equipamentos disponíveis para a denúncia. Esses resultados justificam a qualificação do ensino sobre violência obstétrica no processo de formação desses futuros profissionais, como estratégia de prevenção e combate à violência obstétrica.

Understanding How Health Providers Identify Women with Postpartum Hemorrhage: A Qualitative Study / Compreendendo como os profissionais de saúde identificam as mulheres com hemorragia pós-parto: um estudo qualitativo

Abstract Objective To identify how health providers recognize postpartum hemorrhage early and the difficulties involved in it. Methods An exploratory, descriptive study using a qualitative approach through a semi-structured interview technique. In total, 27 health professionals (nursing tech nicians, nurses, medical residents in Gynecology and Obstetrics, hired medical doctors, and medicine professors) working in a tertiary-level hospital of reference in women's health care in the State of São Paulo, Brazil, participated in the study through an invitation. After they accepted the invitation, they signed the free and informed consent form. All interviews were recorded and transcribed, and a thematic analysis was conducted. We found three analysis categories: a) perception of the severity: "there is something wrong with the women"; b) difficulties in the early diagnosis of postpartum hemorrhage; and c) the process to improve obstetrical care. Results Caregivers believe teamwork and communication should be improved. Besides the visual estimation of blood loss, the nursing team is attentive to behavioral symptoms like irritability, while the medical staff follow protocols and look for objective signs, such as altered vital signs. Conclusion Besides the objective evaluations, the subjective perceptions of the providers are involved in the clinical judgement regarding the diagnosis of postpartum hemorrhage, and this should be included in a broader diagnosis strategy.

Resumo Objetivo Identificar como os profissionais de saúde reconhecem precocemente os casos de hemorragia pós-parto e as suas dificuldades. Métodos Realizou-se um estudo exploratório, descritivo, com uma abordagem qualitativa por meio da técnica de entrevista semiestruturada. Por meio de um convite, participaram do estudo 27 profissionais saúde (técnicas de enfermagem, enfermeiras, residentes de Ginecologia e Obstetrícia, e médicos contratados e docentes) que trabalhavam em um hospital de nível terciário de referência no atendimento à saúde da mulher no estado de São Paulo. Depois que os participantes aceitaram o convite, eles assinaram o termo de consentimento livre e esclarecido. Todas as entrevistas foram gravadas, transcritas, e realizou-se uma análise temática. Identificaram-se três categorias de análise: a) percepção da gravidade: "há algo de errado com as mulheres"; b) dificuldades no diagnóstico precoce da hemorragia pós-parto; e c) o processo para melhorar a atenção em obstetrícia. Resultados Os profissionais de saúde acreditavam que o trabalho em equipe e a comunicação deviam ser aperfeiçoados. Além da estimativa visual da perda de sangue, a equipe de enfermagem estava atenta a sintomas comportamentais como irritabilidade, ao passo que o pessoal médico seguia protocolos e procurava sinais objetivos, como sinais vitais alterados. Conclusão Além das avaliações objetivas, as percepções subjetivas dos provedores estão envolvidas no julgamento clínico do diagnóstico de hemorragia pós-parto, e isto deve ser incluído em uma estratégia de diagnóstico mais ampla.

Buenas prácticas en la atención prenatal a adolescentes embarazadas: perspectivas de profesionales de la salud / Good prenatal care practices in teenage pregnancy from the perspective of healthcare professionals / Boas práticas no atendimento pré-natal para adolescentes grávidas: perspectivas de profissionais da saúde

Objetivo: sistematizar buenas prácticas de atención prenatal en un servicio de referencia para adolescentes embarazadas en Campinas, São Paulo, Brasil, desde la perspectiva de profesionales de la salud. Materiales y métodos: estudio cualitativo desarrollado entre junio y julio de 2017, se emplearon entrevistas semiestructuradas y se realizó un grupo focal con 10 profesionales de la salud que prestaban atención a adolescentes embarazadas en una unidad hospitalaria del sistema público de la región de Campinas, São Paulo, Brasil. Los datos fueron examinados mediante la técnica de análisis de contenido temático de donde surgieron nuevas categorías de análisis. Se hizo validación a través de triangulación de los resultados. Se identificó la aplicabilidad teórica y práctica de los principales hallazgos. Resultados: fueron elaboradas tres categorías emergentes del discurso de los profesionales y de las evidencias en la literatura: 1) análisis integral de las adolescentes en situación de embarazo; 2) experiencias profesionales en la atención a las adolescentes embarazadas que evidencian calidad en el servicio; 3) fortalezas y oportunidades del servicio con posibilidades de replicación como modelo asistencial. Son consideradas buenas prácticas durante el cuidado prenatal aquellas que priorizan la atención integral a las adolescentes embarazadas; estas son coordinadas por un equipo multidisciplinario, y consiguen tener un abordaje multidimensional, sobre todo, valorando la complejidad que supone la maternidad en la adolescencia. Conclusión: dentro de los servicios de salud sexual y reproductiva es recomendable el desarrollo de estrategias educativas, el fortalecimiento de la atención en grupos y la inclusión de la red de apoyo de las adolescentes en la atención, con el fin de favorecer una experiencia positiva durante el cuidado prenatal cuando el proceso de volverse madre acontece durante la adolescencia.

Objective: To systematize good prenatal care practices in a referral center for pregnant teenagers in Campinas, São Paulo, Brazil, from the perspective of healthcare professionals. Material and methods: Qualitative study conducted between June and July 2017 using semi-structured interviews and a focus group with 10 healthcare professionals providing care to pregnant teenagers in a public hospital in the region of Campinas, São Paulo, Brazil. Data were examined using the thematic content analysis technique, which gave rise to new analytical categories. Triangulation of the results was used for validation. The theoretical and practical applicability of the main findings was identified. Results: The study looked into three categories arising from the discourse of the professionals and the evidence found in the literature: 1) comprehensive analysis of pregnant teenagers; 2) professional experiences related to the care of pregnant teenagers reflecting service quality; and 3) strengths and improvement opportunities potentially replicable as a care model. Good practices in prenatal care are those which prioritize comprehensive care for pregnant teenagers, are coordinated by a multidisciplinary team and result in a multidimensional approach, valuing the complexity of motherhood in the teenage years. Conclusion: It is advisable to develop education strategies, strengthen group care and involve the teenager's support network as part of sexual and reproductive health services in order to promote a positive experience during prenatal care when the process of becoming a mother takes place during adolescence.

Objetivo: Sistematizar as boas práticas de atenção pré-natal em um serviço de referência para adolescentes grávidas em Campinas, São Paulo/Brasil desde a perspectiva dos professionais da saúde. Materiais e métodos: Estudo qualitativo desenvolvido entre junho e julho de 2017. Empregaram-se entrevistas semiestruturadas e grupo focal com 10 profissionais da saúde que prestavam atendimento à adolescentes grávidas em uma unidade hospitalar da rede pública da região de Campinas, São Paulo/Brasil. Os dados foram analisados por meio da técnica de análise de conteúdo temática onde surgiram as categorias de análise. Realizou-se validação através de triangulação dos resultados e foi identificada a aplicabilidade teórica e prática dos principais achados. Resultados: Foram elaboradas três categorias emergentes do discurso dos professionais e das evidências na literatura: 1) análise compreensiva das adolescentes em situação de gravidez; 2) vivências profissionais no cuidado de adolescentes grávidas que mostram a qualidade no atendimento; 3) potencialidades e oportunidades do serviço com possibilidades de replicação como modelo assistencial. No atendimento pré-natal, são consideradas como boas práticas aquelas que priorizam a atenção integral à gestante adolescente; as que são coordenadas por uma equipe multidisciplinar e conseguem ter uma abordagem multidimensional, sobretudo, avaliando a complexidade que supõe a maternidade durante a adolescência. Conclusões: Dentro dos serviços de saúde sexual e reprodutiva, é recomendável o desenvolvimento de estratégias educativas, o fortalecimento da atenção em grupos e a inclusão da rede de apoio das adolescentes na atenção para favorecer uma experiência positiva durante o cuidado pré-natal levando em consideração o processo de tornar-se mãe durante a adolescência.

Representações sociais de profissionais de saúde da área hospitalar sobre o parto domiciliar planejado / Social representations of health professionals in the hospital area about planned home birth / Representaciones sociales de los profesionales de la salud en el área hospitalaria acerca del parto planificado en el hogar

Objetivo: apreender as representações sociais de profissionais de saúde da área hospitalar sobre o parto domiciliar planejado. Método: estudo qualitativo, fundamentado na Teoria das Representações Sociais e realizado com 15 profissionais de saúde de um hospital de ensino. Os dados foram coletados no segundo semestre de 2019, por meio de entrevista semiestruturada. Utilizou-se a Análise Temática de Conteúdo. Resultados: os relatos originaram dois temas: 1) Parto domiciliar: uma possibilidade, com critérios de elegibilidade e 2) Parto domiciliar: uma miscelânea de conceitos, opiniões e interpretações. O grupo social investigado entende o parto domiciliar planejado como uma opção de assistência, com critérios de elegibilidade. No entanto, prevalece no senso coletivo uma associação desta modalidade de parto com situações de urgência/emergência, com potencial risco para mulheres e recém-nascidos. Conclusão: as representações compartilhadas revelam a generalização de informações sem respaldo científico sobre o parto domiciliar planejado.

Objective: apprehending the social representations of health professionals in the hospital area about the planned home birth. Method: a qualitative study based on the Theory of Social Representations and conducted with 15 health professionals of a teaching hospital. Data were collected in the second half of 2019 through semi-structured interviews. Thematic Content Analysis was used. Results: the reports originated two themes: 1) Home birth: one possibility, with eligibility criteria and 2) Home birth: a miscellany of concepts, opinions and interpretations. The social group investigated understands planned home birth as an option of care, with eligibility criteria. However, a association of this mode of birth with urgent/emergency situations prevails in the collective sense, with potential risk for women and newborns. Conclusion: the shared representations reveal the generalization of information without scientific support about planned home birth.

Objetivo: aprehender las representaciones sociales de profesionales de la salud en el área hospitalaria acerca del parto planificado en el hogar. Método: un estudio cualitativo basado en la Teoría de las Representaciones Sociales y realizado con 15 profesionales de la salud de un hospital escuela. Los datos fueron recolectados en el segundo semestre de 2019 a través de entrevistas semiestructuradas. Se utilizó el análisis de contenido temático. Resultados: los informes originaron dos temas: 1) Nacimiento en el hogar: una posibilidad, con criterios de elegibilidad y 2) Nacimiento en el hogar: una miscelánea de conceptos, opiniones e interpretaciones. El grupo social investigado entiende el parto planificado en el hogar como una opción de atención, con criterios de elegibilidad. Sin embargo, una asociación de este modo de parto con situaciones de urgencia/emergencia prevalece en el sentido colectivo, con riesgo potencial para las mujeres y los recién nacidos. Conclusión: las representaciones compartidas revelan la generalización de la información sin apoyo científico sobre el parto planificado en el hogar.

Analysis of postural control and muscular performance in young and elderly women in different age groups.

BACKGROUND: muscle strength and power are two factors affecting balance. The impact of muscle strength and power on postural control has not been fully explored among different age strata over sixty. OBJECTIVES: the aim of the present study was to assess the muscle strength and power of elderly women in different age groups and determine their correlation with postural control. METHOD: eighty women were divided into four groups: the young 18-30 age group (n=20); the 60-64 age group (n=20); the 65-69 age group (n=20); and the 70-74 age group (n=20). The participants underwent maximum strength (one repetition maximum or 1-RM) and muscle power tests to assess the knee extensor and flexor muscles at 40%, 70%, and 90% 1-RM intensity. The time required by participants to recover their balance after disturbing their base of support was also assessed. RESULTS: the elderly women in the 60-64, 65-69, and 70-74 age groups exhibited similar muscle strength, power, and postural control (p>0.05); however, these values were lower than those of the young group (p<0.05) as expected. There was a correlation between muscle strength and power and the postural control performance (p<0.05). CONCLUSION: despite the age difference, elderly women aged 60 to 74 years exhibited similar abilities to generate strength and power with their lower limbs, and this ability could be one factor that explains the similar postural control shown by these women.

Is there a relationship between complaints of impaired balance and postural control disorder in community-dwelling elderly women? A cross-sectional study with the use of posturography.

BACKGROUND: Risk of falls increases as age advances. Complaints of impaired balance are very common in the elderly age group. OBJECTIVES: The objective of this study was to investigate whether the subjective perception of impaired balance was associated with deficits in postural control (objective analysis) in elderly community-dwelling women. METHOD: Static posturography was used in two groups: elderly women with (WC group) and without (NC group) complaints of impaired balance. The area, mean sway amplitude and mean speed of the center of pressure (COP) in the anterior-posterior (AP) and medial-lateral (ML) directions were analyzed in three stances: single-leg stance, double-leg stance and tandem stance, with eyes open or closed on two different surfaces: stable (firm) and unstable (foam). A digital chronometer was activated to measure the time limit (Tlimit) in the single-leg stance. Kruskal-Wallis tests followed by Mann-Whitney tests, Friedman analyses followed by post hoc Wilcoxon tests and Bonferroni corrections, and Spearman statistical tests were used in the data analysis. Differences of p<0.05 were considered statistically significant. RESULTS: The results of posturography variables revealed no differences between groups. The timed single-leg stance test revealed a shorter Tlimit in the left single-leg stance (p=0.01) in WC group compared to NC group. A negative correlation between posturography variables and Tlimit was detected. CONCLUSIONS: Posturography did not show any differences between the groups; however, the timed single-leg stance allowed the authors to observe differences in postural control performance between elderly women with and those without complaints of impaired balance.

Dificuldades da assistência ao parto domiciliar na ótica de enfermeiras obstetras / Dificultades en la atención domiciliaria desde la perspectiva de las enfermeras obstetras / Difficulties in home birth care from the perspective of obstetric nurses

Objetivo: investigar as dificuldades encontradas pelas enfermeiras obstetras que estão atuando na assistência ao parto domiciliar. Método: estudo descritivo e de abordagem qualitativa. A coleta de dados foi realizada por meio de uma entrevista semiestruturada com nove enfermeiras obstetras que atendiam partos domiciliares há mais de um ano. Os dados foram analisados segundo a Análise de Conteúdo. Resultados: os depoimentos deram origem a três categorias que revelaram dificuldades relacionadas à: escassez de informações sobre o parto domiciliar; transferência do domicílio para o hospital; e lacunas do processo de trabalho. Conclusão: as enfermeiras obstetras enfrentavam dificuldades de ordem social e prática que fragilizavam e dificultavam a assistência ao parto domiciliar. Estas dificuldades parecem estar relacionadas à falta de regulamentação desse modelo de atenção ao parto nas políticas públicas de saúde do país.

Objetivo: investigar las dificultades encontradas por las enfermeras obstétricas que trabajan en la asistencia al parto domiciliario. Método: estudio descriptivo y de enfoque cualitativo. La recolección de datos se realizó a través de una entrevista semiestructurada con nueve enfermeras obstétricas que realizaban partos domiciliarios durante más de un año. Los datos se analizaron de acuerdo con el Análisis de Contenido. Resultados: de las declaraciones, surgieron tres categorías que revelaron dificultades relacionadas con: escasez de información sobre el parto domiciliario; transferencia de casa al hospital y lagunas en el proceso de trabajo. Conclusión: las enfermeras obstétricas encontraron dificultades sociales y prácticas que debilitaron y obstaculizaron la atención al parto domiciliario. Estas dificultades parecen estar relacionadas con la falta de regulación de este modelo de atención de la prestación en las políticas de salud pública del país.

Objective: to investigate the difficulties encountered by obstetric nurses who are working in home birth care. Method: descriptive study, with qualitative approach. Data collection was performed through a semi-structured interview with nine obstetric nurses who had been attending home births for more than one year. The data were analyzed according to Content Analysis. Results: the statements gave rise to three categories that revealed difficulties related to: scarcity of information about home birth; transfer from home to hospital and gaps in the work process. Conclusion: obstetric nurses faced social and practical difficulties that weakened and hindered home birth care. These difficulties seem to be related to the lack of regulation of this model of delivery care in the country's public health policies.

Validation of an Instrument to guide Nursing Staffing in Obstetric Rooming in / Validación de Instrumento para fundamentar dimensionamiento de Profesionales de Enfermería em Alojamiento Conjunto / Validação de Instrumento para fundamentar dimensionamento de Profissionais de Enfermagem em Alojamento Conjunto

ABSTRACT Objectives: to construct and validate an instrument for the classification of mother-baby binomials that subsidizes personnel Staffing in in-rooming units. Method: methodological study. The construction was based on theoretical and legal references. Content validity was performed by experts through the content validity index measurement. Then, the instrument was applied to a sample of 122 binomials, and exploratory factor analysis was performed using the principal components analysis. Results: the instrument consisted of seven care indicators: Birth route; Maternal morbidity; Neonatal morbidity; Breastfeeding; Social aggravating factors; Care guidance; and interaction and bonding. All with content validity index of 1. The construct was composed of 3 domains, with Cronbach's alpha of 0.62, 0.85 and 0.89. Conclusions: the classification instrument of mother-baby binomials allows the classification of mother-baby binomials and may support personnel Staffing in in-rooming units.

RESUMEN Objetivos: elaborar y validar un instrumento para clasificación de binomios puerperio neonatal que subsidie el dimensionamiento de personal en unidades de alojamiento conjunto. Métodos: estudio metodológico. La construcción ha sido basada en referencias teóricas y legales. La validez de contenido ha sido realizada por expertos por medio de medición del índice de validez de contenido. Luego, el instrumento ha sido aplicado en una muestra de 122 binomios, y ha sido realizado análisis factorial exploratoria por el método de componentes principales. Resultados: el instrumento ha quedó constituido por siete indicadores de cuidado: Vía de parto; Morbilidad materna; Morbilidad neonatal; Amamantamiento; Agravantes sociales; Orientación de cuidados; e Interacción y vínculo. Todos con índice de validez de contenido iguales a 1. El constructo ha sido compuesto por 3 dominios, con Alfa de Cronbach de 0,62, 0,85 y 0,89. Conclusiones: el instrumento para la clasificación de binomios puerperio neonatal permite la clasificación de binomios puerperio neonatal y podrá basarse el dimensionamiento de personal en alojamiento conjunto.

RESUMO Objetivos: construir e validar um instrumento para classificação de binômios puérpera-neonato que subsidie o dimensionamento de pessoal em unidades de alojamento conjunto. Métodos: estudo metodológico. A construção foi embasada em referenciais teóricos e legais. A validade de conteúdo foi realizada por expertos por meio de mensuração do índice de validade de conteúdo. Em seguida, o instrumento foi aplicado em uma amostra de 122 binômios, e foi realizada análise fatorial exploratória pelo método de componentes principais. Resultados: o instrumento ficou constituído por sete indicadores de cuidado: Via de parto; Morbidade materna; Morbidade neonatal; Aleitamento; Agravantes sociais; Orientação de cuidados; e Interação e vínculo. Todos com índice de validade de conteúdo iguais a 1. O constructo foi composto por 3 domínios, com Alfa de Cronbach de 0,62, 0,85 e 0,89. Conclusões: o instrumento para a classificação de binômios puérpera-neonato permite a classificação de binômios puérpera-neonato e poderá embasar o dimensionamento de pessoal em alojamento conjunto.

Perceções de irmãos de crianças hospitalizadas por doença crónica / Perceptions of siblings of children hospitalized due to chronic disease / Percepciones de los hermanos de niños hospitalizados por enfermedad crónica

Enquadramento: O quotidiano familiar de uma criança com doença crónica é modificado decorrente das exigências recorrentes da doença. Os irmãos destas crianças podem receber menos atenção, tanto dos pais, quanto da restante família, que podem interessar-se mais pela criança doente e não da mesma forma pelo irmão considerado saudável. Objetivos: Compilar perceções de irmãos de crianças hospitalizadas por doença crónica. Metodologia: Participaram do estudo irmãos de crianças diagnosticadas com doenças crónicas, com idades entre os 8 e os 16 anos. Utilizaram-se entrevistas abertas, que foram gravadas, transcritas e submetidas à análise. Resultados: Apenas 4 irmãos puderam ser entrevistados. Na análise das entrevistas, emergiram 4 categorias de resultados (Enfrentamento da doença do irmão; Reestruturação familiar; Experiências a partir da hospitalização do irmão; e Experiências de exclusão). Conclusão: Os irmãos das crianças com doenças crónicas estão em situação de vulnerabilidade e exclusão, demonstram dificuldades em lidar com as suas perceções e sentimentos, o que mostra a importância de integrar o irmão no processo de enfermagem.

Background: The daily family life of a child with chronic disease changes according to the illness’s demands. The siblings of these children may receive less attention from both parents, as well as from the rest of the family, who may focus more on the sick child and not in a similar way on the healthy sibling. Objectives: To compile perceptions of siblings of children hospitalized due to chronic disease. Methodology: Siblings of children diagnosed with chronic diseases, aged between 8 and 16 years, participated in the study. We used open interviews, recording, transcribing, and submitting them to analysis. Results: We were able to interview only four siblings. In the interviews’ analysis, four categories of results (Coping with the sibling’s disease; Family restructuring, Experiences resulting from the sibling’s hospitalization; and Experiences of exclusion) emerged. Conclusion: The siblings of children with chronic diseases live in a situation of vulnerability and exclusion, demonstrate difficulties in dealing with their perceptions and feelings, which proves it is essential to involve the sibling in the nursing process.

Marco contextual: La vida diaria familiar de un niño con enfermedad crónica se modifica de acuerdo con las necesidades recurrentes de la enfermedad. Los hermanos de dichos niños pueden recibir menos atención, tanto por parte de los padres como del resto de la familia, quien puede mostrar más interés por el menor enfermo y no tanto por el hermano considerado sano. Objetivos: Recopilar las percepciones de los hermanos de niños hospitalizados por enfermedad crónica. Metodología: Participaron en el estudio hermanos de niños diagnosticados con una enfermedad crónica, con edades comprendidas entre los 8 y los 16 años. Se utilizaron entrevistas abiertas, que se grabaron, transcribieron y sometieron a análisis. Resultados: Solo se pudo entrevistar a 4 hermanos. En el análisis de las entrevistas, surgieron 4 categorías de resultados (Afrontamiento de la enfermedad del hermano; Restructuración familiar; Experiencias a partir de la hospitalización del hermano; y Experiencias de exclusión). Conclusión: Los hermanos de los niños con enfermedades crónicas están en una situación de vulnerabilidad y exclusión, y demostraron dificultades al lidiar con sus percepciones y sentimientos, lo que muestra la importancia de integrar al hermano en el proceso de enfermería.

Knowledge of pregnant adolescents about human papillomavirus / Conhecimento de adolescentes gestantes sobre o papilomavírus humano

Abstract Objective To evaluate the level of information possessed by pregnant adolescents regarding the human papillomavirus (HPV). Methods Descriptive study developed in the adolescent prenatal outpatient clinic of a tertiary hospital fromthe state of São Paulo, Brazil. Data were collected between June and December 2017 following approval from the ethics and research committee (CAAE: 1.887.892/2017). Pregnant adolescents, ≤18 years old, who attended the abovementioned outpatient section, composed the sample. Those diagnosed with a psychiatric disorder and those with hearing or cognitive disabilities were excluded. After acceptance to participate in the present study, the pregnant adolescents signed an Informed Consent Form. Regarding the statistical analysis, the chi-squared test and the Fisher exact test were used. Results Regarding the knowledge about HPV, 123 (80.92%) of the participants had already heard about the subject; for 77 (50.66%), their schools had been the source of the information; 101 (66.45%) did not know how they could be infected by the virus. Age variation did not influence their knowledge on how to prevent themselves from HPV (p = 0.2562). The variable vaccine is associated with HPV prevention (p < 0.0001). Conclusion The pregnant adolescents composing the sample have shown to have knowledge about HPV. However, they do not prevent themselves from it appropriately, given that little more than half of the sample was vaccinated, had not reported an understanding that the use of preservatives and vaccination are effective means of prevention, and did not correlate HPV with uterine cervical cancer.

Resumo Objetivo Avaliar o nível de informação que as adolescentes gestantes possuem em relação ao papilomavírus humano (HPV). Métodos Estudo descritivo desenvolvido no ambulatório pré-natal adolescente de um hospital terciário do estado de São Paulo, Brasil. Os dados foram coletados entre junho e dezembro de 2017, após a aprovação do comitê de ética e pesquisa (CAAE: 1.887.892/2017). A amostra foi composta por adolescentes gestantes com ≤18 anos que frequentaram o ambulatório. Foram excluídas as com transtorno psiquiátrico diagnosticado e as portadoras de deficiência auditiva ou de cognição. Após aceitarem participar do presente estudo, as adolescentes grávidas assinaram o termo de assentimento e consentimento livre e esclarecido. Para as análises estatísticas, foramutilizados os testes de qui-quadrado e exato de Fisher. Resultados Em relação ao conhecimento sobre o HPV, 123 (80,92%) já tinham ouvido falar sobre o assunto; destas adolescentes, 77 (50,66%) receberam as informações que tinham através de suas escolas, e 101 (66,45%) pacientes não sabiam como poderiam contrair o vírus. A variação da idade das adolescentes entrevistadas não influenciou se estas sabiam ou não como se prevenir contra o HPV (p = 0,2562). A variável vacina está associada à prevenção contra o HPV (p < 0,0001). Conclusão As gestantes avaliadas possuem conhecimento sobre o HPV, mas não fazem a prevenção adequada, visto que um pouco mais da metade se vacinaram, não relataram o preservativo e a vacina como métodos eficazes de prevenção, e não relacionaram o HPV com o câncer de colo de útero.