Factors associated with antepartum pilgrimage at a reference maternity hospital in Ceará.

OBJECTIVE: To identify factors associated with antepartum pilgrimage in pregnant women in Fortaleza, Ceará, Brazil. METHOD: A cross-sectional study with 300 postpartum women from a state reference maternity hospital, carried out from March 2020 to January 2021. The frequency of pilgrimage was estimated according to socioeconomic characteristics and prenatal care. Analysis with Pearson's chi-square test selected variables for adjusted Poisson regression. RESULTS: The frequency of antepartum pilgrimage to more than one health service was 34.3%. Not knowing the reference maternity hospital (1.16; 95%CI: 1.04-1.30) and not living close to the reference maternity hospital (1.16; 95%CI: 1.03-1.31) were associated with the occurrence of pilgrimage among women. Personal characteristics and prenatal care were not associated. CONCLUSION: There was an association between antepartum pilgrimage and lack of knowledge of the reference maternity hospital and residence far from that maternity hospital, which requires better team communication and the guarantee of easier access to obstetric care services, through effective implementation of regionalization of maternal care.

Urinary proteomics reveals biological processes related to acute kidney injury in Bothrops atrox envenomings.

Acute kidney injury (AKI) is a critical systemic complication caused by Bothrops envenoming, a neglected health problem in the Brazilian Amazon. Understanding the underlying mechanisms leading to AKI is crucial for effectively mitigating the burden of this complication. This study aimed to characterize the urinary protein profile of Bothrops atrox snakebite victims who developed AKI. We analyzed three groups of samples collected on admission: healthy subjects (controls, n = 10), snakebite victims who developed AKI (AKI, n = 10), and those who did not evolve to AKI (No-AKI, n = 10). Using liquid-chromatography tandem mass spectrometry, we identified and quantified (label-free) 1190 proteins. A panel of 65 proteins was identified exclusively in the urine of snakebite victims, with 32 exclusives to the AKI condition. Proteins more abundant or exclusive in AKI's urine were associated with acute phase response, endopeptidase inhibition, complement cascade, and inflammation. Notable proteins include serotransferrin, SERPINA-1, alpha-1B-glycoprotein, and NHL repeat-containing protein 3. Furthermore, evaluating previously reported biomarkers candidates for AKI and renal injury, we found retinol-binding protein, beta-2-microglobulin, cystatin-C, and hepcidin to be significant in cases of AKI induced by Bothrops envenoming. This work sheds light on physiological disturbances caused by Bothrops envenoming, highlighting potential biological processes contributing to AKI. Such insights may aid in better understanding and managing this life-threatening complication.

Effects of auriculotherapy on nausea and vomiting in pregnant women: A randomized clinical trial.

BACKGROUND: Pregnancy induces physiological changes, commonly marked by nausea and vomiting in the first trimester, posing risks for both mother and baby. This study evaluates the effects of auriculotherapy on nausea and vomiting during the first trimester of pregnancy. MATERIALS AND METHODS: A randomized clinical trial was conducted in two primary health care centers with 56 Brazilian pregnant women who reported nausea or vomiting in the first trimester. The participants were divided into an intervention group (auriculotherapy with seeds) and a placebo group (sham auriculotherapy). The intervention was divided into three moments: pre-intervention with assessment of nausea and vomiting and application of questionnaires, and two follow-ups conducted on the fourth and seventh day of the intervention, with reassessment of nausea and vomiting. RESULTS: Both groups experienced a decrease in nausea and vomiting over time, with no statistically significant differences between groups in the within-group analyses at various time points. The intervention group had a greater reduction in symptoms. Within the intervention group, symptoms were more common among ferrous sulfate users and those without reported dietary disturbances. In addition, a higher incidence of nausea and vomiting was associated with the use of analgesics, morning snacks, and low intake of protein, vegetables, and fruits. CONCLUSIONS: The intervention did not affect the between-group differences in the incidence of nausea and vomiting and vomiting effort in the first trimester of pregnancy. However, a greater reduction was observed in the intervention group.

Prenatal care associated with neonatal outcomes in maternity hospitals: a hospital-based cross-sectional study.

OBJECTIVE: To verify the association between prenatal care quality indicators and neonatal outcomes in maternity hospitals. METHOD: Hospital-based cross-sectional study in four high-risk referral maternity hospitals in the five health macro-regions enabled by the Stork Network in Ceará-Brazil. Between April 2017 and July 2018, 440 puerperal women were interviewed using simple probabilistic sampling and a formula with finite populations and stratification of each maternity hospital. The analysis involved Pearson's Chi-Square, Adjusted Residuals Analysis and Fisher's Exact. RESULTS: There was an association between fewer consultations with prematurity and low birth weight. Delivery in the maternity hospital where the woman lived was associated with low birth weight and the need for ventilatory support. CONCLUSION: Prenatal care quality indicators influenced neonatal outcomes, which underlines the importance of ensuring access and quality of care as ways of reducing infant morbidity and mortality.

Factors associated with infant feeding intention among usual-risk pregnant women.

OBJECTIVE: To identify the factors associated with infant feeding intention among usual-risk pregnant women. METHODS: A quantitative cross-sectional study was conducted in two primary healthcare institutions in Fortaleza, Ceará, Brazil, with usual-risk pregnant women. A non-probabilistic convenience sampling method was used, and 119 pregnant women participated. Data collection took place from May 2022 to February 2023. The data collection process involved using forms and the Infant Feeding Intention Scale. Ethical considerations were strictly adhered to. RESULTS: The study revealed statistically significant differences in the infant's means. The majority of pregnant women (96.6%) declared that they would breastfeed after giving birth. The intention to breastfeed exclusively was statistically higher in mothers with younger children and previous experience of breastfeeding or complications in the current pregnancy. CONCLUSION: This study clarified that the intention to breastfeed up to 6 months is influenced by variables encompassing the age of the youngest child, previous breastfeeding experience, and pregnancy complications, emphasizing the intricate nature of the determinants of intention to breastfeed.

Sociodemographic and obstetric factors associated with health-related quality of life of high-risk pregnant women.

OBJECTIVE: To evaluate the association between sociodemographic and obstetric factors and the health-related quality of life of pregnant women in high-risk prenatal care. METHODS: A cross-sectional study of women in high-risk prenatal care in Ceara, Brazil. The investigated outcomes were health-related quality of life, using the Medical Outcomes Study 36-item short-form health survey; the investigated covariates were sociodemographic and obstetric data. Associative analyses were performed using the Jamovi® software version 0.9. RESULTS: Of the 276 women included in the study, women with the following characteristics presented a better quality of life in some domain of the scale: age equal to or greater than 35 years, higher income per dependent, religious, living with three or fewer persons, with their own home, in primigestation, nulliparous, with no history of previous abortion, and with up to two living children. The regression model showed an association between the total scale score, which means a higher quality of life in women with age equal to or greater than 35 years and a higher income per dependent. CONCLUSION: The study identified sociodemographic and obstetric factors that may affect the quality of life of high-risk pregnant women, providing subsidies to health providers so that they can promote better prenatal care.

Diagrama de prevenção de quedas para pessoas idosas: revisão integrativa / Diagrama de prevención de caídas para personas mayores: revisión integradora / Fall prevention diagram for older adults: an integrative review

Resumo Objetivo Propor um diagrama de prevenção de quedas para pessoas idosas, baseado no Modelo de Promoção da Saúde de Nola Pender. Métodos A construção do diagrama foi embasada no modelo de Nola Pender e em seus elementos. Para isso, foi realizado um estudo de revisão integrativa, com o objetivo de coletar dados sobre características e experiências individuais, sentimentos e conhecimentos e adoção de comportamento saudável para prevenção de quedas. Após a coleta dessas informações, realizou-se análise de similitude dos estudos selecionados por meio do IRaMuTeQ. Os elementos obtidos da análise de similitude facilitaram o agrupamento dos estudos quanto aos elementos encontrados e, assim, proporcionaram a organização do diagrama de prevenção de quedas. Resultados A amostra final foi constituída de 54 artigos, divididos de acordo com os elementos do modelo de Nola Pender: 36 abordavam características e experiências individuais, 40 sentimentos e conhecimentos, e 20 eram referentes ao comportamento. Os elementos obtidos da análise de similitude geraram um leque semântico de palavras mais frequentes: queda, prevenção, mulher e medo. Já as palavras menos frequentes foram cognição, autoeficácia, transporte e planejamento, os quais contribuíram para a construção do diagrama. Conclusão A partir da revisão, elaborou-se um diagrama, que favoreceu a identificação dos fatores pessoais, barreiras e facilidades, para um comportamento desejável à prevenção de quedas.

Resumen Objetivo Proponer un diagrama de prevención de caídas para personas mayores, basado en el modelo de promoción de la salud de Nola Pender. Métodos La elaboración del diagrama se basó en el modelo de Nola Pender y sus elementos. Para tal fin, se realizó un estudio de revisión integradora con el objetivo de recopilar datos sobre características y experiencias individuales, sentimientos y conocimientos y adopción de un comportamiento saludable para la prevención de caídas. Después de recopilar la información, se realizó un análisis de similitud de los estudios seleccionados mediante IRaMuTeQ. Los elementos obtenidos del análisis de similitud permitieron agrupar los estudios respecto a los elementos encontrados y, de esta forma, proporcionaron la organización del diagrama de prevención de caídas. Resultados La muestra final estuvo compuesta por 54 artículos, divididos de acuerdo con los elementos del modelo de Nola Pender: 36 abordaban características y experiencias individuales, 40 sentimientos y conocimientos y 20 eran sobre el comportamiento. Los elementos obtenidos del análisis de similitud generaron un conjunto semántico de palabras más frecuentes: caída, prevención, mujer y miedo. Por otro lado, las palabras menos frecuentes fueron: cognición, autoeficacia, transporte y planificación, que contribuyeron para la elaboración del diagrama. Conclusión A partir de la revisión, se elaboró un diagrama que favoreció la identificación de los factores personales, barreras y facilidades para un comportamiento conveniente en la prevención de caídas.

Abstract Objective To propose a fall prevention diagram for older adults, based on Nola Pender's Health Promotion Model. Methods Diagram construction was based on Nola Pender's model and its elements. For this, an integrative review study was carried out with the objective of collecting data on individual characteristics and experiences, behavior-specific cognitions and affect and behavioral outcome for fall prevention. After collecting this information, a similarity analysis of the selected studies was carried out using IRaMuTeQ. The elements obtained from similarity analysis facilitated the grouping of studies regarding the elements found and thus provided fall prevention diagram organization. Results The final sample consisted of 54 articles, divided according to the elements of Nola Pender's model: 36 addressed individual characteristics and experiences, 40 referred to behavior-specific cognitions and affect, and 20 referred to behavioral outcome. The elements obtained from the similarity analysis generated a semantic range of the most frequent words: fall, prevention, woman and fear. The least frequent words were cognition, self-efficacy, transportation and planning, which contributed to diagram construction. Conclusion From the review, a diagram was prepared, which favored identifying personal factors, barriers and facilities for a desirable behavior to prevent falls.

Epidemiology of HIV in pregnant women and its relationship with the period of the COVID-19 pandemic.

OBJECTIVE: To analyze, in the light of the Social Ecological Theory, the progression of reported cases of HIV during pregnancy in a Brazilian state and their relationship with the onset of the COVID-19 pandemic. METHOD: Retrospective study, with a sample consisting of all reports of gestational HIV in the state of Ceará - Brazil from 2017 to 2021, on the IntegraSUS platform. Data collection was carried out in January 2022. The analyzed variables were organized according to the theoretical levels: macrosystem, exosystem, mesosystem, and microsystem. RESULTS: A total of 1,173 cases of HIV in pregnant women were recorded. When comparing the pre- and post-pandemic period, a reduction in the disease detection rate (from 231 to 122.67 pregnant women) was observed, as well as 1.82 times more chances of women not using antiretrovirals during childbirth after the start of the pandemic. There was a 55% reduction in vaginal births and 39% in cesarean sections among women diagnosed with HIV after the start of the pandemic. CONCLUSION: The COVID-19 pandemic had an epidemiological and care impact, leading to a reduction in the number of notifications and in the detection rate of pregnant women living with HIV in the state of Ceará. Therefore, the need to ensure health care coverage is emphasized, with early diagnosis actions, guaranteed treatment, and quality prenatal care.

Fatores associados à satisfação de acadêmicos com o curso de graduação em Enfermagem: um estudo transversal / Factors associated with students satisfaction with the undergraduate nursing course: a cross-sectional study / Factores asociados a la satisfacción de académica os con el curso e pregrado de enfermería: un estudio transversal

Objetivo: a pesquisa em tela tem como objetivo avaliar a associação entre variáveis sociodemográficas, hábitos de vida, relacionamentos interpessoais e relações acadêmicas com a satisfação dos acadêmicos quanto ao curso de graduação em Enfermagem. Métodos: estudo seccional realizado em uma universidade pública com amostragem de 199 estudantes de Enfermagem, utilizando instrumentos de caracterização sociodemográfica, acadêmica, de relacionamento interpessoal, saúde e satisfação dos alunos. Associações com valor de significância menor que 0,2 na análise bivariada foram incluídas no modelo de regressão de Poisson com estimação robusta de variância. Resultados: observou-se que as variáveis sociodemográficas, hábitos de vida, relacionamentos interpessoais e relacionamentos acadêmicos não demonstraram associações de poder estatístico significante após a análise de regressão. Contudo, alunos que possuem bons relacionamentos com os docentes apresentaram mais satisfação com o curso. Conclusão: a variável relacionamento docente-discente apresentou relação significativa com a satisfação com o curso de Enfermagem. Já os fatores sociodemográficos, hábitos de vida, variáveis acadêmicas e de saúde não apresentaram associação significativa com a satisfação do curso. Contribuições para a prática: o presente estudo pode contribuir para a identificação de quais variáveis podem ou não colaborar para que o discente tenha maior satisfação com o curso, além de nortear estratégias para a efetiva diminuição da evasão do curso de graduação em Enfermagem.(AU)

Objective: the research on screen aims to evaluate the association between sociodemographic variables, life habits, interpersonal relationships, and academic relationships with the satisfaction of academics regarding the undergraduate course in Nursing. Methods: cross-sectional study carried out at a public university with a sample of 199 Nursing students, using sociodemographic, academic, interpersonal relationship, health, and student satisfaction instruments. Associations with a significance value of less than 0.2 in the bivariate analysis were included in the Poisson regression model with robust estimation of variance. Results: it was observed that the sociodemographic variables, life habits, interpersonal relationships and academic relationships did not show significant statistical power associations after the regression analysis. However, students who have good relationships with professors were more satisfied with the course. Conclusion: the professor-student relationship variable showed a significant relationship with satisfaction with the Nursing course. On the other hand, sociodemographic factors, life habits, academic and health variables did not present a significant association with course satisfaction. Contributions to practice: the present study can contribute to the identification of which variables may or may not collaborate so that the student has greater satisfaction with the course, in addition to guiding strategies for the effective reduction of dropout from the undergraduate Nursing course.(AU)

sociodemográficas, hábitos de vida, relaciones interpersonales y relaciones académicas con la satisfacción de los académicos con respecto al curso de graduación en Enfermería. Métodos: estudio transversal, realizado en una universidad pública, con una muestra de 199 estudiantes de enfermería, utilizando instrumentos sociodemográficos, académicos, de relaciones interpersonales, de salud y de satisfacción de los estudiantes. Las asociaciones con un valor de significación inferior a 0,2 en el análisis bivariado se incluyeron en el modelo de regresión de Poisson con estimación robusta de la varianza. Resultados: se observó en el presente estudio que las variables sociodemográficas, estilo de vida, relaciones interpersonales y relaciones académicas no mostraron asociaciones de poder estadístico significativas después del análisis de regresión. Sin embargo, los estudiantes que tienen buenas relaciones con los profesores se mostraron más satisfechos con el curso. Conclusión: la variable relación profesor-alumno mostró una relación significativa con la satisfacción con la carrera de Enfermería. Los factores sociodemográficos, hábitos de vida, variables académicas y de salud no mostraron una asociación significativa con la satisfacción del curso. Contribuciones a la práctica: el presente estudio puede contribuir a la identificación de qué variables pueden o no colaborar para que el...(AU)

Factors associated with puerperal women's perception of the support received from their companions during labor and delivery.

OBJECTIVE: The aim of the current study was to associate sociodemographic characteristics and satisfaction with the support received from companions during labor and delivery. METHOD: An analytical cross-sectional study was performed in a maternity hospital in Fortaleza, Brazil, from March to August 2019, with 320 postpartum women. A form containing sociodemographic and obstetric questions, companion-related information, type of support provided, and the Birth Companion Support Questionnaire (BCSQ) were used to assess the frequency of social support behaviors. χ2 and Fisher exact tests were used for statistical analyses. RESULTS: Nonpharmacological methods were associated with an unsatisfactory perception of support, but the emotional support provided by companions was positively associated with women's satisfaction. CONCLUSION: The findings of the current study concerning women's perceptions of the support received from their companions may allow improvements in the delivery of care to women in labor toward the humanization of obstetric practices.

Women know about perineal trauma risk but do not know how to prevent it: Knowledge, attitude, and practice.

OBJECTIVE: To evaluate the knowledge, attitude, and practice (KAP) of pelvic floor muscle (PFM) preparation for birth among postpartum women, and its related factors. METHODS: Cross-sectional study conducted in a maternity unit among Brazilian women aged 14 years or older during the first 72 h postpartum, who desired and had vaginal birth. Sociodemographic, clinical, and obstetric data were collected using a standardized form from medical charts. A 15-question questionnaire was used to measure the KAP of PFM preparation for birth. Knowledge was categorized as: poor, average, and good. RESULTS: In all, 326 women completed the survey (mean age 24.3 ± 6.2 years) and 167 (51.2%) women had poor knowledge. The attitude of searching for information on how to prevent perineal trauma was reported by 14 (4.3%) women. Only 13 (4.0%) participants reported that they had practiced at least one session of PFM preparation during pregnancy (PFM training, perineal massage, etc.) Multivariate analysis showed that lower educational level was associated with poor knowledge (P < 0.05). CONCLUSION: The KAP of PFM preparation for birth is inadequate among postpartum women. Health education regarding PFM care during pregnancy and postpartum should be addressed among pregnant women, specifically younger women with lower levels of education and income.

Determinantes sociais de saúde associados à reinternação hospitalar de pessoas com HIV / Determinantes sociales de la salud asociados a la reinternación hospitalaria de personas con VIH / Social determinants of health associated with hospital readmissions of people with HIV

Resumo Objetivo Avaliar a associação entre os determinantes sociais de saúde e a ocorrência de reinternação hospitalar de pessoas vivendo com HIV. Métodos Estudo transversal, com dados de 262 prontuários de pessoas com HIV, que foram internadas no período de 12 meses, em Fortaleza, Ceará. Foram incluídos prontuários disponíveis na íntegra no arquivo hospitalar. A variável de desfecho foi analisada de duas formas: reinternação como variável dicotômica (sim/não) e de forma multinomial, por meio do número de reinternações (nenhuma, 1-2, 3 ou ≥4 reinternações). Foi considerado significante p<0,05 com nível de confiança de 95%. Resultados Das pessoas que faziam uso de drogas ilícitas, 63% (n=51) apresentavam reinternação, em comparação aos 47,3% (n=71) daqueles não faziam uso (p=0,02). Houve reinternação em 66,7% (n=36) das pessoas que recebiam até um salário mínimo e 48% (n=71) das que recebiam entre um e dois salários mínimos. Ocorreu percentual de 30,8% (n=12) de reinternação em afastados do trabalho, 41,3%; (n=26) em pessoas que estavam exercendo atividades laborais e 60,9% (n=70) de reinternação em desempregados (p=0,001). Conclusão O determinante social de saúde individual relacionado às reinternações que obteve destaque foi idade ≥ 40 anos; quanto aos determinantes proximais, uso de drogas ilícitas esteve mais relacionado às reinternações registradas. O determinante intermediário com maior evidência de reinternação esteve relacionado à situação de trabalho, uma vez que os desempregados apresentaram maior percentual de três ou mais internações. Assim, os determinantes sociais de saúde com impacto na ocorrência de reinternação hospitalar de pessoas vivendo com HIV, foram: uso de drogas ilícitas, pessoas que recebiam valor menor ou igual a um salário mínimo e os desempregados.

Resumen Objetivo Evaluar la relación entre los determinantes sociales de la salud y los episodios de reinternación hospitalaria de personas que viven con el VIH. Métodos Estudio transversal, con datos de 262 historias clínicas de personas con VIH que fueron internadas durante un período de 12 meses en Fortaleza, Ceará. Se incluyeron historias clínicas disponibles en su totalidad en el archivo hospitalario. La variable de resultado fue analizada de dos formas: reinternación como variable dicotómica (sí/no) y de forma multinomial, mediante el número de reinternaciones (ninguna, 1-2, 3 o ≥4 reinternaciones). Se consideró significante p<0,05, con nivel de confianza de 95 %. Resultados De las personas que consumían drogas ilícitas, el 63 % (n=51) presentó reinternación, comparado con el 47,3 % de los que no consumían (p=0,02). Hubo reinternación en el 66,7 % (n=36) de las personas que ganaban hasta un salario mínimo y en el 48 % (n=71) de las que ganaban entre uno y dos salarios mínimos. Se observó un porcentaje de 30,8 % (n=12) de reinternaciones en personas con licencia laboral, un 41,3 % (n=26) en personas que estaban ejerciendo actividades laborales y un 60,9 % (n=70) de reinternaciones en personas desempleadas (p=0,001). Conclusión El determinante social de la salud individual relacionado con las reinternaciones que predominó fue la edad ≥ 40 años. Respecto a los determinantes proximales, el consumo de drogas ilícitas se vio más relacionado con las reinternaciones registradas. El determinante intermedio con mayor evidencia de reinternación se relacionó con la situación laboral, dado que las personas desempleadas presentaron un porcentaje mayor de tres internaciones o más. De esta forma, los determinantes sociales de la salud con impacto en los episodios de reinternación hospitalaria de personas que viven con el VIH fueron: consumo de drogas ilícitas, personas que ganaban un valor menor o igual a un salario mínimo y personas desempleadas.

Abstract Objective To assess the association between social determinants of health and occurrence of hospital readmissions of people living with HIV. Methods This is a cross-sectional study, with data from 262 medical records of people with HIV who were hospitalized within a 12-month period, in Fortaleza, Ceará. Medical records available in full in the hospital file were included. The outcome variable was analyzed in two ways: readmission as a dichotomous variable (yes/no) and in a multinomial way, through the number of readmissions (none, 1-2, 3 or ≥4 readmissions). P<0.05 was considered significant with a confidence level of 95%. Results Of the people who used illicit drugs, 63% (n=51) were readmitted, compared to 47.3% (n=71) of those who did not use them (p=0.02). There was readmission in 66.7% (n=36) of people who earned up to one minimum wage and 48% (n=71) of those who earned between one and two minimum wages. There was a percentage of 30.8% (n=12) of rehospitalization in those away from work; 41.3% (n=26) in people who were performing work activities; and 60.9% (n=70) of readmission in unemployed. Conclusion The individual social determinant of health related to readmissions that stood out was age ≥ 40 years. Regarding the proximal determinants, illicit drug use was more related to the readmissions recorded. The intermediate determinant with the highest evidence of rehospitalization was related to the employment situation, since unemployed individuals had a higher percentage of three or more hospitalizations. Thus, the social determinants of health with an impact on the occurrence of hospital readmissions of people living with HIV were illicit drug use, people who received less than or equal to a minimum wage and who were unemployed.

Desenvolvimento de cartilha como tecnologia educacional para alívio da dor do parto / Elaboración de cartilla como tecnología educativa para el alivio del dolor de parto / Development of a booklet as an educational technology for birth pain relief

Resumo Objetivo Descrever os processos de construção e validação de cartilha educativa sobre métodos não farmacológicos para alívio da dor no trabalho de parto e parto. Métodos Estudo metodológico, realizado em três etapas. Na primeira, foi realizado levantamento bibliográfico para seleção dos conteúdos referentes à temática. Na segunda etapa, realizou-se validação com 24 juízes de conteúdo e três juízes técnicos. Na terceira etapa, ocorreu validação pelo público-alvo, com 30 gestantes. O período do estudo foi de setembro a novembro de 2018. Foi utilizado o editor de planilhas do Office para análise dos dados. Resultados O nível de concordância atribuído pelos juízes de conteúdo e técnicos esteve entre 97,2% e 98,9% e entre 83,3% e 100%, respectivamente; o Índice de Validade de Conteúdo global foi de 0,92 e 0,97, respectivamente. Na avaliação realizada com o Suitability Assesment of Materials, os juízes de conteúdo classificaram a cartilha como "superior", com média de 85,2% e os técnicos com média de 77,5%. O público-alvo validou a cartilha com Índice de Validade de Conteúdo global de 0,98 e nível de concordância de 99,7%. Conclusão A cartilha educativa mostrou-se válida para ser utilizada junto às gestantes, sendo considerada tecnologia educativa inovadora e relevante na utilização em consulta pré-natal.

Resumen Objetivo Describir el proceso de elaboración y validación de cartilla educativa sobre métodos no farmacológicos para aliviar el dolor en el trabajo de parto y en el parto. Métodos Estudio metodológico, realizado en tres etapas. En la primera, se realizó el análisis bibliográfico para seleccionar contenidos relacionados con la temática. En la segunda etapa, se realizó la validación con 24 jueces de contenido y tres jueces técnicos. En la tercera etapa, se llevó a cabo la validación por parte del público destinatario, con 30 mujeres embarazadas. El período de estudio fue de septiembre a noviembre de 2018. Se utilizó el editor de planillas de Office para el análisis de datos. Resultados El nivel de concordancia atribuido por los jueces de contenido fue entre 97,2 % y 98,9 % y de los técnicos entre 83,3 % y 100 %. El Índice de Validez de Contenido global fue de 0,92 y 0,97, respectivamente. En la evaluación realizada con Suitability Assesment of Materials, los jueces de contenido clasificaron la cartilla como "superior", con promedio de 85,2 % y los técnicos con promedio de 77,5 %. El público destinatario validó la cartilla con Índice de Validez de Contenido global de 0,98 y nivel de concordancia de 99,7 %. Conclusión La cartilla educativa demostró ser válida para ser utilizada con mujeres embarazadas y fue considerada una tecnología educativa innovadora y relevante para utilizar en consultas de control prenatal.

Abstract Objective To describe the construction and validity of an educational booklet on non-pharmacological methods for labor and birth pain relief. Methods This is a methodological study, carried out in three stages. In the first, a bibliographic survey was carried out to select the contents related to the theme. In the second stage, validity was carried out with 24 content judges and three technical judges. In the third stage, there was validity by the target audience, with 30 pregnant women. The study took place from September to November 2018. The Office spreadsheet editor was used for data analysis. Results The level of agreement attributed by the content and technical judges was between 97.2% and 98.9% and between 83.3% and 100%, respectively. The overall Content Validity Index was 0.92 and 0.97, respectively. In the assessment carried out with the Suitability Assessment of Materials, the content judges classified the booklet as "superior", with an average of 85.2%, and the technicians, with an average of 77.5%. The target audience validated the booklet with an overall Content Validity Index of 0.98 and an agreement level of 99.7%. Conclusion The educational booklet proved to be valid for use with pregnant women, being considered innovative and relevant educational technology for use in prenatal consultation.

Prenatal care associated with neonatal outcomes in maternity hospitals: a hospital-based cross-sectional study / Cuidados prenatales asociados a los resultados neonatales en maternidades: un estudio transversal hospitalario / Assistência pré-natal associada aos desfechos neonatais em maternidades: estudo transversal de base hospitalar

ABSTRACT Objective: To verify the association between prenatal care quality indicators and neonatal outcomes in maternity hospitals. Method: Hospital-based cross-sectional study in four high-risk referral maternity hospitals in the five health macro-regions enabled by the Stork Network in Ceará-Brazil. Between April 2017 and July 2018, 440 puerperal women were interviewed using simple probabilistic sampling and a formula with finite populations and stratification of each maternity hospital. The analysis involved Pearson's Chi-Square, Adjusted Residuals Analysis and Fisher's Exact. Results: There was an association between fewer consultations with prematurity and low birth weight. Delivery in the maternity hospital where the woman lived was associated with low birth weight and the need for ventilatory support. Conclusion: Prenatal care quality indicators influenced neonatal outcomes, which underlines the importance of ensuring access and quality of care as ways of reducing infant morbidity and mortality.

RESUMEN Objetivo: Verificar la asociación entre los indicadores de calidad de la atención prenatal y los resultados neonatales en las maternidades. Método: Estudio transversal de base hospitalaria en cuatro maternidades de referencia de alto riesgo en las cinco macrorregiones sanitarias autorizadas por la Red Cigüeña en Ceará-Brasil. Entre abril de 2017 y julio de 2018, se entrevistaron 440 puérperas mediante muestreo probabilístico simple y fórmula con poblaciones finitas y estratificación de cada maternidad. El análisis involucró Chi-Cuadrado de Pearson, Análisis de Residuos Ajustados y Exacto de Fisher. Resultados: Hubo asociación entre menor número de consultas con prematuridad y bajo peso al nacer. El parto en el hospital de maternidad donde vivía la mujer se asoció con el bajo peso al nacer y la necesidad de asistencia ventilatoria. Conclusión: Los indicadores de calidad de la atención prenatal influyeron en los resultados neonatales, lo que subraya la importancia de garantizar el acceso y la calidad de la atención como formas de reducir la morbimortalidad infantil.

RESUMO Objetivo: Verificar a associação entre os indicadores da qualidade do pré-natal e os desfechos neonatais em maternidades. Método: Estudo transversal de base hospitalar, em quatro maternidades referências para alto risco nas cinco macrorregiões de saúde habilitadas na Rede Cegonha no Ceará-Brasil. Realizou-se entre abril de 2017 e julho de 2018, entrevista com 440 puérperas, por amostragem probabilística simples e fórmula com populações finitas e estratificação de cada maternidade. A análise envolveu o Qui-Quadrado de Pearson, Análise de Resíduos Ajustados e Exato de Fisher. Resultados: Nota-se associação entre menor número de consultas com prematuridade e baixo peso ao nascer. Parto na maternidade de residência da mulher esteve associada com baixo peso ao nascer e necessidade de suporte ventilatório. Conclusão: Indicadores de qualidade do pré-natal influenciaram os desfechos neonatais, o que afirma a importância da garantia de acesso e qualidade da assistência como formas de reduzir a morbimortalidade infantil.

Epidemiology of HIV in pregnant women and its relationship with the period of the COVID-19 pandemic / Epidemiología del VIH en mujeres embarazadas y su relación con el período de la pandemia de COVID-19 / Epidemiologia do HIV em gestantes e sua relação com o período da pandemia de COVID-19

ABSTRACT Objective: To analyze, in the light of the Social Ecological Theory, the progression of reported cases of HIV during pregnancy in a Brazilian state and their relationship with the onset of the COVID-19 pandemic. Method: Retrospective study, with a sample consisting of all reports of gestational HIV in the state of Ceará - Brazil from 2017 to 2021, on the IntegraSUS platform. Data collection was carried out in January 2022. The analyzed variables were organized according to the theoretical levels: macrosystem, exosystem, mesosystem, and microsystem. Results: A total of 1,173 cases of HIV in pregnant women were recorded. When comparing the pre- and post-pandemic period, a reduction in the disease detection rate (from 231 to 122.67 pregnant women) was observed, as well as 1.82 times more chances of women not using antiretrovirals during childbirth after the start of the pandemic. There was a 55% reduction in vaginal births and 39% in cesarean sections among women diagnosed with HIV after the start of the pandemic. Conclusion: The COVID-19 pandemic had an epidemiological and care impact, leading to a reduction in the number of notifications and in the detection rate of pregnant women living with HIV in the state of Ceará. Therefore, the need to ensure health care coverage is emphasized, with early diagnosis actions, guaranteed treatment, and quality prenatal care.

RESUMEN Objetivo: Analizar, a la luz de la Teoría Ecológica Social, la evolución de los casos notificados de VIH durante el embarazo en un estado brasileño y su relación con el inicio de la pandemia de COVID-19. Método: Estudio retrospectivo, con una muestra compuesta por todos los informes de VIH gestacional en el estado de Ceará - Brasil de 2017 a 2021, en la plataforma IntegraSUS. La recolección de datos se realizó en enero de 2022. Las variables analizadas se organizaron según los niveles teóricos: macrosistema, exosistema, mesosistema y microsistema. Resultados: Se registraron 1.173 casos de VIH en gestantes. Al comparar el período pre y pospandemia, hubo una reducción en la tasa de detección de la enfermedad (de 231 a 122,67 mujeres embarazadas) y 1,82 veces más posibilidades de que las mujeres no usaran antirretrovirales durante el parto después del inicio de la pandemia. Hubo una reducción del 55% en los partos vaginales y del 39% en las cesáreas entre las mujeres diagnosticadas con VIH después del inicio de la pandemia. Conclusión: La pandemia de COVID-19 tuvo un impacto epidemiológico y asistencial, lo que provocó una reducción en el número de notificaciones y en la tasa de detección de mujeres embarazadas que viven con el VIH en el estado de Ceará. Por lo tanto, se refuerza la necesidad de asegurar la cobertura de salud, con acciones de diagnóstico temprano, tratamiento garantizado y atención prenatal de calidad.

RESUMO Objetivo: Analisar, à luz da Teoria Social Ecológica, a evolução dos casos notificados de HIV na gestação em um estado brasileiro e sua relação com o início da pandemia de COVID-19. Método: Estudo retrospectivo, com amostra composta por todas as notificações de HIV gestacional do estado do Ceará - Brasil no período de 2017 a 2021, na plataforma IntegraSUS. A coleta de dados foi realizada em janeiro de 2022. As variáveis analisadas foram organizadas de acordo com os níveis teóricos: macrossistema, exossistema, mesossistema e microssistema. Resultados: Foram registrados 1.173 casos de HIV em gestantes. Ao comparar o período pré e pós-pandemia, observou-se redução da taxa de detecção da doença (de 231 para 122,67 gestantes) e 1,82 vezes mais chances de as mulheres não usarem antirretrovirais no parto após o início da pandemia. Houve redução de 55% de partos vaginais e de 39% de cesarianas das mulheres com diagnóstico de HIV após o início da pandemia. Conclusão A pandemia de COVID-19 causou impacto epidemiológico e assistencial, levando a uma redução do número de notificações e taxa de detecção de gestantes que vivem com HIV no estado do Ceará. Logo, reforça-se a necessidade de assegurar a cobertura de atenção à saúde, com ações de diagnóstico precoce, garantia de tratamento e uma assistência pré-natal de qualidade.

Fatores preditores de insônia em acadêmicos de enfermagem de universidade pública / Factores predictores de insomnio en académicos de enfermería de universidad pública / Predictors of insomnia in public university nursing students

Objetivo: identificar fatores preditores de insônia em estudantes de Enfermagem. Método: estudo transversal, realizado com 199 alunos do 1º ao 10º semestre do curso de Enfermagem de uma Universidade Federal, Brasil. Os dados foram coletados no período de junho a setembro de 2019. Aplicou-se o questionário sociodemográfico e de saúde e o Sense of Coherence de Antonovsky. Resultados: as variáveis renda (p=0,016), tempo de lazer (p=0,021), horas suficientes de sono (p=0,005), uso de drogas psiquiátricas (p=0,002), plano de saúde (p=0,006), menor sensação de coerência (p=0,003), depressão moderada-grave (p=0,004) foram significativas. Regressão logística: as variáveis idade (p=0,008) e raça negra (p=0,028) foram significativas. Conclusão: os fatores sociais, individuais, acadêmicos e de saúde influenciam no desfecho da insônia.

Objetivo: identificar factores predictores de insomnio en estudiantes de Enfermería. Método: estudio transversal, realizado con 199 alumnos del 1º al 10º semestre del curso de Enfermería de una Universidad Federal, Brasil. Los datos se recopilaron entre junio y septiembre de 2019. Se aplicó el cuestionario sociodemográfico, y de salud y el Sense of Coherence de Antonovsky. Resultados: las variables renta (p=0,016), tiempo de ocio (p=0,021), horas suficientes de sueño (p=0,005), uso de drogas psiquiátricas (p=0,002), plan de salud (p=0,006), menor sensación de coherencia (p=0,003), depresión moderada-grave (p=0,004) fueron significativas. Regresión logística: las variables edad (p=0,008) y raza negra (p=0,028) fueron significativas. Consideraciones finales: se evidencia que factores sociales, individuales, académicos y de salud influyen en el desenlace del insomnio.

Objective: to identify predictors of insomnia in nursing students. Method: cross-sectional study, conducted with 199 students from the 1st to the 10th semester of the Nursing course of a Federal University, Brazil. Data were collected from June to September 2019. The sociodemographic and health questionnaire and Antonovsky's Sense of Coherence were applied. Results: income (p=0.016), leisure time (p=0.021), sufficient sleep (p=0.005), use of psychiatric drugs (p=0.002), health insurance (p=0.006), lower sense of coherence (p=0.003), moderate-severe depression (p=0.004) were significant. Logistic regression: the variables age (p=0.008) and black race (p=0.028) were significant. Final considerations: social, individual, academic and health factors influence the outcome of insomnia.

Pregnancy outcomes after snakebite envenomations: A retrospective cohort in the Brazilian Amazonia.

Snakebite envenomations (SBEs) in pregnant women can result in adverse maternal or neonatal effects, such as abortion, placental abruption, preterm labor, fetal malformations, and maternal, fetal or neonatal deaths. Despite the high incidence of SBEs in the Brazilian Amazon, there is no literature on the impact of SBEs on pregnancy outcomes. The objective of this study was to describe clinical epidemiology and outcomes associated with SBEs in women of childbearing age and pregnant women in the state of Amazonas, Western Brazilian Amazon, from 2007 to 2021. Information on the population was obtained from the Reporting Information System (SINAN), Mortality Information System (SIM) and Live Birth Information System (SINASC) for the period from 2007 to 2021. A total of 36,786 SBEs were reported, of which 3,297 (9%) involved women of childbearing age, and 274 (8.3%) involved pregnant women. Severity (7.9% in pregnant versus 8.7% in non-pregnant women) (P = 0.87) and case-fatality (0.4% in pregnant versus 0.3% in non-pregnant women) rates were similar between groups (P = 0.76). Pregnant women who suffered snakebites were at higher risk for fetal death (OR: 2.17, 95%CI: 1.74-2.67) and neonatal death (OR = 2.79, 95%CI: 2.26-3.40). This study had major limitations related to the completeness of the information on the pregnancy outcomes. Although SBE incidence in pregnant women is low in the Brazilian Amazon, SBEs increased the risk of fetal and neonatal deaths.

Effect of educational intervention for compliance of school adolescents with the human papillomavirus vaccine.

OBJECTIVE: to assess the effects of "Piss off, HPV!", an educational intervention to increase adolescents' knowledge, attitude and compliance with human papillomavirus vaccination. METHOD: a randomized clinical trial by cluster, carried out in six schools in two municipalities in Ceará, with 238 girls. The control group (n = 120) received routine instructions, and the intervention group (n = 118), printed message cards about the quadrivalent HPV vaccine. A pre- and post-intervention knowledge, attitude and practice survey was applied to both groups. The McNemar test, to analyze knowledge, attitude and pre- and post-intervention practice, the chi-square test, to compare compliance in relation to knowledge and attitude, and a logistic regression model, to assess vaccine compliance, were carried out. A significance level of 5% was adopted. RESULTS: pre-intervention, knowledge was inadequate and attitude was adequate in both groups. Post-intervention, adequate knowledge and practices became greater in the intervention group. Adequate post-intervention knowledge and attitude, in addition to being 12 years of age or older, increase the chance for vaccination, explaining 70% of the practice. CONCLUSION: the educational intervention was effective for adolescents' knowledge and compliance with the quadrivalent HPV vaccine. UTN: U1111-1254-5546; ReBEC: RBR-107hzdqt.

The severity of acute kidney injury correlates with plasma venom levels in Bothrops atrox envenomings.

The Brazilian Amazon has high rates of snakebite envenomings (SBEs), with ∼90% caused by Bothrops atrox. Envenomings by this species can trigger local and systemic effects, such as acute kidney injury (AKI). Our aim was to identify predictors of AKI in Bothrops SBEs in patients from Manaus, Western Brazilian Amazon. A total of 127 patients were enrolled, with a predominance of men between 16 and 45 years old from rural areas. Of the 127 patients, 38.6% developed AKI, with 61.2% presenting stage I, 34.7% presenting stage II and 4.1% presenting stage III severity. The age groups 0-10 years and ≥60 years presented a significantly higher frequency of AKI compared to the 11-40 years group. Moderate/severe edema in the affeccted limb was significantly associated with lower risk of AKI [p = 0.01; OR = 0.11 (95%CI 0.02-0.53)]. Nausea [p = 0.01; OR = 54.44 (95%CI = 3.26-909.27)] and high blood urea levels [p = 0.01; OR = 5.38 (95%CI = 2.12-13.66)] were risk factors for AKI. There was a significant positive correlation between circulating venom levels and the highest creatinine serum values during the hospital stay (p = 0.03) and with the difference between the maximum creatinine levels and the creatinine levels on admission (p = 0.02). A positive correlation between serum venom concentrations and creatinine levels suggests a direct or indirect dose-dependent participation of the venom toxins in the pathogenesis of AKI.

Acupuncture for perceived stress in pregnant women: an intervention study.

OBJECTIVE: To analyze the effects of acupuncture in the treatment of perceived stress in pregnant women. METHOD: A before-after intervention study, carried out in a primary health unit in Fortaleza-Ceará, with 56 pregnant women. The pregnant women underwent six acupuncture sessions, with two 30-minute sessions per week. Before the first session, an instrument to collect sociodemographic, clinical, and obstetric data was applied. The Global Perceived Stress Scale (PSS10) was applied weekly to monitor the progression of stress during treatment. RESULTS: After the intervention, there was a significant decrease in the scores of the following scale items: being upset, inability to control, nervousness, tiredness, anger, and inability to overcome stress. (p < 0.05). There was a significant increase in the score of the item control of situations (p = 0.003). There was a significant difference in the mean perceived stress of the initial session compared to the 1st, 2nd and 3rd week sessions (p < 0.001). CONCLUSION: The use of acupuncture to treat stress during pregnancy reduced the stress perceived by pregnant women.