Influence of COVID-19 on the notification of drug-resistant pulmonary tuberculosis cases.

BACKGROUND: To analyze the influence of the COVID-19 pandemic on the process of diagnosis and monitoring of drug-resistant pulmonary tuberculosis (TB) cases reported in the state of Paraná, Brazil, from 2015 to 2020. METHODS: Ecological study with quantitative approach. This study was based on diagnosed cases of pulmonary TB reported in the Notifiable Disease Information System in residents of Paraná; as well as through the number of confirmed cases of COVID-19 in the state epidemiological bulletin for the year 2020. The study data were analyzed using descriptive statistics. RESULTS: It was found that, although the number of reported pulmonary TB cases (drug-resistant and general) increased between 2015 and 2019, there was a drop in notification in 2020, the first year of the COVID-19 pandemic. The notification of TB cases was also influenced monthly during the year according to the increase in the number of COVID-19 cases. For cases of drug-resistant pulmonary TB, the provision of diagnostic tests and Directly Observed Treatment decreased by more than half in 2020, especially when compared to 2019. CONCLUSIONS: In view of these findings, the influence of COVID-19 on the diagnosis and monitoring of drug-resistant and general pulmonary TB cases is evident, showing that the pandemic has compromised the advances of recent decades in achieving the goals established for its eradication by 2035.

Skin injuries in newborns hospitalized in neonatal intensive care: a cross-sectional study.

OBJECTIVE: To analyze the skin injuries of hospitalized newborns and identify factors related to the number of lesions. METHOD: This was a cross-sectional epidemiological study carried out over a period of one year in a Neonatal Intensive Care Unit in the west of Paraná. The study included 74 newborns with a score ≥5 on the Newborn Skin Condition Scale. Data analysis by chi-square and Pearson's test (p < 0.05). RESULTS: The frequency was 25.4%, 59.4% had more than one lesion, mainly dermatitis and pressure injury. Birth characteristics were not related to the number of lesions. Not using antibiotics and parenteral nutrition, hemoglobin >11g/dl, phototherapy, pain score <4 and hospitalization >30 days were related to the number of lesions. The presence of two injuries led to longer healing time and three to longer hospitalization. A higher score on the Skin Condition Scale was related to healing time and late start of the diet. CONCLUSION: Skin injuries were found to be infrequent among newborns, but there is still a need to improve practices to prevent and maintain skin integrity.

Cross-cultural nursing care for immigrant women during pregnancy and childbirth: experiences and vulnerabilities.

OBJECTIVE: To understand the experiences and vulnerabilities for cross-cultural nursing care for immigrant women during pregnancy and delivery. METHOD: Exploratory, qualitative research, in the light of the Theory of Diversity and Universality of Cultural Care, in Foz do Iguaçu, Brazil, through interviews with eight postpartum woman and 18 nurses, between February and September 2022. The interpretation of meanings was adopted for analysis. RESULTS: The categories of analysis emerged: Experiences, vulnerabilities and acculturation of immigrant women during pregnancy and delivery; Cross-cultural care and vulnerabilities experienced by immigrants in Brazilian health services. Vulnerabilities were identified in Cultural and Social Structure Dimensions expressed in access to work, low socioeconomic conditions, lack of family and social support and specific services for this population. The potentialities experienced included good care provided by health services, quality of the multidisciplinary team and appreciation of professional knowledge, however, the understanding of expectations and cultural aspects needs to be deepened. FINAL CONSIDERATIONS: Understand that immigrant women experience situations of vulnerability in pregnancy and childbirth, in the Brazilian context, mainly related to social and programmatic dimensions. However, potentialities were also experienced, evidenced by positive aspects in cross-cultural nursing care in Brazil.

Safety, Efficacy, and Immunogenicity of Therapeutic Vaccines for Patients with High-Grade Cervical Intraepithelial Neoplasia (CIN 2/3) Associated with Human Papillomavirus: A Systematic Review.

Despite the knowledge that HPV is responsible for high-grade CIN and cervical cancer, little is known about the use of therapeutic vaccines as a treatment. We aimed to synthesize and critically evaluate the evidence from clinical trials on the safety, efficacy, and immunogenicity of therapeutic vaccines in the treatment of patients with high-grade CIN associated with HPV. A systematic review of clinical trials adhering to the PRISMA 2020 statement in MEDLINE/PubMed, Embase, CENTRAL Cochrane, Web of Science, Scopus, and LILACS was undertaken, with no data or language restrictions. Primary endpoints related to the safety, efficacy, and immunogenicity of these vaccines were assessed by reviewing the adverse/toxic effects associated with the therapeutic vaccine administration via histopathological regression of the lesion and/or regression of the lesion size and via viral clearance and through the immunological response of individuals who received treatment compared to those who did not or before and after receiving the vaccine, respectively. A total of 1184 studies were identified, and 16 met all the criteria. Overall, the therapeutic vaccines were heterogeneous regarding their formulation, dose, intervention protocol, and routes of administration, making a meta-analysis unfeasible. In most studies (n = 15), the vaccines were safe and well tolerated, with clinical efficacy regarding the lesions and histopathological regression or viral clearance. In addition, eleven studies showed favorable immunological responses against HPV, and seven studies showed a positive correlation between immunogenicity and the clinical response, indicating promising results that should be further investigated. In summary, therapeutic vaccines, although urgently needed to avoid progression of CIN 2/3 patients, still present sparse data, requiring greater investments in a well-designed phase III RCT.

Mental health of parents of children and adolescents who require special health care.

OBJECTIVE: To identify the manifestations presented by parents of children and adolescents who require special health attention that can impact their mental health. METHODS: exploratory, qualitative research, based on the concept of vulnerability, with data collection carried out through interviews with 18 parents of children and adolescents with special health care needs, hospitalized in the pediatric ward of a hospital in Paraná, between May/2017 and May/ 2018. Data analyzed by inductive thematic analysis. RESULTS: parents experienced situations of vulnerability when providing care at home, with repercussions on their mental health, expressed by manifestations of lack of protection, anxiety and depression. FINAL CONSIDERATIONS: It is important that health professionals seek to expand actions to promote care and reduce situations that generate threats, insecurities, concerns and damage to the health of parents, which can impact and further weaken care for children and adolescents who need attention especially health.

Risk Factors for Death among Hospitalized and Nonhospitalized Patients due to COVID-19 in a Triple International Border Municipality.

Introduction: The severity of COVID-19 in the general population ranges from minimally symptomatic disease to critical illness, which may require hospitalization and progress to death. Methods: A retrospective cohort study carried out with all positive cases of COVID-19 reported in the municipality of Foz do Iguaçu (PR) between the period from March 2020 to December 2021. Data were collected from Bank Notifies COVID-19 is the name of the information system that provides notifications by professionals of suspected and confirmed cases of the disease. Data were analyzed using descriptive statistical techniques and calculation of relative risk. Results: 24,647 confirmed cases were identified in the study; among these, 22,211 (90.1%) were not hospitalized and 2436 (9.9%) were hospitalized. Among the 2436 patients hospitalized for COVID-19, 947 (38.9%) died and 1489 (61.1%) recovered. Among the 22,211 outpatients, 93 (0.4%) died and 22,118 (99.6%) recovered. An association between death and the following characteristics was identified among the cases that were hospitalized: male gender, all age groups over 40 years, indigenous race/color, hospital staylength of more than 10 days,hospitalization in a Unified Health System (SUS) bed and in an Intensive Care Unit (ICU). According to the clinical characteristics of symptoms and comorbidities, the following prevailed:ities dyspnea, intercostal retraction, cyanosis, hypertension, diabetes, obesity, cardiovascular disease, smoking, lung disease, kidneydisease, neurological disease, neoplasia, and immunodeficiency. Among the cases that were not hospitalized, death was associated with: malegender, all age groups over 50 years, dyspnea, cyanosis, hypertension, diabetes, obesity, cardiovascular disease, kidney disease, neurological disease, neoplasia, and liver disease. Conclusions: Older adults, male, and Caucasian people are commonly affected by COVID-19 and can evolve with aggravation when they have modifiable risk factors such as obesity and smoking, as well as nonmodifiable risk factors such as: cardiovascular disease, neurological disease, renal, hypertension, diabetes, and immunosuppression.

Educational intervention about airway obstructions for early childhood teachers: a quasi-experimental study.

OBJECTIVE: To verify the effect of an educational intervention about airway obstructions and an airway clearing technique in teachers from Municipal Child Education Centers in a municipality in western Paraná. METHOD: A quasi-experimental pre- and post-test study. Data was collectedusing a questionnaire with thirty questions to assess knowledge about the subject. For the analyses, the chi-square and McNemar tests were used, withanα = 5% of significance. RESULTS: After the training sessions, there was a 16.22% increase in the number of correct answers to the questions dealing with the recognition of the obstruction (<0.0001) and the airway clearance technique (<0.0001). CONCLUSION: The intervention improved the knowledge of early childhood teachers in the municipality regarding the identification of airway obstruction and techniquesairway clearing in school-age children.

Therapeutic itinerary of children with special health care needs: analysis guided by care systems.

OBJECTIVE: To understand the therapeutic itinerary taken by families in search of attention to their child's special health care needs in a Brazilian border town. METHOD: Qualitative research based on dialectical hermeneutics and on the Health Care Systems model. Interviews and Talking Maps (Dynamics of Creativity and Sensitivity) were carried out with 19 caregivers of children with special health care needs, attended at care institutions in Foz do Iguaçu, Paraná, in 2020. For data analysis, thematic analysis was used. RESULTS: The fragilities of the Health Care System were highlighted, permeated by: difficulties in accessing the diagnosis and consultations; overload for care; (dis)organization of the care itinerary; and deconstruction of the bond, due to failures in communication and reception. Conclusion: The deconstruction of the therapeutic itinerary of children with special health care needs involved, above all, the professional context in the Health Care System, leading to the search for care in private services and in care institutions.

Risk areas for the occurrence of leprosy in border countries of South America - Brazil and Argentina.

OBJECTIVE: The aim was to analyze the spatial association and relative risk (RR) of leprosy cases diagnosed in southern Brazil and in the Argentinean province of Misiones during 2010 to 2016. METHODS: This ecological-type epidemiological study analyzed data from the Health Ministries of both countries. The analysis included frequency measures, spatial autocorrelation, RR cluster analysis and map construction. RESULTS: A hyperendemic occurrence was identified in all study regions, in the state of Paraná 71.2% of the municipalities were hyperendemic and in Misiones, Argentina 41.2%. The GI* statistical analysis showed clusters of high incidence rates in the state of Paraná and low-risk clusters in much of the state of Rio Grande do Sul, both in Brazil. The analysis indicated an area with RR equal to 3.87 - (p < .0001) when considering the entire territory and an RR of 2.80 - (p < .0001) excluding the state of Paraná, with the number of departments of Misiones, Argentina included in the risk clusters increasing significantly. CONCLUSIONS: The findings indicate a high probability of similar illness in adjacent areas, according to their relative position in space, as the occurrence of the disease is influenced by neighboring clusters.

Follow-up care for premature children: the repercussions of the COVID-19 pandemic.

OBJECTIVE: to analyze elements of the follow-up care provided to premature children amidst the COVID-19 pandemic. METHOD: qualitative study from the perspective of philosophical hermeneutics, interpreting experiences with childcare provided at home. Twelve mothers and 14 children aged two years old were interviewed online via a text messaging application. Data were analyzed by interpreting meanings. RESULTS: weaknesses stood out in the follow-up care provided to children such as gaps of communication, lack of guidance and delayed immunizations, while care intended to meet health demands was interrupted. Vulnerability aspects affecting child development included: social isolation measures that impeded the children from socializing with their peers, increased screen time, the manifestation of demanding behaviors and irritation and the mothers experiencing an overload of responsibilities. The elements that strengthened maternal care included the mothers being attentive to contagion, enjoying greater experience and satisfaction with the maternal role, spending more time with their children, and recognizing respiratory signs and symptoms, especially fever. CONCLUSION: follow-up care provided to children in stressful situations implies implementing practices that support the wellbeing of children and families, decreasing the likelihood of children being exposed to development deficits, and detecting signs and symptoms timely. The use of nursing call centers can break the invisibility of longitudinal needs and promote health education actions at home.

Factors related to duration of hospitalization and death in premature newborns.

OBJECTIVE: To analyze factors related to prolonged hospitalization and death in premature newborns in a border region. METHOD: Cross-sectional study, with retrospective data collection, which analyzed 951 medical records of premature newborns hospitalized between 2013 and 2017. The independent variables were maternal age, nationality, prenatal appointments, maternal intercurrences, gestational age, weight at birth, Apgar, complications; the dependent variables were days of hospitalization, discharge, death, and transference. The tests Pearson Chi-squared and Fisher's Exact were employed. RESULTS: Premature birth amounted to 10.3%; out of these, 43.3% were hospitalized. The prevalence of mortality was 21.3%. Few prenatal appointments, maternal intercurrences, low fifth minute Apgar, and the baby's health complications increased days of hospitalization. Lower weight and gestational age, low Apgar and complications with the baby increased death. CONCLUSION: Understanding hospitalization aspects enabled the identification of factors that lead to complications to the premature newborn, which are relevant to efforts to overcome unfavorable outcomes and face challenges posed by the sequels throughout life. The integration between countries and their borders is a notorious condition to accelerate care processes and promote better outcomes.

Information system on tuberculosis: data completeness spatial analysis in the state of Paraná, Brazil.

OBJECTIVE: To analyze the spatiality of completeness of the Information System on Diseases of Compulsory Declaration of tuberculosis in Paraná state, focusing on the border region. METHOD: A study composed by the notified cases of the disease treated in Paraná between 2008 and 2017. The variable completeness was classified as excellent (<5% of incompleteness), good (5 to <10%), regular (10 to <20%), poor (20% to 50%), and very poor (>50%). Moran global was used for the spatial correlation and local association was analyzed. Logistic regression was employed to assess the spatial association of the variables with the border and, for the significant variables, multiple logistic regression was used. The study abides by the resolution 510/2016 of the National Health Council. RESULTS: There was a "high-high" correlation for education level, 2- and 6-month sputum smear in the Eastern health macroregional and "high-high" correlation in the Northwestern macroregional for 2-month sputum smear and antibiotic sensitivity testing. There was no spatial association with the border. CONCLUSION: Unsatisfactory completeness was identified in the database and conglomerates, indicating spatial association of incompleteness of some variables, but with no relation with the border. There was no worsening of completeness nor of the case outcomes related to these regions.

Coping with COVID-19 in an international border region: health and economy.

OBJECTIVE: to analyze how the social isolation measures and closed borders affected the health and economy in an international border region. METHOD: descriptive cross-sectional study conducted in the western region of Paraná, Brazil, using an electronic form created using Google® forms. A sample of 2,510 people was addressed. Descriptive analysis and the Chi-square test were performed, with a level of significance established at 5%. This public opinion survey, addressing unidentified participants, is in accordance with Resolutions 466/2012 and 510/2016. RESULTS: the participants were 41.5 years old on average, most were women and worked in the education sector; 41.9% reported that the closing of borders/commercial businesses negatively influenced income; 17.7% reported the possibility of losing their jobs; 89.0% consider that a larger number of people would be sick if the borders/commercial had not been closed; 63.7% believe the health services are not prepared to deal with the pandemic; 74.9% realize that the Brazilian Unified Health System may not have sufficient service capacity; 63.4% reported anxiety; and 75.6% of commercial workers will experience changes in their income level. CONCLUSION: the closing of international borders and commercial businesses was related to a perception of physical and mental changes, job loss, and decreased income.

The vulnerabilities of premature children: home and institutional contexts.

OBJECTIVE: To analyze situations in which premature children are vulnerable in home care, in the first six months after hospital discharge. METHOD: Qualitative study, from the perspective of philosophical hermeneutics, carried out in a Brazilian city on the border. In-depth interviews were conducted, with a data analysis considering the method of interpretation of meanings. 18 mothers of premature children discharged from a hospital unit participated. 25 home visits and 56 calls were made. RESULTS: The reports from the mothers express situations of vulnerability, concerns, needs for care, singularities of the development of the premature baby, and repercussions of institutional routines in home care. FINAL CONSIDERATIONS: There are vulnerable circumstances in prematurity that reaffirm interconnected individual, social, and institutional dimensions. It is important to highlight that the institutional dimension involves the responsibility of health professionals not to increase individual and social vulnerabilities, but to promote care and seek to reduce situations that generate risks, uncertainties, concerns, and damages.

Care opportunities for premature infants: home visits and telephone support.

OBJECTIVE: to analyze opportunities for orientations to promote the care of premature infants during home visits and telephone support. METHOD: a qualitative study from the perspective of philosophical hermeneutics conducted with 18 mothers of premature infants discharged from hospital. Hospital contact and interviews were carried out, 15 and 45 days after discharge and at the infants' six months of life, with data analysis by interpretation of meanings from 25 home visits and 56 telephone support contacts. RESULTS: the following two thematic units emerged: Needs for contact and guidance: the place for home visits and opportunities for resolving doubts by telephone support, indicating aspects that suggest weakening child health, discontinuity in follow-up and vulnerability in specialized follow-ups. Home visits and telephone support favored the concern of health needs, doubts about basic care and problem solving, as ways to prevent damage and promote child health. CONCLUSION: home visits and telephone support emerge as collaborative practices of care and detection of latent conditions, which can be reduced or interrupted with prompt return of guidance, suggesting opportune strategies to increase follow-up, linkage and access to the health services.

Itinerário terapêutico de crianças com necessidades especiais de saúde: revisão integrativa / Therapeutic itinerary of children with special healthcare needs: integrative review / Itinerario terapéutico de niños con necesidades especiales de atención en salud: revisión integradora

Objetivo: analisar a produção científica sobre os itinerários terapêuticos estabelecidos para crianças com necessidades especiais de saúde no Sistema Único de Saúde brasileiro. Métodos: revisão integrativa da literatura nas bases de dados MEDLINE, LILACS, CINAHL, SciELO, BDENF, Web of Science, referente ao período de janeiro de 2012 a janeiro de 2024. A questão norteadora e os descritores foram elaborados a partir da estratégia PICo. Os estudos foram exportados para o aplicativo Rayyan QCRI e analisados baseados no Sistema de Cuidados nas dimensões Folclórica, Individual e Profissional. Resultados: foram selecionados nove estudos, nos quais evidenciaram-se o protagonismo das famílias/cuidadores de crianças com necessidades especiais de saúde (CRIANES) na construção do itinerário terapêutico, a necessidade de melhorias no sistema de cuidados profissional, o fortalecimento da rede de apoio e suporte dos sistemas de cuidados popular e folclórico. Conclusão: há déficits no alcance dos princípios constitucionais de Direito à saúde, universalidade, equidade e integralidade nas ações voltadas para as crianças com necessidades especiais de saúde, evidenciando uma rede de atenção fragilizada, fragmentada e incipiente.

Objective: to analyze the scientific production on therapeutic itineraries established for children with special healthcare needs in the Brazilian Unified Health System. Methods:integrative review of the literature in the databases MEDLINE, LILACS, CINAHL, SciELO, BDENF, Web of Science, covering the period from January 2012 to January 2024. The PICo strategy was used to prepare the guiding question and descriptors. The studies were exported to the Rayyan QCRI application and analyzed based on the Care System in the Folk, Individual and Professional dimensions. Results: nine studies were selected. They highlighted the leading role of families/caregivers of CSHCN in the construction of the therapeutic itinerary, the need for improvements in the professional care system and strengthening of the support network with support from popular and folk care systems. Conclusion: there are deficits in achieving the constitutional principles of the Right to health, universality, equity and comprehensiveness in actions aimed at CSHCN, highlighting a weakened, fragmented and incipient care network.

Objetivo: analizar la producción científica sobre itinerarios terapéuticos establecidos para niños, niñas y adolescentes con necesidades especiales de atención en salud en el Sistema Único de Salud de Brasil. Métodos: revisión integradora de la literatura en las bases de datos MEDLINE, LILACS, CINAHL, SciELO, BDENF, Web of Science, abarcando el período de enero de 2012 a enero de 2024. La pregunta orientadora y los descriptores se elaboraron con base en la estrategia PICo. Los estudios fueron exportados a la aplicación Rayyan QCRI y analizados con base en el Sistema de Atención en las dimensiones Tradicional, Individual y Profesional. Resultados: se seleccionaron nueve estudios. Ellos destacaron el papel protagónico de las familias/cuidadores de niños, niñas y adolescentes con necesidades especiales de atención en salud (NANEAS) en la construcción del itinerario terapéutico, la necesidad de mejoras en el sistema de atención profesional y del fortalecimiento de la red de apoyo con el apoyo de los sistemas de atención popular y tradicional. Conclusión: existen déficits en el logro de los principios constitucionales del Derecho a la salud, universalidad, equidad e integralidad en las acciones dirigidas a los NANEAS, evidenciando una red de atención debilitada, fragmentada e incipiente.

Safety, efficacy and immunogenicity of therapeutic vaccines in the treatment of patients with high-grade cervical intraepithelial neoplasia associated with human papillomavirus: a systematic review protocol.

INTRODUCTION: Eighty per cent of the sexually active population will get human papillomavirus (HPV) infection, which is the most prevalent sexually transmitted disease worldwide. Persistence of high-grade HPV infection may evolve to a cervical intraepithelial neoplasia (CIN), and these lesions may be precursors of cervical cancer. However, this progression can be prevented by the administration of therapeutic vaccines which use the main oncoproteins responsible for cancer development in an attempt to trigger a more specific and effective immunological response against this disorder. We aim to evaluate the safety, efficacy and immunogenicity of therapeutic vaccines in the treatment of patients with high-grade CIN 2/3 associated with HPV. METHODS AND ANALYSIS: A systematic review of clinical trials will be undertaken. Medline, Excerpta Medica Database, Cochrane Central Register of Controlled Trials, Web of Science, Latin American and Caribbean Health Sciences Literature, Scientific Electronic Library Online and Scopus will be searched, with no restriction regarding publication date. Primary outcomes will include measures related to safety, efficacy and the immunogenicity of the therapeutic vaccines used in these patients. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Methodological appraisal of the studies will be assessed by the Cochrane Risk-of-Bias Tool for randomised controlled trials, and the quality evidence of the risk of bias in single studies will be evaluated by Grading of Recommendations Assessment, Development and Evaluation. A narrative synthesis will be done for all included studies. Outcomes will be analysed according to the subgroups of HPV type, CIN grade, route of vaccine administration and vaccine type. Also, if sufficient data are available, a meta-analysis will be conducted. The effect sizes will be generated using Hedges' g score for both fixed and random effect models. I 2 statistics will be used to assess heterogeneity and identify their potential sources. ETHICS AND DISSEMINATION: Ethical approval is not required as primary data will not be collected. Findings will be disseminated widely via peer-reviewed publication and in different media, for example, conferences, congresses or symposia. PROSPERO REGISTRATION NUMBER: CRD42017077428.

Imunização da gestante em tempos de pandemia da COVID-19 / Inmunización de mujeres embarazadas en tiempos de pandemia de COVID-19 / Immunization of pregnant women in times of the COVID-19 pandemic

Objetivo: analisar e comparar a imunização de gestantes no período da pandemia da COVID-19 no Oeste do Paraná. Método: pesquisa analítica e transversal, realizada na nona e décima regionais de saúde do Paraná. Participaram 823 puérperas, a coleta de dados foi conduzida por inquérito e informações do prontuário entre setembro a dezembro de 2021. Utilizaram-se análise descritiva e teste de qui-quadrado com nível significância de 5%. Resultados: a nona regional apresentou melhor desempenho na imunização contra Hepatite-B, Influenza, Difteria, Tétano e Coqueluche em comparação à décima regional. A vacinação contra COVID-19 teve baixa adesão em ambas as regionais, cujos motivos foram: medo, opção própria, orientação médica e desejo de esperar o filho nascer. Conclusão: são necessárias novas estratégias e campanhas de sensibilização para aumentar o índice vacinal entre gestantes, sobretudo para a vacina contra COVID-19, considerando as complicações para a saúde materno-infantil.

Objective: analyze and compare the immunization of pregnant women during the COVID-19 pandemic in western Paraná. Method: this is an analytical, cross-sectional study carried out in the ninth and tenth regional health departments of Paraná. A total of 823 puerperal women took part, and data was collected using a survey and information from medical records between September and December 2021. Descriptive analysis and the chi-square test were used, with a significance level of 5%. Results: the ninth region performed better in immunization against Hepatitis-B, Influenza, Diphtheria, Tetanus and Pertussis compared to the tenth region. Vaccination against COVID-19 had low uptake in both regions, the reasons for which were: fear, own choice, medical advice and the wish to wait for the child to be born. Conclusion: new strategies and awareness campaigns are needed to increase the vaccination rate among pregnant women, especially for the COVID-19 vaccine, considering the complications for maternal and child health.

Objetivo: analizar y comparar la inmunización de mujeres embarazadas durante la pandemia de COVID-19 en el Oeste de Paraná. Método: investigación analítica y transversal, realizada en la novena y décima región sanitaria de Paraná. Participaron 823 puérperas. La recolección de datos se realizó mediante encuesta e información de historias clínicas entre septiembre y diciembre de 2021. Se utilizó análisis descriptivo y prueba de chi cuadrado con un nivel de significancia del 5%. Resultados: la novena región presentó mejor desempeño en inmunización contra Hepatitis B, Influenza, Difteria, Tétanos y Tos Ferina en comparación con la décima región. La vacunación contra la COVID-19 tuvo baja adherencia en ambas regiones y los motivos fueron: miedo, elección personal, consejo médico y deseo de esperar a que nazca el niño. Conclusión: son necesarias nuevas estrategias y campañas de sensibilización para aumentar la tasa de vacunación entre las mujeres embarazadas, especialmente de la vacuna contra la COVID-19, considerando las complicaciones para la salud materna e infantil.

Skin injuries in newborns hospitalized in neonatal intensive care: a cross-sectional study / Lesiones cutáneas en recién nacidos hospitalizados en cuidados intensivos neonatales: estudio transversal / Lesão de pele em recém-nascidos hospitalizados em terapia intensiva neonatal: estudo seccional

ABSTRACT Objective: To analyze the skin injuries of hospitalized newborns and identify factors related to the number of lesions. Method: This was a cross-sectional epidemiological study carried out over a period of one year in a Neonatal Intensive Care Unit in the west of Paraná. The study included 74 newborns with a score ≥5 on the Newborn Skin Condition Scale. Data analysis by chi-square and Pearson's test (p < 0.05). Results: The frequency was 25.4%, 59.4% had more than one lesion, mainly dermatitis and pressure injury. Birth characteristics were not related to the number of lesions. Not using antibiotics and parenteral nutrition, hemoglobin >11g/dl, phototherapy, pain score <4 and hospitalization >30 days were related to the number of lesions. The presence of two injuries led to longer healing time and three to longer hospitalization. A higher score on the Skin Condition Scale was related to healing time and late start of the diet. Conclusion: Skin injuries were found to be infrequent among newborns, but there is still a need to improve practices to prevent and maintain skin integrity.

RESUMEN Objetivo: Analizar las lesiones cutáneas en recién nacidos hospitalizados e identificar los factores relacionados con el número de lesiones. Material y método: Estudio epidemiológico transversal realizado durante un año en una unidad de terapia intensiva neonatal del oeste de Paraná. Fueron incluidos 74 recién nacidos con puntuación ≥5 en la Escala de Estado de la Piel del Recién Nacido. Los datos se analizaron mediante chi-cuadrado y test de Pearson (p < 0,05). Resultados: La frecuencia fue del 25,4%, el 59,4% presentaba más de una lesión, principalmente dermatitis y lesiones por presión. Las características del nacimiento no se relacionaron con el número de lesiones. No utilizar antibióticos ni nutrición parenteral, hemoglobina >11g/dl, fototerapia, puntuación del dolor <4 y hospitalización >30 días se relacionaron con el número de lesiones. La presencia de dos lesiones conllevaba un mayor tiempo de curación y tres una hospitalización más prolongada. Una puntuación más alta en la escala de estado de la piel se relacionó con el tiempo de curación y el inicio tardío de la dieta. Conclusión: Se observó que las lesiones cutáneas son poco frecuentes entre los recién nacidos, pero sigue siendo necesario mejorar las prácticas de prevención y mantenimiento de la integridad de la piel.

RESUMO Objetivo: Analisar as lesões de pele de recém-nascidos hospitalizados e identificar fatores relacionados ao número de lesões. Método: Estudo epidemiológico seccional, realizado no período de um ano, em Unidade de Terapia Intensiva Neonatal do Oeste do Paraná. Foram incluídos 74 recém-nascidos com escore ≥5 na Escala de Condição da Pele do Recém-Nascido. Análise de dados por teste qui-quadrado e Pearson (p < 0,05). Resultados: A frequência foi de 25,4%, 59,4% apresentaram mais de uma lesão, principalmente dermatites e lesão por pressão. Características do nascimento não se relacionaram ao número de lesões. Não usar antibióticos e nutrição parenteral, hemoglobina >11g/dl, fototerapia, escore de dor <4 e hospitalização >30 dias foram relacionados ao número de lesões. Presença de duas lesões levou maior tempo de cicatrização e três, de hospitalização. Maior escore na Escala de Condição da Pele se relacionou ao tempo de cicatrização e início tardio da dieta. Conclusão: A lesão de pele mostrou-se pouco frequente entre os recém-nascidos, mesmo assim, é preciso aprimorar as práticas para prevenir e manter a integridade da pele.

Repercussões da COVID-19 no cuidado às crianças com necessidades de saúde especiais / Repercusiones del COVID-19 en el cuidado de infantes con necesidades de salud especiales / Repercussions of COVID-19 on the care of children with special health needs

Resumo Objetivo Compreender as repercussões da pandemia COVID-19 no cuidado de crianças com necessidades de saúde especiais. Métodos Pesquisa exploratória, qualitativa, ancorada no quadro conceitual de vulnerabilidade em saúde nas dimensões individual, social e institucional. Foram realizadas entrevistas, no período de outubro de 2020 a fevereiro de 2021 (pré-vacinação contra COVID-19) com 19 cuidadores familiares, 11 profissionais de instituições de educação, proteção social e saúde e 15 enfermeiros de atenção primária à saúde em um município brasileiro na fronteira Brasil-Argentina-Paraguai. Foi aplicada análise temática reflexiva. Resultados Descontinuidade no cuidado, baixo alcance da proteção social e contexto institucional instável marcaram a atenção de crianças com necessidades de saúde especiais. Destacaram-se vulnerabilidades individuais em decorrência de atraso vacinal, medo de contágio e mudanças no desenvolvimento; vulnerabilidade institucional por restrições de visita domiciliar, lista de espera, falta de profissionais e ausência de atividades grupais; e vulnerabilidade social relacionadas às dificuldades de auxílio social e fechamento de fronteiras terrestres. Os elementos relacionados à estratégia de telessaúde e mecanismos que assumem responsabilidade profissional expressaram fortalezas para o cuidado de crianças com necessidades de saúde especiais. Conclusão As medidas restritivas adotadas no início da pandemia COVID-19 repercutiram negativamente no cuidado de crianças com necessidades de saúde especiais, intensificando suas vulnerabilidades individual e social. Fortalecer os contextos familiares e comunitários e ampliar o diálogo entre os setores da atenção primária à saúde indicam evitar o descompasso entre o apoio profissional e as necessidades prementes dessas crianças, assegurando a continuidade da atenção.

Resumen Objetivo Comprender las repercusiones de la pandemia de COVID-19 en el cuidado de infantes con necesidades de salud especiales. Métodos Estudio exploratorio, cualitativo, basado en el mapa conceptual de vulnerabilidad en salud en la dimensión individual, social e institucional. Se entrevistó a 19 cuidadores familiares, 11 profesionales de instituciones de educación, protección social y salud y 15 enfermeros de atención primaria de salud, en el período de octubre de 2020 a febrero de 2021 (antes de la vacunación contra COVID-19), en un municipio brasileño en la frontera de Brasil, Argentina y Paraguay. Se aplicó el análisis temático reflexivo. Resultados La atención de infantes con necesidades de salud especiales fue marcada por la discontinuidad del cuidado, el bajo alcance de la protección social y el contexto institucional inestable. Se observaron vulnerabilidades individuales como consecuencia del retraso de vacunación, miedo del contagio y cambios del desarrollo; vulnerabilidades institucionales por restricciones de visitas domiciliarias, lista de espera, falta de profesionales y ausencia de actividades grupales; y vulnerabilidades sociales relacionadas con las dificultades de ayuda social y cierre de fronteras terrestres. Los elementos relacionados con la estrategia de salud electrónica y mecanismos que asumen responsabilidad profesional expresaron fortalezas para el cuidado de infantes con necesidades de salud especiales. Conclusión Las medidas restrictivas adoptadas al comienzo de la pandemia de COVID-19 repercutieron negativamente en el cuidado de infantes con necesidades de salud especiales, lo que intensificó sus vulnerabilidades individuales y sociales. Fortalecer los contextos familiares y comunitarios y ampliar el diálogo entre los sectores de la atención primaria de salud parecen evitar la divergencia entre el apoyo profesional y las necesidades urgentes de estos infantes, para garantizar la continuidad de la atención.

Abstract Objective Understanding the repercussions of the COVID-19 pandemic on the care of children with special health needs. Methods Exploratory, qualitative research, anchored in the conceptual framework of health vulnerability in the individual, social and institutional dimensions. Interviews were carried out from October 2020 to February 2021 (pre-vaccination against COVID-19) with 19 family caregivers, 11 professionals from education, social protection and health institutions and 15 primary health care nurses in a Brazilian city on the Brazil-Argentina-Paraguay border. Reflective thematic analysis was applied. Results Discontinuity in care, low scope of social protection and unstable institutional context marked the attention of children with special health needs. Individual vulnerabilities were highlighted as a result of vaccination delays, fear of contagion and changes in development; institutional vulnerability due to restrictions on home visits, waiting lists, lack of professionals and absence of group activities; and social vulnerability related to difficulties in social assistance and the closure of land borders. Elements related to the telehealth strategy and mechanisms that assume professional responsibility expressed strengths for the care of children with special health needs. Conclusion The restrictive measures adopted at the beginning of the COVID-19 pandemic had a negative impact on the care of children with special health needs, intensifying their individual and social vulnerabilities. Strengthening family and community contexts and expanding dialogue between sectors of primary health care indicate avoiding a mismatch between professional support and the pressing needs of these children, ensuring continuity of care.