Effects of calcium supplementation on changes in the IL2, IL4, IL6, IL10 axes and oxidative stress in pregnant women at risk for pre-eclampsia.

BACKGROUND: Pregnant women with hypertensive disorders are at increased risk for inflammatory diseases and oxidative stress. The dilemma raised by the best dosage of calcium supplementation on these factors is evident. The aim of the current study was to examine the effects of calcium on biomarkers of the purinergic system, inflammation and oxidative stress, which are factors contributing to vascular damage in pregnant women at high risk of pre-eclampsia. METHODS: A prospective, double-blind and placebo-controlled study conducted with 101 women at risk of pre-eclampsia were randomized to take 500 mg calcium/day or 1,500 mg calcium/day or placebo for 6 weeks from the 20th gestational week until delivery. Fasting blood samples were collected at the beginning of the study and 6 weeks after the intervention. RESULTS: Taking calcium supplements (500 mg calcium/day) led to a significant increase in ATP hydrolysis (p < 0.05), NTPDase activity with increased hydrolysis of ADP and AMP nucleotides in platelets and lymphocytes. In the intragroup analysis IL-2, IL-6, IL-4 and interferon-É£ presented lower values in the calcium 1,500 mg/day group (p < 0.005). Oxidative stress was assessed by TBARS pro-oxidant marker, with an increase for the calcium groups when compared to the placebo group. The Vitamin C antioxidant marker presented a significant increase (p < 0.005) for the group that received high calcium doses. CONCLUSIONS: Calcium administration for 6 weeks had antioxidant action and positively modulated the purinergic system and inflammatory markers in pregnant women at risk of pre-eclampsia.

Self-testing for SARS-CoV-2 in São Paulo, Brazil: results of a population-based values and attitudes survey.

BACKGROUND: Brazil is among the countries in South America where the COVID-19 pandemic has hit the general population hardest. Self-testing for SARS-CoV-2 infection is one of the community-based strategies that could help asymptomatic individuals at-risk of COVID-19, as well as those living in areas that are difficult for health personnel to reach, to know their infectious status and contribute to impeding further transmission of the virus. METHODS: A population-based survey was conducted in November 2021, to assess the acceptability of rapid SARS-CoV-2 antigen self-testing among the population of São Paulo. Survey respondents were approached at more than 400 different street-points that were randomly selected using a five-stage randomization process. A 35-item structured questionnaire was used. Dependent variables for our analyses were the likelihood to use and willingness to pay for self-testing, and the likelihood of taking preventive measures to prevent onward transmission of SARS-CoV-2 following a reactive self-test result. Bivariate and multivariate regression analyses were performed. RESULTS: Overall, 417 respondents (44.12% female) participated; 19.66% had previously had COVID-19 disease. A minority (9.59%) felt at high-risk of COVID-19. The majority of both females and males (73.91% and 60.09%, respectively) were in favor of the idea of SARS-CoV-2 self-testing. Overall, if self-tests were available, almost half of the sample would be very likely (n = 54, 12.95%) or likely (n = 151, 36.21%) to use one if they felt they needed to. Upon receiving a positive self-test result, the majority of respondents would communicate it (88.49%), request facility-based post-test counseling (98.32%), self-isolate (97.60%), and warn their close contacts (96.64%). CONCLUSION: Rapid SARS-CoV-2 antigen self-testing could be an acceptable screening tool in São Paulo. The population would be empowered by having access to a technology that would allow them to test, even if asymptomatic, when traveling, or going to work or school. If there is a surge in the incidence of cases, self-testing could be a good approach for mass case detection by Brazil's already overstretched Unified Health System.

Care bundle for family interview for pediatric organ donation.

PURPOSE: to develop a care bundle for best practices in conducting the family interview for organ and tissue donation with the families of children and adolescents. DESIGN AND METHODS: methodological study, with a qualitative approach, developed in Brazil, in three stages: literature review, qualitative study with professionals and family members, and development of the care bundle. RESULTS: Nine studies were selected and 17 health professionals and nine family members were interviewed. With this data, the care bundle was developed in three categories: communication of death, emotional support and information about organ and tissue donation. The recommendations were evaluated by five external professionals and all of them assessed the bundle as having the highest possible quality. CONCLUSIONS: the care bundle was built following the stages of integrative literature review and interviews with professionals working in this scenario and family members who have already gone through a family interview for organ and tissue donation of children and adolescents. PRACTICE IMPLICATIONS: the use of this material is seen as an important resource to support the professional during the conduction of the family interview in a scenario as sensitive and challenging as the care to family members facing death and the decision of organ and tissue donation of children and adolescents. Furthermore, the care bundle can increase the quality of family interviews and impact the reduction of family refusals. DESCRIPTORS: Practice Guideline as Topic. Tissue and Organ Procurement. Patient Care Team. Nursing. Pediatrics. Communication.

[Efficiency indicators to assess the organ donation and transplantation process: systematic review of the literature]. / Indicadores de eficiência no processo de doação e transplante de órgãos: revisão sistemática da literatura.

OBJECTIVE: To search the literature and identify indicators used to monitor and control the organ donation and transplantation process and to group these indicators into categories. METHOD: In November 2014, a systematic review of the literature was carried out in the following databases: Biblioteca Virtual em Saúde (BVS), EBSCO, Emerald, Proquest, Science Direct, and Web of Science. The following search terms (and the corresponding terms in Brazilian Portuguese) were employed: "efficiency," "indicators," "organ donation," "tissue and organ procurement," and "organ transplantation." Of the 344 articles retrieved, 23 original articles published between 1992 and 2013 were selected and reviewed for analysis of efficiency indicators. RESULTS: The review revealed 117 efficiency indicators, which were grouped according to similarity of content and divided into three categories: 1) 71 indicators related to organ donation, covering mortality statistics, communication of brain death, clinical status of donors and exclusion of donors for medical reasons, attitude of families, confirmation of donations, and extraction of organs and tissues; 2) 22 indicators related to organ transplantation, covering the surgical procedure per se and post-transplantation follow-up; and 3) 24 indicators related to the demand for organs and the resources of hospitals involved in the process. CONCLUSIONS: Even if organ transplantation is a recent phenomenon, the high number of efficiency indicators described in the literature suggests that scholars interested in this field have been searching for ways to measure performance. However, there is little standardization of the indicators used. Also, most indicators focus on the donation step, suggesting gaps in the measurement of efficiency at others points in the process. Additional indicators are needed to monitor important stages, such as organ distribution (for example, organ loss indicators) and post-transplantation aspects (for example, survival and quality of life).

Donation and Equitable Access to Organ, Tissue, and Cell Transplants: A Brazilian Perspective on the Strategy and Plan of Action 2019-2030.

OBJECTIVE: To position the Brazilian Transplant System within the context of the 4 Strategic Lines of Action proposed by the Pan-American Health Organization. METHOD: A specialist analysis was conducted through comparative analyses of the 4 Strategic Lines of Action, objectives, and indicators outlined in the Action Plan, along with the donation and transplantation system in accordance with Brazilian transplantation law. Subsequent to an in-depth review of the document issued by the health authority, a series of meetings involving 8 specialists in organ donation and transplantation were conducted. During these meetings, discussions were carried out with the objective of numerically interpreting each strategy presented in the document, and recommendations constructed. RESULTS: Four strategies were evaluated and only 2 of them the third (81,3%) and the fourth (90%) do not achieve the indicators to complete the objective related to equitable access to organ, tissue, and cell transplants in Brazil. CONCLUSION: The recommendations developed carry importance, as they are innovative and contribute to the establishment of priorities when shaping public policies. The report not only highlights indicators that were not satisfactorily met but also provides insights into the recommendations formulated to improve those indicators that have already been achieved and to work toward achieving those that have not yet been realized. Additionally, these recommendations can justify actions and establish priorities for research efforts in the field.

Adverse Events Reporting Systems in Cells, Organs, and Tissues Donation and Transplantation: Scoping Review.

BACKGROUND: This study aimed to map adverse events reporting systems in cells, organs, and tissues donation and transplantation, including the terms applicable in each system and scientific literature. METHODS: This was a scoping review using the Joanna Briggs Institute method. A search strategy in 3 phases was used, and searches were conducted in PubMed, Embase, LILACS, Scholar Google, and government and organ donations and transplantation associations' sites during June and August 2021. Data collection and analysis were independently made by 2 researchers. The scoping review protocol was registered. RESULTS: Twenty-four articles and other materials were selected for data collection. Eleven reporting systems were analyzed, and terms were identified. CONCLUSIONS: Adverse reporting systems in cells, organs, and tissues donation and transplantation were mapped. The main features are presented, which can help develop new and better systems, with an important discussion about the terms used.

Time Elapsed Between Cells, Tissues, and Organs Donation and Transplantation and Adverse Events Detection.

BACKGROUND: This study was designed to discuss the time elapsed between cell, tissue, and organ donation and transplantation and detection of adverse events notified in São Paulo, Brazil. METHODS: This is a descriptive study with a quantitative approach. Data were provided by the Transplant Center of the state of São Paulo from the "Individual notification form of adverse reactions in Biovigilance" between 2016 and 2019. Analysis was performed using descriptive statistics. RESULTS: Fifty-two notifications were analyzed, and 3 categories were formed: (1) adverse events detected on the same day of the transplant, 8; (2) adverse events detected between 1 week and 1.5 years after transplant, 40; and (3) adverse events detected 2 years after transplant, 4. CONCLUSION: The discussion on the topic is beginning; however, it is important. Clinical management of transplant recipients and comprehending what is considered an adverse event and the natural course of a patient's life can impact clinical decision-making, public policies, and patient safety research. This study highlights the need to investigate related factors to adverse events, especially the time between the transplant procedure and adverse event detection, to establish clinical guidelines.

Understanding organ donation processes and structures in ontario: A social network analysis approach.

BACKGROUND: Transplant rates in Ontario rose steeply in the decade prior to the COVID-19 pandemic. Reasons for that increase remain unclear, but the inter-organizational arrangement of organ donation programs may have contributed. However, there is a paucity of literature investigating these inter-organizational arrangements, with a limited understanding of how communication facilitates organ donation. Understanding these arrangements may help to re-establish rising organ donation rates post-pandemic. OBJECTIVE: To describe interprofessional interactions of Organ and Tissue Donation Coordinators (OTDCs) during organ donation cases, within organ donation programs in Ontario, from an organizational perspective (describing structure, context, process). METHODS: Mixed-method social network analysis (SNA) approach analyzing 14 organ donation cases just before the COVID-19 pandemic. RESULTS: Structure: Social network graphs depict the joint work performed by hospital staff and OTDCs, with a great part of the communication being processed through the OTDC. CONTEXT: Network density ranged from 0.05 to 0.24 across cases, and health care professionals perceived an atmosphere of shared vision and trust among team members. PROCESS: Most networks had a degree centralization <0.50 suggesting a decentralized information flow, and participants perceived decisions being jointly made. The characteristic path length of cases ranged from 1.6 to 3.2, suggesting potential for rapid information diffusion. Overall, data reinforced the OTDC role of intermediator within the communication process, and hospital staff perceived OTDCs as central players. Hospital staff and OTDCs reported frustration with some aspects of the flow of information during the organ allocation processes. CONCLUSION: Findings from this study provide a network map of communications within organ donation cases and reinforce the importance of the OTDC role. Opportunities for quality improvement within these processes are identified.

Care actions in obtaining tissues and organs during the COVID-19 pandemic: a mixed methods study.

OBJECTIVE: to map health care actions in the organ and tissue donation process in Brazilian regions during the COVID-19 pandemic. METHODS: a mixed methods study. Data collection was performed simultaneously through an online questionnaire with 72 nurses. Descriptive statistical analysis and content analysis. RESULTS: a total of 34.7% of professionals work in the state of São Paulo. The largest number of responses was from the Southeast region. Four categories emerged. The first addresses triage care actions; the second involves guidelines for SARS-CoV-2 prevention in potential donors; the third relates to the epidemiological screening of professionals; the fourth presents the scenario of donation training in pandemic times. CONCLUSION: care actions are aimed at tracking the path taken until arrival at the hospital, assessing temperature and saturation curves, in addition to screening for signs and symptoms for SARS-CoV-2 contamination among professionals.

Brain death communication with parents of children and adolescents: care strategies.

OBJECTIVES: to identify care strategies developed by professionals from critically ill patients' units in communicating BD with parents of children and adolescents. METHODS: an exploratory and descriptive research with a qualitative approach, carried out in two health institutions between October and December 2019, through semi-structured interviews. Data analysis took place through content analysis. RESULTS: twenty-one professionals participated. Three care strategies were identified: actual clinical situation in suspected brain death; sensitizing families to the real clinical situation after brain death diagnosis; and time to assimilate the death information. FINAL CONSIDERATIONS: the care strategies for communicating brain death to families identified in this study present the possibility of subsidizing health managers in training and support promotion for professionals in care practice. Moreover, they can be incorporated and validated in the care practice of the studied context.

Factors related to mammography adherence among women in Brazil: A scoping review.

AIM: To explore and synthesize the literature on factors related to mammography screening adherence among women in Brazil. DESIGN: A scoping review. METHODS: We searched 11 databases for studies published between 2006-January 2020. All identified articles were screened, and data were extracted from eligible studies. We used the UK Government Social Research Service weight of evidence appraisal tool to appraise the quality of the included study. RESULTS: From a total of 1,384 identified articles, 22 were retained. All included studies used quantitative, non-experimental methods and all but two studies used cross-sectional data. Quality of evidence varied across studies. We identified 41 factors that were investigated across the set of studies. Demographic and socio-economic factors were the most commonly investigated, with older age, urban residence, living in the southeast of Brazil, higher level of education, higher income and private health insurance most consistently associated with mammography adherence.

Understanding childbirth pain in Brazilian women: A qualitative descriptive study.

BACKGROUND: The pain associated with childbirth is a cause of severe pain, and the literature suggests that it can be influenced by psychosocial influences, the environment, and cognitive processes, creating the overall experience of childbirth. Therefore, the investigation of women's childbirth pain experience is essential. AIM: The purpose of this study is to understand women's childbirth pain and determine which influences can contribute to building different experiences. METHOD: A qualitative descriptive approach was adopted to explore the women's childbirth pain experiences, by understanding the influences on their experiences. Data were collected through in-depth interviews with 21 women in a hospital setting in São Paulo, Brazil, and analysed by thematic analysis. RESULTS: Three major themes emerged from the analysis: (1) experiencing childbirth pain, (2) face-to-face with pain, and (3) empowerment needs. DISCUSSION: Many factors influence how Brazilian women manage pain and shape their experience during childbirth. The findings suggest that when women had a positive experience, they asked for minimal support, demonstrated balance, and expressed that the pain was manageable; when they had unfavourable experiences, they regarded pain as a threat and a punishment and associated it with unpleasant emotions. CONCLUSION: The results outlined concerns that should be addressed in the provision of specific, appropriate care for women, to support them in improving their experience during childbirth.

Defining Quality Criteria for Success in Organ Donation Programs: A Scoping Review.

BACKGROUND: Well-established performance measures for organ donation programs do not fully address the complexity and multifactorial nature of organ donation programs such as the influence of relationships and organizational attributes. OBJECTIVE: To synthesize the current evidence on key organizational attributes and processes of international organ donation programs associated with successful outcomes and to generate a framework to categorize those attributes. DESIGN: Scoping Review using a mixed methods approach for data extraction. SETTING: Databases included PubMed, CINAHL, Embase, LILACS, ABI Business ProQuest, Business Source Premier, and gray literature (organ donation association websites, Google Scholar-first 8 pages), and searches for gray literature were performed, and relevant websites were perused. SAMPLE: Organ donation programs or processes. METHODS: We systematically searched the literature to identify any research design, including text and opinion papers and unpublished material (research data, reports, institutional protocols, government documents, etc). Searches were completed on January 2018, updated it in May 2019, and lastly in March 2020. Title, abstracts, and full texts were screened independently by 2 reviewers with disagreements resolved by a third. Data extraction followed a mixed method approach in which we extracted specific details about study characteristics such as type of research, year of publication, origin/country of study, type of journal published, and key findings. Studies included considered definitions and descriptions of success in organ donation programs in any country by considering studies that described (1) attributes associated with success or effectiveness, (2) organ donation processes, (3) quality improvement initiatives, (4) definitions of organ donation program effectiveness, (5) evidence-based practices in organ donation, and (6) improvements or success in such programs. We tabulated the type and frequency of the presence or absence of reported improvement quality indicators and used a qualitative thematic analysis approach to synthesize results. RESULTS: A total of 84 articles were included. Quantitative analysis identified that most of the included articles originated from the United States (n = 32, 38%), used quantitative approaches (n = 46, 55%), and were published in transplant journals (n = 34, 40.5%). Qualitative analysis revealed 16 categories that were described as positively influencing success/effectiveness of organ donation programs. Our thematic analysis identified 16 attributes across the 84 articles, which were grouped into 3 categories influencing organ donation programs' success: context (n = 39, 46%), process (n = 48, 57%), and structural (n = 59, 70%). LIMITATIONS: Consistent with scoping review methodology, the methodological quality of included studies was not assessed. CONCLUSIONS: This scoping review identified a number of factors that led to successful outcomes. However, those factors were rarely studied in combination representing a gap in the literature. Therefore, we suggest the development and reporting of primary research investigating and measuring those attributes associated with the performance of organ donation programs holistically. TRIAL REGISTRATION: Not applicable.

CONTEXTE: Les mesures de rendement bien établies pour les programmes de dons d'organes ne tiennent pas entièrement compte de la complexité et de la nature multifactorielle de ces programmes, notamment de l'influence des relations et des attributs organisationnels. OBJECTIF: Synthétiser les données actuelles sur les processus et les principaux attributs organisationnels des programmes internationaux de dons d'organes qui sont associés à des résultats favorables, et générer un cadre pour classer ces attributs. TYPE D'ÉTUDE: Examen de la portée où une approche à méthodes mixtes a servi à l'extraction des données. SOURCES: Ont été consultées les bases de données PubMed, CINAHL, Embase, LILAS, ABI Business ProQuest et Business Source Premier, ainsi que la littérature grise (huit premières pages de Google Scholar) et les sites Web pertinents (sites Web d'associations de dons d'organes). ÉCHANTILLON: Les programmes ou processus de don d'organes. MÉTHODOLOGIE: Nous avons procédé à une recherche systématique de la documentation pour répertorier tout plan de recherche pertinent, y compris les manuscrits, articles d'opinion et documents non publiés (données de recherche, rapports, protocoles institutionnels, documents gouvernementaux, etc.). Les recherches se sont terminées en janvier 2018 et ont été mises à jour en mai 2019 et en mars 2020. Les titres, les abrégés et les textes complets ont été révisés de façon indépendante par deux examinateurs; les désaccords ayant été résolus par un troisième. Une combinaison de méthodes a été employée pour l'extraction des données, lesquelles incluaient notamment des détails concernant l'étude (type de recherche, année de publication, pays/origine de l'étude, type de publication, principales conclusions). Les études retenues définissaient et donnaient une description du succès des programmes de dons d'organes dans tout pays; l'examen s'est concentré sur les études décrivant: 1) les attributs associés au succès ou à l'efficacité; 2) les processus de don d'organes; 3) les initiatives d'amélioration de la qualité; 4) les définitions de l'efficacité du programme; 5) les pratiques fondées sur des données probantes, et; 6) les améliorations ou le succès des programmes. Pour chaque amélioration mentionnée, le type et la fréquence de la présence ou de l'absence d'indicateurs de la qualité ont été colligés pour chaque amélioration mentionnée, et une méthode d'analyse thématique qualitative a servi à synthétiser les résultats. RÉSULTATS: En tout, 84 articles ont été inclus. L'analyse quantitative a révélé qu'en majorité, les articles provenaient des États-Unis (n=32 [38 %]), qu'ils utilisaient des approches quantitatives (n=46 [55 %]) et qu'ils avaient été publiés dans des revues de transplantation (n=34 [40,5 %]). L'analyse qualitative a dégagé 16 catégories décrites comme ayant une influence positive sur le succès et l'efficacité des programmes de dons d'organes, alors que l'analyse thématique a permis de répertorier 16 attributs. Ces derniers ont été classés dans trois catégories influençant le succès des programmes de dons d'organes: le contexte (n=39 [46 %]), le processus (n=48 [57 %]) et la structure (n=59 [70 %]). LIMITES: Conformément à la méthodologie d'un examen de la portée, la qualité méthodologique des études incluses n'a pas été évaluée. CONCLUSION: Cet examen de la portée a permis de dégager un certain nombre de facteurs menant à des résultats favorables; ceux-ci ont cependant rarement été étudiés en combinaison, ce qui constitue une lacune dans la littérature. Dès lors, nous suggérons l'élaboration et la présentation de rapports de recherche visant à étudier et à mesurer les attributs associés au rendement des programmes de dons d'organes de façon holistique.

Organ donation procedures: an epidemiological study.

OBJECTIVE: To evaluate the impact of organ and tissue donation processes on family members of deceased donors and the probability that they would be an organ or tissue donor in the future. METHODS: Cross-sectional survey of 69 families of deceased donors of the organ procurement organizations of the Federal University of São Paulo. RESULTS: Donors were predominantly men (57% vs 43%) with a median age of 35.9 years. The primary causes of death were classified as natural (65%), traumatic injury (33%), and other (1%). Of the family members surveyed, 40% had an elementary school education and 59% were unemployed. Family members expressed an understanding of the brain death diagnosis (67%). Among them, 74% had no doubt about brain death and had time to ask questions. The diagnosis was provided by the doctor responsible for the patient (89%). Family members also used funeral aid benefit (63%), perceived organ donation positively (97%), and indicated that they would donate again (79%). A significant relationship was found between families that took advantage of the funeral aid benefit and families that would donate again (79% vs 22%, P = .002). CONCLUSION: The intent to donate organs for transplantation may be based more on moral and cultural factors that go beyond the family members' knowledge about the donation process per se.

[Human Papillomavirus (HPV) and uterine cervical cancer]. / Vírus HPV e câncer de colo de útero.

This article refers to a review of literature about the HPV virus and the cervical neoplasia, aiming at raising aspects of the virus infection which influences in the natural development of the uterine cervical cancer such as: the type of virus, the duration and the persistence of the infection and also the association with the manifestations of the preceding lesions up to the evolution of the neoplasia. It was possible to notice the strong association of the infection with the evolution of the cervical neoplasia, however, studies to better elucidate certain aspects of the infection of the HPV virus that acts on the uterine cervix are still necessary so that the actions of prevention and fight against the disease will be more efficient.

[Organ donation and transplantation: Brazilian nursing publications]. / Doação e transplante de órgãos: produção científica da enfermagem brasileira.

The objectives of this bibliographic study were to identify and to characterize nursing scientific productions of organ donation and transplantation since 1997 to 2007. The LILACS, MEDLINE, BDENF, PERIENF AND DEDALUS databases were searched using the following keywords: "nursing and transplantation" and "nursing and donation", identifying 30 articles. The results had shown that the most of publications from the southeast region; the majority of approaching was qualitative; nurses were the main authors and the principal subjects were renal and hepatic transplantation. It was concluded that it is necessary more Brazilian nursing publications of organ donation and transplantation.

Medication non-adherence in heart transplant patients. / Não adesão medicamentosa nos pacientes transplantados cardíacos.

OBJECTIVE: To measure medication non-adherence in patients after heart transplantation using the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS) and the Visual Analogue Scale (VAS); to compare the results of biopsies performed with the prevalent comorbidities and survival. METHOD: Quantitative historical cohort. The population consisted of patients undergoing transplantation between 2009 and 2016. RESULTS: Participation of 60 patients. The measurement using the BAASIS was 46.7% of non-adherence and 53.3% of patient adherence. The group with greater difficulty in non-adherence reported up to 2 hours delay of medication intake in relation to the prescribed time (25%), although there was no interruption in medications. The initial diagnosis was Chagas disease (33.3%). The studied comorbidities were systemic arterial hypertension (SAH), diabetes mellitus (DM), dyslipidemia (DLP) and chronic renal failure (CRF). CONCLUSION: Assessment using the BAASIS showed medication non-adherence in 46.7% of heart transplant patients. The VAS according to patients' self-report and nurse's assessment showed high values (93.3% vs 83.3%). The BAASIS tends to address the difficulties reported by patients, when there is a change in doses, delays or anticipations of time and dose.

Validation of the american quality assessment model and performance improvement to the brazilian transplant.

OBJECTIVE: To validate the quality assessment and performance improvement instrument of US transplant programs to the Brazilian reality. METHOD: Methodological study developed for semantic validation and cultural adaptation of the Quality assessment and Performance Improvement instrument in the following steps: 1) translation; 2) synthesis; 3) back translation; 4) review by expert committee; 5) pretest and 6) content validation. To evaluate the agreement between the five judges, the Kappa coefficient was used and for content validation, the content validation index. RESULTS: Kappa coefficient showed the agreement of the judges for semantic, idiomatic, cultural and conceptual equivalences. Content validation index values for relevance and item sequence of at least 0.80 for all blocks. CONCLUSION: The instrument of Quality Evaluation and Performance Improvement of Transplantation Programs proved to be valid and reliable. This instrument will contribute to the development of quality assurance programs for transplant teams in Brazil.

Nonadherence to Immunosuppressive Medications Following Pediatric Kidney Transplantation Within Full Cost Coverage Health System: Prevalence and Correlates.

OBJECTIVES: Pediatric patients are at higher risk of nonadherence to immunosuppressive medication after kidney transplant and the resulting adverse outcomes. Factors associated with nonadherence vary, which follow an epidemiological framework and according to health system patterns. The Brazilian public health system covers all costs of kidney transplant, including immunosuppressive medications. We aimed to assess the prevalence and correlates of nonadherence to immunosuppressive medications in a pediatric kidney transplant population who received free access to immunosuppressive medications within the health care system. MATERIALS AND METHODS: In this single-center crosssectional study, we studied a convenience sample of 156 outpatients (< 18 years old) who were a minimum of 4 weeks posttransplant. Implementation nonadherence to immunosuppressive medications was measured by the 4 questions of the Basel Assessment of Adherence to Immunosuppressive Medications Scale. Multilevel correlates to non - adherence (patient, micro, and macro levels) were assessed. RESULTS: In our patient population, 61% were males, mean age was 13.6 ± 3.1 years, 77% were adolescents, and 84% received organs from deceased donors. We found that 33% were nonadherent to immuno - suppressive medications, mainly in timing (25%) and taking (10.9%) dimensions. Being an adolescent (odds ratio: 2.66; CI, 1.02-6.96), religion other than Catholic or Protestant (odds ratio: 4.33; CI, 1.13-16.67), and family income higher than 4 reference wages (odds ratio: 3.50; CI, 1.14-10.75) were factors associated with nonadherence. CONCLUSIONS: In our patient population of mostly adolescents, one-third displayed nonadherence to immunosuppressants. Unexpectedly, a higher economic profile, potentially representing better previous access to health care, was independently associated with nonadherence. This result highlights the need for identifying specific correlates to non - adherence before designing interventions.

Maternal factors associated with prematurity in public maternity hospitals at the Brazilian Western Amazon.

OBJECTIVE: To analyse maternal factors associated with prematurity in public maternity hospitals. DESIGN: Retrospective unmatched case-control study on two public maternity hospitals in the State of Acre, Brazil. SETTING AND PARTICIPANTS: A sample of 341 newborn infants of premature birth (< 37 weeks; case group) and 388 newborn infants of term delivery (≥ 37 weeks; control group). METHODS: A validated instrument was used for interviews, and information was collected from hospital records. The variables were divided into five blocks: (1) maternal sociodemographic and economic characteristics, (2) maternal biological and reproductive characteristics, (3) maternal habits, (4) pregnancy complications, and (5) neonatal characteristics. The hierarchical analysis was performed using multiple logistic regression. RESULTS: The risk factors associated with premature birth were as follows: newborn infants of mothers who were born premature (p = 0.005), with low BMI (p = 0.006), history of a previous preterm child (p<0.003), who had stress (p = 0.020) and physical injury during pregnancy (p = 0.025), with quality of prenatal care classified as inadequate II (p = 0.001), which presented abnormal amniotic fluid volume (p<0.001), pre-eclampsia/eclampsia (p<0.001), bleeding (p = 0.013) and hospitalization during pregnancy (p = 0.001). CONCLUSION: The variables that were associated with premature birth were mother born preterm, low BMI, previous premature child, stress and physical injury during pregnancy, prenatal care inadequate II, bleeding, abnormal amniotic fluid volume, pre-eclampsia/eclampsia and hospitalization during pregnancy. It is important to properly perform prenatal care, having a multidisciplinary approach as support, with the objective of keep up with changes in nutritional classification and monitoring of adverse clinical conditions.