Perinatal psychological interventions to promote breastfeeding: a narrative review.

BACKGROUND: Emotional distress in mothers inhibits the let-down reflex, thus affecting breastfeeding self-efficacy. A breastfeeding mother may have to cope with both physical discomfort and psychological distress. However, literature on initiatives to improve breastfeeding rates has focused mainly on providing community-based peer support, or social policies. The aim of this review is to assess evidence on the effectiveness of a broad range of psychological interventions to facilitate breastfeeding for mothers facing difficulties around the time of delivery. METHODS: The review of the literature is derived from a search on Cochrane Library, PubMed, EBSCOhost, and PsycINFO for papers published since 1980. The approach was to explore quantitative and qualitative parameters. Quantitative parameters included breastfeeding initiation, duration, and composition. Qualitative parameters recorded the evaluation of maternal perceptions on breastfeeding success. The high heterogeneity of the studies led to a narrative review; 20 selected papers that report on breastfeeding outcomes and psychological programs met the inclusion criteria. RESULTS: The evidence on breastfeeding support through psychotherapy is heterogeneous and scant. Out of the included studies, 11 were randomized controlled trials, two were non-randomised trials, and two used a quasi-experimental design. None of the studies reported an increase in adverse breastfeeding outcomes. Three studies failed to report an association between psychological procedures and improved breastfeeding outcomes. A literature review showed that 17 (85%) analyses support stress-releasing techniques to facilitate breastfeeding. CONCLUSIONS: This review suggests that relaxation interventions carefully tailored to address perinatal emotional distress may lead to important health benefits, including improvement in breastfeeding outcomes. There is also some indication that psychotherapy support while breastfeeding may have more impact than routine counselling. Conversely, this review did not find an association between self-hypnosis and breastfeeding outcomes. Data from this study can be used in designing prevention programs and future research with appropriate theoretical underpinning.

[Benefits of mindfulness in pregnant women]. / Beneficios del mindfulness en mujeres embarazadas.

This article is intended to review the effect of mindfulness-based interventions on perinatal mental health. A search of the literature published until September 2019 in the Web of Science (WOS) database was carried out. Taking into account the inclusion and exclusion criteria and after reading the title and abstracts of the articles found, 26 of them have been selected. Finally we only analyzed randomized controlled trials (RCTs) that show data on anxiety, depression, perceived stress and mindfulness before and after intervention and with follow-up data. The results found show that mindfulness-based interventions (IBMs) are more effective than the usual healthcare (TAU) that pregnant women receive for the reduction of depressive, anxious and perceived stress symptoms as well as increasing their postintervention mindfulness levels. For future research, a postpartum follow-up would be considered interesting taking into account variables such as the quality of the mother-baby attachment, adherence to breastfeeding and the evolutionary development of the newborn.

Este trabajo tiene el propósito de revisar el efecto de las intervenciones basadas en mindfulness sobre la salud mental perinatal. Se efectuó una búsqueda de la literatura publicada hasta septiembre 2019 en la base de datos Web of Science (WOS). Teniendo en cuenta los criterios de inclusión y exclusión y después de leer el título y abstracts de los artículos encontrados, se han seleccionado 26 de ellos, de los que se han escogido solo ocho por tratarse de ensayos controlados y aleatorizados (RCTs) que estudian datos de ansiedad, depresión, estrés percibido y mindfulness pre y post-intervención y con datos de seguimiento. Los resultados encontrados muestran que las intervenciones basadas en mindfulness (IBMs) son más eficaces que la asistencia sanitaria habitual (TAU) para la mujer embarazada a la hora de reducir la sintomatología depresiva, ansiosa y estrés percibido e incrementar sus niveles de mindfulness post-intervención. Para futuras investigaciones se consideraría interesante realizar el seguimiento de estas variables en el posparto e incluir otras como la calidad del vínculo madre-bebé, la adherencia a la lactancia materna y el desarrollo evolutivo del recién nacido.

Beneficios del mindfulness en mujeres embarazadas / Benefits of mindfulness in pregnant women

Este trabajo tiene el propósito de revisar el efecto de las intervenciones basadas en mindfulness sobre la salud mental perinatal. Se efectuó una búsqueda de la literatura publicada hasta septiembre 2019 en la base de datos Web of Science (WOS). Teniendo en cuenta los criterios de inclusión y exclusión y después de leer el título y abstracts de los artículos encontrados, se han seleccionado 26 de ellos, de los que se han escogido solo ocho por tratarse de ensayos controlados y aleatorizados (RCTs) que estudian datos de ansiedad, depresión, estrés percibido y mindfulness pre y post-intervención y con datos de seguimiento. Los resultados encontrados muestran que las intervenciones basadas en mindfulness (IBMs) son más eficaces que la asistencia sanitaria habitual (TAU) para la mujer embarazada a la hora de reducir la sintomatología depresiva, ansiosa y estrés percibido e incrementar sus niveles de mindfulness post-intervención. Para futuras investigaciones se consideraría interesante realizar el seguimiento de estas variables en el posparto e incluir otras como la calidad del vínculo madre-bebé, la adherencia a la lactancia materna y el desarrollo evolutivo del recién nacido.

This article is intended to review the effect of mindfulness-based interventions on perinatal mental health. A search of the literature published until September 2019 in the Web of Science (WOS) database was carried out. Taking into account the inclusion and exclusion criteria and after reading the title and abstracts of the articles found, 26 of them have been selected. Finally we only analyzed randomized controlled trials (RCTs) that show data on anxiety, depression, perceived stress and mindfulness before and after intervention and with follow-up data. The results found show that mindfulness-based interventions (IBMs) are more effective than the usual healthcare (TAU) that pregnant women receive for the reduction of depressive, anxious and perceived stress symptoms as well as increasing their post-intervention mindfulness levels. For future research, a postpartum follow-up would be considered interesting taking into account variables such as the quality of the mother-baby attachment, adherence to breastfeeding and the evolutionary development of the newborn.

Relationship between normative and self-perceived criteria for orthodontic treatment need and satisfaction with esthetics and mastication in adolescents.

INTRODUCTION: Orthodontic treatments are performed to improve esthetics and masticatory functions. In general, clinical criteria are used to recommend such treatments without considering the opinion of the patient. This study aimed to evaluate the relationship between technically defined orthodontic need (normative criteria) and the need for treatment perceived by adolescent patients. METHODS: A total of 215 students aged between 15 and 19 years were selected and asked to respond to a questionnaire concerning their perception of need for orthodontic treatment and their satisfaction with their own esthetics and mastication. One trained and calibrated examiner obtained normative data using the Dental Aesthetic Index (DAI) on the need for orthodontic treatment of these students. RESULTS: Associations were found between the DAI score and the patient's perception of need for orthodontic treatment (P <0.001), satisfaction with esthetics (P = 0.003), and satisfaction with mastication (P = 0.047). When occlusal characteristics were analyzed separately, associations between several normative and perceived needs, as well as for satisfaction with esthetics, were found. Satisfaction with mastication analysis was only found to be associated with open bite malocclusion (P = 0.003). CONCLUSIONS: The DAI revealed a consistent opinion in adolescents to link their perceived malocclusion-related conditions to esthetics.

Construção participativa de uma política de saúde para institutos federais / Participatory construction of a health policy for Federal Institute

Introdução:No Brasil, quando se mencionam serviços públicos de saúde nos remetemos aos serviços do Sistema Único de Saúde ­SUS. Contudo, há instituições públicas, não integrantes do SUS, que disponibilizam serviços de saúde e, assim, fariam jus a uma política de saúde específica. Objetivo: Reportar a estruturação de uma política de saúde para a assistência estudantil do Instituto Federal Educação, Ciência e Tecnologia do Rio Grande do Norte (IFRN) mediante construção de uma matriz de indicadores.Métodos:Estudo de avaliação cujo processo de criação da política foi: análise documental para definir missão e atribuições dos setores de saúde/IFRN; consulta a inquéritos nacionais (SB Brasil, Saúde na Escola, CENSO), relatório socioeconômico aluno/IFRN e análise dos recursos/IFRN (questionário Google forms®) para o diagnóstico situacional; Definição de diretrizes/objetivos/problemas-alvo; Construção de matriz de indicadores; validação da matriz por coordenadores/profissionais de saúde/IFRN via técnica conferência consenso; criação de instrumentos de monitoramento (programação anual de saúde, relatório de execução).Resultados: As diretrizes foram legitimadas, 01 objetivo foi excluído e 01 modificado. Quanto aos indicadores, houve redução de 42 para 37 tidos como pertinentes/válidos/oportunos.Conclusão:Para viabilização da política são necessárias estratégias para institucionalização da educação em saúde, da pesquisa científica, dos processos de avaliação/planejamento/monitoramento, normatização do funcionamento dos serviços e o desenvolvimento de açõesintersetoriais (AU).

Introduction: In Brazil, when referring to public health services we usually refer to the services of the Unified Health System -SUS. However, there are public institutions, not members of the SUS, that provide health services and should hav a specific health policy.Objective: To report the structuring of a health policy for the student assistance of the Federal Institute of Education, Science and Technology of Rio Grande do Norte (IFRN) through the construction of a matrix of indicators.Method: Evaluation study whosepolicy creation process was: document analysis to define IFRN health sector ́s mission and responsibilities; consultation on national surveys (OH Brazil, School Health; CENSUS), to IFRN student ́s socioeconomic report and analysis of IFRN ́s resources (Google forms® questionnaire) for the situational diagnosis; definition of guidelines/objectives/target problems; construction of an indicator's matrix; validation of the matrix by IFRN ́s coordinators/health professionals by technical consensus conference; creation of monitoring instruments (annual health programming, implementation report).Results: The guidelines were legitimized, 01 objective was excluded and 01 was modified. As for the indicators, there was a reduction of 42 to 37 taken as relevant/valid/timely.Conclusion: Implementing the policy requires necessary strategies to institutionalize health education process, scientific research, assessment/planning/monitoring process, standardization of service ́s operation and the development of intersectoral actions (AU).

Missão e valores organizacionais da assistência à saúde dos institutos federais de educação, ciência e tecnologia do Rio Grande do norte / Mission and organizational values of federalinstitutes of education, science and technology of Rio Grande do Norte's health assistance

Introdução:Os valores de uma organização permitem predizer o seu funcionamento e o comportamento organizacional dos seus membros. As organizações se mantêm pelos seus produtos elaborados. No caso das organizações de saúde, o produto seria a atenção dispensada ao usuário. Assim, o tipo e qualidade da atenção ofertada estariam relacionados aos valores que orientam à instituição.Objetivo:Avaliar os valores organizacionais que orientam os processos de trabalho nos serviços de saúde dos diversos campi do IFRN no ano de 2014 a partir da percepção dos servidores da assistência estudantil, verificando se os valores organizacionais estão relacionados à perspectiva de trabalho em equipe, atenção pautada no cuidado e gestão participativa.Metodologia:Estudo seccional do tipo avaliação para gestão onde o Inventário de Valores Organizacionais (IVO), questionário constituído por 36 valores distribuídos em três dimensões bipolares: autonomia x conservadorismo, hierarquia x igualitarismo e domínio x harmonia, foi respondido por 41 servidores da assistência à saúde do IFRN, selecionados por conveniência, de um universo de 104 servidores.Foram realizadas as frequências absolutas e relativas e as medidas de tendência central das variáveis, bem como teste de diferença de média (t student pareado) entre as dimensões bipolares. Resultados:Dentre os valores organizacionais, o conservadorismo e a hierarquia são os mais relevantes vivenciados na vida organizacional do IFRN. O perfil axiológico do IFRN revela uma instituição mais centrada em si mesma do que na valorização dos seus membros.Conclusão:Ainda são necessários mecanismos para disseminar valores que promovam o alcance dos objetivos e metas pretendidos pela instituição e que esses sejam reconhecidos por todos que compõem a instituição (AU).

Introduction: The values of an organization allows topredict the functioning of the organization and the organizational behavior of its members. The organizations keep their elaborate products. In the case of healthcare organizations, the product would be the attention paid to the user. Thus, the type and quality of care offered wouldbe related to the values that guide the institution.Objective: To evaluate the organizational values that guide the work processes in the health services of the various IFRN campuses in the year 2014, based on the perception ofthe servants of the student assistance, verifying if the organizational values are relatedto the perspective of teamwork, attention based on participatory care and management.Methodology: An evaluation for the management of health services Sectional Study which The Organizational Values Inventory (IVO), questionnaire consisting of 36 values distributed in three bipolar dimensions: autonomy x conservatism, hierarchy x egalitarianism and domain x harmony, was answered by 41 IFRN health care providers, selected by a non-probabilistic sample, from a universe of 104 health care providers. The absolute and relative frequencies and the measures of central tendency of the variables were performed, as well as the mean difference test (t student paired) between the bipolar dimensions.Results: Among these organizational values, conservatism and hierarchy are the most relevant values lived in the organizational life of the IFRN. The axiological profile of the IFRN reveals a more self-centered institution than the value of its members.Conclusion: It was observed that mechanisms are still needed to disseminate values that promote the achievement of the objectives and goals sought by the institution and that their importance is recognized by all that make up the institution (AU).

Prenatal Nonvisualization of the Gallbladder: A Diagnostic and Prognostic Dilemma.

INTRODUCTION: Nonvisualization of the fetal gallbladder has been associated with benign conditions such as isolated gallbladder agenesis or severe diseases such as biliary atresia (BA). Recently, gamma-glutamyl transpeptidase (GGTP) fetal blood levels were reported as useful after 22 weeks. OBJECTIVE: To determine the contribution of fetal blood GGTP levels after 22 weeks, based on 2 cases. Case 1: 20+4-week secundipara, with subcutaneous edema and pleural effusion. At 24+4 weeks, the gallbladder could not be visualized. Progressive hydrops deterioration was observed. 32+2-week magnetic resonance imaging (MRI) confirmed nonvisualization of the gallbladder. BA was suspected. The patient decided to terminate the pregnancy and fetal blood sample was obtained at feticide. GGTP was 573 IU/L. Fetal necropsy confirmed BA. Case 2: At the 22+6- and 24+0-week ultrasound scan, the gallbladder could not be visualized. Amniocentesis was offered, but declined by the patient. MRI at 35+0 weeks failed also to visualize it. Fetal cord blood sample at delivery was obtained, and GGTP was 129 IU/L. Ultrasound confirmed gallbladder agenesis with normal extra- and intrahepatic bile ducts. CONCLUSION: Cases of nonvisualized gallbladder after 22 weeks have rarely been reported in the literature. Until now, no standard management has been proposed. Our cases support the potential usefulness of fetal blood digestive enzymes.

Absceso cerebral sobre infarto isquémico previo / Cerebral abscess over a previous ischemic infarction

No disponible

Influência das condições de saúde bucal no desempenho das atividades diárias de adolescentes escolares / Influence of oral health in the performance of daily activities of school adolescents

Em odontologia utilizam-se instrumentos de mensuração da Qualidade de Vida Relacionada à Saúde Bucal (QVRSB) para dimensionar o quanto a condição bucal interfere nos âmbitos funcional, psicológico e social da vida das pessoas. Este estudo seccional, realizado em Natal/RN, com 215 alunos do Instituto Federal de Educação, Ciência e Tecnologia do Rio Grande do Norte (IFRN), investigou a existência de associação entre o desempenho de atividades diárias e a condição de saúde bucal de adolescentes escolares de 15 a 19 anos de idade, através dos índices normativos CPO-D (dentes permanentes cariados, perdidos e obturados), CPI (índice periodontal comunitário) e DAI (índice de estética dental) e do questionário subjetivo de avaliação da qualidade de vida relacionada à saúde bucal OIDP (índice de impactos orais no desempenho diário). Também foi realizada a caracterização socioeconômica dos alunos por meio de dados do próprio IFRN. Quanto à análise dos dados, realizou-se a análise descritiva das variáveis através de suas frequências absolutas e relativas e medidas de tendência central. O teste do qui-quadrado foi utilizado para verificar a associação existente entre a variável dependente e as variáveis independentes categóricas e o teste t de Student para as quantitativas. Realizou-se ainda uma análise múltipla, pela regressão de Poisson com variância robusta, entre o desfecho "presença de impacto" e as variáveis independentes que apresentaram valor de p<0,20. Para todos os testes estatísticos foi adotado um nível de significância de 5%. Entre os adolescentes pesquisados, 51,16% relataram que ao menos uma atividade avaliada pelo OIDP tinha sua execução dificultada em decorrência de algum problema odontológico. As dificuldades foram mais acentuadas nas atividades de comer (31,6%), higienizar a boca (25,6%) e sorrir (25,1%). A posição dentária, seguida pela dor de dentes, foram as causas dos impactos mais relatadas pelos adolescentes. Existiu uma associação significativa entre a presença do impacto e a presença de um ou mais dentes cariados (p=0,012), a presença de sangramento gengival (p=0,012) e a necessidade de tratamento ortodôntico (p=0,003), independente das demais variáveis. Não houve associação significativa entre as condições de saúde bucal e as características socioeconômicas e demográficas dos adolescentes. Os resultados da pesquisa demonstraram que existe uma associação entre as condições de saúde bucal da população estudada e os relatos de dificuldades na realização das atividades diárias avaliadas. Quanto piores as condições de saúde bucal, maiores são os impactos dessa condição na qualidade de vida dos adolescentes. (AU)

Instruments are used in odontology to measure the Quality of Life Related to Oral Health (OHRQoL) to scale how the oral condition interferes with functional areas, of the people's psychological and social life. This cross-sectional study, held in Natal/RN, with 215 students from the Federal Institute of Education, Science and Technology of Rio Grande do Norte (IFRN) has investigated the association between the performance of daily activities and oral health status of school adolescents from 15 to 19 years of age, through the normative index DMFT (permanent teeth decayed, missing and filled), CPI (Community Periodontal Index) and DAI (dental Aesthetic Index) and subjective questionnaire assessment of quality of life related oral health OIDP index (oral impacts on daily performance). It was also carried out the socioeconomic characteristics of students through IFRN own data. Concerning the analysis of data was performed a descriptive analysis of the variables by their absolute and relative frequencies and measures of central tendency. The chi-square test was used to assess the association between the dependent variable and the independent categorical variables and the Student t test for quantitative. It was also conducted a further multiple analysis out using Poisson regression with robust variance between the outcome "presence of impact" and the independent variables that showed p <0.20. It was used for all the statistical tests a significance level of 5%. Among the adolescents surveyed, 51.16% reported that at least one activity assessed by OIDP had hampered its implementation due to some dental problem. The difficulties were more pronounced in the activities of eating (31.6%), oral hygiene (25.6%) and smile (25.1%).The tooth position, followed by toothache, were the causes of the impacts reported by most teenagers. There was a significant association between the presence and impact of the presence of one or more decayed teeth (p = 0.012), the presence of gum bleeding (p = 0.012) and for orthodontic treatment (p = 0.003), independently of other variables. There was no significant association between oral health status and socioeconomic and demographic characteristics of the adolescents. The survey results showed that there is an association between oral health status of the population studied and reports of difficulties in carrying out daily activities evaluated. The worse the oral health status, the greater the impact of this condition on the adolescents' quality of life. (AU)

Interrupción aislada de la vena cava inferior / Isolated interruption of the inferior vena cava

El diagnóstico prenatal de la interrupción de vena cava inferior con continuación de la vena ácigos es infrecuente. Su hallazgo nos obligará a descartar la presencia de un síndrome de cardioesplenia o isomerismo, fundamentalmente el isomerismo izquierdo o poliesplenia, ya que la interrupción de vena cava inferior es un excelente marcador de esta afección: se encuentra en un 55-85% de los casos. Sin embargo, también puede corresponder a una malformación vascular aislada, con nula o escasa repercusión en el pronóstico vital del recién nacido, aunque luego no esté exento de posibles complicaciones en el transcurso de su vida adulta (AU)

The prenatal diagnosis of interruption of the inferior vena cava with azygos vein continuation is uncommon. Its finding will require us to rule out the presence of a cardiosplenic syndrome or isomerism, particularly left isomerism or polysplenia, as interruption of the inferior vena cava is an excellent marker of this disease, being found in 55-85% of cases. However, it can also correspond to an isolated vascular malformation, with no or little effect on the prognosis, essential in the newborn. Although there could be complications later on during their adult life (AU)