Organizational culture of public health services from the perspective of nursing professionals / Cultura organizacional dos serviços públicos de saúde na perspectiva dos profissionais de enfermagem

INTRODUCTION: Culture is present in all environments, representing, in general, the ways of thinking, acting, feeling, learning, and sharing by a plurality of people. OBJECTIVE: Analyze the values and practices that characterize the organizational culture of health services of the public network from the perspective of nursing workers. METHODS: A cross-sectional, descriptive-analytical, quantitative study was conducted with 156 nursing workers from the public health services of a city in the State of Goias, Brazil. The Brazilian Instrument for Assessment of Organizational Culture and a sociodemographic and labor characterization questionnaire were used. The data were analyzed in the STATA program. RESULTS: It was identified that the female sex was significant with the reward and training practices (p=0.050). The professional nurse category was related to the values of competitive, individualistic, satisfaction, and well-being professionalism (p=0.036 and p=0.041). Income was correlated with cooperative professionalism (p=0.010). CONCLUSION: Managers of health institutions must promote an adequate work environment, with the use of tools capable of assessing the needs and abilities of subjects.

INTRODUÇÃO: A cultura está presente em todos os ambientes, representa, em geral, os modos de pensar, agir, sentir, aprendidos e compartilhados por uma pluralidade de pessoas. OBJETIVO: Analisar os valores e práticas que caracterizam a cultura organizacional dos serviços de saúde da rede pública na perspectiva dos trabalhadores de enfermagem. MÉTODO: Estudo transversal, descritivo-analítico, quantitativo, com 156 trabalhadores de enfermagem dos serviços públicos de saúde de um município do estado de Goiás, Brasil. Foram utilizados o Instrumento Brasileiro de Avaliação da Cultura Organizacional e um questionário sociodemográfico e de caracterização do trabalho. Os dados foram analisados no programa STATA. RESULTADOS: Identificou-se que o sexo feminino foi significativo com as práticas de recompensa e treinamento (p=0,050). A categoria profissional de enfermagem esteve relacionada aos valores de profissionalismo competitivo, individualismo, satisfação e bem-estar (p=0,036 e p=0,041). A renda foi correlacionada com o profissionalismo cooperativo (p=0,010). CONCLUSÃO: É importante que os gestores das instituições de saúde promovam um ambiente de trabalho adequado, com a utilização de ferramentas capazes de avaliar as necessidades e habilidades dos participantes.

Gravidez na adolescência: perfil sociodemográfico de adolescentes grávidas no período de 2015 até 2019 / Embarazo en adolescentes: perfil sociodemográfico de las adolescentes embarazadas en el periodo de 2015 a 2019 / Adolescent pregnancy: sociodemographic profile of pregnant adolescents from 2015 to 2019

Objetivo: analisar o perfil sociodemográfico de adolescentes grávidas no Brasil entre os anos de 2015 até 2019. Método: estudo transversal descritivo, com abordagem quantitativa, proveniente do Departamento de Informática do Sistema Único de Saúde. A análise de dados utilizou frequências absolutas e relativas (%). Resultados: foram registradas 2.405.248 adolescentes grávidas. A maioria das gestações ocorreram em meninas de 15 a 19 anos (95,2%), de cor parda (65,4%), solteiras (64,9%), com 8 a 11 anos de instrução materna (66,9%). Quanto as características da gestação, 98,7% foram gravidez única, com duração de 37 a 41 semanas (81,7%) e tipo de parto vaginal (61,2%). A análise temporal apresentou queda de 2015 a 2019. Conclusão: a gravidez na adolescência constitui-se como um evento complexo em que a atenção deve abordar um contexto biopsicossocial. Assim, delinear o perfil sociodemográfico dessas adolescentes é necessário, pois possibilita conhecer a população em estudo e suas condições de vulnerabilidade.

Objective: to analyze the sociodemographic profile of pregnant adolescents in Brazil between 2015 and 2019. Method: descriptive cross-sectional study, with a quantitative approach, coming from the Information Technology Department of the Unified Health System. Data analysis used absolute and relative frequencies (%). Results: 2,405,248 pregnant adolescents were registered. The majority of pregnancies occurred in girls aged 15 to 19 years (95.2%), of a brown color (65.4%), single (64.9%), with 8 to 11 years of maternal education (66.9%). As for the characteristics of pregnancy, 98.7% were single pregnancy, lasting 37 to 41 weeks (81.7%) and vaginal type of delivery (61.2%). The temporal analysis showed a drop from 2015 to 2019. Conclusion: teenage pregnancy is a complex event in which attention must address a biopsychosocial context. Thus, delineating the sociodemographic profile of these adolescents is necessary, as it makes it possible to get to know the population under study and its vulnerability conditions.

Objetivo: analizar el perfil sociodemográfico de las adolescentes embarazadas en Brasil entre los años 2015 y 2019. Método: estudio descriptivo transversal, con enfoque cuantitativo, del Departamento de Informática del Sistema Único de Salud. En el análisis de los datos se utilizaron frecuencias absolutas y relativas (%). Resultados: se registraron 2.405.248 adolescentes embarazadas. La mayoría de los embarazos se produjeron en chicas de entre 15 y 19 años (95,2%), morenas (65,4%), solteras (64,9%), con entre 8 y 11 años de educación materna (66,9%). En cuanto a las características del embarazo, el 98,7% fueron embarazos únicos, con una duración de 37 a 41 semanas (81,7%) y tipo de parto vaginal (61,2%). El análisis temporal mostró un descenso de 2015 a 2019. Conclusión: el embarazo en la adolescencia constituye un evento complejo en el que se debe prestar atención a un contexto biopsicosocial. Por lo tanto, es necesario delinear el perfil sociodemográfico de los adolescentes, ya que permite conocer a la población en estudio y sus condiciones de vulnerabilidad.

A amamentação em tempos da COVID-19: uma revisão narrativa / Breastfeeding during COVID-19 period: a narrative review

Analisar a amamentação em tempos de pandemia da COVID-19. Método: Revisão narrativa da literatura que selecionou artigos na base dados USA National Library of Medicine (Pubmed), no portal regional da Biblioteca Virtual em Saúde (BVS) e na biblioteca eletrônica Scientific Eletronic Library Online (Scielo) utilizando os termos de busca "Aleitamento Materno", "Coronavírus" e "Infecções por Coronavírus", e entre os termos o operador boleano AND. Na Pudmed os descritores foram "Breast Feeding", "Coronavirus" e "Coronavirus Infections", conforme o Medical Subject Headings (MeSH). Incluíram-se artigos em português e publicado entre 2019-2021. Resultados: 129 artigos foram selecionados, 125 foram excluídos e três foram analisados. Conclusão: Ainda há escassez de estudos abordando a temática principalmente em português. Contudo, até o momento, as recomendações vigentes encorajam a amamentação pelas nutrizes com suspeita ou positivas para COVID-19, porém com medidas de biossegurança corretas devido aos benefícios da amamentação.(AU)

Objective: Analyze breastfeeding during COVID-19 pandemic. Method: Narrative review of the literature that selected articles in the USA National Library of Medicine (Pubmed) database, in the regional portal of the Virtual Health Library (VHL) and in the electronic library Scientific Electronic Library Online (Scielo) using the descriptors "Breastfeeding","Coronavirus "and" Coronavirus Infections", and between the terms the Boolean operator AND. At Pudmed, the descriptors were "Breast Feeding", "Coronavirus" and "Coronavirus Infections", according to the Medical Subject Headings (MeSH). Articles in Portuguese and published between 2019-2021 were included. Results: 129 articles were selected, 125 were excluded and three were analyzed. Conclusion: There is still a shortage of studies addressing the theme mainly in Portuguese. However, to date, current recommendations encourage breastfeeding by breastfeeding mothers who are suspected or positive for COVID-19, but with correct biosafety measures due to the benefits of breastfeeding. (AU)

Objetivo: Analizar la lactancia materna en tiempos de la pandemia de COVID-19. Método: Revisión narrativa de la literatura que seleccionó artículos en la base de datos de la Biblioteca Nacional de Medicina de EE. UU. (Pubmed), en el portal regional de la Biblioteca Virtual en Salud (BVS) y en la biblioteca electrónica Scientific Eletronic Library Online (Scielo) utilizando los términos de búsqueda. "Lactancia materna", "Coronavirus" e "Infecciones por coronavirus", y entre los términos el operador booleano AND. En Pudmed, los descriptores fueron "Lactancia materna", "Coronavirus" e "Infecciones por coronavirus", de acuerdo con Medical Subject Headings (MeSH). Se incluyeron artículos en portugués y publicados entre 2019-2021. Resultados: se seleccionaron 129 artículos, se excluyeron 125 y se analizaron tres. Conclusión: todavía hay una escasez de estudios que aborden el tema principalmente en portugués. Sin embargo, hasta la fecha, las recomendaciones actuales fomentan la lactancia materna en madres que amamantan con sospecha o positividad de COVID-19, pero con las medidas de bioseguridad correctas debido a los beneficios de la lactancia materna. (AU)

Óbitos evitáveis em crianças menores de cinco anos em Passos/MG / Avoidable deaths in children under five years in Passos/MG / Muertes evitables de niños menores de cinco años Passos/MG

Objetivo: Descrever as principais causas de óbitos evitáveis em crianças menores de cinco anos no município de Passos, Minas Gerais, entre os anos de 2010 a 2018, segundo a "Lista Brasileira de Causas de Mortes Evitáveis". Método: Pesquisa descritiva, retrospectiva, com abordagem quantitativa, por meio dos dados coletados pela base de dados do Sistema de Informação sobre Mortalidade (SIM), posteriormente digitados em planilhas do Excel 2010 e analisados por estatística descritiva simples. Resultados: Houve maior ocorrência de óbitos em crianças do sexo masculino, no período neonatal precoce. As causas mais prevalentes foram as reduzíveis por adequada atenção à mulher na gestação, seguida por adequada atenção ao recém-nascido. Conclusão: Há necessidade de maior envolvimento dos gestores em saúde quanto à assistência pré-natal, com implementação de ações que promovam a saúde e a prevenção de doenças e agravos, garantindo assim serviços de excelência para o atendimento destes grupos vulneráveis.(AU)

Objective: To describe the main causes of preventable deaths in children under five years of age in the municipality of Passos, Minas Gerais, between 2010 and 2018, according to the "Brazilian List of Causes of Avoidable Deaths". Method: Descriptive, retrospective research, with a quantitative approach, using data collected from the Mortality Information System (SIM) database, which were later entered into Excel 2010 spreadsheets and analyzed using simple descriptive statistics. Results: There was a higher occurrence of deaths in male children in the early neonatal period. The most prevalent causes were those that could be reduced by adequate care for women during pregnancy, followed by adequate care for the newborn. Conclusion: There is a need for greater involvement of health managers in terms of prenatal care, with the implementation of actions that promote health and the prevention of diseases and injuries, thus guaranteeing excellent services for the care of these vulnerable groups.(AU)

Objetivo: Describir las principales causas de muertes evitables en menores de cinco años en el municipio de Passos, Minas Gerais, entre 2010 y 2018, según la "Lista Brasileña de Causas de Muertes Evitables". Método: Investigación descriptiva, retrospectiva, con enfoque cuantitativo, utilizando datos recolectados de la base de datos del Sistema de Información de Mortalidad (SIM), que luego fueron ingresados en hojas de cálculo Excel 2010 y analizados mediante estadística descriptiva simple. Resultados: Hubo una mayor incidencia de muertes en niños varones en el período neonatal temprano. Las causas más prevalentes fueron las que podrían reducirse con una atención adecuada a la mujer durante el embarazo, seguida de una atención adecuada al recién nacido. Conclusión: Existe la necesidad de una mayor participación de los gestores de salud en materia de atención prenatal, con la implementación de acciones que promuevan la salud y la prevención de enfermedades y lesiones, garantizando así excelentes servicios para la atención de estos grupos vulnerables.(AU)

Aleitamento materno e seu conhecimento por alunos de enfermagem / Breastfeeding and their knowledge by nursing students / Lactancia materna y su conocimiento por los estudiantes de enfermeira

Objetivo: Investigar o conhecimento dos alunos de enfermagem sobre o aleitamento materno. Métodos: Abordagem transversal, qualitativa e quantitativa de campo desenvolvido em Universidade particular do interior de São Paulo. A coleta de dados foi realizada utilizando-se questionário, com 15 perguntas sobre amamentação, distribuídas em três partes. Foram incluídas perguntas sobre manejo na amamentação, aspectos legais na proteção ao aleitamento materno e benefícios da amamentação para o binômio. Analisou-se os dados por meio da descritiva simples e para as comparações foi utilizado a análise de variância. Resultados: Os alunos de enfermagem do oitavo semestre obtiveram desempenho geral de 81,2% nas respostas corretas, valor estatisticamente superior a uma das turmas do sétimo período, mas semelhante à outra turma. Assim a turma sétimo A e oitavo tiveram resultados significativos na pesquisa. Conclusão: Apesar do bom conhecimento sobre as vantagens do aleitamento, evidenciou-se conhecimento inferior ao esperado no que se refere ao processo fisiológico do aleitamento materno.(AU)

Objective: To investigate the knowledge of nursing students about breastfeeding. Methods: Cross-sectional, qualitative and quantitative approach developed at a private university in an inner city in São Paulo State. Data collection was performed using a questionnaire comprising 15 questions about breastfeeding, distributed in three parts. Questions about breastfeeding management, legal aspects of breastfeeding protection and breastfeeding benefits were included. Data were analyzed using the simple descriptive and variance analysis was performed for comparisons. Results: Nursing students in the eighth semester achieved an overall performance of 81.2% in the correct answers, a value statistically superior to one of the classes in the seventh period, but similar to the other. Conclusion: Despite the good knowledge about the advantages of breastfeeding, knowledge was shown to be lower than expected with regard to the physiological process of breastfeeding.(AU)

Objetivo: Investigar el conocimiento de los estudiantes de enfermería sobre la lactancia materna. Métodos: enfoque transversal, cualitativo y cuantitativo desarrollado en una universidad privada en una ciudad del interior del estado de São Paulo. La recolección de datos se realizó mediante un cuestionario que comprende 15 preguntas sobre lactancia materna, distribuidas en tres partes. Se incluyeron preguntas sobre el manejo de la lactancia materna, los aspectos legales de la protección y los beneficios de la lactancia materna. Los datos se analizaron mediante el análisis descriptivo simple y se realizó un análisis de varianza para las comparaciones. Resultados: Los estudiantes de enfermería en el octavo semestre lograron un rendimiento general del 81.2% en las respuestas correctas, un valor estadísticamente superior a una de las clases en el séptimo período, pero similar al otro. Conclusión: a pesar del buen conocimiento sobre las ventajas de la lactancia materna, se demostró que el conocimiento es menor de lo esperado con respecto al proceso fisiológico de la lactancia materna.(AU)

Pregnancy-specific urinary incontinence in women with gestational hyperglycaemia worsens the occurrence and severity of urinary incontinence and quality of life over the first year post partum.

OBJECTIVE: To determine the occurrence and severity of pregnancy-specific urinary incontinence (PSUI) in women with gestational hyperglycaemia, and its impact on quality of life (QoL) over the first year post partum. STUDY DESIGN: Three hundred and eighty-eight pregnant women with PSUI were distributed into two groups (normoglycaemic and hyperglycaemic) and analysed at five timepoints during pregnancy and the first year post partum. Gestational hyperglycaemia was defined according to the criteria of the American Diabetes Association and the glucose profile test. Relationships with outcome were analysed using Chi-squared test for categorical variables and Student's t-test for quantitative variables. RESULTS: The overall prevalence rate of PSUI was 54.1 %, with prevalence rates of 43.3 % and 56.7 % in normoglycaemic and hyperglycaemic Brazilian pregnant women, respectively. Women with gestational hyperglycaemia had a higher amount of urine loss (p < 0.0027), frequency of UI (p < 0.0014), impact of UI on QoL (p < 0.0001), severity of UI (p = 0.0003) and total scores on the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-SF) and Incontinence Severity Index (ISI) (p<0.0001) at the two timepoints during pregnancy; and a higher amount of urine loss (p = 0.0079), frequency of UI (p = 0.0382), impact of UI on QoL (p < 0.0001), severity of UI (p = 0.0053) and questionnaire scores (p < 0.0001 for ICIQ-SF and p = 0.003 for ISI) over the first year post partum. CONCLUSIONS: PSUI in women with gestational hyperglycaemia worsens the occurrence and severity of UI, and the impact of UI on QoL over the first year post partum. These results emphasize the interaction between PSUI, gestational hyperglycaemia and long-term maternal outcome.

Profile of pro-inflammatory cytokines in colostrum of nursing mothers at the extremes of reproductive age.

Gestations at the extremes of reproductive age are characterized as high-risk pregnancies, conditions that might influence colostrum composition. This first milk secretion contains nutrients necessary for the development and immunity of the newborn; therefore, this study aims to compare adolescent and advanced maternal age mothers regarding sociodemographic, gestational, and perinatal characteristics and the colostrum levels of pro-inflammatory cytokines in these groups of study. This cross-sectional study has compared sociodemographic, gestational and perinatal data from adolescent mothers (between 10 and 24 years old) (n = 117), advanced maternal age mothers (over 35 years of age) (n = 39) and mothers considered a control group (25 to 34 years old) (n = 58). Additionally, colostrum samples were obtained from the studied and control group subjects by manual milking, between 48 and 72 hours postpartum, and the samples were analyzed for cytokine concentrations by enzyme-linked immunosorbent assay (ELISA). The majority of the studied mothers reported living a stable union, and 81.2% of the adolescent mothers did not carry out any paid activity. Mothers with advanced maternal age mainly delivered by cesarean section and presented a higher body mass index (BMI). Neonatal weight and Apgar score were not different between the groups. The concentrations of interleukin (IL)-1ß and IL-6 were higher in the colostrum of mothers with advanced age compared to adolescent mothers, but did not differ from the control group. The concentrations of IL-8 and tumor necrosis factor alpha did not differ between the three groups. Therefore, our data demonstrated that maternal age influenced the sociodemographic and gestational characteristics as well as the composition of colostrum cytokines.

Busca por modelos de organização do trabalho nos atendimentos primários de saúde do Brasil e de países internacionais no enfrentamento da Covid-19 / Search for work organization models in primary health care in Brazil and international countries to face Covid-19

No dia 11 de março de 2020, a Organização Mundial da Saúde declarou oficialmente a pandemia da Covid-19. Essa declaração se deu não pela gravidade da patologia, mas pelo grande poder de contágio do vírus causador da doença. Por esse motivo, todos os países se viram frente um novo desafio de saúde mundial tendo a necessidade de se organizar para enfrentar essa nova demanda por meio da criação de novos fluxos, monitoramento interno dos profissionais e pacientes, e monitoramento externo dos mesmos. Além disso, por se tratar de um vírus com novas características, diversas pesquisas foram publicadas em tempo real a pandemia, trazendo novas informações úteis para o trabalho.Por esse motivo, o projeto Safety foi criado com intuito de captar essas novas publicações, avaliar e posteriormente, inserir essas informações no trabalho proporcionando novas ferramentas de enfrentamento de acordo com a aplicabilidade no Brasil. (AU)

On March 11, 2020, the World Health Organization officially registered a Covid-19 pandemic. This statement came about not because of the seriousness of the pathology, but because of the great contagion power of the virus, that causes the disease. For this reason, all countries faced a new global health challenge with the need to organize themselves to face this new demand through the creation of the new flows, internal and external professionals monitoring as patients. In addition, because it is a virus with new characteristics, several studies were published in real time on the pandemic bringing new useful information to the work. For this reason, the Safety project was created in order to capture these new publications, evaluate and later, insert this information into the work providing new coping tools according to the applicability in Brazil. (AU)

Telomere Length and Telomerase Activity in Foetal Membranes from Term and Spontaneous Preterm Births.

The reduction of telomere length, the protective cap structures of chromosomes, is one of the biomarkers of senescence (a mechanism of ageing), and ageing of foetal gestational tissues is associated with both term and preterm parturition. A mechanism regulating telomere length is the activity of telomerase, an enzyme that adds telomere fragments during DNA replication and cell division; however, its role in regulating telomere length is not well studied in gestational tissues. The objective of this study is to correlate telomere length and telomerase activity in foetal membranes from term and spontaneous preterm births. Foetal membrane samples were collected from pregnant women experiencing term labour (TL), term not in labour (TNL), preterm premature rupture of membranes (pPROM) and spontaneous preterm labour (PTL) with intact membranes (n = 20/group). Telomere length and telomerase activity were analyzed by relative quantification (T/S), real-time PCR and PCR-based fluorometric detection, respectively. Data were analyzed by ANOVA or the Kruskal-Wallis test. Demographic variables were not statistically different among the groups. Foetal membranes from the TL group showed telomere length reduction compared with those from the others (p < 0.0002). Telomerase activity did not change in foetal membranes irrespective of pregnancy outcome. Telomere shortening in foetal membranes is suggestive of senescence associated with triggering of labour at term; however, this is likely independent of telomerase activity, while prematurity may be associated with senescence, but due to other mechanisms than telomere length reduction in foetal membranes.

Determination of antimicrobial susceptibility and biofilm production in Staphylococcus aureus isolated from white coats of health university students.

This study aimed at detecting Staphylococcus aureus from white coats of college students and characterizing antimicrobial susceptibility and biofilm production. Bacterial samples (n = 300) were obtained from white coats of 100 college students from August 2015 to March 2017 S. aureus was isolated and it´s resistance profile was assessed by antimicrobial disk-diffusion technique, screening for methicillin-resistant Staphylococcus aureus (MRSA), detection of mecA gene by PCR, and determination of staphylococcal cassette chromosome mec (SCCmec) by multiplex PCR. Congo red agar (CRA) and icaA and icaD genes by PCR were used for biofilm characterization. S. aureus was identified in 45.0% of samples. Resistance of S. aureus sample to antimicrobial was seen for penicillin (72.59%), erythromycin (51.85%), cefoxitin (20.74%), oxacillin (17.04%), clindamycin (14.81%) and levofloxacin (5.18%). MRSA was detected in 53.3% of the samples with SCCmec I (52.8%), SCCmec III (25%) and SCCmec IV (11.1%). Biofilm production was observed in 94.0% S. aureus samples. These data show that biosafety measures need to be enhanced in order to prevent dissemination of multiresistant and highly adhesive bacteria across other university settings, relatives, and close persons.

Maternal age influence in human colostrum acidity composition in a Maternity in an country side city of São Paulo State / Impacto da idade materna na acidez do colostro de nutrizes em maternidade do interior do Estado de São Paulo

INTRODUCTION: OBJECTIVE: To analyze sociodemographic and gestational characteristics and to compare colostrum acidity content in adolescent and advanced maternal age mothers METHODS: This cross-sectional study included 98 adolescents (up to 18 year-old) and 33 advanced maternal age (more than 35 year-old) mothers admitted at the maternity of Presidente Prudente Regional Hospital, Brazil. An approximated volume of 10 mL of colostrum was obtained by manual expression of the breasts within 72h postpartum and stored at -20ºC up to processing. Acidity of colostrum was evaluated in Dornic degrees. Statistical analysis was performed using Mann-Whitney test or X² RESULTS: The median age adolescents and advanced maternal age mothers were 20 years (12-24) 37 years (35-45), respectively. The majority of the adolescents (66.3%) were primiparous and C-section delivery had occurred in 66.7% of advanced age mothers. Gestational body mass index (BMI) was statically higher in advanced maternal age women (32.17±5.6 vs 26.09±3.6, p< 0.0001). Acidity measurement was similar between the studied groups CONCLUSIONS: Sociodemographic and gestational characteristics of adolescents and advanced age mothers showed population heterogeneity, thus, specific follow up and orientations should be applied at each one. Colostrum constitution was constant regarding casein and proteins content, independently of maternal age

INTRODUÇÃO: OBJETIVO: Analisar as características sociodemográficas e gestacionais e comparar a acidez do colostro de nutrizes adolescentes e idade materna avançada MÉTODO: Estudo prospectivo transversal, que incluiu 98 nutrizes adolescentes (até 18 anos) e 33 nutrizes com idade materna avançada (maior que 35) atendidas na Maternidade do Hospital Regional de Presidente Prudente. Amostras de aproximadamente 10 mL de colostro foram obtidas por meio da ordenha manual entre 48 a 72h após o parto, e armazenadas a -20ºC até o processamento. A acidez foi verificada por meio da titulação e calculada em graus Dornic. A análise estatística foi realizada utilizando-se o teste de Mann-Whitney ou X² RESULTADOS: A mediana da idade materna das nutrizes adolescentes foi de 20 (12-24) anos, e das nutrizes com idade materna avançada foi de 37 (35-45) anos. A maioria das nutrizes adolescentes (66,3%) eram primíparas e a via de parto cesárea ocorreu em 66,7% das nutrizes em idade materna avançada. O índice de massa corpórea (IMC) gestacional foi estatisticamente maior em nutrizes com idade materna avançada (31,3±5,6 vs 26,06±3,6, p< 0,0001). A acidez do colostro das nutrizes nos extremos da idade reprodutiva não apresentou diferença significativa entre os grupos de nutrizes CONCLUSÃO: As características sociodemográficas e gestacionais de adolescentes e mães com idade materna avançada evidenciam heterogeneidade dessas populações e consequentemente, atendimento e condutas específicas devem ser aplicados a cada uma. A constituição do colostro em caiseina e proteinas apresentou-se constante, independente da idade materna

Mother-to-child transmission and gestational syphilis: Spatial-temporal epidemiology and demographics in a Brazilian region.

Syphilis is a Sexually Transmitted Infection (IST) with significant importance to public health, due to its impact during pregnancy (Gestational Syphilis-GS); especially because syphilis can affect fetus and neonates' development (mother-to-child transmission-MTCT of syphilis), by increasing susceptibility to abortion, premature birth, skeletal malformations, meningitis and pneumonia. Measures to control and eliminate MTCT of syphilis have failed on the last few years in Brazil and this research aimed to identify the seasonality of notified cases of syphilis in a region of São Paulo state. The studied region, Pontal do Paranapanema, comprises 32 cities located in the West of São Paulo state, in Brazil. Data collected from the National System of Aggravations and Notification (SINAN) website was used to calculate the incidence rate of GS and MTCT. The incidence rate of GS was acquired dividing number of cases by number of women in each municipality and MTCT using number of live births in each year (from 2007 to 2013) in each municipality. This result was then, standardized multiplying incidence rate by 10,000 and expressed as incidence/10,000 women or live births, for GS and MTCT, respectively. To identify possible endemic/epidemic periods, a control diagram was performed using the standard deviation (SD) of incidence rate. Thematic maps representing the spatial distribution of incidence rates were constructed using a Geographic Information System software (GIS, based on cartographic vector available on the Brazilian Institute of Geography and Statistics (IBGE) website. Eighty cases of GS and 61 cases of MTCT were notified in the studied region. An increase of GS notification was detected in the Pontal do Paranapanema in 2011 followed by an increase in number of MTCT cases in the subsequent year, suggesting inefficacy in the treatment during gestational period. Most of those cases were reported on February and November which suggested seasonality for this IST in the region. The control diagram, based on the inputs collected from SINAN, showed no endemic period; however, the most susceptible month to happen an endemic event of GS and MTCT was February. Our study provided a new methodology to understand the syphilis dynamics as a potential tool to improve the success of future measures to control and possibly eliminate MTCT of syphilis.

Validation of a symphysis-fundal height chart developed for pregnancy complicated by diabetes and hyperglycemia: an observational study.

BACKGROUND: The present study validates a symphysis-fundal height chart (SFH-chart) for pregnant women with type 2 diabetes mellitus (DM2), gestational diabetes mellitus (GDM) and mild gestational hyperglycemia (MGH) attending at the Diabetes and Pregnancy Reference Service of the Botucatu Medical School, UNESP, Brazil. METHODS: A cross-sectional study was carried out to evaluate the performance of the specific FHC in predicting small (SGA) and large (LGA) for gestational age newborns (NB). We evaluated 206 pregnant women with DM2, GDM or MGH and their NB. The last symphysis-fundal height measure, taken at birth, was used to determine the sensitivity index (Sens), specificity index (Spe), positive prediction value (PPV), negative prediction value (NPV) and accuracy in predicting SGA and LGA. The gold standard was the Lubchenco birth weight/gestational age ratio evaluated at birth. RESULTS: The mothers showed adequate glycemic control; 91.3 % of all pregnant women achieved HbA1c < 6,5 % in the third trimester. The SFH-chart tested achieved 100 % of Sens and NPV in predicting both SGA and LGA, with accuracy of 90.3 % (85.5; 93.6) and 91.8 % (87.2; 94.8), respectively, for predicting SGA and LGA newborns. CONCLUSIONS: The Basso SFH-chart showed high performance in predicting both SGA and LGA newborns of DM-2, GDM and MGH mothers, with better performance than the national reference SFH-chart. These findings support the internal validation of the Basso SFH-chart, which may be implemented in the prenatal care of the Diabetes and Pregnancy Reference Service-Botucatu Medical School/UNESP.

Depression and anxiety in pregnant women with diabetes or mild hyperglycemia.

INTRODUCTION: A number of physical and psychological changes that occur during pregnancy can stimulate the development of psychological disorders such as anxiety and depression. The study evaluated psychological aspects related to maternal depression and anxiety in pregnant women with diabetes mellitus or hyperglycemia, contrasting the results with those of non-diabetic pregnant women. METHOD: In a prospective and longitudinal approach, two questionnaires were applied and validated for use in Brazil, the Beck depression inventory and the State-Trait Anxiety Inventory. The questionnaires were applied to pregnant women at the first prenatal visit or at the time of disease diagnosis (T1) and reapplied at admission for delivery (T2). Regardless of the degree of hyperglycemia, both at first and in the second stage most women had severe anxiety trait. In early pregnancy (T1), however, severe state anxiety was more frequent in women with hyperglycemia than in those from the NG group. RESULTS: Most pregnant women showed moderate state anxiety over their pregnancy, regardless of glycemic status. In early pregnancy, however, severe state anxiety was more prevalent in hyperglycemic women than in those with normal glycemic status. Most women showed moderate trait anxiety and mild depression in both early and late pregnancy, irrespective of glycemic status. CONCLUSION: The incidence of severe state anxiety in early pregnancy is more frequent in women with diabetes or hyperglycemia, but their levels of trait anxiety and depression are not affected by glycemic status.

Changes in T-cell phenotype and cytokines profile in maternal blood, cord blood and colostrum of diabetic mothers.

OBJECTIVE: The present study evaluated the cells and cytokine of maternal blood, cord blood and colostrum of diabetic mothers. METHODS: The women evaluated were divided according to their body mass index (BMI) and glycemic status into non-diabetic (ND - N = 15), mild gestational hyperglycemic (MGH - N = 15), diabetes mellitus gestational (DMG - N = 13) and type-2 diabetes mellitus (DM2 - N = 15) groups. The subsets of cells and cytokine profile were determined by flow cytometry. RESULTS: Maternal blood from MGH group had increase percentage of CD3(+)T cells, and DM-2 group had decrease percentage of CD4(+) T cells. The cord blood from hyperglycemic groups showed lower percentage of CD3(+) T cells expressing CD45RO(+) and higher of CD4(+) T cells and CD4(+) T cells expressing CD45RA(+). In the colostrum, the CD4(+) T cells and CD4(+) T cells expressed CD45RA(+) increase in hyperglycemic groups. The DM2 group exhibited higher IL17 levels in maternal blood. IFN-γ was lower in cord blood from MGH and DMG groups with overweight/obese. Irrespective of the glycemic status, IL6 was higher in colostrum. CONCLUSION: The results obtained suggest that maternal hyperglycemia modifies the phenotypes of T cells and cytokines profile in maternal, cord blood and colostrum.

IRS-1 gene polymorphism and DNA damage in pregnant women with diabetes or mild gestational hyperglycemia.

BACKGROUND: Pregnant women with mild gestational hyperglycemia present a high risk for hypertension and obesity, and appear to reproduce the model of metabolic syndrome in pregnancy, including hyperinsulinemia and insulin resistance. Diabetic patients have a higher frequency of the IRS-1 Gly972Arg variant and this polymorphism is directly related to insulin resistance and subsequent hyperglycemia. In diabetes, hyperglycemia and other associated factors generate reactive oxygen species that increase DNA damage. The aims of this study were to evaluate the presence of the IRS-1 Arg972 polymorphism in pregnant women with diabetes or mild gestational hyperglycemia, and in their newborns. Additionally, we evaluated the level of primary DNA damage in lymphocytes of Brazilian pregnant women and the relationship between the amount of genetic damage and presence of the polymorphism. METHODS: A based on the oral glucose tolerance test (OGTT) results and on glycemic profiles (GP), as follows: non-diabetic group, mild gestational hyperglycemia (MGH) and diabetic group. Eighty-five newborns were included in the study. Maternal peripheral blood samples and umbilical cord blood samples (5-10 mL) were collected for genotyping by PCR-RFLP and for comet assays. RESULTS: The prevalence of genotype Gly/Arg in pregnant women groups was not statistically significant. In newborns, the frequency of Gly/Arg was significantly higher in the MGH and diabetic groups than in the non-diabetic group. Taken together, groups IIA and IIB (IIA + IIB; diabetes) presented lower amounts of DNA damage than the non-diabetic group (p = 0.064). No significant association was detected between genetic damage and the presence of the Arg972 genotype in pregnant women. CONCLUSION: The polymorphism was more prevalent in newborns of diabetic and MGH women. We believe that it is necessary to increase the number of subjects to be examined in order to better determine the biological role of the Arg972 polymorphism in these patients. Despite being classified as low-risk, pregnant women with mild gestational hyperglycemia characterize a population of maternal and perinatal adverse outcomes, and that, together with their newborns, require better monitoring by professionals and health services.

DNA damage and its cellular response in mother and fetus exposed to hyperglycemic environment.

The increased production of reactive oxygen species (ROS) plays a key role in pathogenesis of diabetic complications. ROS are generated by exogenous and endogenous factors such as during hyperglycemia. When ROS production exceeds the detoxification and scavenging capacity of the cell, oxidative stress ensues. Oxidative stress induces DNA damage and when DNA damage exceeds the cellular capacity to repair it, the accumulation of errors can overwhelm the cell resulting in cell death or fixation of genome mutations that can be transmitted to future cell generations. These mutations can lead to and/or play a role in cancer development. This review aims at (i) understanding the types and consequences of DNA damage during hyperglycemic pregnancy; (ii) identifying the biological role of DNA repair during pregnancy, and (iii) proposing clinical interventions to maintain genome integrity. While hyperglycemia can damage the maternal genetic material, the impact of hyperglycemia on fetal cells is still unclear. DNA repair mechanisms may be important to prevent the deleterious effects of hyperglycemia both in mother and in fetus DNA and, as such, prevent the development of diseases in adulthood. Hence, in clinical practice, maternal glycemic control may represent an important point of intervention to prevent the deleterious effects of maternal hyperglycemia to DNA.

The role of cytokines in the functional activity of phagocytes in blood and colostrum of diabetic mothers.

Immune response changes induced by diabetes are a risk factor for infections during pregnancy and may modify the development of the newborn's immune system. The present study analyzed colostrum and maternal and cord blood of diabetic women to determine (1) the levels of the cytokines IFN- γ and TGF- ß and (2) phagocytic activity after incubation with cytokines. Methods. Colostrum and maternal and cord blood samples were classified into normoglycemic (N = 20) and diabetic (N = 19) groups. Cytokine levels, superoxide release, rate of phagocytosis, bactericidal activity, and intracellular Ca(2+) release by phagocytes were analyzed in the samples. Irrespective of glycemic status, IFN- γ and TGF- ß levels were not changed in colostrum and maternal and cord blood. In maternal blood and colostrum, superoxide release by cytokine-stimulated phagocytes was similar between the groups. Compared to spontaneous release, superoxide release was stimulated by IFN- γ and TGF- ß in normoglycemic and diabetic groups. In the diabetic group, cord blood phagocytes incubated with IFN- γ exhibited higher phagocytic activity in response to EPEC, and maternal blood exhibited lower microbicidal activity. These data suggest that diabetes interferes in maternal immunological parameters and that IFN- γ and TGF- ß modulate the functional activity of phagocytes in the colostrum, maternal blood, and cord blood of pregnant diabetic women.

Transfer of maternal immunity to newborns of diabetic mothers.

This study was carried out with hyperglycemic pregnant women to investigate the transfer of antibody classes to newborns across the placenta or by colostrum and the functional activity of phagocytes in maternal blood, cord blood, and colostrum from diabetes mothers. Samples from maternal blood, cord blood, and colostrum were collected from 20 normoglycemic and 20 hyperglycemic pregnant women. We determined antibodies levels, superoxide release, phagocytosis and bactericidal activity of phagocytes. We demonstrated that IgG levels in cord blood were higher in the hyperglycemic group. IgA and IgM levels were higher in maternal than in cord blood samples. Plasma antibody levels were lower in hyper- than in normoglycemic women. The colostrum of diabetic mothers had lower IgA and IgG levels. Colostrum and maternal blood phagocytes when exposed to EPEC increased the superoxide release. Cord blood phagocytes of hyperglycemic group, independently of bacteria, had higher superoxide release. Colostrum and blood phagocytes from diabetic group exhibited some phagocytic and microbicidal activity in response to EPEC. Mononuclear phagocytes from cord blood had the lowest phagocytosis, and bactericidal activity for EPEC, regardless of glycemic status. These data showed that hyperglycemia altered IgG transfer across the placenta and decreases immunoglobulin levels in maternal blood and colostrum.