Concentrations of Lead and Arsenic in Mother's Milk and Children's Blood in Peruvian Breastfeeding Dyads.

BACKGROUND: Toxic trace elements could enter human milk through mothers' food consumption, drinking water, air, or incidental soil ingestion, and are of concern to the nursing infant. RESEARCH AIM: To determine the concentration of toxic trace elements (lead and arsenic) in Peruvian mothers' milk and their association with blood concentrations in their own infants 3-20 months old. METHOD: This exploratory, cross-sectional study, carried out in Peru, included breastfeeding mother/child dyads (N = 40). Following standardized protocols, biospecimens of human milk and child's blood were collected. RESULTS: Lead and arsenic concentrations in milk were above the method detection limits in 73% and 100% of samples with median concentrations of 0.26 µg/L (IQR = 0.10, 0.33 µg/L) and 0.73 µg/L (IQR = 0.63, 0.91 µg/L), respectively. Concentrations of lead and arsenic in blood were 2.05 µg/dL (SD = 1.35), and 1.43 µg/dl (geometric mean: SD = 1.39), respectively. Blood lead concentrations in 12.5% (n = 5) of the samples were above the U.S. Center for Disease Control and Prevention reference value (< 3.5 µg/dl), and over half of arsenic concentrations were above the acceptable levels of < 1.3 µg/dl (Mayo Clinic Interpretative Handbook). Our results showed that for every one-month increase in age, lead blood concentrations increased by 0.1 µg/dl (p = 0.023). Additionally, every 1 µg/L increase in the mother's milk arsenic was associated with a 1.40 µg/dl increase in the child's blood arsenic concentration. CONCLUSIONS: Implementing effective interventions to decrease the toxic exposure of reproductive-aged women is needed in Peru and worldwide.

Bundle para quantificação de perda sanguínea pós-parto vaginal / Bundle para la cuantificación de pérdida sanguínea posparto vaginal / Bundle for quantifying vaginal blood loss after childbirth

Resumo Objetivo Construir e validar o conteúdo de um bundle para quantificação da perda sanguínea pós-parto vaginal. Métodos Estudo metodológico desenvolvido de fevereiro a agosto de 2022, em três etapas: levantamento bibliográfico, construção do instrumento e validação de conteúdo por 14 experts. O instrumento para validação foi composto por 11 itens selecionados a partir de revisão sistemática. Para cada item do bundle aplicou-se escala Likert e para verificar a concordância entre experts, calculou-se o Índice de Concordância. Consideraram-se válidos os itens com concordância acima de 80%. A validação de conteúdo foi realizada em uma única rodada de avaliação. Resultados A versão final do bundle foi composta por nove itens. Os cuidados propostos estão relacionados à quantificação direta do sangramento pós-parto e seu registro, observação da puérpera, a utilização de protocolos institucionais em casos de hemorragia pós-parto, assim como a capacitação da equipe. Conclusão O estudo permitiu construir e validar bundle para quantificação da perda sanguínea pós-parto vaginal, com vistas à melhora do diagnóstico de hemorragia pós-parto.

Resumen Objetivo Elaborar y validar el contenido de un bundle para la cuantificación de pérdida sanguínea posparto vaginal. Métodos Estudio metodológico, llevado a cabo de febrero a agosto de 2022, en tres etapas: análisis bibliográfico, construcción del instrumento y validación de contenido por 14 expertos. El instrumento para validación consistió en 11 ítems seleccionados a partir de revisión sistemática. Se aplicó la escala Likert para cada ítem del bundle; y para verificar la concordancia entre expertos, se calculó el Índice de Concordancia. Se consideraron válidos los ítems con concordancia superior a 80 %. La validación de contenido se realizó en una única ronda de evaluación. Resultados La versión final del bundle consistió en nueve ítems. Los cuidados propuestos están relacionados con la cuantificación directa del sangrado posparto y su registro, la observación de la puérpera, la utilización de protocolos institucionales en casos de hemorragia posparto, así como también la capacitación del equipo. Conclusión El estudio permitió elaborar y validar un bundle para la cuantificación de pérdida sanguínea posparto vaginal, con el fin de mejorar el diagnóstico de hemorragia posparto.

Abstract Objective To construct and validate the content of a bundle to quantify vaginal blood loss after childbirth. Methods This is a methodological study developed from February to August 2022, divided into bibliographic survey, instrument construction and content validity, by 14 experts. The instrument for validity consisted of 11 items selected from a systematic review. For each item in the bundle, a Likert scale was applied, and to check agreement among experts, the Concordance Index was calculated. Items with agreement above 80% were considered valid. Content validity was carried out in a single round of assessment. Results The final version of the bundle consisted of nine items. The proposed care is related to direct quantification of postpartum bleeding and its recording, observation of postpartum women, use of institutional protocols in cases of postpartum hemorrhage as well as team training. Conclusion The study allowed constructing and validating a bundle for quantifying vaginal blood loss after childbirth, with a view to improving postpartum hemorrhage diagnosis.

Effectiveness of individualized counseling on the duration of exclusive breastfeeding: study protocol for a multicenter, randomized, parallel, and open clinical trial.

BACKGROUND: Despite the benefits of breastfeeding, early weaning is a reality, so less than 50% of children worldwide and in Brazil are on exclusive breastfeeding in the sixth month of life. A strategy to counteract this scenario is breastfeeding counseling. This study aims to verify the effectiveness of individualized counseling by nurses trained in breastfeeding counseling, on the duration of exclusive breastfeeding, compared to standard care. METHODS: Multicenter, randomized, parallel, and open clinical trial, with primiparous women aged over 18 years, hospitalized in rooming-in wards at participating centers and hemodynamically stable, aware, and oriented, who had a single-fetus pregnancy and gave birth, regardless of the type of delivery, with live child, gestational age of 37 to 42 weeks and birth weight greater than 2500 g. The women will be initially approached in rooming-in wards and, upon consent to participate in the study, will be allocated through randomization by blocks composed of eight participants in two groups: intervention and control. The randomization lists will be organized by a central without involvement with the study, which will manage the allocation groups and be prepared in the Randon® program. Women allocated to the intervention group will receive breastfeeding counseling by trained nurses, and those in the control group will receive standard care at the center participating in the study. DISCUSSION: The results can contribute to breastfeeding by evidencing possible exclusivity and duration of the counseling trained nurses provide. TRIAL REGISTRATION: REBEC RBR-4w9v5rq (UTN: U1111-1284-3559) ( https://ensaiosclinicos.gov.br/rg/RBR-4w9v5rq ). Posted on March 20, 2023.

Hospital Adhering to the Ten Steps to Successful Breastfeeding Predicts Exclusive Breastfeeding in Latinx Mothers.

Introduction: Assessing how well a hospital adheres to the Ten Steps to Successful Breastfeeding is the key to outlining necessary modifications in mother breastfeeding support. This study aimed to assess Latinx mothers' perception of how well a hospital adheres to the Ten Steps to Successful Breastfeeding and its influence on exclusive breastfeeding (EBF) rates at hospital discharge. Methods: Secondary analysis of two longitudinal studies. The combined sample (N = 74) of Latinx pregnant women residing in the US. We modified, translated, and evaluated reliability of the Questionnaire for the Breastfeeding Mother (QBFM), which was applied to evaluate mothers' perception of how well a hospital adheres to the Ten Steps to Successful Breastfeeding. Results: The QBFM obtained a standardized KR-20 of 0.77. Mothers who EBF had higher scores of the QBFM than mothers who used formula during hospitalization. For each point that the QBFM score increased, the likelihood that the mother was EBF at discharge increased by 1.30 times. Conclusion: Mothers' perceptions of how well a hospital adheres to the Ten Steps to Successful Breastfeeding were the only significant variable associated with EBF at discharge. The QBFM Spanish version is a valuable instrument that can be used to obtain measurable outcomes and outlines necessary changes after implementing the Ten Steps to Successful Breastfeeding.

Prática dos profissionais da saúde em aleitamento materno e fatores associados: estudo transversal / Health professionals' breastfeeding practices and associated factors: a cross-sectional study

OBJETIVO: Analisar a prática dos profissionais da saúde da atenção básica quanto ao aleitamento materno e fatores associados. MÉTODO: Estudo transversal, analítico, realizado com todos os profissionais da saúde atuantes em aleitamento materno de cinco unidades da atenção básica através de questionário autoaplicável. Para análise da associação das variáveis categóricas com a prática profissional, utilizou-se teste Qui-quadrado com nível de significância de 5%. RESULTADOS: Participaram 38 profissionais. Houve associação estatística significativa (p=0.04597) entre a variável atualização em aleitamento materno nos últimos cinco anos e a prática de implementação em grupos de apoio. O manejo clínico, a orientação quanto aos direitos maternos e o apoio para a resolução de dificuldades na amamentação foram menos informados. CONCLUSÃO: A prática dos profissionais da saúde apresentou fragilidades evidenciando a necessidade de valorização do tema por profissionais e gestores através de estratégias que incluam capacitação contínua e monitoramento do aleitamento materno na rede de atenção básica.

OBJECTIVE: To analyze primary care health professionals' breastfeeding practices and associated factors. METHOD: A cross-sectional and analytical study was carried out with all health professionals working in breastfeeding support in five primary healthcare units, through a self-administered questionnaire. The chi-square test was used with a significance level of 5% to analyze the association of categorical variables with professional practice. RESULTS: Thirty-eight professionals participated. There was a statistically significant association (p=0.04597) between the variable update on breastfeeding in the last five years and the practice of implementing breastfeeding through support groups. Clinical management, guidance on maternal rights, and support for resolving difficulties in breastfeeding were less reported. CONCLUSION: The practice of health professionals showed weaknesses, highlighting the need for professionals and managers to value the breastfeeding issue through strategies that include continuous training and monitoring of breastfeeding in the primary healthcare network.

School connectedness mediates the association of social function with depressive symptoms in teenagers with attention deficit hyperactivity disorder.

BACKGROUND: Depressive symptoms commonly co-occur in teenagers with attention deficit hyperactivity disorder (ADHD), and poor social function is a known predictor of depressive symptoms. This study's purpose was to determine whether school connectedness mediates the association between social function and depressive symptoms in teenagers with ADHD. METHOD: In this secondary analysis, we selected 313 (74%) of 425 teenagers with ADHD (male 72%, mean age = 15 years) who had completed data on depressive symptoms, social function, and school connectedness in the Fragile Families and Child Well-Being Study. The mediation effect of school connectedness was tested by multiple regression using SPSS PROCESS macro with 5000 bootstrap samples controlling covariates (teenagers' age, gender, and race, their relationship with primary caregivers, type of school teenager attends, time of living with primary caregivers, and primary caregivers' education). RESULTS: Social function predicted depressive symptoms (direct effect = -0.132, 95% CI = -0.218, -0.045). School connectedness mediated the relationship between social function and depressive symptoms (indirect effect = -0.084; 95% CI = -0.130, -0.045). CONCLUSION: This study points to the importance of considering school factors in understanding depression symptoms in children with ADHD. Also, clinicians should consider asking teenagers about school-related factors such as school connectedness which is likely important in understanding the experience of depressive symptoms in this population. Identifying ways to help enhance school connectedness for young people with ADHD should be prioritized.

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.

Social Health Care Determinants of Breastfeeding Black Women: A Multigenerational Study.

Background: Black women encounter many challenges to breastfeeding, including inequitable access to support and resources and medical racism. However, limited research investigates how Black women across generations interface with health care systems to initiate or continue breastfeeding and what factors facilitate or hinder their breastfeeding experiences. Objective: Using the social determinants of health (SDoH) theoretical framework, this study qualitatively explored how a multigenerational sample of Black mothers' interactions with health care systems facilitated or hindered their breastfeeding initiation and continuation. There were three areas of interest: (1) access and quality, (2) professional and personal support, and (3) literacy and resources. Materials and Methods: Four age cohorts and three breastfeeding length cohorts of Black mothers in Kentucky completed semi-structured interviews on their breastfeeding experiences. Responses to research questions (e.g., "What was your experience during the birthing process and how did it impact your decision to breastfeed?") informed by the SDoH were analyzed using thematic analysis. Results: Four themes emerged on how experiences within health care systems influence Black women's breastfeeding initiation and continuation: (1) health care access, (2) health care quality/bias, (3) health care-related support, and (4) health care resource use. Conclusions: Interpersonal and systemic barriers in health care related to access, quality, support, and resources hindered Black mother's breastfeeding across generations. Mothers across each age and breastfeeding cohorts emphasized a need for culturally tailored pro-breastfeeding health care systems to meet their breastfeeding needs.

Experiences of ethnic discrimination and COMT rs4680 polymorphism are associated with depressive symptoms in Latinx adults at risk for cardiovascular disease.

BACKGROUND: Ethnic discrimination is frequently experienced among U.S. Latinx communities, and is linked to CVD risk factors, such as depression. Genetic variants may influence this relationship. OBJECTIVES: The objectives of this study were to examine associations between experiences of discrimination, rs4680 genotype, and depressive symptoms in Latinx adults. METHODS: We analyzed data from 124 Latinx adults with two or more CVD risk factors, and conducted hierarchical linear regression, adjusting for sex, age, income, education, and acculturation. RESULTS: Participants were predominately female (74.2%) and aged 40.2 ± 9.3 years. More experiences of discrimination were associated with higher depressive symptoms (p = 0.041). Those with Met-Met-and Val-Met-genotypes had increased depressive symptoms than those with Val-Val-genotype (p = 0.049). Rs4680 was not a moderator. CONCLUSION: Findings suggest discrimination and rs4680 genotype are associated with depressive symptoms in Latinx adults, which may increase CVD risk. Further research is needed to better understand biological mechanisms of these relationships.

Transforming Obesity Prevention for CHILDren (TOPCHILD) Collaboration: protocol for a systematic review with individual participant data meta-analysis of behavioural interventions for the prevention of early childhood obesity.

INTRODUCTION: Behavioural interventions in early life appear to show some effect in reducing childhood overweight and obesity. However, uncertainty remains regarding their overall effectiveness, and whether effectiveness differs among key subgroups. These evidence gaps have prompted an increase in very early childhood obesity prevention trials worldwide. Combining the individual participant data (IPD) from these trials will enhance statistical power to determine overall effectiveness and enable examination of individual and trial-level subgroups. We present a protocol for a systematic review with IPD meta-analysis to evaluate the effectiveness of obesity prevention interventions commencing antenatally or in the first year after birth, and to explore whether there are differential effects among key subgroups. METHODS AND ANALYSIS: Systematic searches of Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo and trial registries for all ongoing and completed randomised controlled trials evaluating behavioural interventions for the prevention of early childhood obesity have been completed up to March 2021 and will be updated annually to include additional trials. Eligible trialists will be asked to share their IPD; if unavailable, aggregate data will be used where possible. An IPD meta-analysis and a nested prospective meta-analysis will be performed using methodologies recommended by the Cochrane Collaboration. The primary outcome will be body mass index z-score at age 24±6 months using WHO Growth Standards, and effect differences will be explored among prespecified individual and trial-level subgroups. Secondary outcomes include other child weight-related measures, infant feeding, dietary intake, physical activity, sedentary behaviours, sleep, parenting measures and adverse events. ETHICS AND DISSEMINATION: Approved by The University of Sydney Human Research Ethics Committee (2020/273) and Flinders University Social and Behavioural Research Ethics Committee (HREC CIA2133-1). Results will be relevant to clinicians, child health services, researchers, policy-makers and families, and will be disseminated via publications, presentations and media releases. PROSPERO REGISTRATION NUMBER: CRD42020177408.

Exclusive breastfeeding and professionals from the family health strategy / Lactancia materna exclusiva y los profesionales de la estrategia de salud familiar / Aleitamento materno exclusivo e os profissionais da estratégia saúde da família

ABSTRACT Objectives: to analyze the perception of health professionals about exclusive breastfeeding in Family Health Strategy units in the city of Macaé. Methods: qualitative study carried out in four units of the Family Health Strategy in the city of Macaé, Rio de Janeiro. Thirty health professionals were interviewed from March to May 2019. Textual contents were processed in the IRaMuTeQ® software by the Descending Hierarchical Classification. Results: professionals use different strategies for actions to promote, protect and support breastfeeding in prenatal consultations, but social and cultural determinants are important issues that interfere in this process, the involvement of the family being essential for the success of this practice. Final Considerations: health professionals, including nurses, need training and qualification to strengthen the support and social network of pregnant women and insert the family in the different strategies used to improve adherence to exclusive breastfeeding.

RESUMEN Objetivos: analizar la percepción de los profesionales de la salud sobre la lactancia materna exclusiva en las unidades de la Estrategia Salud de la Familia de la ciudad de Macaé. Métodos: estudio cualitativo realizado en cuatro unidades de la Estrategia Salud de la Familia en la ciudad de Macaé, Rio de Janeiro. Treinta profesionales de la salud fueron entrevistados de marzo a mayo de 2019. Los contenidos textuales fueron procesados en el software IRaMuTeQ® por la Clasificación Jerárquica Descendente. Resultados: los profesionales utilizan diferentes estrategias de acciones para promover, proteger y apoyar la lactancia materna en las consultas prenatales, pero los determinantes sociales y culturales son cuestiones importantes que interfieren en este proceso, siendo el involucramiento de la familia fundamental para el éxito de esta práctica. Consideraciones Finales: los profesionales de la salud, incluidos los enfermeros, necesitan capacitación y capacitación para fortalecer el apoyo y la red social de la gestante e insertar a la familia en las diferentes estrategias utilizadas para mejorar la adherencia a la lactancia materna exclusiva.

RESUMO Objetivos: analisar a percepção dos profissionais de saúde sobre aleitamento materno exclusivo em unidades de Estratégia Saúde da Família do município de Macaé. Métodos: estudo qualitativo realizado em quatro unidades de Estratégia Saúde da Família no município de Macaé, estado do Rio de Janeiro. Entrevistaram-se 30 profissionais de saúde entre março e maio de 2019. Os conteúdos textuais foram processados no software IRaMuTeQ® pela Classificação Hierárquica Descendente. Resultados: os profissionais utilizam diferentes estratégias para ações de promoção, proteção e apoio ao aleitamento materno nas consultas de pré-natal, mas determinantes sociais e culturais são questões importantes que interferem nesse processo, sendo essencial o envolvimento da família para o sucesso dessa prática. Considerações Finais: os profissionais de saúde, incluindo os enfermeiros, necessitam de treinamento e capacitação para fortalecer o apoio e a rede social da gestante e inserir a família nas diferentes estratégias utilizadas para melhorar a adesão ao aleitamento materno exclusivo.

Exclusive breastfeeding and professionals from the family health strategy.

OBJECTIVES: to analyze the perception of health professionals about exclusive breastfeeding in Family Health Strategy units in the city of Macaé. METHODS: qualitative study carried out in four units of the Family Health Strategy in the city of Macaé, Rio de Janeiro. Thirty health professionals were interviewed from March to May 2019. Textual contents were processed in the IRaMuTeQ® software by the Descending Hierarchical Classification. RESULTS: professionals use different strategies for actions to promote, protect and support breastfeeding in prenatal consultations, but social and cultural determinants are important issues that interfere in this process, the involvement of the family being essential for the success of this practice. FINAL CONSIDERATIONS: health professionals, including nurses, need training and qualification to strengthen the support and social network of pregnant women and insert the family in the different strategies used to improve adherence to exclusive breastfeeding.

Blood's Concentration of Lead and Arsenic Associated with Anemia in Peruvian Children.

This exploratory, descriptive cohort study (N = 60) determined lead (Pb) and arsenic (As) blood concentrations in Peruvian children and their association with hematological parameters of iron-deficient anemia (IDA) and anthropometric measurement. The mean age of children was 10.8 months (SD = 4.7) and ranged from 3 to 24 months old. Anemia (Hb levels below 10.5 g/dL) was found in 20% of this cohort. Additionally, microcytosis (MCV < 70 fL) was present in 54%, and hypochromia (MCH < 23 pg) in 42% of the group of children. Chi-square analysis showed that 88% of the children with anemia also had microcytosis and hypochromia (p < 0.001). Pb and As were detected in 100% of the infants' blood samples, and the concentrations were significantly higher in older infants than in younger ones. Pb and As were not associated with the sex, anthropomorphic parameters, or infant hemogram changes. Infants who received iron supplementation were 87% less likely to have low Hb compared with those who did not (OR = 0.13, 95% CI = 0.02-0.88, p=0.04). Herbal tea intake was significantly associated with microcytosis and hypochromia. Our finding uncovered that hematological parameters for anemia are modified in Peruvian children with high levels of microcytosis and hypochromia. Concentrations of Pb and As were above method detection limits in all Peruvian children, but these were not associated with IDA or anthropometric measurements. A large study, including other variables, would benefit from allowing a more complex model predicting anemia in Peruvian children.

Women's Perceptions of Hospital-Based Breastfeeding Care and the Association With Exclusive Breastfeeding.

OBJECTIVE: To examine the differences in women's perceptions of hospital-based breastfeeding care and the association of these perceptions with exclusive breastfeeding. DESIGN: Observational, mixed-methods study. SETTING/LOCAL PROBLEM: A 932-bed, Baby-Friendly Hospital Initiative-designated, university hospital with approximately 2,000 births per year, where 50% of women who wanted to breastfeed were supplementing with formula before hospital discharge. PARTICIPANTS: Thirty-four women who gave birth to a term, singleton newborn and had a desire to breastfeed exclusively. MEASUREMENTS: Women's perceptions were assessed using a modified version of the Questionnaire for the Breastfeeding Mother. RESULTS: Women's perceptions of breastfeeding care were positively associated with exclusive breastfeeding (p = .049). In addition, the influence of how a woman's own mother fed her as an infant was shown, because women who themselves were breastfed as infants were more likely to exclusively breastfeed their own newborns. Content analysis showed that women appreciated the care received in the hospital from lactation consultants and access to a hospital-administered breastfeeding clinic after discharge. CONCLUSION: Creating a hospital environment supportive of breastfeeding could yield positive breastfeeding outcomes for women and newborns.

Evaluación del disbalance autonómico en el paciente con serología positiva para enfermedad de Chagas: Score de diagnóstico y tratamiento

La enfermedad de Chagas es una enfermedad parasitaria (Trypanosoma cruzi), endémica en 21 países de América y que las migraciones la han dispersado en distintos continentes. Una de las manifestaciones más precoces de esta enfermedad son las alteraciones disautonómicas o disfunción autonómica. La severidad de este inadecuado funcionamiento del sistema nervioso autónomo resulta mensurable, de modo que la evolución y/o progresión de la enfermedad puede constatarse mediante la alteración de estudios clínicos y detección de anticuerpos antimuscarínicos. Estos anticuerpos están presentes en un 30% de los infectados y aparecen muy precozmente una vez instalada la parasitosis; además otros estudios, como la dispersión del QT (>65 mseg) y la variabilidad de la frecuencia cardíaca (<100 mseg) presentan valores anormales. La utilización de nuevos paradigmas de atención, diagnóstico y tratamientos adecuados son imprescindibles para prevenir el desarrollo de esta cardiopatía.

Chagas disease is a parasitic disease (Trypanosoma cruzi), endemic in 21 countries of America and that migrations have dispersed it in different continents. One of the earliest manifestations of this disease is dysautonomic alterations or autonomic dysfunction. The severity of this inadequate functioning of the autonomic nervous system is measurable, so that the evolution and/or progression of the disease can be verified by altering clinical studies and detecting antimuscarinic antibodies. These antibodies are present in 30% of those infected and appear very early once the parasitosis is installed; In addition, other studies, such as QT dispersion (> 65 ms) and heart rate variability (<100 ms) show abnormal values. The use of new paradigms of care, diagnosis and appropriate treatments are essential to prevent the development of this heart disease.

A doença de Chagas é uma doença parasitária (Trypanosoma cruzi), endêmica em 21 países da América e que as migrações a dispersaram em diferentes continentes. Uma das primeiras manifestações desta doença são as alterações disautonômicas ou disfunção autonômica. A gravidade desse funcionamento inadequado do sistema nervoso autônomo é mensurável, de modo que a evolução e/ou progressão da doença pode ser verificada alterando os estudos clínicos e detectando anticorpos antimuscarínicos. Esses anticorpos estão presentes em 30% dos infectados e aparecem muito cedo, uma vez instalada a parasitose; Além disso, outros estudos, como a dispersão do QT (> 65 mseg) e a variabilidade da freqüência cardíaca (<100 mseg), mostram valores anormais. A utilização de novos paradigmas de atendimento, diagnóstico e tratamentos adequados são essenciais para prevenir o desenvolvimento desta doença cardíaca.

Qualidade da relação da gestante com as pessoas próximas e o aleitamento materno / Calidad de la relación de la embarazada con las personas cercanas y la lactancia materna / Pregnant relationship quality with the closest people and breastfeeding

RESUMO Objetivos Identificar a pessoa próxima à gestante, que atua como sua fonte de apoio primária, bem como avaliar a qualidade dessa relação por meio do instrumento qualidade da relação com as pessoas próximas e sua influência no aleitamento materno. Método Estudo quantitativo, descritivo e exploratório realizado com uma amostra não probabilística consecutiva de 152 gestantes, em Unidades de Saúde de município de médio porte na região Oeste do Paraná, durante o ano de 2019, para responder à pergunta de pesquisa "a qualidade da relação da mulher na gestação com a sua fonte de apoio primária tem implicações na amamentação? Utilizou-se, para obtenção dos dados, a escala "Qualidade da relação com as pessoas próximas-ARI", que classifica o vínculo por meio de pontos que podem variar de 40 a 128, sendo que quanto maior, também maior será a qualidade do vínculo com aquela pessoa. Os dados foram analisados por estatística descritiva. Resultados As mulheres identificaram o companheiro/esposo (58,6%) e outros membros da família (40,1%) como as pessoas mais importantes e atuantes como sua fonte de apoio primária. A média do escore foi de 103,5, apontando que o relacionamento é saudável e predominam aspectos positivos. Conclusão Quanto mais positivos os resultados, maior é o suporte recebido pela gestante e, consequentemente, maior a influência para que a mulher inicie e mantenha o aleitamento materno exclusivo. Implicações para a prática clínica A escala utilizada pode ser aplicada com regularidade na atenção primária para o enfermeiro identificar vínculos frágeis que influenciariam a amamentação.

RESUMEN Objetivos Identificar a la persona cercana a la mujer embarazada, que actúa como su principal fuente de apoyo, así como evaluar la calidad de esta relación por medio del instrumento cualidad de la relación con las personas cercanas a ella y su influencia en la lactancia materna. Método Estudio cuantitativo, descriptivo y exploratorio, realizado con una muestra consecutiva no probabilística de 152 gestantes, en Unidades de Salud de un municipio mediano de la región oeste de Paraná, durante el año 2019, para responder a la pregunta de investigación "¿la calidad de la relación de las mujeres en gestación con su fuente de apoyo principal tiene implicaciones para la lactancia materna? La escala "Calidad de la relación con personas cercanas - ARI" se utilizó para obtener los datos, que clasifican el vínculo mediante puntos que pueden variar de 40 a 128, cuanto mayor sea la calidad, mayor el vínculo con esa persona. Los datos se analizaron mediante estadística descriptiva. Resultados Las mujeres identificaron a la pareja / esposo (58.6%) y otros miembros de la familia (40.1%) como las personas más importantes y activas como su principal fuente de apoyo. El puntaje promedio fue de 103.5, lo que indica que la relación es saludable y predominan los aspectos positivos. Conclusión Cuanto más positivos sean los resultados, mayor será el apoyo recibido por la mujer embarazada y, en consecuencia, mayor será la influencia para que la mujer inicie y mantenga la lactancia materna exclusiva. Implicaciones para la práctica clínica La escala utilizada puede aplicarse regularmente en la atención primaria para que las enfermeras identifiquen los vínculos frágiles que influirían en la lactancia materna.

ABSTRACT Objectives To identify the closest person to the pregnant woman, who acts as her primary support source, and evaluate the relationship quality through the instrument quality with the persons close to her and their influence on breastfeeding. Method Quantitative, descriptive, and exploratory study with a consecutive non-probabilistic sample of 152 pregnant women, in Health Units in a medium-sized municipality in the western region of Paraná, during the year 2019, to answer the research question "does the quality of the relationship between women in pregnancy and their primary source of support have implications for breastfeeding?. The "Quality of the relationship with the closest people scale - ARI" was used to obtain the data, which classifies the bond using points that can vary from 40 to 128, and the higher, the higher will be the quality of the bond with that person. The data were analyzed using descriptive statistics. Results Women identified the partner/husband (58.6%) and other family members (40.1%) as the most important and active people as their primary support source. The average score was 103.5, indicating that the relationship is healthy and positive aspects predominate. Conclusion The more positive the results, the greater the support received by the pregnant woman and, consequently, the greater the influence for the woman to initiate and maintain exclusive breastfeeding. Implications for the clinical practice The scale used can be applied regularly in primary care for nurses to identify fragile bonds that would influence breastfeeding.

Enabling Nursing Students to Achieve Their Breastfeeding Goals.

INTRODUCTION: US workplace law requires employers to provide reasonable break time and space other than a bathroom for breastfeeding women to express their milk. However, this law does not include students in higher education institutions who choose to breastfeed, as students are typically not employed by their schools. The purpose of this report is to describe the joint efforts of faculty members and students to successfully operationalize a lactation room and develop college-specific lactation guidelines in a university in central Kentucky. METHOD: Students from a college of nursing (CON) participated in a survey (N=135), of which 30% were parenting at that time (n=41). RESULTS: Responses from this subset were used to make the case to CON leadership and faculty to develop college-specific guidelines entitled, "Guidelines for Lactation Support," which was included in students' handbooks, and to the designated space for a lactation room in the CON building. DISCUSSION: The combined effort of faculty, administrators, and students was crucial to promote a breastfeeding-friendly environment in the CON.

Assessing Barriers to Implement Birth Kangaroo Care in Kentucky Birthing Hospitals.

INTRODUCTION: Kentucky continues to have one of the lowest state breastfeeding rates in the country. In 2014, the majority of the birthing hospitals in Kentucky implemented a practice change to the healthcare model known as Birth Kangaroo Care (BKC) as an effort to increase breastfeeding initiation. The goal of this study was to identify current practices and barriers to implementing BKC. METHODS: An evaluation/surveillance study that incorporated an Internet survey to collect information about the practices and policies of BKC in birthing hospitals in Kentucky was completed. FINDINGS: The response rate was 54% (n = 25). The birthing hospitals responders to the survey (84%) reported that a BKC policy was established after the educational intervention. Data identified two perceived barriers regarding uninterrupted BKC. One barrier was the interruption by family members to hold the newborn, and the second was a delay in BKC for medical evaluations of the baby by staff members. CONCLUSION: Breastfeeding rates after implementation of the BKC policy in Kentucky birthing hospitals showed a statistically significant (p = .02) improvement of "ever breastfed" infants.

Tradução, adaptação e validação da Escala Calidad de la relación con su persona cercana / Translation, adaptation, and validation of the Calidad de la relación con su persona cercana Scale

RESUMO Objetivo traduzir, adaptar culturalmente e validar a Escala Calidad de la relación con su persona cercana para o português brasileiro. Métodos estudo metodológico, cujas etapas foram: tradução inicial; síntese das traduções; retrotradução; elaboração da versão pré-final, por comitê de nove especialistas; validação do conteúdo da versão pré-final, com 14 juízes; pré-teste, com 30 gestantes; análise da confiabilidade; e envio da versão traduzida para as duas autoras do instrumento original. Resultados os termos discrepantes foram revistos e ajustados durante o processo de tradução e adaptação. A escala alcançou equivalência conceitual e idiomática. O índice de validade de conteúdo foi de 0,92 e o Alfa de Cronbach 0,869. O escore geral na aplicação variou de 59 a 124, com média de 94,4. Conclusão após tradução e adaptação, a escala foi denominada Qualidade da Relação com a Pessoa Próxima, alcançando equivalência semântica e idiomática.

ABSTRACT Objective to translate, culturally adapt, and validate the Calidad de la relación con su persona cercana Scale into Brazilian Portuguese. Methods a methodological study, whose steps were: initial translation; translation synthesis; back-translation; pre-final version development by a panel of nine experts; pre-final version content validity, with 14 judges; pre-test with 30 pregnant women; reliability analysis; sending the translated version to the two authors of the original instrument. Results outliers were reviewed and adjusted during translation and adaptation. The scale achieved conceptual and idiomatic equivalence. Content validity index was 0.92 and Cronbach's Alpha was 0.869. The general score in the application ranged from 59 to 124, with an average of 94.4. Conclusion after translation and adaptation, the scale was entitled Qualidade da Relação com a Pessoa Próxima, achieving semantic and idiomatic equivalence.

"We keep quiet": exploring the context of pregnancy intention in a low-resource community in Ecuador.

Unintended pregnancies are both a consequence and a cause of socioeconomic inequality. Family planning prevents unintended pregnancy and reduces health disparities. The purpose of this study is to describe the structural, social, economic context of pregnancy intention in a peri-urban, diverse, low-resource community in Ecuador. A qualitative descriptive methodology was used. Semi-structured individual interviews were performed with 19 female participants of reproductive age. Interviews were professionally transcribed in Spanish, translated into English, and analysed in MAXQDA using content analysis. The majority of pregnancies were reported as unintended and four themes emerged to describe the context. (1) Women's autonomy is limited by men, (2) Women keep quiet, (3) Systems failed women, and (4) Building resilience. Health systems, gender-based violence, limited education and financial means, and policies yet to be enforced served as barriers to both empowerment and family planning. In spite of this, many women were able to transition into safety, and prevent or delay pregnancy with new partners. Ecuador has made significant economic gains in the past two decades, but these findings suggest that inequality persists in some regions of Ecuador. The women in this study report needing to feel safe, productive and valued to plan their families. Public health professionals need to involve multi-sectors in solutions to reduce health disparities and address determinants of maternal/child health including gender-based violence, economic and systemic limitations. DOI:10.1080/26410397.2019.1686198.