Melatonin in Human Milk: A Scoping Review.

Melatonin is vital in human circadian rhythm and infant development. This scoping review summarized the current knowledge about melatonin's presence and effects in human milk to promote better understanding of its secretion pattern and clinical advancement of maternal-infant health. The review followed the Joanna Briggs Institute guideline and answered the question: What is the current knowledge about melatonin hormone in human milk? The databases searched were PubMed, CINAHL, SCOPUS, Web of Science, LILACS, Scielo, EMBASE, Science Direct, Eric, Cochrane, in addition to grey literature and reference lists of included sources. Research papers included English, Spanish, or Portuguese languages, regardless of study type or publication date. The study selection and data extraction involved two independent reviewers. Twenty-nine studies met inclusion criteria. The studies, conducted between 1993 and 2023, employed diverse designs, with cross-sectional studies being the most prevalent. Melatonin concentration exhibited a consistent pattern, being higher at night, and elevated in colostrum. The analysis methods for melatonin concentration evolved, with recent advancements contributing to more accurate measurements. Factors influencing melatonin levels, such as delivery type, maternal age, and health conditions, demonstrated a complex relationship, potentially impacting the health and development of infants. The dynamic nature of melatonin in human milk calls for continued interdisciplinary research, bridging gaps between clinical, biochemical, and epidemiological perspectives. Standardizing melatonin analysis methods are needed. Nurses should assess factors influencing melatonin levels in milk to promote interventions and guidance aimed at enhancing the regulation of the circadian cycle during the perinatal period and its benefits.

Context of digital media use in early childhood: Factors associated with cognitive development up to 36 months of age.

The influence of digital media on child cognitive development is a complex factor that goes beyond screen time. This study investigates the broader impact of digital media on child cognitive development, considering contextual variables such content type, parental mediation, and maternal mental health. Brazilian mothers (N = 212) of children 4-36 months old answered an online survey. Results showed that children's screen time increases with age. The model with unmediated use, non-educational content, and mother's screen time explains 28.7 % of children's screen time variance. Non-educational content and simultaneous screen media use explained 5.3 % of the variance in toddlers' cognitive development. Mothers with common mental disorders tended not to mediate their children's media use. We discuss the influence of caregivers' availability to mediate infants' and toddlers' digital media use and its impact on children's cognitive development. These findings underscore the necessity for educational and awareness campaigns aimed at fostering access to high-quality digital content for children during critical stages of development.

The invisible problem of early adolescent pregnancy in the Dominican Republic: a descriptive analysis.

Study objectives: The aim of this article is to describe the problem of pregnancy in girls under 15 years of age in the Dominican Republic in the period 2000-2021, to develop a specific indicator for this age group and describing the related factors. Methods: This is an exploratory ecological study, based on secondary data sources, such as birth records from the National Statistics Office (NSO) and the Ministry of Public Health (MPH). We calculated the rates of fertility and pregnancy in early adolescence, as well as analyzed their main determining factors and consequences. Results: Fertility Rate in Early Adolescence (FREA) decreases from 6.27 to 1.04 per thousand in the period 2001-2021. The average FREA for 2015-2021 was 1.78. The average Estimated Rate of Pregnancy in Early Adolescence (ERPEA) for the same period was 3.39. Disability-Adjusted Life Years (DALYs) were 11,620 years. Years of Life Lost (YLL) were 9,665.9 years. The prevalence of Low Birth Weight (LBW) in the under 15-year-old age group was 14.2 %. Conclusions: Pregnancy in childhood implies risks for both the mother and the child, including low birth weight. The official fertility rate is substantially underreported (2.84 vs. 1.79).The fertility rate indicator traditionally used does not accurately measure the number of pregnancies in women, particularly in specific age groups or populations where pregnancies may be interrupted by various factors. Therefore, the use of ERPEA is recommended.We emphasize the need for implementing the proposed indicator for the target group, as well as monitoring Sustainable Development Goal indicator 3.7.2.

Gestação de Substituição em Portugal: Orientações para a prática clínica

Introdução: A aprovação na Assembleia da República, em dezembro de 2021, da lei aplicável à Gestação de Substituição, suscita a reflexão acerca dos aspetos práticos em que o regime se concretizará e das orientações necessárias para os profissionais de saúde envolvidos. Por esse motivo, foram definidos como objetivos: analisar um conjunto de recomendações para a prática clínica no âmbito da Gestação de Substituição em países com experiência no procedimento e promover uma discussão com peritos na área da Procriação Medicamente Assistida. Material e Métodos: Foi realizada uma análise documental das publicações e documentos oficiais sobre o tema que serviu de base para o estudo de desenho qualitativo baseado em grupos focais com diferentes profissionais -médicos e psicólogos- com experiência em Procriação Medicamente Assistida. A discussão foi concretizada através de sessões via Zoom®, realizadas separadamente com os dois grupos focais. Resultados: Na discussão os peritos fizeram as suas apreciações e propostas de melhoria em relação à versão inicial do documento resultante da análise documental. Conclusão: Obteve-se uma versão consolidada do conjunto de orientações para os profissionais de saúde com as dimensões a avaliar e acompanhar junto da gestante e parte beneficiária na Gestação de Substituição.

Introducción : La aprobación por el Parlamento portugués, en diciembre de 2021, de la ley aplicable a la Gestación Subrogada, plantea la reflexión sobre los aspectos prácticos en los que se implementará el esquema y las directrices necesarias para los profesionales de la salud involucrados. Por este motivo, se definieron los siguientes objetivos: analizar un conjunto de recomendaciones para la práctica clínica en el ámbito de la gestación subrogada en países con experiencia en el procedimiento y promover un debate con expertos en el campo de la Reproducción Médicamente Asistida. Material y Métodos : Se realizó un análisis documental de publicaciones y documentos oficiales sobre el tema, que sirvió de base para el estudio de diseño cualitativo basado en focus group con diferentes profesionales -médicos y psicólogos- con experiencia en Reproducción Médicamente Asistida. La discusión se realizó a través de sesiones via Zoom®, celebradas por separado con los dos focus group. Resultados : En la discusión, los expertos realizaron sus apreciaciones y propuestas de mejora respecto a la versión inicial del documento resultante del análisis documental. Conclusión : Se obtuvo una versión consolidada del conjunto de directrices para los profesionales de la salud con las dimensiones para evaluar y dar seguimiento a la madre sustituta y a los beneficiarios en la Gestación Subrogada.

Introduction: The approval by the Portuguese Parliament, in December 2021, of the law applicable to Surrogate Pregnancy, raises reflection on the practical aspects in which the scheme will be implemented and the necessary guidelines for health professionals involved. For this reason, the following objectives were defined: to analyze a set of recommendations for clinical practice in surrogacy in countries with experience in the procedure and to promote a discussion with experts in Medically Assisted Reproduction. Material and Methods: A documental analysis of publications and official documents on the theme was conducted. This served as a basis for the qualitative design study based on focus groups with different professionals -physicians, and psychologists- with experience in Medically Assisted Reproduction. The discussion was realized through sessions via Zoom®, held separately with the two focus groups. Results : In the debate, the experts made their appreciation and proposals for improvement concerning the initial version of the document resulting from the document analysis. Conclusion : A consolidated version of the set of guidelines for health professionals was obtained with the dimensions to evaluate and follow up with the surrogate and beneficiaries in Surrogacy.

Impact of maternal HIV infection on perinatal outcomes: A systematic review.

BACKGROUND: Maternal HIV infection remains a significant global health concern with potential repercussions on perinatal outcomes. Emphasis on early intervention to improve peri- and postnatal outcomes in infected mothers and infants is a valid therapeutic concern. OBJECTIVES: To comprehensively analyze perinatal outcomes associated with maternal HIV infection and evaluate adverse effects associated with the HIV infection in the existing literature. SEARCH STRATEGY: A comprehensive search of PubMed, MEDLINE, and Google Scholar was conducted from 2013 to September 2023, using relevant MeSH terms. SELECTION CRITERIA: The included studies encompassed original studies, cross-sectional, prospective, retrospective studies and observational studies focused on perinatal outcomes in the context of maternal HIV infection. DATA COLLECTION AND ANALYSIS: The selected studies underwent rigorous data collection and comprehensive quality checks and adhered to the PRISMA guidelines. MAIN RESULTS: Nine eligible studies from Brazil, China, India, Malawi, Nigeria, Tanzania, the USA, and Canada were included. These studies have consistently demonstrated that maternal HIV infection is associated with adverse perinatal outcomes. The analysis revealed a higher risk of preterm birth (OR 1.57, 95% CI: 1.39-1.78), low birth weight (OR 1.33, 95% CI: 1.18-1.49), and small for gestational age (OR 1.38, 95% CI: 1.24-1.53) among infants born to mothers living with HIV. Notably, the impact of antiretroviral treatment (ART) on these outcomes varied, but maternal HIV infection remained a significant risk factor regardless of income level and geographic region. CONCLUSION: Maternal HIV infection is consistently associated with adverse perinatal outcomes, emphasizing the need for targeted interventions and improved prenatal care in pregnant women with HIV infection.

Fatores associados à deficiência de vitamina D em mulheres gestantes e lactantes / Factores asociados a la deficiencia de vitamina D en mujeres embarazadas y lactantes / Factors associated with vitamin d deficiency in pregnant and lactatingwomen

Introdução: A deficiência de vitamina D durante a gestação e a lactação pode repercutir negativamente no desenvolvimento fetal e infantil, devido seu papel fundamental nos sistemas imunológico, cardíaco, ósseo, muscular e neural. Objetivo: Realizar uma revisão de literatura para integrar estudos que evidenciam a deficiência de vitamina D em gestantes e lactantes, e os fatores de risco associados a essa carência. Metodologia: Foi realizado um levantamento bibliográfico entre agosto e outubro de 2021, com atualização entre outubro e novembro de 2022 através de pesquisas às bases Pubmed e Scielo, bem como às listas de referências dos artigos selecionados. Foram empregados os descritores consumo alimentar, vitamina D, deficiência de vitamina D, gestantes e lactantes, usando-se o operador booleano AND para a associação entre eles. Como critérios de inclusão foram adotados o tipo de estudo (epidemiológicos, ensaios clínicos e revisões integrativa e sistemática), o idioma (espanhol, inglês e português) e o período de publicação (2010 a 2022). Resultados: Evidenciou-se que existem vários fatores de riscos para a inadequação do status de vitamina D em gestantes e lactantes como a baixa exposição da pele à luz solar e fatores relacionados (uso excessivo de protetor solar, menor tempo de atividades ao ar livre, clima, religião e hábitos culturais, maior escolaridade);a pigmentação mais escura da pele; o baixo consumo alimentar de vitamina D e variáveis associadas; a menor idade materna; o primeiro trimestre gestacional; a primiparidade e o excesso de tecido adiposo. Conclusões: Em gestantes e lactantes, a carência de vitamina D associa-se a distintos fatores, com destaque principalmente para a baixa exposição à luz solar, a pigmentação mais escura da pele e o excesso de tecido adiposo, sendo de extrema importância que sejam abordados com cautela, visando ações voltadas a variáveis modificáveis, de modo a auxiliar na redução da hipovitaminose D nestes grupos (AU).

Introduction: Vitamin D deficiency during pregnancy and breastfeeding can have a negative impact on fetal and infant development due to its fundamental role in the immune, cardiac, bone, muscular and neural systems. Objective: To conduct a literature review to integrate studies which show the Vitamin D deficiency in pregnant andlactating women, and the risk factors associated with this deficiency. Methodology: A bibliographic survey was carried out between August and October 2021, with an update between October and November 2022 through searches in the Pubmed and Scielo databases, as well as the reference lists of the selected articles. The descriptors food consumption, vitamin D, vitamin D deficiency, pregnant and lactating women were used, using the Boolean operator AND for the association between them. The type of study (epidemiological, clinical trials and integrative and systematic reviews), language (Spanish, English and Portuguese) and publication period (2010 to 2022) was adopted as inclusion criteria.Results:It was shown that there are several risk factors for inadequate vitamin D status in pregnant and lactating women, such as low skin exposure to sunlight and related factors (excessive use of sunscreen, less time spent outdoors, climate, religion and cultural habits, higher education); darker skin pigmentation; low dietary intake of vitamin D and associated variables; the lowest maternal age; the first gestational trimester; primiparity and excess adipose tissue.Conclusions: Vitamin D deficiency in pregnant and lactating women is associated with different factors, witha main emphasis on low exposure to sunlight, darker skin pigmentation and excess adipose tissue. Furthermore, it is extremely important that these factors are approached with caution, implementing actions aimed at modifiable variables in order to help reduce hypovitaminosis D in these groups (AU).

Introducción: La deficiencia de vitamina D durante el embarazo y la lactancia puede tener un impacto negativo en el desarrollo fetal e infantil, por su papel fundamental en los sistemas inmunológico, cardíaco, óseo, muscular y neural. Objetivo: Realizar una revisión bibliográfica para integrar estudios que evidencien la deficiencia de vitamina D en mujeres embarazadas y lactantes, y los factores de riesgo asociados. Metodología:Se realizó un levantamiento bibliográfico entre agosto y octubre de 2021, con actualizaciones entre octubre y noviembre de 2022 mediante búsquedas en las bases de datos Pubmed y Scielo, así como en las listas de referencias de los artículos seleccionados. Se utilizaron los descriptores consumo de alimentos, vitamina D, deficiencia de vitamina D, gestantes y lactantes, utilizándose el operador booleano AND para la asociación entre ellos. Se adoptaron como criterios de inclusión el tipo de estudio (epidemiológicos, clínicos, revisiones integradoras y sistemáticas), idioma (español, inglés y portugués) y período de publicación (2010 a 2022).Resultados: Existen varios factores de riesgo para un estado inadecuado de vitamina D en mujeres embarazadas y lactantes, como la baja exposición de la piel a la luz solar y factores relacionados (uso excesivo de protector solar, menor tiempo al aire libre, clima, religión y hábitos culturales, educación más alta); pigmentación de la piel más oscura; baja ingesta dietética de vitamina D y variables asociadas; la edad materna más baja; el primer trimestre gestacional; Primiparidad y exceso de tejido adiposo. Conclusiones:En mujeres embarazadas y lactantes, el déficit de vitamina D se asocia a diferentes factores, especialmente la baja exposición solar, la pigmentación de la piel más oscura y el exceso de tejido adiposo, y es de suma importancia abordarlos con precaución, apuntando a acciones dirigidas a variables modificables, con el fin de ayudar a reducir la hipovitaminosis D en estos grupos (AU).

Parent-child associations of sleep quality: is physical activity a confounder? The EPI-FAMILY health study.

INTRODUCTION: The incidence of sleep deprivation has increased in pediatric populations, however, the relationship with physical activity (PA) remains uncertain and lacks evidence. Although some studies have shown that parents' lifestyle habits can influence this process, one point that requires further clarification in the literature is whether parents' sleep quality is linked to that of their children and whether parents' physical activity could play an important role in these possible relationships. OBJECTIVES: To investigate the relationship of sleep quality between parents and children and verify the role of physical activity in this association. METHODS: This is a cross-sectional study. Sleep quality was assessed using the Mini Sleep Questionnaire. The amount of sleep was estimated by the number of hours slept. PA domains (occupational activities, leisure, and active commuting) were assessed using the Baecke questionnaire, while moderate to vigorous PA (MVPA) was assessed with an accelerometer. Socioeconomic status was obtained through a questionnaire. The relationship of sleep quality between parents and children was carried out using hierarchical models with Binary Logistic Regression, where the factors were inserted one by one (1. unadjusted model; 2. sociodemographic variables; 3. children's PA; 4. parents' PA). RESULTS: The study sample consisted of 102 children and adolescents (6-17 years), 92 mothers, and 69 fathers. Poor sleep quality of mothers was associated with their children's sleep quality (OR = 3.95; 95%CI = 1.33-11.38; P = 0.013). After inserting mothers' PA intensity into the final model, the associations remained significant (OR = 8.05; 1.33-48.59; P = 0.023). No relationship was observed between poor sleep quality of fathers and their children's sleep quality. CONCLUSION: The relationship between poor sleep quality of mothers and that of their children remained significant, regardless of confounding variables.

Electroencephalographic activity during direct breastfeeding and breast milk expression in primiparous mothers.

Breastfeeding is recognized worldwide as the best option for infant feeding. Expressing breast milk is an alternative for mothers to provide their infants all the benefits of maternal milk. During breast milk expression, mothers receive a distinct kind of sensory stimulation, because there is no direct bodily or affective interaction with their infants, many women report feeling isolated, generating a love-hate relation with pumping, and even low levels of satisfaction while expressing breast milk. While it is well known that the prefrontal, parietal, and temporal cortices play important roles in the emotional and cognitive processing of maternal stimuli, knowledge about how these cortical areas function during breastfeeding is lacking. This study was designed to characterize EEG activity in the prefrontal and parietal cortices and the affective scores of primiparous breastfeeding mothers during two conditions of milk expression: breast milk expression and direct breastfeeding. Participants reported higher valence and arousal and a pleasant state during direct breastfeeding. In the direct breastfeeding condition, both prefrontal areas showed a higher absolute power (AP) of the slow bands, with a lower AP of the alpha band in the parietal cortex. A lower correlation between frontopolar and dorsolateral areas with a higher correlation between prefrontal and parietal cortices was obtained mainly in the right hemisphere. This EEG activity could be linked to an internal state of focused attention and, simultaneously, open monitoring of the environment that suggests an integration of the motive-emotional and cognitive processes necessary for adequate mother-baby interaction during direct breastfeeding.

The effect of paternal anxiety on mother-infant bonding in neonatal intensive care.

BACKGROUND: The hospitalization of a preterm infant in the NICU can lead to mental health difficulties in parents, but not much is known how paternal anxiety might affect the mother-infant relationship. METHODS: This prospective cohort study is a secondary analysis investigating how paternal anxiety levels might affect maternal bonding in the NICU using the dataset of the multinational pragmatic randomized controlled trial LongSTEP. A linear mixed-effects model was used for correlations of paternal anxiety (GAD-7) and maternal bonding (PBQ) at NICU discharge, and at 6 and 12 months infant corrected age. Secondary analyses examined effects on paternal anxiety related to: site (Argentina, Colombia, Israel, Norway, and Poland), maternal depression (EPDS), infant gestational age at birth, paternal age, and type of pregnancy. RESULTS: Paternal anxiety did not predict maternal bonding at NICU discharge (p = 0.096), at 6 months (p = 0.316), or at 12 months infant corrected age (p = 0.473). Secondary outcomes showed a statistically significant site effect, with higher paternal anxiety levels at the two Colombian sites at baseline (p = 0.014 and p = 0.020) and for one site at discharge (p = 0.012), but not for paternal age (p = 0.925 and p = 0.793), infant gestational age at birth (p = 0.974 and p = 0.686 and p = 0.340), or type of pregnancy (p = 0.381). Maternal depression predicted paternal anxiety at baseline (p < 0.001) and at discharge (p = 0.003). CONCLUSIONS: In this study, paternal anxiety did not predict maternal bonding. Paternal anxiety varied by site, indicating a need for research on potential cultural differences in manifestation of paternal anxiety. Maternal depression predicted paternal anxiety, confirming a previously reported correlation. Further research on variations in paternal mental health in the neonatal period is warranted, as well as exploration of the social contagion of mental health in preterm parents. TRIAL REGISTRATION: ClinicalTrials.gov NCT03564184.

Life satisfaction and time-use among full-time and part-time working mothers in Brazil.

BACKGROUND: Working part-time or full-time is a persistent dilemma for women, especially mothers, as they strive to manage their time across various roles. However, the existing literature remains unclear on whether part-time work contributes more to life satisfaction than full-time work. OBJECTIVE: This study aims to describe and compare time-use patterns in different occupational roles and levels of life satisfaction among 795 mothers in Brazil who are employed either part-time or full-time. METHODS: Data was collected through an online survey and the snowball technique. Regression and correlation analyses were performed on the data obtained from the following instruments: the Role Checklist for assessing time-use within occupational roles, the Satisfaction with Life Scale, and demographic information. RESULTS: Our analysis revealed no significant differences in life satisfaction between mothers working full-time and those working part-time (t (793)=1.160, p = 0.24). However, life satisfaction scores were positively correlated with the number of occupational roles performed (r = 0.222, p < 0.01), higher family income (P < 0.001), and engagement in social roles such as Friend (r = 0.106, p = 0.003), Hobbyist/Amateur (r = 0.08, p = 0.018), and Caregiver (r = 0.07, p = 0.026). CONCLUSION: While our society places significant emphasis on time spent at work, our findings highlight that life satisfaction extends far beyond the dichotomy of working part-time or full-time. There are deeper dimensions to consider, including the number of occupational roles, family income, and engagement in social roles, which have a more substantial impact on overall life satisfaction.

Family issues and custodial mothers' quest for justice: Evidence from Colombia.

Access to justice is limited for many worldwide. Although prior research generally recognizes the legal needs and barriers faced by women, less is known about mothers. This study examined the legal needs of mothers in different family configurations and the actions they took in response to these needs through the lens of help-seeking theories. We used unique data from the 2016 Colombian Quality of Life Survey (QLS) to produce descriptive statistics on the legal needs of mothers in two-parent families and custodial mothers. We then conducted multivariate analyses to examine the factors associated with having a family issue and seeking institutional help. Custodial mothers were more likely than mothers in two-parent families to have reported any legal need, and to report a family legal issue. The most frequent legal issues related to the family were issues with child support, custody, and/or visitation. The most frequent action taken to resolve issues was through an institutional actor. Among custodial mothers, single, younger mothers and mothers with more children were more likely to experience family legal issues, but they were not the ones seeking institutional help-those mothers were often more socioeconomically advantaged. That more socioeconomically disadvantaged mothers are more likely to experience a family legal issue but less likely to seek institutional help, the most frequent route to action, calls for research that examines the barriers faced by these mothers and policies to improve their access to justice.

Identificação do contexto familiar e social em registros de consultas de enfermagem ao binômio mãe-bebê / Identificación del contexto familiar y social en registros de consultas de enfermería para el binomio madre-bebé / Identification of the family and social context in records of nursing consultations with the mother-baby binomial

Objetivo: identificar informações relacionadas ao contexto familiar e social em registros da primeira consulta de enfermagem ao binômio mãe-bebê. Método: estudo de Métodos Mistos com Estratégia Incorporada Concomitante de Dados. Utilizou-se roteiro composto por oito questões com respostas do tipo dicotômicas e espaço para transcrever as sentenças relacionadas ao contexto familiar e social. Dados analisados por estatística descritiva e análise de conteúdo dedutiva. Resultados: dos 326 registros, 30% descreveram a presença de outros familiares na consulta e o estado emocional da puérpera. Informações sobre estrutura familiar e rede de apoio estavam presentes em 27,3 e 21,8% deles, respectivamente. A experiência da gestação foi o aspecto menos mencionado (4,3%). O diagnóstico comumente incluído foi "Vínculo mãe e filho preservado". As sentenças convergiram com os dados quantitativos ao indicar limitada exploração do contexto e centralidade no modelo biomédico. Conclusão: na maioria dos registros não constava informações sobre o contexto familiar e social.

Objective: to identify information related to the family and social context in records of the first nursing consultation with the mother-baby binomial. Method: Mixed-methods study with Concomitant Data Incorporated Strategy. A script was used consisting of eight questions with dichotomous answers and space to transcribe the sentences related to the family and social context. Data was analyzed using descriptive statistics and deductive content analysis. Results: of the 326 records, 30% described the presence of other family members at the appointment and the emotional state of the puerperal woman. Information on family structure and support networks was present in 27.3 and 21.8% of them, respectively. The experience of pregnancy was the least mentioned aspect (4.3%). The diagnosis most commonly included was "Mother-child bond preserved". The sentences converged and indicated a limited exploration of the context and a focus on the biomedical model. Conclusion: the majority of records lacked information on the family and social context.

Objetivo: identificar información relacionada al contexto familiar y social en registros de la primera consulta de enfermería para el binomio madre-bebé. Método: estudio de métodos mixtos con estrategia integrada de datos concomitantes. Se utilizó un guion compuesto por ocho preguntas con respuestas dicotómicas y espacio para transcribir las frases relacionadas con el contexto familiar y social. Datos analizados mediante estadística descriptiva y análisis de contenido deductivo. Resultados: de los 326 registros, el 30% describió la presencia de otros familiares en la consulta y el estado emocional de la puérpera. La información sobre la estructura familiar y la red de apoyo estuvo presente en el 27,3 y el 21,8% de ellos, respectivamente. La experiencia del embarazo fue el aspecto menos mencionado (4,3%). El diagnóstico comúnmente incluido fue "Vínculo preservado entre madre e hijo". Las frases convergieron con los datos cuantitativos al indicar una exploración limitada del contexto y la centralidad en el modelo biomédico. Conclusión: la mayoría de los registros no contenían información sobre el contexto familiar y social.

Repercussões psicossociais da pandemia da covid-19 para mães de crianças com transtorno do espectro autista / Psychosocial repercussions of the covid-19 pandemic for mothers of children with autism spectrum disorder / Repercusiones psicosociales de la pandemia de covid-19 en las madres de niños con trastorno del espectro autista

RESUMO Objetivo: compreender as repercussões psicossociais da pandemia da COVID-19 para mães de crianças com Transtorno do Espectro Autista. Método: estudo qualitativo, com a participação de 22 mães. Os dados foram coletados de maio a julho de 2022, no interior da Paraíba, Brasil, por meio de uma Dinâmica de Criatividade e Sensibilidade. A análise deu-se através do referencial teórico-analítico da análise de discurso francesa. Resultados: medo, ansiedade, angústia, preocupações assumiram um lugar central no movimento dialógico das mães. Diante das demandas e reconfigurações na rotina, houve uma sobrecarrega física, emocional e psicológica, com repercussões na vida materna. A solidão pôde ser evidenciada pela frágil ou inexistente rede de apoio durante o período pandêmico. Conclusão: o estudo pode subsidiar a reflexão sobre as repercussões da pandemia na vida de mães de crianças com autismo e viabilizar a elaboração de ações que priorizem a saúde mental, auxiliando-as na superação de momentos de adversidades.

ABSTRACT Objective: to understand the psychosocial repercussions of the COVID-19 pandemic for mothers of children with Autism Spectrum Disorder. Method: a qualitative study, with participation of 22 mothers. The data were collected from May to July 2022 in the inland of Paraíba, Brazil, through the Dynamics of Creativity and Sensitivity. The analysis took place through the theoretical-analytical framework of French discourse analysis. Results: fear, anxiety, anguish and concerns assumed a central place in the mothers' dialogical movement. Faced with the demands and reconfigurations in the routine, there was physical, emotional and psychological overload, with repercussions on maternal life. Loneliness can be seen in the weak or non-existent support network during the pandemic. Conclusion: the study can support reflection on the repercussions of the pandemic on the lives of mothers of children with autism and enable the development of actions that prioritize mental health, helping them to overcome moments of adversity.

RESUMEN Objetivo: comprender las repercusiones psicosociales de la pandemia de COVID-19 en las madres de niños con Trastorno del Espectro Autista. Método: estudio cualitativo, con la participación de 22 madres. Los datos fueron recolectados de mayo a julio de 2022, en el interior de Paraíba, Brasil, mediante una Dinámica de Creatividad y Sensibilidad. El análisis se realizó siguiendo el marco teórico-analítico del análisis del discurso francés. Resultados: el miedo, la ansiedad, la angustia y las preocupaciones ocuparon un lugar central en el movimiento dialógico de las madres. Ante las exigencias y reconfiguraciones de la rutina, las madres sufrieron una sobrecarga física, emocional y psicológica que afectó su vida. La soledad se puede ver en la débil o nula red de apoyo que tuvieron durante la pandemia. Conclusión: el estudio puede contribuir a la reflexión sobre las repercusiones de la pandemia en la vida de las madres de niños con autismo y posibilitar el desarrollo de acciones que prioricen la salud mental que las ayuden a superar momentos de adversidad.

Associações de mães e familiares afetados pela síndrome congênita de Zika vírus: perfil e principais discussões relacionadas / Associations of mothers and family members affected by congenital Zika virus syndrome: profile and main related discussions

Resumo No Brasil, o impacto de emergências sanitárias consecutivas nos últimos cinco anos, como a epidemia de zika (2015) e a pandemia de Covid-19 (2020), atingiu de forma aguda as famílias de crianças com síndrome congênita do zika (SCZ). Este artigo explora processos epidêmicos que replicam as intersecções de deficiência, cuidado, gênero, classe e raça, e propõe a construção de um perfil das associações civis de mães e familiares de crianças com SCZ, bem como suas mobilizações, sobretudo da União Mães de Anjos (UMA). A partir da literatura sobre o tema, realização de entrevistas e oficinas com as mães de crianças com SCZ ligadas às associações em diferentes partes do Brasil, observou-se que as epidemias produzem impactos desiguais em relação a idade, raça, classe, gênero, localidade e deficiência. Embora os impactos das emergências de saúde possam ser contínuos para as pessoas que vivem na intersecção de múltiplas opressões, destacamos a resistência na forma de capacidade organizacional para navegar no acesso a direitos e reconfigurar dinâmicas de poder.

Abstract No Brasil, o impacto de emergências sanitárias consecutivas nos últimos cinco anos, como a epidemia de zika (2015) e a pandemia de COVID-19 (2020), atingiu de forma aguda as famílias de crianças com síndrome congênita do zika (SCZ). Este artigo explora processos epidêmicos que replicam as intersecções de deficiência, cuidado, gênero, classe e raça, e propõe a construção de um perfil das associações civis de mães e familiares de crianças com SCZ, bem como suas mobilizações, sobretudo da União Mães de Anjos (UMA). A partir da literatura sobre o tema, realização de entrevistas e oficinas com as mães de crianças com SCZ ligadas às associações em diferentes partes do Brasil, observou-se que as epidemias produzem impactos desiguais em relação a idade, raça, classe, gênero, localidade e deficiência. Embora os impactos das emergências de saúde possam ser contínuos para as pessoas que vivem na intersecção de múltiplas opressões, destacamos a resistência na forma de capacidade organizacional para navegar no acesso a direitos e reconfigurar dinâmicas de poder.Abstract: In Brazil, the impact of consecutive health emergencies in the last five years, such as the Zika epidemic (2015) and the COVID-19 pandemic (2020), acutely affected families of children with congenital Zika syndrome (CZS). This article explores epidemic processes that replicate the intersections of disability, care, gender, class and race, and proposes the construction of a profile of civil associations of mothers and families of children with CZS, as well as their mobilizations, especially the União Mães de Anjos (UMA). Based on the literature on the topic, interviews and workshops with mothers of children with CZS linked to associations in different parts of Brazil, it was observed that epidemics produce unequal impacts in relation to age, race, class, gender, location and disability. While the impacts of health emergencies can be ongoing for people living at the intersection of multiple oppressions, we highlight resistance in the form of organizational capacity to navigate access to rights and reconfigure power dynamics.

Mothers' perception of the care of newborn in the home environment / Percepción de las madres sobre el cuidado del recién nacido en entorno domiciliario / Percepção de mães sobre o cuidado de recém-nascidos em ambiente domiciliar

ABSTRACT Objectives: to identify mothers' perceptions about caring for newborns in the home environment, from the perspective of complexity thinking. Methods: qualitative, exploratory and descriptive research, carried out between November/2022 and February/2023. Data were collected through individual interviews with 21 mothers from southern Brazil who cared for newborns at home and analyzed using the thematic analysis technique. Results: the four thematic axes resulting from the data analysis: Living amidst order and disorder; embracing singularities; dealing with the certain and the uncertain; support network in the (re)organizing process demonstrate that the mother caring for a newborn in their home environment experiences a distinct and plural adaptive process, which must be welcomed and understood by health professionals who work within the family environment. Final Considerations: the care of newborns in a home environment, in the perception of mothers, requires differentiated attention and a formal or informal support network that considers the unique specificities of each woman/mother in the personal, family and social spheres. Therefore, in addition to the social support network, it is important to rethink home intervention approaches.

RESUMEN Objetivos: identificar las percepciones de las madres sobre el cuidado de los recién nacidos en un entorno domiciliario, bajo la perspectiva del pensamiento de la complejidad. Métodos: es una investigación cualitativa, de carácter exploratorio y descriptivo, realizada entre noviembre de 2022 y febrero de 2023. Los datos se recopilaron mediante entrevistas individuales a 21 madres del sur de Brasil que cuidaron de neonatos en entorno domiciliario y se estudiaron bajo la óptica de la técnica del análisis temático. Resultados: los cuatro ejes temáticos resultantes del análisis de los datos fueron: convivencia en medio del orden y del desorden; acogimiento de las singularidades; lucha entre lo cierto y lo incierto; red de apoyo en el proceso de (re)organización. La madre que cuida de un recién nacido en entorno doméstico experimenta un proceso adaptativo distinto y plural, que debe ser atendido y comprendido por los profesionales sanitarios que trabajan en el ámbito familiar. Consideraciones Finales: el cuidado de los recién nacidos en un entorno doméstico, según la percepción de las madres, requiere una atención diferenciada y una red de apoyo formal o informal que tenga en cuenta las especificidades únicas de cada mujer/madre en los ámbitos personal, familiar y social. Por consiguiente, además de la red de apoyo social, es importante replantearse los enfoques de intervención en la atención domiciliaria.

RESUMO Objetivos: identificar percepções de mães sobre o cuidado de recém-nascidos em ambiente domiciliar, na perspectiva do pensamento da complexidade. Métodos: pesquisa qualitativa, de caráter exploratório e descritivo, realizada entre novembro/2022 e fevereiro/2023. Os dados foram coletados por meio de entrevistas individuais com 21 mães do sul do Brasil que cuidaram de recém-nascidos em ambiente domiciliar e analisados pela técnica de análise temática. Resultados: os quatro eixos temáticos resultantes da análise dos dados: Convivendo em meio a ordem e desordem; acolhendo às singularidades; lidando entre o certo e o incerto; rede de apoio no processo (re)organizador demonstram, que a mãe cuidadora de um recém-nascido em ambiente domiciliar vivência um processo adaptativo distinto e plural, que deve ser acolhido e compreendido pelos profissionais de saúde que atuam em âmbito familiar. Considerações Finais: o cuidado de recém-nascidos em ambiente domiciliar, na percepção de mães, requer atenção diferenciada e uma rede de apoio formal ou informal que considere as especificidades singulares de cada mulher/mãe em âmbito pessoal, familiar e social. Assim, para além da rede de apoio social é importante que se repense as abordagens de intervenção domiciliar.

The Role of Mothers' Socioeconomic Class on their Children's Dental Health

ABSTRACT Objective: To assess the relationship between the mother's educational level and family income on the dental caries experience of their children. Material and Methods: A cross-sectional study was conducted at the Department of Pediatric Dentistry, University of Babylon, Iraq. The sample comprised 100 children aged 5-15 years. Data was collected in two parts: first, a self-administered questionnaire was obtained from mothers: Mother's age, level of education, family income, child age, and gender. Another part included the clinical examination of dental caries that was measured for mothers and their children using the DMFT/dmft index for permanent and primary dentition sequentially. The collected data were statistically analyzed using mean ± standard deviation (SD mean and standard deviation, t-test, and F-test. Results: The sample showed 60% were boys and 40% were girls, 86% with dental caries. Mothers with a high level of education and high monthly income have significantly lower dental caries experiences than their children (p<0.05). In contrast, there was a significant difference between the two age groups (p=0.000), a considerable difference between the level of family monthly income and dmft (p=0.01), and there was a correlation value between the caries index DMFT value of the children and their mother with mother's education level. Conclusion: Many dental caries were reported among Babylon City/Iraq children. Mothers with high educational levels and family monthly income were correlated to lower dental care for their children than those with low educational levels and economic status, so they need to focus on oral health knowledge and encourage prophylactic intervention and preventive measures for the population.

Factors that interfere in maternal perception of security at postpartum / Fatores que interferem na percepção de segurança materna no pós-parto

Abstract Objectives: to identify the factors and variables that interfere with the maternal perception of security at postpartum. Methods: a cross-sectional study, carried out in three Portuguese hospital units, with a non-probabilistic sample of 352 puerperal women, recruited from the postpartum units on the day of hospital discharge after delivery. Maternal sociodemographic and obstetric characteristics, as well as data on monitored pregnancy, childbirth and infant feeding, were collected through the application of a questionnaire developed by the researchers. For the analysis of maternal perception of security, the instrument "Parents' postnatal sense of security" (PPSS) was used. Descriptive and inferential statistics were used for data analysis. Results: women who lived with their partner (t (349) = - 2.34, p=0.020), were multiparous (t (349) = - 2.26, p=0.025), had pregnancy monitored (t (349) = -3.25, p=0.001), had a positive childbirth experience (F (1, 351) = 7.07, p=0.008) and those who exclusively breastfed during hospitalization (F (2, 351) = 11,43, p<0.001), presented greater perception of security at postpartum. Conclusions: the factors that affect the maternal perception of security at postpartum are cohabitation with a partner, parity, monitored pregnancy, childbirth experience and infant feeding. Defining which factors interfere with maternal security at postpartum may contribute to the construction of intervention programs that promote the maternal perception of security at the time of hospital discharge after delivery.

Resumo Objetivos: identificar os fatores que interferem na percepção de segurança materna no pós-parto. Métodos: estudo transversal, realizado em três unidades hospitalares portuguesas, com uma amostra não probabilística de 352 puérperas recrutadas nos serviços de internamento, no dia da alta hospitalar após o parto. As caraterísticas sociodemográficas e obstétricas maternas, assim como os dados relativos aos cuidados pré-natais, ao parto e ao tipo de aleitamento, foram recolhidos através da aplicação de um questionário desenvolvido pelas investigadoras. Para a análise da percepção de segurança materna foi usado o instrumento "Parents' Postnatal Sense of Security" (PPSS). Foi utilizada estatística descritiva e inferencial para a análise de dados. Resultados: as mulheres que viviam com o companheiro [t (349) = - 2,34, p=0,020], as multíparas (t (349) = - 2,26, p=0,025), as que vigiaram a gravidez [t (349) = -3,25, p=0,001], as que tiveram uma experiência de parto positiva [F (1, 351) = 7,07, p=0,008] e as que amamentaram em exclusivo durante o internamento [F (2, 351) = 11,43, p<0,001], apresentaram maior percepção de segurança no pós-parto. Conclusões: os fatores que interferem na percepção de segurança materna no pós-parto são a coabitação com o companheiro, a paridade, a vigilância da gravidez, a experiência de parto e o tipo de aleitamento. Determinar os fatores que interferem com a segurança materna no pós-parto pode contribuir para a construção de programas de intervenção promotores da percepção de segurança materna no momento da alta hospitalar após o parto.

Donor mothers portrayal and associated variables with breast milk donation in a Human Milk Bank / Retrato das mães doadoras e variáveis associadas à doação de leite materno em um Banco de Leite Humano

ABSTRACT Objective To describe and analyze the donor mothers' profile and variables associated with breast milk donation at Human Milk Bank in the municipality of Guarapuava, Paraná, Brazil. Methods This was a cross-sectional study obtained from information contained in the donor registration form between the period July 2013 (implementation of the service) to December 2019. The collected data were tabulated and descriptive analysis of variables and Chi-square and Fischer's exact association tests were performed. Results Of 1,491 records analyzed, this research identified that 70.73% of donors were between 20 to 34 years old; 67.69% had prenatal care at public health network and 61.37% have had cesarean delivery. Most mothers (61.44%) remained as donor for 29 days and 53.83% of them donated up to 500 ml of milk. In addition, statistically significant association was observed between milk volume donated and donation time for the following variables: prenatal place care, gestational age, child's birth weight, child age, and smoking. Maternal age was associated with a higher volume of donated milk. Conclusion The study's findings reinforce the approaching importance the possibility of human milk donation during prenatal care, with emphasis on private health service, and throughout the women's and children's health care network, as well as on the community.

RESUMO Objetivos Descrever e analisar o perfil de mães doadoras e as variáveis associadas à doação de leite materno em um Banco de Leite Humano no município de Guarapuava, Paraná, Brasil. Métodos Trata-se de um estudo transversal obtido a partir de informações constantes no formulário de cadastro de doadoras entre o período de julho de 2013 (implementação do serviço) até o mês de dezembro de 2019. Os dados coletados foram tabulados e posteriormente foi feita a análise descritiva das variáveis e testes de associação do Qui-quadrado e exato de Fischer. Resultados Das 1.491 fichas analisadas, a presente pesquisa identificou que 70,73% das doadoras tinham entre 20 e 34 anos de idade; 67,69% realizaram o pré-natal na rede pública de saúde e 61,37% realizaram parto cesárea. A maioria das mães, 61,44%, permaneceu como doadora por 29 dias e 53,83% delas doaram o volume de até 500ml de leite. Além disso, observou-se associação estatisticamente significativa entre o volume de leite doado e o tempo de doação para as seguintes variáveis: local de realização do pré-natal, idade gestacional, peso ao nascer, idade da criança e tabagismo. A idade materna se associou ao maior volume de leite doado. Conclusão Os achados do estudo reforçam a importância da abordagem ainda no pré-natal sobre a possibilidade de doação de leite humano, com ênfase no serviço privado de saúde, e, em toda a rede de atenção à saúde da mulher e da criança, bem como na comunidade.

Effects of Virtual Health Messages on Maternal Therapeutic Adherence for Childhood Anemia

Introduction: Therapeutic adherence for childhood anemia is addressed in health services with unsatisfactory results. Therefore, the implementation of this strategy will favor greater adherence to treatment with ferrous sulfate. Objective: To evaluate the effect of virtual health messages on maternal therapeutic adherence for childhood anemia. Materials and Methods: A pre-experimental and longitudinal study was developed between November and December 2022, in which 24 mothers of children diagnosed with anemia participated. Adherence was determined using a test and inferential analysis through the Wilcoxon test. Results: The mothers were between 18 and 29 years old (50.0 %), of rural origin (66.7 %), who completed primary school (33.3 %), housewives (83.3 %), and cohabitants (79.2 %). In the pre-test, high adherence was observed in social factors (50 %), health personnel (75 %), illness (87.5 %), and person supplementing the ferrous sulfate and the patient (75.5 %). The overall adherence was medium in the pretest (50.0 %) and high in the post-test (100.0 %). Message reception was high for the overall test (62.6 %), reminder (79.2 %), informational (79.2 %), and motivational (75.0 %) messages. Conclusion: Virtual health messages have a positive effect on maternal therapeutic adherence for childhood anemia (p < 0.05) and their inclusion in primary health services will contribute favorably to obtaining optimal results.

Introducción: la adherencia terapéutica de anemia infantil es un tópico abordado en los servicios de salud, con resultados poco satisfactorios; por lo tanto, la implementación de esta estrategia favorecerá una mayor adherencia al tratamiento con sulfato ferroso. Objetivo: evaluar el efecto de los mensajes virtuales en salud sobre la adherencia terapéutica materna de anemia infantil. Materiales y Métodos: se desarrolló un estudio preexperimental y longitudinal entre noviembre y diciembre de 2022, en el cual participaron 24 madres de niños diagnosticados con anemia; la adherencia se determinó mediante un test y el análisis inferencial por medio de la prueba de Wilcoxon. Resultados: Las madres tenían entre 18 y 29 años (50,0 %), procedencia rural (66,7 %), primaria completa (33,3 %), amas de casa (83,3 %) y convivientes (79,2 %). En el pretest, se observó alta adherencia en factores sociales (50 %), personal de salud (75 %), enfermedad (87,5 %), persona que suplementa y paciente (75,5 %), y adherencia media en factores relacionados a la suplementación (54,2 %); en el postest, la adherencia alta se presentó en factores sociales (100,0 %), personal de salud (100,0 %), enfermedad (87,5 %), suplementación (95,8 %), persona que suministra el sulfato ferroso y paciente (100,0 %). La adherencia global fue media en el pretest (50,0 %) y alta en el postest (100,0 %). La recepción de mensajes fue alta para el test global (62,6 %), mensajes recordatorios (79,2 %), informativos (79,2 %) y motivacionales (75,0 %). Conclusión: los mensajes virtuales en salud tienen un efecto positivo en la adherencia terapéutica materna de anemia infantil (p < 0,05) y su inclusión en los servicios primarios de salud contribuirá favorablemente en la obtención de resultados óptimos.

Introdução: a adesão ao tratamento da anemia infantil é um tema abordado nos serviços de saúde, com resultados insatisfatórios; portanto, a implementação dessa estratégia favorecerá uma maior adesão ao tratamento com sulfato ferroso. Objetivo: avaliar o efeito das mensagens virtuais de saúde na adesão materna ao tratamento da anemia infantil. Materiais e método: foi realizado um estudo pré-experimental e longitudinal entre novembro e dezembro de 2022, do qual participaram 24 mães de crianças diagnosticadas com anemia; a adesão foi determinada por meio de um teste e a análise inferencial, por meio do teste de Wilcoxon. Resultados: as mães tinham entre 18 e 29 anos de idade (50 %), eram de áreas rurais (66,7 %), concluíram o ensino fundamental (33,3 %), eram donas de casa (83,3 %) e viviam juntas (79,2 %). No pré-teste, foi observada alta adesão em fatores sociais (50 %), equipe de saúde (75 %), doença (87,5 %), pessoa que suplementa e paciente (75,5 %), e adesão média em fatores relacionados à suplementação (54,2 %); no pós-teste, foi observada alta adesão em fatores sociais (100 %), equipe de saúde (100 %), doença (87,5 %), suplementação (95,8 %), pessoa que fornece sulfato ferroso e paciente (100 %). A adesão geral foi média no pré-teste (50 %) e alta no pós-teste (100 %). A recepção das mensagens foi alta para o teste geral (62,6 %), lembretes (79,2 %), mensagens informativas (79,2 %) e motivacionais (75 %). Conclusões: as mensagens virtuais de saúde têm um efeito positivo na adesão materna ao tratamento da anemia infantil (p < 0,05) e sua inclusão nos serviços de saúde primários contribuirá favoravelmente para a otimização dos resultados.

The association between maternal fears about their infant/toddler during the COVID-19 pandemic and depression and anxiety: a birth cohort study

Objective: To assess the association between maternal fears about their infant/toddler and depression and anxiety during the COVID-19 pandemic. Methods: In 2019, all mothers who gave birth in hospitals in Rio Grande, RS, Brazil were asked to respond to a standardized questionnaire (baseline). We followed them between May-June 2020 (first follow-up point), August-December 2020 (second follow-up point), and from October 2021 to March 2022 (third follow-up point), and asked them if they were: (1) afraid that their infant/toddler would become infected with COVID or get sick (yes/no), (2) afraid that they would contaminate their own child with COVID, and/or (3) worried about the pandemic's effects on their child's future. At baseline and at all follow-up points, we assessed depressive symptoms using the Edinburgh Postnatal Depression Scale and anxiety symptoms using the Generalized Anxiety Disorder Scale, creating symptom trajectories using group-based trajectory modelling. We used multinomial logistic regression to calculate adjusted relative risk ratios (RRR). Results: A total of 1,296 mothers participated. Worrying about the pandemic's effects on their child's future and the fear of contaminating their own child with COVID-19 increased the risk of raising depressive symptoms to a clinical level (RRR = 4.97, 95%CI 2.32-10.64 and RRR = 3.87, 95%CI 1.58-9.47, respectively) and anxiety to a moderate level (RRR = 2.91, 95%CI 1.69-5.01 and RRR = 1.86, 95%CI 1.03-3.35, respectively). Conclusion: Fear for their children increased maternal depressive and anxiety symptoms during the pandemic.