Ansiedade e depressão em profissionais de enfermagem de uma maternidade durante a pandemia de COVID-19 / Anxiety and depression in nursing professionals of a maternity during the COVID-19 pandemic / Ansiedad y depresión en profesionales de enfermería de una maternidad durante la pandemia de COVID-19

Objetivo: Estimar a prevalência de sintomas de ansiedade e depressão e seus fatores relacionados, entre os profissionais de enfermagem de uma maternidade, durante a pandemia de COVID-19. Método: Estudo observacional, descritivo e transversal, realizado com 189 profissionais de enfermagem de uma maternidade de referência, em Fortaleza-Ceará. A coleta de dados ocorreu durante três meses − de agosto a outubro de 2020 −, e utilizou-se Formulário Sociodemográfico e Clínico e Escala Hospitalar de Ansiedade e Depressão. Os fatores relacionados para depressão ou ansiedade foram determinados pela análise bivariada, por meio do teste qui-quadrado (nominais) e Wilcoxon (numéricas), com significância de p<0,05. Resultados: Estimou-se a prevalência de sintomatologia ansiosa e depressiva em 58,3% e 29,6% dos participantes, respectivamente. Cerca de 53,5% foram afastados por suspeita de COVID-19 e 58%, infectados pelo vírus. Observou-se que os profissionais que atuavam na emergência, clínica obstétrica e Unidade de Terapia Intensiva materna foram os mais expostos ao risco de ter depressão (p=0,01055). Conclusão e implicações para a prática: Alta prevalência de sintomas de ansiedade e depressão entre os participantes, independentemente de estarem na linha de frente da pandemia ou não. A situação requer acolhimento às demandas da saúde mental

Objective: To estimate the prevalence of anxiety and depression symptoms and their related factors among nursing professionals in a maternity hospital during the COVID-19 pandemic. Method: Observational, descriptive and cross-sectional study carried out with 189 nursing professionals from a reference maternity hospital in Fortaleza-Ceará. Data collection took place over three months, from August to October 2020, using the Sociodemographic and Clinical Form and the Hospital Anxiety and Depression Scale. Factors related to depression or anxiety were determined by bivariate analysis using the chi-square (nominal) and Wilcoxon (numerical) tests, with a significance of p<0.05. Results: The prevalence of anxious and depressive symptoms was estimated in 58.3% and 29.6% of the participants, respectively. About 53.5% were removed due to suspected COVID-19 and 58% were infected with the virus. It was observed that professionals who worked in the emergency, obstetric clinic and maternal Intensive Care Unit were the most exposed to the risk of having depression (p=0.01055). Conclusion and implications for practice: High prevalence of anxiety and depression symptoms among participants, regardless of whether they are on the front lines of the pandemic or not. The situation requires meeting the demands of mental health.

Objetivo: Estimar la prevalencia de síntomas de ansiedad y depresión y sus factores relacionados entre profesionales de enfermería en una maternidad durante la pandemia de COVID-19. Método: Estudio observacional, descriptivo y transversal realizado con 189 profesionales de enfermería de una maternidad de referencia en Fortaleza-Ceará. La recolección de datos ocurrió durante tres meses, de agosto a octubre de 2020, utilizando el Formulario Sociodemográfico y Clínico y la Escala Hospitalaria de Ansiedad y Depresión. Los factores relacionados con la depresión o la ansiedad se determinaron mediante análisis bivariado mediante las pruebas de chi-cuadrado (nominal) y Wilcoxon (numérica), con una significancia de p<0,05. Resultados: La prevalencia de síntomas ansiosos y depresivos se estimó en 58,3% y 29,6% de los participantes, respectivamente. Alrededor del 53,5% fueron retirados por sospecha de COVID-19 y el 58% estaban infectados con el virus. Se observó que los profesionales que actuaban en emergencia, clínica obstétrica y Unidad de Terapia Intensiva materna eran los más expuestos al riesgo de tener depresión (p=0,01055). Conclusión e implicaciones para la práctica: Alta prevalencia de síntomas de ansiedad y depresión entre los participantes, independientemente de si están en la primera línea de la pandemia o no. La situación requiere atender las demandas de salud mental.

Group of high-risk pregnant women as a health education strategy. / Grupo de gestantes de alto-risco como estratégia de educação em saúde.

OBJECTIVE: To understand the importance of group strategy in the process of nursing care to high-risk pregnant women. METHODS: Qualitative and descriptive study conducted at Assis Chateaubriand Teaching Maternity Hospital in February-March 2017, through focus groups with 24 hospitalized pregnant women. Data was submitted to content analysis and the relevant ideas of the discourses were extracted, forming categories. RESULTS: Three thematic categories were constructed: Interactive groups as a space of bond and coexistence, Educational strategy as an approach to good delivery and birthcare practices, Impact of group experience in strengthening the connection between the health team and the pregnant woman. The group of pregnant women is a space of coexistence and bonding that stimulates them to share knowledge and experiences, re-signifying links. The groups promote sharing of experiences, learning and reflection on the possibilities and limitations of the health-disease process, reducing anxiety and contributing to empowerment in decision making. CONCLUSION: The considerations and suggestions of the pregnant women guided the nurses in the development of the groups, which became strategic spaces of care, acquisition of knowledge and establishment of trust relationships with the nurses, with a consequent impact on the quality of care.

Grupo de gestantes de alto-risco como estratégia de educação em saúde / Grupo de gestantes de alto riesgo como estrategia de educación en salud / Group of high-risk pregnant women as a health education strategy

Resumo OBJETIVO Compreender a importância do grupo no processo de cuidado de enfermagem as gestantes de risco. MÉTODOS Estudo qualitativo, descritivo realizado na Maternidade Escola Assis Chateaubriand, de fevereiro a março/2017, através de grupos focais com 24 gestantes internadas. Dados submetidos à análise de conteúdo e as ideias relevantes dos discursos foram extraídas, formando categorias. RESULTADOS Construíram três categorias: Grupos interativos como espaço de vínculo e convivência, Estratégia educativa como abordagem das boas práticas do parto/nascimento, Repercussão da experiência do grupo no fortalecimento do vínculo entre equipe de saúde e gestante. Os grupos promovem partilha de experiência, aprendizado e reflexão sobre as possibilidades e limitações do processo saúde-doença, reduzindo a ansiedade e contribuindo para o empoderamento na tomada de decisões. CONCLUSÃO As considerações das gestantes nortearam a equipe no desenvolvimento do grupo e efetivá-lo como espaço estratégico de cuidados, ampliação do conhecimento e relação de confiança, impactando na qualidade da assistência.

Resumen OBJETIVO Comprender la importancia del grupo en el proceso de cuidado de enfermería las gestantes de riesgo. MÉTODO Estudio cualitativo y descriptivo realizado en la Maternidad Escuela Asis Chateaubriand, de febrero a marzo/2017, a través de grupos focales con 24 gestantes internadas. Los datos sometidos al análisis de contenido y las ideas relevantes de los discursos fueron extraídas, formando categorías. RESULTADOS Se construyeron tres categorías temáticas: Grupos interactivos como espacio de vínculo y convivencia, Estrategia educativa como abordaje de las buenas prácticas del parto/nacimiento, Repercusión de la experiencia del grupo en el fortalecimiento del vínculo entre equipo de salud y gestante. El grupo de gestantes es un espacio de convivencia y vínculo que las estimulan a compartir conocimientos y experiencias, resignificando vínculos. Se comprendió que los grupos promueven compartir experiencia, aprendizaje y reflexión sobre las posibilidades y limitaciones del proceso salud-enfermedad, reduciendo la ansiedad y contribuyendo al empoderamiento en la toma de decisiones. CONCLUSIÓN Las consideraciones y sugerencias de las gestantes contribuyeron a orientar a la enfermera en el desarrollo del grupo y realizarlo como espacio estratégico de cuidados y ampliación del conocimiento y relación de confianza con el enfermero, impactando en la calidad de la asistencia.

Abstract OBJECTIVE To understand the importance of group strategy in the process of nursing care to high-risk pregnant women. METHODS Qualitative and descriptive study conducted at Assis Chateaubriand Teaching Maternity Hospital in February-March 2017, through focus groups with 24 hospitalized pregnant women. Data was submitted to content analysis and the relevant ideas of the discourses were extracted, forming categories. RESULTS Three thematic categories were constructed: Interactive groups as a space of bond and coexistence, Educational strategy as an approach to good delivery and birthcare practices, Impact of group experience in strengthening the connection between the health team and the pregnant woman. The group of pregnant women is a space of coexistence and bonding that stimulates them to share knowledge and experiences, re-signifying links. The groups promote sharing of experiences, learning and reflection on the possibilities and limitations of the health-disease process, reducing anxiety and contributing to empowerment in decision making. CONCLUSION The considerations and suggestions of the pregnant women guided the nurses in the development of the groups, which became strategic spaces of care, acquisition of knowledge and establishment of trust relationships with the nurses, with a consequent impact on the quality of care.

Anti-inflammatory polysaccharides of Azadirachta indica seed tegument

Azadirachta indica A. Juss., Meliaceae, or Indian neem is a plant used to treat inûammatory disorders. Total polysaccharide (TPL) and FI (fractioned by ion exchange chromatography) from the seed tegument of A. indica were evaluated in models of acute inflammation (paw edema/peritonitis) using Wistar rats. Paw edema (measured by hydroplethysmometry) was induced s.c. by Λ-carrageenan (300 µg), histamine (100 µg), serotonin (20 µg), compound 48/80 (10 µg), prostaglandin (PGE2 30 µg) or L-arginine (15 µg). Peritonitis (analyzed for leukocyte counts/protein dosage) was induced i.p. by carrageenan (500 mg) or N-formyl-methionyl-leucyl-phenylalanine (fMLP 50 ng). Animals were treated i.v. with TPL (1 mg/kg) or FI (0.01, 0.1, 1 mg/kg) 30 min before stimuli. FI toxicity (at 0.1 mg/kg, i.v. for seven days) was analyzed by the variation of body/organ mass and hematological/biochemical parameters. TPL extraction yielded 1.3%; FI, presenting high carbohydrate and low protein content, at 0.1 mg/kg inhibited paw edema induced by carrageenan (77%), serotonin (54%), PGE2 (69%) and nitric oxide (73%), and the peritonitis elicited by carrageenan (48%) or fMLP (67%), being well tolerated by animals. FI exhibited potent anti-inflammatory activity, revealing to be important active component in traditionally prepared remedies to treat inflammatory states.

Polysaccharide fractions of Caesalpinia ferrea pods: potential anti-inflammatory usage.

ETHNOPHARMACOLOGICAL RELEVANCE: Caesalpinia ferrea (Caesalpinioideae), known as pau-ferro or juca, has been used in the traditional medicine in North and Northeast of Brazil in inflammatory disorder, among others. Thus, experimental evaluation of the anti-inflammatory activity of extracts and fraction polysaccharides of Caesalpinia ferrea pods, and correlation with its anti-inflammatory activity and popular use is important. MATERIALS AND METHODS: Total polysaccharides (TPL) were applied to ion exchange chromatography and eluted stepwise. Paw edema was induced s.c. by λ-carrageenan, dextran, histamine, serotonin, compound 48/80, bradykinin, prostaglandin E(2) (PGE(2)) or L-arginine and analyzed by plethysmometry and protein leakage by spectrophotometry. Peritonitis was induced i.p. by carrageenan or N-formyl-methionyl-leucyl-phenylalanine (fMLP) and analyzed 4 h later for leukocyte migration and protein leakage. Animals were treated i.v. with TPL or polysaccharide fractions (0.01, 0.1, 1 mg/kg) 30 min before stimuli in both models. Toxicity (variation of body/organ mass and hematological/biochemical parameters) was evaluated after the seven-day treatment with the most active polysaccharide fraction (1 mg/kg; i.v.). RESULTS: Chromatography of TPL (2.8% yield) provided three major polysaccharide fractions (FI, FII, FIII). At 1 mg/kg, TPL inhibited the paw edema induced by carrageenan (60%) and FIII (fraction presenting high carbohydrate and low protein content) inhibited the inflammatory parameters in the paw edema induced by the following stimuli: carrageenan (70%), dextran (53%), histamine (65%), serotonin (62%), bradykinin (60%), PGE(2) (63%), nitric oxide (61%) and compound 48/80 (36%). Additionally, FIII at 1 mg/kg inhibited the carrageenan-induced edema in animals with intact mast cells, but only the late phase of those with degranulated mast cells elicited by compound 48/80. Moreover, FIII inhibited cell migration and protein leakage in the model of peritonitis elicited by carrageenan (88%) and fMLP (64%), being well tolerated by animals. CONCLUSIONS: Extracts and polysaccharide fractions of Caesalpinia ferrea pods exhibit potent anti-inflammatory activity via negative modulation of histamine, serotonin, bradykinin, PGE(2) and NO released in the carrageenan-induced edema, showing involvement of mast cells. FIII could be interfering not only in the vascular, but also in cellular inflammatory events, revealing to be an important active component of traditionally prepared remedies used to treat inflammatory states.

Dificuldades de mães de adolescentes diabéticos tipo 1 no acesso ao atendimento de saúde / Difficulties of access to public health care as perceived by mothers of type 1 diabetic adolescents

A pesquisa teve como objetivo analisar as dificuldades de mães de adolescentes diabéticos tipo 1 no acesso ao atendimento de saúde. Trata-se de um estudo descritivo-exploratório. Os participantes foram 25 mães de adolescentes diabéticos, na faixa etária de 10 a 19 anos, acompanhados em um centro de referência no período de março a maio de 2006. Foram efetuadas entrevistas semi-estruturadas e as temáticas foram geradas pela análise de conteúdo de Bardin. Evidenciou-se que as mães apresentaram dificuldades para confirmação do diagnóstico. A colaboração entre os níveis de atendimento, por meio de um sistema de referência e contra-referência eficaz contribui para um atendimento qualitativo. Concluiu-se que as dificuldades na resolubilidade nas unidades básicas de saúde desgastam a clientela e atrasam o diagnóstico expondo a clientela a riscos de complicações.