Use of continuous subcutaneous insulin infusion in children and adolescents with type 1 diabetes mellitus: a systematic mapping review.

BACKGROUND: Among the treatments for type 1 diabetes mellitus (T1DM), Continuous Subcutaneous Insulin Infusion (CSII) is a device that infuses insulin through the subcutaneous tissue in an uninterrupted manner and that comes closest to the physiological secretion of insulin. The use of CSII can provide the family with greater security and children and adolescents have more autonomy in relation to the treatment of T1DM. There is a lack of reviews that systematically gather the mounting evidence about the use of CSII in children and adolescents with T1DM. Therefore, the aim of this review was to group and describe primary and secondary studies on the use of CSII in children and adolescents with T1DM. METHODS: A systematic mapping review was performed based on searches in the following databases: PubMed, Embase, CINAHL, Lilacs and PsycINFO, using a combination of descriptors and keywords. The screening of the studies was carried out with the aid of the Rayyan software and reading in full was conducted independently by two reviewers. The data extraction of the studies was performed using an extraction tool adapted and validated by researchers specialized in diabetes. The data were analyzed according to the content analysis technique. The map from geocoding of the studies was produced using the ArcGis 10.5 software. RESULTS: A total of 113 studies were included in the review, including primary studies, literature reviews and gray literature publications. The content analysis of the results of the studies allowed for the identification of four categories: 1) metabolic control; 2) support networks; 3) benefits of using CSII; and 4) challenges of using CSII, each category having its respective subcategories. The review also made it possible to conduct a rigorous mapping of the literature on the use of CSII considering the location of development and the design of the studies. CONCLUSIONS: The use of CSII should be indicated by health professionals able to prepare children, adolescents, and their families for the treatment of T1DM, and, despite being a technological device, it may not be suitable for the entire pediatric population.

Evidências de validade da estrutura interna da versão brasileira do Needs of Parents Questionnaire (NPQ) / Internal structure validity evidence of the Brazilian version of the Needs of Parents Questionnaire (NPQ)

A valorização da permanência, participação e envolvimento dos pais nos cuidados à criança hospitalizada tem sido um qualificador para a assistência de enfermagem pediátrica. Esta tríade representa em fonte de proteção, apoio e segurança para a criança, pois contribui para aproximar a díade criança/adolescente-pais/cuidadores, reduzir o estresse emocional de ambos, além de fortalecer vínculos. O processo de hospitalização demanda adaptações dos pais/cuidadores e da criança/adolescente a uma nova realidade, que evoluirá de forma equilibrada se os recursos forem adequados. Nesse processo, os pais/cuidadores vivenciam diversos sentimentos, o que gera necessidades de várias ordens. Identificar essas necessidades de forma sistematizada, por meio, por exemplo, de um questionário para esse fim, pode auxiliar a equipe de saúde, particularmente a de enfermagem, a planejar intervenções que qualifiquem o cuidado prestado. Assim, este estudo objetivou avaliar as evidências de validade da estrutura interna da versão brasileira do Needs of Parents Questionnaire (NPQ). Esse questionário avalia a perspectiva de pais/cuidadores sobre suas necessidades no contexto da hospitalização de seus filhos. O estudo foi aprovado pelo Comitê de Ética em Pesquisa das instituições proponente e coparticipante. O estudo de campo foi realizado com uma amostra de 510 pais e/ou cuidadores que acompanhavam a hospitalização de seus filhos, por um período de no mínimo 48h, independentemente do diagnóstico. Métodos estatísticos rigorosos e contemporâneos da psicometria foram utilizados para a análise dos dados, em busca de um modelo de melhor ajustamento ao questionário original. As primeiras análises evidenciaram índices de adequabilidade para a análise fatorial: determinante da matriz de correlação < 0.000001; KMO= 0,71024; esfericidade de Bartlett= 5677,8 (df = 528; P = 0,000010). A dimensionalidade apresentou critérios de UNICO (0,911), ECV (0,799), MIREAL (0,244). As comunalidades variaram de 0.216 a 0.665, e a variância explicada foi de 44,68%. A confiabilidade demonstrou valores de 0.93 para Alpha de Cronbach, 0.92 para Omega McDonald's e 0.98 para GLB. O G-H latente obteve escores de 0.94 e 0.87, o que sugere uma latente variável bem definida. O NPQ-Brasil conformou-se no modelo bidimensional, bem-estar parental (20 itens) e cuidado parental (13 itens), totalizando 33 itens. Tais resultados indicam o ajuste do modelo e sustentam que o NPQ-Brasil está adequado para sua aplicação na população alvo, no contexto brasileiro. A enfermagem pediátrica, a enfermagem familiar e áreas afins se beneficiarão da versão validada do NPQ-Brasil, na medida em que apoiará enfermeiros e profissionais de saúde a acessar e planejar intervenções que atendam às necessidades de pais/cuidadores durante a hospitalização de seus filhos, com vistas à qualificação do cuidado

The valuation of the permanence, participation and involvement of parents in the care of hospitalized children has been a qualifier for pediatric nursing care. This triad constitutes a source of protection, support and security for the child, contributing to bring the dyad child/adolescent-parents/caregivers closer, reducing emotional stress for both, in addition to strengthening bonds. The hospitalization process demands adaptations from parents/caregivers and the child/adolescent to a new reality, which will evolve in a balanced way if the resources are adequate. In this process, parents/caregivers experience different feelings, which generates different types of needs. Identifying these needs in a systematic way, through, for example, a questionnaire for this purpose can help the health team, particularly the nursing team, to plan interventions that qualify the care provided. Thus, this study aimed to assess the evidence of validity of the internal structure of the Brazilian version of the Needs of Parents Questionnaire (NPQ). This questionnaire assesses the perspective of parents/caregivers about their needs in the context of their children's hospitalization. The Research Ethics Committee of the proposing and co-participating institutions approved the study. The field study was carried out with a sample of 510 parents and/or caregivers who accompanied their children's hospitalization for a period of at least 48 hours, regardless of diagnosis. Rigorous and contemporary psychometrics statistical methods were used to analyze the data, in search of a better fit model to the original questionnaire. The first analyzes showed suitability indices for the factor analysis: determinant of the correlation matrix < 0.000001; KMO=0.71024; Bartlett's sphericity = 5677.8 (df = 528; P = 0.000010). Dimensionality presented criteria of UNICO (0.911), ECV (0.799), MIREAL (0.244). The commonalities ranged from 0.216 to 0.665, and the explained variance was 44.68%. Reliability showed values of 0.93 for Cronbach's Alpha, 0.92 for Omega McDonald's and 0.98 for GLB. The latent G-H obtained scores of 0.94 and 0.87, which suggests a well-defined latent variable. The NPQ-Brazil was based on the two-dimensional model, parental well-being (20 items) and parental care (13 items), totaling 33 items. These results indicate the adjustment of the model and support that the NPQ-Brazil is suitable for its application in the target population, in the Brazilian context. Pediatric nursing, family nursing and related areas will benefit from the validated version of the NPQ-Brazil, as it will support nurses and health professionals to access and plan interventions that meet the needs of parents/caregivers during their children's hospitalization, with a view to qualifying care

Mothers living with HIV: replacing breastfeeding by infant formula / Madres viviendo con VIH: la sustitución de la lactancia por una fórmula láctea infantil / Mães vivendo com HIV: a substituição do aleitamento por fórmula láctea infantil

ABSTRACT Objective: To explore factors that interact and shape the meaning and experience of mothers of HIV-exposed children in relation to replacing breastfeeding by infant formula. Method: A qualitative study was carried out with 23 mothers living with HIV, whose children were up to 18 months of age and under follow-up in a specialized care service. Symbolic Interactionism, semi-structured interviews and content analysis were adopted as theoretical framework. Results: The social symbols of breastfeeding, the (un)availability of the milk formula and the (lack of)support of health professionals influenced the mothers' experience with formula feeding. Social, cultural and economic constraints have proved capable of undermining the conditions necessary for the replacement of breastfeeding. Final considerations: The availability of infant formula, access to lactation inhibitor and quality of health services still represent challenges to eradicate new HIV infections in children.

RESUMEN Objetivo: Explorar los factores que interactúan y moldean el significado y la experiencia de madres de niños expuestos al VIH en relación a la sustitución de la lactancia por una fórmula láctea infantil. Método: Estudio cualitativo, con 23 madres viviendo con VIH, cuyos hijos tenían hasta 18 meses de edad y estaban bajo seguimiento en servicio de asistencia especializada. Se adoptaron el Interaccionismo Simbólico como referencial teórico, entrevistas semiestructuradas y el análisis de contenido. Resultados: Los símbolos sociales de la lactancia, la (in) disponibilidad de la fórmula láctea y el (des) apoyo de los profesionales de la salud influenciaron a la experiencia de las madres con la alimentación por una fórmula láctea. Los cercos sociales, culturales y económicos se mostraron capaces de perjudicar las condiciones necesarias para la sustitución de la lactancia materna. Consideraciones finales: La disponibilidad de la fórmula láctea infantil, el acceso al inhibidor de la lactancia y la calidad de los servicios de salud todavía representan desafíos para eliminar nuevas infecciones por el VIH en niños.

RESUMO Objetivo: Explorar os fatores que interagem e moldam o significado e a experiência de mães de crianças expostas ao HIV em relação à substituição do aleitamento por fórmula láctea infantil. Método: Estudo qualitativo, com 23 mães vivendo com HIV, cujos filhos tinham até 18 meses de idade e estavam sob acompanhamento em serviço de assistência especializado. Foram adotados o Interacionismo Simbólico como referencial teórico, entrevistas semiestruturadas e análise de conteúdo. Resultados: Os símbolos sociais da amamentação, a (in)disponibilidade da fórmula láctea e o (des)apoio dos profissionais de saúde influenciaram a experiência das mães com a alimentação por fórmula láctea. Cerceamentos sociais, culturais e econômicos mostraram-se capazes de prejudicar as condições necessárias para a substituição do aleitamento materno. Considerações finais: A disponibilidade da fórmula láctea infantil, o acesso ao inibidor de lactação e a qualidade dos serviços de saúde ainda representam desafios para eliminar novas infecções pelo HIV em crianças.

Mothers living with HIV: replacing breastfeeding by infant formula.

OBJECTIVE: To explore factors that interact and shape the meaning and experience of mothers of HIV-exposed children in relation to replacing breastfeeding by infant formula. METHOD: A qualitative study was carried out with 23 mothers living with HIV, whose children were up to 18 months of age and under follow-up in a specialized care service. Symbolic Interactionism, semi-structured interviews and content analysis were adopted as theoretical framework. RESULTS: The social symbols of breastfeeding, the (un)availability of the milk formula and the (lack of)support of health professionals influenced the mothers' experience with formula feeding. Social, cultural and economic constraints have proved capable of undermining the conditions necessary for the replacement of breastfeeding. FINAL CONSIDERATIONS: The availability of infant formula, access to lactation inhibitor and quality of health services still represent challenges to eradicate new HIV infections in children.