Description of the use of integrative mixed method in neonatal nursing.

To describe the application of the integrative mixed method and its steps. Descriptive methodological study. The integrative mixed method approach was exemplified in a study conducted in neonatal nursing on maternal stress throughout the experience of premature newborns' care. Data on maternal stress level (quantitative approach) and maternal perception of care (qualitative approach) were grouped after analyzes made separately according to the analysis technique of each approach. Subsequently, quantitative and qualitative data were integrated, which originated a new set of data to be interpreted, and consequently enabled a greater understanding of the phenomenon under study and emphasized the importance of the integrative mixed method. The integration of the two approaches, qualitative and quantitative, is a denser theoretical framework with strong scientific evidence for a better understanding of the phenomenon under study than the use of a single approach, since, at the same time, it identifies the frequency of the phenomenon and the reason for its occurrence.

Chronic disease in childhood and adolescence: continuity of care in the Health Care Network.

OBJECTIVE: To evaluate the continuity of care for children and adolescents with chronic diseases in the health care network. METHODS: This qualitative study was conducted between February and October 2013 with 12 families, six health managers, and 14 health professionals from different health care services in a municipality of the state of Paraíba, Brazil, using focal groups, semi-structured interviews, and medical record consultation. The data were analyzed by triangulation and thematic analysis. RESULTS: Two categories were created: "health care management" and "(dis)continuity of care." We found gaps in the system, including poor data recording aimed to facilitate follow-up and guide the planning actions as well as sporadic and discoordinate services with a limited flow of information, which hinders follow-up over time. CONCLUSION: Continuity of care in the health care network is limited and creates the need to develop strategies to improve these services. OBJETIVO: Analisar a continuidade do cuidado à criança/adolescente com doença crônica na rede de atenção à saúde. MÉTODO: Pesquisa qualitativa realizada entre fevereiro e outubro de 2013 com 12 familiares, seis gestores e 14 profissionais de saúde de diferentes serviços da rede de saúde de um município da Paraíba através das técnicas de grupo focal, entrevista semiestruturada e consulta a prontuários. A triangulação dos dados e a análise temática subsidiaram a interpretação dos dados. RESULTADOS: Foram construídas duas categorias: "Gestão da atenção à saúde" e "(Des)continuidade do cuidado". Constataram-se lacunas como a ausência de cadastro para favorecer o acompanhamento e nortear o planejamento de ações; atendimento pontual e desarticulado entre os serviços com fragilidade no fluxo de informações, que obstaculizam o seguimento ao longo do tempo. CONCLUSÃO: A continuidade do cuidado na rede de atenção à saúde está fragilizada e há necessidade do desenvolvimento de estratégias que a favoreçam.

Weaknesses in the continuity of care for preterm infants discharged from the neonatal unit.

OBJECTIVE: To identify weaknesses in the continuity of care for preterm infants discharged from a neonatal unit, based on the perspective of professionals in the family health strategy. METHOD: Qualitative research, carried out with 16 professionals from four health regions in a capital city in the center-west of Brazil. Data collection took place from October to December 2020, through semi-structured, individual, and in-person interviews. Data underwent content analysis, supported by the concept of continuity of care. RESULTS: The analysis consisted of three categories: Challenges for care in the unit and referral to specialized services; weak interactions between the preterm baby's family and health professionals; Information: essential aspect for the connection between health professionals and the family of the preterm newborn. CONCLUSION: Health services are shown to be fragile in terms of the dimensions of continuity of care, contributing to the discontinuity of care for preterm children.

Elective pediatric surgery: profile description of children and late referral identification.

Pediatric surgery receives great demand for referrals from primary care services in order to evaluate the need for surgical intervention. However access to this specialized evaluation and in intervention does not always occur at the appropriate time. This study aims to characterize the profile of pediatric patients electively operated in the western Paraná state region, between 2018 and 2020, and identify those who were lately referred to surgical evaluation. This is a descriptive, cross-sectional and retrospective study through the review of electronic medical records. The variables evaluated were sociodemographic data, information on underlying diseases, referral data, specialist assessment and surgical procedure. During this period, 410 patients underwent an elective surgical procedure, of which 289 were included in the research. The sample was predominantly male (72.3%) with a mean age of 57.9 months at the surgeons assessment and 59 months at the date of surgery. Most of the patients came from primary care (75%) and the most common pathology was inguinal hernia (39.1%). The mean time interval between referral through primary care and surgery was 4.98 months, and between the surgeons assessment and surgery was 1.21 months. Of the total sample, 77 (26.6%) patients were identified as being referred late for the surgical procedure. Knowing the profile of patients and the problems experienced in this region in relation to the care provided in pediatric surgery provides subsidies to propose improvement strategies not only for the health system in this location, but for several inner regions of Brazil in a similar situation.

Hospital discharge intervention developed in a dialogical way with families to prepare them to care for children with chronic diseases at home: Mixed methods study.

A convergent parallel mixed methods design with qualitative data collection embedded in a quasi-experimental study was developed to examine the potential of three modalities of preparation for hospital discharge of the families of children with chronic diseases in terms of uncertainty levels and management of the disease at home. Caregivers of these children were divided into three groups: two experimental groups and one control group. Two scales were applied: one measured family management, and the other evaluated uncertainties in relation to the disease. In addition, an in-depth interview was conducted. Wilcoxon's test and the integrated response index were used in data analysis to compare performance between the groups. Inductive thematic analysis was employed for the qualitative data. The data were integrated, comparing the groups before and after preparation for hospital discharge. Twenty-five family caregivers completed this study. Data integration showed that the intervention group, in which the families developed planning to prepare for discharge in a dialogical way with professionals, presented better perceptions regarding care management when compared to structured guide and usual care groups. Participation of families in planning for hospital discharge showed a reduction in uncertainties regarding the disease and better care management of children at home.

Body mass index and abdominal waist values are related to increased cardiometabolic risk in schoolchildren aged five to ten years.

OBJECTIVE: To evaluate the frequency of obesity and cardiometabolic risk in schoolchildren under ten years old. METHODS: This is a cross-sectional study with schoolchildren (n=639) aged five to ten years in a municipally of southern of Brazil. The cardiometabolic risk was calculated from values of body mass index (BMI), waist circumference (WC), diastolic (DBP) and systolic blood pressure (SBP), blood glucose levels, triglycerides and total cholesterol (TC). Odds ratio (OR), Spearman correlation and principal component analysis (PCA) were analyzed. RESULTS: Independent of sex, elevated WC and BMI were related to higher values of SBP, DBP, and TC in schoolchildren. The frequency of cardiometabolic risk was 6.0% in girls and 9.9% in boys. Schoolchildren with elevated values of SBP, triglycerides and TC presented high OR for cardiometabolic risk. PCA indicated that schoolchildren with high WC (p>80) presented more frequently altered glucose levels, triglycerides, and TC. CONCLUSIONS: Obesity, especially when associated with elevated WC, is related to metabolic dysfunctions and cardiometabolic risk in schoolchildren under ten years of age. These findings indicate the urgency of stablishing metabolic risk for this age group, enabling early diagnosis and adequate treatment, to prevent the development of diabetes and cardiovascular dysfunction throughout life.

Association between duration of exclusive breastfeeding and nursing mothers' self-efficacy for breastfeeding.

OBJECTIVE: To verify the association of nursing mothers' self-efficacy for breastfeeding in the immediate postpartum period and six months after birth and obstetric and sociodemographic variables with the duration of exclusive breastfeeding. METHOD: Observational, longitudinal, prospective study which followed nursing mothers from the immediate postpartum period to the sixth month postpartum in a municipality in Southern Brazil. For data collection, a questionnaire with sociodemographic and obstetric variables and the scale Breastfeeding Self-Efficacy Scale - short form - were employed in the maternity ward and six months after birth. Inferential and descriptive statistics were employed. RESULTS: A total of 158 nursing mothers have participated. The prevalence of exclusive breastfeeding in the sixth month was 36.70%, out of which 77.34% have presented a high self-efficacy score. Sociodemographic factors had a negative impact on exclusive breastfeeding. CONCLUSION: High levels of self-efficacy favor exclusive breastfeeding; however, such factor, in isolation, is not decisive for exclusive breastfeeding. Self-efficacy should be identified during the pre-natal period through mothers' employment and marital status data to promote preventive actions against early weaning.

Biochemical predictors for metabolic syndrome in preterm infants according to weight ratio.

OBJECTIVE: Prematurity and low birth weight predispose preterm infants to cardiovascular disease in later life. Is the metabolic profile of these children impacted by the relation between birth weight and gestational age (GA)? This study aimed to evaluate whether the relationship between birth weight and GA of preterm infants has a positive correlation with the metabolic profile from birth to the sixth month of corrected age. METHODS: This is a longitudinal, prospective study with a cohort of 70 preterm and 54 term infants, who were enrolled in the study and shared into two groups: Appropriate for GA (AGA) and Small for GA (SGA), both classified at birth by Fenton and Kim curves. Longitudinal evaluation of anthropometry measures and blood samples of total cholesterol, glucose, triglycerides, and insulin were collected at birth, NICU discharge, and the sixth month of corrected age. Data were analyzed using descriptive and inferential statistical analysis (ANOVA, Fisher test, Shapiro-Wilk, and Cochran test). The effect size was 0.15, power was 0.92, and confidence interval 95%. RESULTS: No significant statistical differences were observed in relation to biochemical tests between AGA and SGA groups. However, a significant increase in triglyceride results above the reference values for age in the SGA group was observed throughout the follow-up. CONCLUSION: Changes observed in the preterm infant metabolic profile show no correlation with adequacy of birth weight. Preterm lipid profile requires continuous evaluation at follow-up, due to the increased cardiovascular risk in later life.

Hypertension and maternal urinary tract infection and the metabolic conditions of preterm infants.

OBJECTIVE: The present study evaluated the anthropometric and metabolic profiles of preterm infants (PT) born from mothers with urinary tract infections (UTI) and mothers with hypertensive disorders (HD). METHOD: This was a longitudinal prospective study conducted between May 2015 and August 2016. First, 59 mothers with premature birth were included; after excluding 29 mothers, two subgroups were created: UTI-mothers (n=12) and HD-mothers (n=18). The anthropometric and metabolic variables of mothers and their respective PT were analyzed at birth and at 6 months of corrected age (CA). RESULTS: Plasma triglyceride levels were higher among HD-mothers and their respective PT in comparison with UTI-mothers and their PT at 6 m of CA. CONCLUSION: Plasma triglyceride level is an important metabolic biomarker in HD-mothers resulting in higher triglyceride levels among PT at the CA of 6 m, suggesting an early programming effect of maternal hypertension.

Weaknesses in the continuity of care for preterm infants discharged from the neonatal unit / Debilidades en la continuidad de la atención a los recién nacidos prematuros egresados de la unidad neonatal / Fragilidades para a continuidade do cuidado ao pré-termo egressoda unidade neonatal

ABSTRACT Objective: To identify weaknesses in the continuity of care for preterm infants discharged from a neonatal unit, based on the perspective of professionals in the family health strategy. Method: Qualitative research, carried out with 16 professionals from four health regions in a capital city in the center-west of Brazil. Data collection took place from October to December 2020, through semi-structured, individual, and in-person interviews. Data underwent content analysis, supported by the concept of continuity of care. Results: The analysis consisted of three categories: Challenges for care in the unit and referral to specialized services; weak interactions between the preterm baby's family and health professionals; Information: essential aspect for the connection between health professionals and the family of the preterm newborn. Conclusion: Health services are shown to be fragile in terms of the dimensions of continuity of care, contributing to the discontinuity of care for preterm children.

RESUMEN Objetivo: Identificar debilidades en la continuidad de la atención al recién nacido prematuro egresado de una unidad neonatal, desde la perspectiva de los profesionales de la estrategia de salud de la familia. Método: Investigación cualitativa, realizada con 16 profesionales de cuatro regiones sanitarias de una capital del centro-oeste de Brasil. La recolección de datos se realizó de octubre a diciembre de 2020, mediante entrevistas semiestructuradas, individuales y presenciales. Los datos fueron sometidos a análisis de contenido, sustentado en el concepto de continuidad de la atención. Resultados: Tres categorías comprendieron el análisis: Desafíos para la atención en la unidad y derivación a servicios especializados; Interacciones débiles entre la familia del bebé prematuro y los profesionales de la salud; Información: aspecto esencial para la vinculación entre los profesionales de la salud y la familia del recién nacido prematuro. Conclusión: Los servicios de salud son frágiles en términos de continuidad de la atención, lo que contribuye a la discontinuidad de la atención a los niños nacidos prematuros.

RESUMO Objetivo: Identificar as fragilidades para a continuidade do cuidado ao pré-termo egresso de unidade neonatal, a partir da perspectiva de profissionais da estratégia saúde da família. Método: Pesquisa qualitativa, realizada junto a 16 profissionais de quatro regionais de saúde de uma capital do centro-oeste do Brasil. A coleta dos dados ocorreu nos meses de outubro a dezembro de 2020, por meio de entrevistas semiestruturadas, individuais e presenciais. Os dados foram submetidos à analise de conteúdo, sustentada pelo conceito da continuidade do cuidado. Resultados: Três categorias compuseram a análise: Desafios para o atendimento na unidade e para o encaminhamento aos serviços especializados; Interações frágeis entre família do pré-termo e profissionais de saúde; Informação: aspecto essencial para a conexão entre profissionais de saúde e família do recém-nascido pré-termo. Conclusão: Os serviços de saúde mostram-se frágeis quanto às dimensões da continuidade do cuidado colaborando para a descontinuidade da atenção à criança nascida pré-termo.

Glycemia and Lipidemia in Term Newborns Correlate With Maternal Metabolism.

The present study characterized the plasma glycemic and lipid profiles in full-term newborn babies at birth and correlated these variables with growth markers and maternal clinical and metabolic conditions, to observe if maternal pregnancy conditions can influence metabolic programming in these newborn babies. Anthropometric and biochemical data were collected from 162 mother/newborn binomials at birth and at 6 months at a public hospital in Western Paraná State, Brazil. Samples of blood tests for glucose, insulin, total cholesterol, and triglycerides were obtained. Two classes of mothers/babies were statistically defined. The glycemic profiles in Class 1, at birth, were 63.0 ± 19.6 mg/dL and at 6 months 80.4 ± 10.6 mg/dL; in Class 2, at birth, they were 66.1 ± 20.8 mg/dL and at 6 months 78.2 ± 9.4 mg/dL. The triglycerides levels in Class 1 and Class 2, at birth, were 124.5 ± 47.8 mg/dL and 132.6 ± 60.2 mg/dL, respectively, and at 6 months they were 139.0 ± 51.5 mg/dL and 115.2 ± 39.9 mg/dL, respectively. Even though most of the pregnant women were overweight at the end of the gestation period, the anthropometric patterns found for babies followed the desirable standards. Furthermore, the average glycemic profile values were between the cutoff standards at birth and at 6 months; however, the triglycerides were above the expected values.

Perfil sociodemográfico e clínico-obstétrico de gestantes com diagnóstico de COVID-19 e desfecho após nascimento / Sociodemographic and clinical-obstetric profile of pregnant women diagnosed with COVID-19 and outcome after birth

Descrever o perfil sociodemográfico e clínico-obstétrico de gestantes com diagnóstico de COVID-19, bem como o desfecho, após o nascimento, das gestantes e dos recém nascidos atendidos no Hospital Universitário do Oeste do Paraná. Pesquisa quantitativa, descritiva, documental, retrospectiva. Coleta de dados realizada por roteiro estruturado, com base em prontuários de gestantes atendidas na instituição do estudo. As variáveis foram sobre características sociodemográficas, clínico-obstétricas, complicações, puerpério e dados do recém-nascido. Os dados foram analisados mediante análise descritiva simples. As mulheres estavam, principalmente, na faixa etária de 20 a 39 anos, assintomáticas, diagnosticadas com COVID-19 na admissão, idade gestacional a termo, prevalência de cesárea; dentre as complicações, a respiratória foi maior. Das causas de internação dos recém-nascidos em unidade de tratamento intensivo, preponderaram prematuridade e desconforto respiratório. Recomenda-se ampla imunização da população materna para prevenção de complicações e consequente redução das taxas de morbimortalidade por essa doença.

To describe the sociodemographic and clinical-obstetric profile of pregnant women diagnosed with COVID-19, as well as the outcome, after birth, of pregnant women and newborns-seen at the University Hospital of the West of Paraná. A quantitative, descriptive, documentary, retrospective research. Data collection was performed by a structured script, based on medical records of pregnant women seen at the study institution. The variables concerned sociodemographic and clinical-obstetric characteristics, complications, puerperium and newborn data. The data were analyzed using a simple descriptive analysis. Thewomen were mainly in the age group of 20 to 39 years, asymptomatic, diagnosed with COVID-19at admission, gestational age at term, and prevalence of cesarean section; among the complications, respiratory was the highest one. Of the causes of hospitalization of newborns in an intensive care unit, prematurity and respiratory discomfort deserved highlight. It is recommended that widespread immunization of the maternal population is recommended to prevent complications and a consequent reduction of morbidity and mortality rates due to this disease.

Elective pediatric surgery: profile description of children and late referral identification / Cirurgia pediátrica eletiva: caracterização do perfil das crianças e identificação dos encaminhamentos em atraso

ABSTRACT Pediatric surgery receives great demand for referrals from primary care services in order to evaluate the need for surgical intervention. However access to this specialized evaluation and in intervention does not always occur at the appropriate time. This study aims to characterize the profile of pediatric patients electively operated in the western Paraná state region, between 2018 and 2020, and identify those who were lately referred to surgical evaluation. This is a descriptive, cross-sectional and retrospective study through the review of electronic medical records. The variables evaluated were sociodemographic data, information on underlying diseases, referral data, specialist assessment and surgical procedure. During this period, 410 patients underwent an elective surgical procedure, of which 289 were included in the research. The sample was predominantly male (72.3%) with a mean age of 57.9 months at the surgeons assessment and 59 months at the date of surgery. Most of the patients came from primary care (75%) and the most common pathology was inguinal hernia (39.1%). The mean time interval between referral through primary care and surgery was 4.98 months, and between the surgeons assessment and surgery was 1.21 months. Of the total sample, 77 (26.6%) patients were identified as being referred late for the surgical procedure. Knowing the profile of patients and the problems experienced in this region in relation to the care provided in pediatric surgery provides subsidies to propose improvement strategies not only for the health system in this location, but for several inner regions of Brazil in a similar situation.

RESUMO Introdução: a cirurgia pediátrica representa especialidade com demanda significativa de encaminhamentos dos serviços de atenção primária para avaliação da necessidade de intervenção cirúrgica. Contudo, nem sempre o acesso a essa intervenção ocorre no momento adequado. Nesse sentido, objetivou-se caracterizar o perfil dos pacientes pediátricos operados eletivamente, no recorte temporal 2018-2020, e identificar pacientes que foram encaminhados em atraso para a avaliação com o cirurgião. Métodos: Estudo descritivo, transversal e retrospectivo mediante a revisão de prontuários eletrônicos. As variáveis avaliadas foram dados sociodemograficos, informações das doenças de base, dados do encaminhamento, da avaliação do especialista e do procedimento cirúrgico. Resultados: neste período 410 pacientes foram submetidos a procedimento cirúrgico eletivo, dos quais 289 foram incluídos na pesquisa. O sexo masculino (72,3%%) foi predominante, com idade média de 57,9 meses na avaliação pelo cirurgião e 59 meses na data da cirurgia. A procedência dos pacientes foi na maioria da atenção básica (75%) e a patologia mais incidente foi a hérnia inguinal (39,1%). O intervalo de tempo médio entre o encaminhamento pela atenção primária até a realização da cirurgia foi 4,98 meses e entre a avaliação pelo cirurgião e a realização da cirurgia foi 1,21 meses. Do total, 77 (26,6%) pacientes foram identificados como encaminhados em atraso para a realização do procedimento cirúrgico. Conclusão: conhecer o perfil dos pacientes e os problemas vivenciados nesta região em relação aos atendimentos prestados na cirurgia pediátrica apresenta subsídios para propor estratégias de melhoria não só do sistema de saúde local, mas de diversas regiões interioranas do Brasil em situação semelhante. .

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.

Clinical application of the Standard Operating Procedure of Positioning with Premature Infants.

OBJECTIVE: To compare the physiological and behavioral responses of Premature Infant (PREEMIE) positioned by the Unit Routine Decubitus (URD) and the Standard Operating Procedure (SOP). METHOD: A quasi-experimental comparative study performed at a Neonatal Intensive Care Unit in Southern Brazil. We evaluated 30 PREEMIEs with gestational age ≤32 weeks, randomly assigned to Unit Routine Decubitus (URD) and Intervention Group (IG), subdivided into Right Lateral Decubitus (RLD), Dorsal Decubitus (DD), Left Lateral Decubitus (LLD) and Ventral Decubitus (VD). It was evaluated before, during and after the procedure: Heart Rate (HR); Respiratory Frequency (RF); Peripheral Oxygen Saturation (SpO2); behavior by the Neonatal Behavioral Assessment Scale (NBAS); by NIPS. RESULTS: During the intervention, RR (p = 0.023), indexes in NBAS (p = 0.01) and NIPS (p <0.0001) reduced significantly in SOP. HR and SpO2 did not present a significant difference. CONCLUSION: Positioning according to the SOP shows benefit in relation to the behavioral and physiological status of PREEMIE.

Autoeficácia materna para o cuidado de recém-nascido prematuro e da manutenção do aleitamento / Maternal self-efficacy for premature newborn care and breastfeeding maintenance / Autoeficacia materna en la atención al recién nacido prematuro y del mantenimiento de la lactancia materna

RESUMO Objetivo: avaliar a autoeficácia materna para o cuidado de recém-nascido prematuro na unidade de terapia intensiva neonatal e após a alta hospitalar, e relacionar com a duração do aleitamento materno em casa. Método: estudo longitudinal que empregou escalas de avaliação da autoeficácia de 38 mães de nascidos prematuros no período de novembro de 2020 a janeiro de 2022 na cidade de Cascavel - PR - Brasil. Dados analisados por estatística descritiva e inferencial. Resultados: A autoeficácia materna durante hospitalização mostrou-se elevada, mantendo-se assim na avaliação após alta. A autoeficácia para a prática do aleitamento materno não teve diferenças estatísticas significativas no período da hospitalização (p=0,335) e nem no pós-alta (p=0,640). Contudo, mães com elevada autoeficácia na hospitalização e em casa, mantiveram o aleitamento materno exclusivo por mais tempo. Conclusão: Identificar a autoeficácia materna deve ser uma rotina na prática clínica de enfermagem na hospitalização e após a alta, para potencializar a manutenção do aleitamento materno exclusivo.

ABSTRACT Objective: to assess maternal self-efficacy for the care of premature newborns in the neonatal intensive care unit and after hospital discharge and relate it to the duration of breastfeeding at home. Method: longitudinal study that used self-efficacy assessment scales of 38 mothers of premature newborns in the period from November 2020 to January 2022 in the city of Cascavel - PR - Brazil. Data analyzed by descriptive and inferential statistics. Results: Maternal self-efficacy during hospitalization turned out to be high, remaining so in the assessment after discharge. Self-efficacy for breastfeeding had no statistically significant differences during hospitalization (p=0.335) and after discharge (p=0.640). However, mothers with high self-efficacy in hospitalization and at home maintained exclusive breastfeeding longer. Conclusion: Identifying maternal self-efficacy should be a routine in nursing clinical practice during hospitalization and after discharge, to enhance the maintenance of exclusive breastfeeding.

RESUMEN Objetivo: evaluar la autoeficacia materna para el cuidado de recién nacidos prematuros en la unidad de cuidados intensivos neonatales y después del alta hospitalaria, y relacionarla con la duración de la lactancia materna en el hogar. Método: estudio longitudinal que empleó escalas de evaluación de autoeficacia de 38 madres de recién nacidos prematuros en el período de noviembre de 2020 a enero de 2022 en la ciudad de Cascavel - PR - Brasil. Los datos fueron analizados por estadística descriptiva e inferencial. Resultados: La autoeficacia materna durante la hospitalización mostró ser elevada, y se mantuvo, así, en la evaluación tras el alta. La autoeficacia para la lactancia no presentó diferencias estadísticamente significativas durante la hospitalización (p=0,335) ni tras el alta (p=0,640). Sin embargo, las madres con alta autoeficacia en la hospitalización y en el hogar mantuvieron la lactancia materna exclusiva durante más tiempo. Conclusión: Identificar la autoeficacia materna debe ser una rutina en la práctica clínica de la enfermería en la hospitalización y seguimiento post alta, para potencializar el mantenimiento de la lactancia materno exclusivo.

Apoio social e estratégias para promoção do aleitamento materno segundo profissionais de saúde / Apoyo social y estrategias para la promoción de la lactancia materna según profesionales de la salud / Social support and strategies for breastfeeding promotion according to health professionals

RESUMO Objetivo: Conhecer as estratégias utilizadas pelos profissionais de saúde para promoção do aleitamento materno exclusivo bem como sua percepção sobre o apoio recebido pelas mulheres. Método: Estudo qualitativo realizado com 28 profissionais de saúde que atuam em unidades de saúde da família no Oeste do Paraná. Os dados foram coletados por meio de entrevistas semiestruturadas, no período de setembro de 2018 a novembro de 2019. A análise foi de conteúdo, modalidade temática. Resultados: Os profissionais de saúde se autodeclararam a principal fonte de apoio à mulher no período do aleitamento materno, sendo que seis deles indicam a família como uma fonte de apoio complementar nesse processo e a mencionam como principal estratégia para proteção, promoção e manutenção do aleitamento materno, a educação em saúde. Considerações finais: Os profissionais percebem-se como o principal suporte das mulheres para a amamentação. Citam como estratégias utilizadas a educação em saúde e as orientações durante os atendimentos.

RESUMEN Objetivo: conocer las estrategias utilizadas por los profesionales de salud para la promoción de la lactancia materna exclusiva, así como su percepción sobre el apoyo recibido por las mujeres. Método: estudio cualitativo realizado con 28 profesionales de salud que actúan en unidades de salud de la familia en el Oeste del Paraná-Brasil. Los datos fueron recolectados a través de entrevistas semiestructuradas, entre septiembre de 2018 y noviembre de 2019. El análisis fue de contenido, modalidad temática. Resultados: los profesionales de salud se auto declararon la principal fuente de apoyo a la mujer en el período de lactancia materna, siendo que seis de ellos indican la familia como una fuente de apoyo complementaria en ese proceso y mencionan la educación en salud como principal estrategia para protección, promoción y el mantenimiento de la lactancia materna. Consideraciones finales: los profesionales se perciben como el principal soporte de las mujeres para la lactancia. Relatan como estrategias utilizadas la educación en salud y las orientaciones durante las atenciones.

ABSTRACT Objective: To know the strategies used by health professionals to promote exclusive breastfeeding as well as their perception of the support received by women. Method: This is a qualitative study carried out with 28 health professionals who work in family health units in western Paraná. Data were collected through semi-structured interviews, from September 2018 to November 2019. Analysis was based on thematic content modality. Results: Health professionals declared themselves to be the main source of support for women during the breastfeeding period, six of them indicate the family as a complementary source of support in this process and mentioned health education as the main strategy for breastfeeding protection, promotion and maintenance. Final considerations: Professionals perceive themselves as the main support of women for breastfeeding. They cite health education and guidance during consultations as strategies used.

Body mass index and abdominal waist values are related to increased cardiometabolic risk in schoolchildren aged five to ten years / Valores do índice de massa corpórea e circunferência abdominal estão relacionados a elevado risco cardiometabólico em escolares com idade de cinco a dez anos

ABSTRACT Objective: To evaluate the frequency of obesity and cardiometabolic risk in schoolchildren under ten years old. Methods: This is a cross-sectional study with schoolchildren (n=639) aged five to ten years in a municipally of southern of Brazil. The cardiometabolic risk was calculated from values of body mass index (BMI), waist circumference (WC), diastolic (DBP) and systolic blood pressure (SBP), blood glucose levels, triglycerides and total cholesterol (TC). Odds ratio (OR), Spearman correlation and principal component analysis (PCA) were analyzed. Results: Independent of sex, elevated WC and BMI were related to higher values of SBP, DBP, and TC in schoolchildren. The frequency of cardiometabolic risk was 6.0% in girls and 9.9% in boys. Schoolchildren with elevated values of SBP, triglycerides and TC presented high OR for cardiometabolic risk. PCA indicated that schoolchildren with high WC (p>80) presented more frequently altered glucose levels, triglycerides, and TC. Conclusions: Obesity, especially when associated with elevated WC, is related to metabolic dysfunctions and cardiometabolic risk in schoolchildren under ten years of age. These findings indicate the urgency of stablishing metabolic risk for this age group, enabling early diagnosis and adequate treatment, to prevent the development of diabetes and cardiovascular dysfunction throughout life.

RESUMO Objetivo: Avaliar a frequência de obesidade e risco cardiometabólico em escolares menores de dez anos de idade. Métodos: Este é um estudo transversal com escolares (n=639) com idade de cinco a dez anos de um município do Sul do Brasil. O risco cardiometabólico foi calculado com base nos valores do índice de massa corpórea (IMC), circunferência da cintura (CC), pressão arterial sistólica (PAS) e diastólica (PAD), valores sanguíneos de glicose, triglicerídeos e colesterol total. Odds ratio (OR), correlação de Spearman e análise de componentes principais (PCA) foram obtidos. Resultados: Independentemente do sexo, CC e IMC aumentados foram relacionados com maiores valores de PAS, PAD e colesterol total. A frequência de risco cardiometabólico foi de 6,0% nas meninas e 9,9% nos meninos. Escolares com elevados valores de PAS, triglicerídeos e colesterol total tinham alto OR para risco cardiometabólico. A PCA mostrou que escolares com alta CC (p>80) apresentam mais frequentemente alterações nos níveis sanguíneos de glicose, triglicerídeos e colesterol total. Conclusões: A obesidade, especialmente quando associada a elevados valores de CC, está relacionada com disfunções metabólicas e risco cardiometabólico em escolares menores de dez anos de idade. Estes achados indicam a urgência de estabelecer o risco metabólico para essa faixa etária, possibilitando o diagnóstico precoce, o adequado tratamento para evitar o desenvolvimento de diabetes e disfunções cardiovasculares ao longo da vida.

Preparo para alta de crianças com doenças crônicas: olhar freiriano em aspectos influenciadores do cuidado no domicílio / Preparing for the discharge of children with chronic diseases from hospital: looking at aspects influencing home care through a Freirean lens / Preparación para alta de niños con enfermedades crónicas: mirada freiriana en aspectos que influyen en el cuidado a domicilio

Estudo qualitativo que analisou aspectos envolvidos no preparo para alta hospitalar de crianças com doenças crônicas que influenciam o cuidado no domicílio. Dados das entrevistas de 25 famílias foram interpretados segundo análise temática indutiva e referenciais freirianos. Identificaram-se aspectos do processo de hospitalização, como engajamento e postura dos profissionais no encontro com os familiares e atitude da família frente ao saber dos profissionais; da família, como tempo de diagnóstico da doença, conhecimento construído na hospitalização, literacia em saúde familiar, atitude para superar o medo inicial e envolvimento da criança no autocuidado; e da rede social familiar, que influenciaram a (re)moldagem do cuidado domiciliar. Compreende-se a necessidade de superar a visão bancária no preparo para alta hospitalar, para a família desenvolver seu potencial e transformar a realidade dos cuidados domiciliares dessas crianças.(AU)

This qualitative study analyzed aspects influencing home care involved in preparing for the discharge of children with chronic diseases from hospital. Data from interviews with 25 families were interpreted using inductive thematic analysis and a Freirean frame of reference. We identified aspects of the hospitalization process (staff engagement and posture with family members, family attitudes towards health professionals' knowledge) and the family (length of time to diagnosis, knowledge gained during hospitalization, family health literacy, attitudes to overcoming initial fear, and child involvement in self-care and his/her social network, which influence (re)shaping of home care). The findings reveal the need to overcome the "banking" vision in preparing for hospital discharge so that families can develop their potential and transform the reality of home care for these children.(AU)

Estudio cualitativo que analizó aspectos envueltos en la preparación para el alta hospitalaria de niños con enfermedades crónicas que influyen en el cuidado en el domicilio. Se interpretaron datos de las entrevistas con 25 familias según análisis temático inductivo y referenciales freirianos. Se identificaron los aspectos del proceso de hospitalización: el compromiso y la postura de los profesionales en el encuentro con los familiares y la actitud de la familia ante el saber de los profesionales; de la familia: tiempo de diagnóstico de la enfermedad, conocimiento construido en la hospitalización, alfabetización en salud familiar, actitud para superar el miedo inicial y el envolvimiento del niño en el autocuidado; así como de su red social que influyeron en el (re)moldeado del cuidado familiar. Se comprende la necesidad de superar la visión bancaria en la preparación para el alta hospitalaria, para que la familia desarrolle su potencial y transforme la realidad de los cuidados en domicilio de esos niños.(AU)

Fatores intervenientes nas crenças de capacidade de cuidado de pais de prematuros / Factores intervinientes en las creencias de capacidad de cuidado de padres de prematuros / Intervening factors in the care capacity beliefs of premature infants' parents

Resumo Objetivo Investigar a relação das crenças de pais de recém-nascidos prematuros em unidade de terapia intensiva neonatal, com variáveis sociodemográficas e clínicas, sobre sua capacidade de cuidado, utilizando-se a Escala de Crenças dos Pais. Métodos Estudo transversal com 97 pais e/ou mães de prematuros hospitalizados em Unidade de Terapia Intensiva Neonatal e Unidade de Cuidados Intermediários, de hospital universitário de médio porte, na região Oeste do Paraná. A coleta de dados ocorreu de outubro de 2015 a maio de 2016, utilizando-se a Escala de Crença dos Pais, validada para o Brasil, e instrumento sóciodemográfico e de variáveis clínicas do recém-nascido. A análise foi estatística descritiva e inferencial e avaliou a associação entre os escores da escala, por meio do teste de qui-quadrado para independência, com as variáveis categóricas sociodemográficas e clínicas. Resultados Responderam a escala 86 (88,7%) mães e 11 (11,3%) pais, sendo encontrada associação significativa para a idade dos outros filhos, além do prematuro, com as categorias da escala, e relação inversa para os escores da escala diante da renda familiar, idade e escolaridade materna, com associação estatística significativa para a renda familiar. Dentre os participantes, quanto a capacidade de cuidado, 35 pais e/ou mães foram identificados com suficiência, 49 pais e/ou mães com suficiência moderada e 13 pais e/ou mães com insuficiência moderada. Conclusão A escala apresentou adequada aplicação diante das crenças na capacidade de cuidado dos pais de prematuros, indicando os fatores sociodemográficos influentes. A maioria dos cuidadores demonstrou capacidade para o cuidado.

Resumen Objetivo Investigar la relación entre las creencias de padres de recién nacidos prematuros en Unidad de Cuidados Intensivos Neonatales y variables sociodemográficas y clínicas, respecto a su capacidad de cuidado, utilizando la Escala de Creencias de Padres. Métodos Estudio transversal con 97 padres o madres de prematuros hospitalizados en Unidad de Cuidados Intensivos Neonatales y Unidad de Cuidados Intermedios, de un hospital universitario de porte mediano, en la región oeste del estado de Paraná. La recopilación de datos se realizó de octubre de 2015 a mayo de 2016 y se utilizó la Escala de Creencias de Padres validada para Brasil y el instrumento sociodemográfico y de variables clínicas del recién nacido. El análisis fue estadístico descriptivo e inferencial y evaluó la relación entre la puntuación de la escala, mediante la prueba χ2 de Pearson para la independencia, y las variables categóricas sociodemográficas y clínicas. Resultados La escala fue respondida por 86 (88,7 %) madres y 11 (11,3 %) padres, donde se encontró relación significativa entre la edad de otros hijos, además del prematuro, y las categorías de la escala, y relación inversa entre la puntuación de la escala y los ingresos familiares, edad y escolaridad materna, con relación estadística significativa en los ingresos familiares. Respecto a la capacidad de cuidado, se identificaron entre los participantes 35 padres o madres con suficiencia, 49 padres o madres con suficiencia moderada y 13 padres o madres con insuficiencia moderada. Conclusión La escala presentó una aplicación adecuada ante las creencias de la capacidad de cuidado de los padres de prematuros y se indicaron los factores sociodemográficos influyentes. La mayoría de los cuidadores demostró tener capacidad para el cuidado.

Abstract Objective To investigate the relationship between the beliefs of parents of premature newborns in a neonatal intensive care unit with sociodemographic and clinical variables regarding their care capacity using the Parental Belief Scale. Methods Cross-sectional study of 97 fathers and/or mothers of preterm infants hospitalized in the Neonatal Intensive Care Unit and Intermediate Care Unit of a medium-sized university hospital in the western region of Paraná. The data collection period was between October 2015 and May 2016 using the Parental Belief Scale validated for Brazil, and a sociodemographic instrument and of newborns' clinical variables. Descriptive and inferential statistical analyzes were performed and the association between the scale scores was evaluated using the chi-square test for independence with sociodemographic and categorical clinical variables. Results The scale was answered by 86 (88.7%) mothers and 11 (11.3%) fathers. A significant association with the age of the other children in addition to the premature with categories of the scale was found. An inverse relationship for scores of the scale related to family income, maternal age and schooling was found, with a statistically significant association with family income. Regarding participants' care capacity, 35 fathers and/or mothers were identified with sufficiency, 49 fathers and/or mothers with moderate sufficiency and 13 fathers and/or mothers with moderate insufficiency. Conclusion The scale presented appropriate application in view of the beliefs in the care capacity of parents of preterm infants, indicating the influential sociodemographic factors. Most caregivers demonstrated care capacity.