Using geo-spatial analysis for assessing the risk of hospital admissions due to community-acquired pneumonia in under-5 children and its association with socially vulnerable areas (Brazil).

BACKGROUND: The concentration of under-5 child morbidity and mortality due to pneumonia in developing countries reflects the social inequities. This study aimed to map and assess the spatial risk for hospitalization due to Community-Acquired Pneumonia in children under 5 years of age and its association with vulnerable areas. METHODS: Ecological study in the city of Ribeirão Preto, state of São Paulo, Brazil. The study population consisted of hospitalized under-5 children, diagnosed with community-acquired pneumonia, in Ribeirão Preto-São Paulo-Brazil, from 2012 to 2013. Data were collected in different databases, by a trained team, between March 2012 and August 2013 and from the 2010 Demographic Census of the Brazilian Institute of Geography and Statistics. The 956 urban census tracts were considered as the units of analysis. The incidence of cases per 10,000 inhabitants was calculated by census tracts during the study period. For the identification of the spatial risk clusters, the Kernel density estimator and the Getis-Ord Gi* technique were performed. Generalized additive models were used to verify the association between areas with social vulnerability and the occurrence of childhood pneumonia. RESULTS: The study included 265 children under the age of five, hospitalized due to community-acquired pneumonia. A concentration of cases was identified in the regions with greater social vulnerability (low income, poor housing conditions and homelessness), as well as a lower occurrence of cases in the most developed and economically privileged area of the city. The majority of the children lived in territories served by traditional primary healthcare units, in which the health surveillance and family and community focus are limited. It is important to highlight that the tracts with the highest degrees of vulnerability, such as those identified as high vulnerability (urban) and very high vulnerability (subnormal urban clusters). CONCLUSIONS: The results contribute to the comprehension of the social factors involved in child hospitalization due to pneumonia, based on the analysis of the spatial distribution. This approach revealed a strategic tool for diagnosing the disparities as well presenting evidences for the planning in health and strength health care system in achieving equity, welfare and social protection of children.

Proposal of indicators to evaluate complementary feeding based on World Health Organization indicators.

This study compares complementary feeding World Health Organization (WHO) indicators with those built in accordance with Brazilian recommendations (Ten Steps to Healthy Feeding). A cross-sectional study was carried out during the National Immunization Campaign against Poliomyelitis in Guarapuava-Paraná, Brazil, in 2012. Feeding data from 1,355 children aged 6-23 months were obtained through the 24 h diet recall. Based on five indicators, the proportion of adequacy was evaluated: introduction of solid, semi-solid, or soft foods; minimum dietary diversity; meal frequency; acceptable diet; and consumption of iron-rich foods. Complementary feeding showed adequacy higher than 85% in most WHO indicators, while review by the Ten Steps assessment method showed a less favorable circumstance and a high intake of unhealthy foods. WHO indicators may not reflect the complementary feeding conditions of children in countries with low malnutrition rates and an increased prevalence of overweight/obesity. The use of indicators according to the Ten Steps can be useful to identify problems and redirect actions aimed at promoting complementary feeding.

[Feeding practices for malnourished children under two years old]. / Práticas alimentares de crianças desnutridas menores de dois anos de idade.

OBJECTIVE: Analyze food practices of unnourished children under two years old. METHOD: Exploratory, descriptive and qualitative study. Data were collected through participant observation and interviews. Participants were 42 subjects. The data were subjected to thematic analysis. RESULTS: The following themes emerged when addressing the eating habits of those children. Who prepares the food and what is prepared; How foods are prepared; Children's eating routine; Where and how children are served. Food was varied little, with lacteous food at breakfast and snacks, and with food such as rice, potatoes, beans and sometimes meat at lunch. Fruits and vegetables were scarce and processed foods were present in all homes. CONCLUSION: It was possible to learn the daily eating habits, their inadequacies, insufficient food poor hygiene of complementary food, influence of grandmothers, inappropriate environment for meals and families' living situation.

[Eating behaviors and the social status of families of malnourished children]. / Práticas alimentares e situação social de famílias de crianças desnutridas.

The objective of this study was to learn about the everyday eating behaviors and the social status of the families of malnourished children. This qualitative study involved eight families. Data were collected by participant observation and semi-structured interviews. Thematic analysis revealed the following themes: family eating; the family's social status and eating during childhood; and the presence of social programs and equipment. The family did not gather for meals and their food consisted basically of different sources of carbohydrates. Fruits and vegetables were very limited and considered to be food choices that did not provide sustenance. Differences were observed between the family's' and the children's' eating habits. Social programs and equipment provided important support, especially regarding the positive attachment with institutions and professionals and following the children's health. The family's social status does not allow the offering of appropriate quantities and quality of food throughout the month, thus compromising the nutritional status of the children, who are deprived of appropriate foods of adequate nutritional value.

[Integrated management of childhood illness (IMCI) in the practice of nurses graduated from USP]. / Atenção integrada as doenças prevalentes na infância (AIDPI) na prática de enfermeiros egressos da USP.

This is a description of the Integrated Management of Childhood Illness (IMCI) strategy in the professional practice of nurses graduated from the School of Nursing of University of São Paulo (EE-USP). This is a case study of qualitative approach. The data were collected through focus groups and analyzed using thematic content analysis. IMCI strategy was considered an important tool in child health care, but only the assessment module was apart of professional practice. Difficulties in the use of the IMCI were: the strategy was not implanted at health services, it was unknown by co-workers and institutional obstacles. In spite of the limited and non-systematic use of IMCI, it has allowed nurses to provide integrated and comprehensive attention to the child, which justifies its teaching on undergraduate courses. Maintenance of the educational video, expansion of the practice, integration of courses and optimization of content and workload were suggested for improving the teaching of IMCI at the undergraduate level.

Stigma and cystic fibrosis.

Cystic Fibrosis (CF), also known as Mucoviscidosis, is a chronic disease of autosomal recessive origin and so far incurable. This analysis considers some characteristics of patients and family members that indicate it is a stigmatizing disease. The CF stigmas impact on the lives of children and adolescents can affect treatment adherence, socialization, family relationships and the formation of their life histories, with direct consequences on their quality of life.

Technical attainment, practical success and practical knowledge: hermeneutical bases for child nursing care.

This reflective study aimed to present some aspects of the concepts technical attainment, practical success and practical knowledge, with a view to a broader understanding of child nursing care. Health care is considered in the perspective of reconstructive practices, characterized as contingencies, highlighting the importance of the connection between technical attainment and practical success and the valuation of practical knowledge, based on philosophical hermeneutics, in the context of practical philosophy. Child health nursing can deal with technical attainment and practical success jointly, and also understand practical knowledge in the longitudinality of care. Health promotion, disease prevention, recovery and rehabilitation of child health should be indissociably associated with contextualized realities, shared between professionals and families, aiming to follow the child's growth and development, produce narratives, identify experiences, choices and decision making to broaden health care.

Child health care in Brazil: aspects of program vulnerability and human rights.

This study aimed to examine the epidemiological approach in Brazilian child health programs, towards the reflection on current guidelines from the perspective of program vulnerability and human rights. A descriptive study was carried out, based on the analysis of official documents elaborated by the Brazilian Ministry of Health. The expansion and reorganization of family health practices and integrated care for prevailing childhood diseases are aimed at promoting health and quality of life to children and families. Health professionals, imbued with observation and intervention, can be considered agents to respect, protect and implement human rights.

Health follow-up of children in poverty situation: between the routine and eventuality of daily care.

This study aimed to identify how child care is delivered to children under two in their daily routine. Based on a qualitative approach, the study addresses the care site in the child care, through non-structured interviews with mothers and professionals from two health units in peripheral areas of Ribeirão Preto, SP, Brazil. Results point aspects of how professionals view the mothers and their families, how the child's health, the routine and eventuality of care are followed. Adherence is important in the child's follow up, the longitudinality of care and, mainly, the concern with the mothers' and families' values. Child care in primary health care has a contingency character; it must deal with eventuality, uncertainty and events linked to experiences, integrating practical and technical knowledge.

[Assistance to newborns in a family health program]. / Assistência ao recém-nascido em um Programa de Saúde da Família.

This study describes the neonatal health care implemented through the Family Health Program in a unit in Guarapuava, State of Paraná, with the aim of supporting the organization of child health care in a family context. It is a descriptive survey based on data from live birth statements and files of families with babies born between October 1, 2003 and September 30, 2004, totaling 90 infants. The description of how clients were attracted and the verification of care delivery made possible the construction of a newborn health care flow chart. It was found that the flow chart represents a means for identifying the type of demand, the care delivered by each professional, the procedures, the referrals and the returns, as well as the gaps. This made possible for us to visualize the health care schematically, thus contributing to the organization of newborn health care in Family Health Program units.

[Social organizations and governmental institutions: perspectives on partnerships in children's health care through volunteers and the Pastoral da Criança]. / Organizações sociais e instituições governamentais: perspectivas de parceria na atenção a saúde da criança através dos voluntários e da Pastoral da Criança.

The aim of this research is to present perspectives on partnerships between social organizations and governmental institutions in children's health care. This study reflects on social participation and relations between governmental and non-governmental services in constructing the consolidation of the Sistema Unico de Saúde (Unified Health System), highlighting the role of volunteers and health professionals in this process. In child care, these associations are potential, due to the wide range and prominence of social organizations oriented towards children, particularly the Pastoral da Criança (the Catholic Church's Child Pastoral), which makes it important to discuss public policies aimed at establishing and strengthening these links in the local and national spheres.

Presence and extent of the primary health care attributes among children hospitalized for pneumonia.

OBJECTIVE: to analyze the presence and extent of the primary health care attributes among children hospitalized for pneumonia. METHOD: observational and retrospective study with hospital-based case-control design, developed in three hospitals associated to the Brazilian Unified Health System, located in a city of the State of São Paulo, Brazil. The study included 690 children under five years old, with 345 cases and 345 controls. RESULTS: both groups scored high for access to health services. In contrast, high scores for attributes such as longitudinality and coordination of care were observed for the controls. Despite low scores, integrality and family counseling were also high for the controls. CONCLUSION: knowledge of the aspects involving the primary health care attributes and its provision for child care are very important because they have the potential to support professionals and managers of the Brazilian Unified Health System in the organization of health services.

Child Health Surveillance: nurses perspective.

OBJECTIVE: to analyze conceptions of nurses on child health surveillance in family health units. METHOD: a qualitative study with thematic analysis of the data, based on the paradigm of Health Surveillance. Interviews were conducted with 13 nurses in a countryside city in the state of Sao Paulo. RESULTS: nurses conceived child health surveillance as an active monitoring, which should be comprehensive, identifying risks/vulnerabilities, through multidisciplinary and intersectoral actions that are dependent on maternal involvement. We found partial development of these assumptions in practice, due to difficulties such as lack of maternal involvement in the proposed actions, lack of time for discussion and adoption of measures in the units and disarticulation between levels and sectors of the city. CONCLUSION: a greater political and technical investment is needed to ensure the adoption of this model in different sectors and levels of care of the city.

Interaction during feeding times between mothers and malnourished children under two years of age.

This study sought to understand the relations between mothers and malnourished children at feeding times. It is an exploratory study with qualitative data analysis. Data collection was performed at home by means of participant observation with eight mother-child dyads and three grandmothers. Based on the thematic analysis, the following themes emerged: food and interaction; day-to-day care of the child. The families' life situation was unfavorable. Mothers and grandmothers were responsible for preparing family meals, feeding and child care. The mother-child relationships were permeated by gestures of affection, slaps, scolding, and threats during feeding and there were cases of negligence, physical and psychological violence in daily care. Some mothers and grandmothers spoke quietly and cared for the child to be fed and cleaned while others mothers showed little patience for dealing with the child and they became easily irritated. Mothers' life stories were marked by adverse events and most of them faced emotional problems that could have repercussions in relationships with children at feeding times and in daily care. The mother-child interactions at home do not always favor feeding and responsive care, which may further worsen the nutritional status of these children.

Mother recognition in the Neonatal Intensive Care Unit.

OBJECTIVE: analyze the maternal experience in a neonatal intensive care unit, focusing on relations of recognition. METHOD: a qualitative study, built on the perspective of Gadamer's hermeneutics, based on Honneth's concept of recognition. In-depth interviews were conducted with 10 mothers of children admitted to a neonatal intensive care unit. RESULTS: failures were reported in the process of mother recognition in the unit, with consequent feelings of insecurity and obligation to child care, resulting in fragility of self-esteem. CONCLUSION: interactions with health professionals in the NICU and its standards and protocols cause vulnerabilities and affect maternal recognition and autonomy.

[Nursing practice in the health care of children at a basic health unit]. / A prática de enfermagem na atenção à saúde da criança em unidade básica de saúde.

This study aimed at identifying nursing actions in the follow-up of growth and development of children under five years old who were assisted at two Basic Health Units in Franca, Brazil. The empirical study was based on observation of nursing activities in the vaccination, pre-consultation, post-consultation and newborn screening test collection sectors, using video recording. We concluded that basic follow-up actions concerning growth and development, breastfeeding stimulation, food orientation, vaccination and prevalent disease prevention are permeating nursing care, although in a fragmented way in communication and ties established with clients.

[Health education for puerperal women in neonatal rooming-in: knowledge acquisition with an educational game]. / Educação em saúde de puérperas em alojamento conjunto neonatal: aquisição de conhecimento mediado pelo uso de um jogo educativo.

The study aims at verifying knowledge acquisition through health education activities mediated by the use of an educational game on breast-feeding and basic care provided to the newborn, in rooming-in. Study accomplished at a philanthropic maternity of Ribeirão Preto-SP. Educational activities were accomplished in group, coordinated by the nurse, using board game. Through structured interview guided by a route before and after-game, the authors verified the knowledge acquisition, classifying the answers in insufficient (0-4), regular (5-9), good (10-14) and excellent (15-20). Of the mothers' previous knowledge, 16.7% of answers were excellent increasing for 77.8% after participation in the educational activity. They concluded that the game constituted in appropriate strategy to facilitate change of experiences between puerperas and the development of the health education through ludic-pedagogical activities.

[Undergraduate education at the University of São Paulo at Ribeirão Preto College of Nursing throughout the 50 years of its history (1953-2003)]. / O ensino de graduação na Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo ao longo dos seus 50 anos (1953-2003).

This study aims to describe the course of undergraduate education developed at the University of São Paulo at Ribeirão Preto College of Nursing throughout the 50 years of its history (1953-2003), offering tools for reflection about the historical and social context, about current curricular guidelines and political and pedagogical challenges with a view to nursing formation.

[Maternal care of low-birth weight infants]. / Cuidados maternos a crianças de baixo peso ao nascer.

This is an exploratory and descriptive study which aimed at characterizing mothers' accounts on the care given to the health of children with low weight at birth during their first and second years of life by means of home interviews with a group of eleven mothers of children from Ribeirão Preto--SP. The mothers pointed to difficulties with breastfeeding, the babies' diet and medication use. They also referred to concerns about intercurrences, re-hospitalizations and psychomotor development, which results in the need for professional support in order to evaluate and follow the growth and development process of children within families' everyday life.

[Nursing care given to children aged less than one year at a basic district health unit]. / Assistência de enfermagem a crianças menores de um ano de idade em unidade básica de saúde.

This study is characterized as descriptive and exploratory, based on the observation of nursing care at the sectors of vaccination, pre- and post-consultation, and first aid at a basic district health unit in the city of Ribeirão Preto, state of São Paulo, Brazil. The purpose of this observation was the characterization and understanding of the nursing care given to children aged less than one year and the follow-up of their growth and development, as previously approved by a Research Ethics Committee. Thirty-two children, accompanied by their mothers, participated in the study, totaling 56 hours of observation. In general, the set of assistance episodes allowed the comprehension of nursing guidelines in vaccination and the follow-up of the child, which has shown the need to expand care and introduce the strategy of Integrated Management of Childhood Illness.