RESUMO
RESUMO Este estudo objetivou descrever as etapas de planejamento, implementação e monitoramento das ações de promoção ao Aleitamento Materno (AM) nos Centros de Educação Infantil (CEI) da Rede Municipal de Ensino de São Paulo. Foram estruturadas quatro frentes de trabalho: elaboração de materiais orientativos; realização de formações; estruturação de campanha de comunicação; e monitoramento. Além de vídeos de publicização, foi produzido informativo para as equipes educacionais com orientações para a manutenção do AM após a matrícula da criança. As formações anuais visaram subsidiar ações pedagógicas e atingiram todos os territórios educacionais do município. A campanha CEI Amigo do Peito definiu critérios para reconhecer os CEI comprometidos com o AM. O número de CEI Amigos do Peito passou de 93 em 2018 para 875 em 2022. Foi enviado formulário eletrônico para todos os CEI do município para avaliação de indicadores: interesse de familiares em manter o AM; ambiente disponível para amamentação; realização de projetos; presença de mães amamentando; e entrega de leite materno. A adesão dos respondentes variou de 40,8% a 50,9%. Os resultados mostraram a urgência da responsabilidade compartilhada entre setores governamentais para promover o AM.
ABSTRACT This study describes the planning, implementation, and monitoring of actions to promote Breastfeeding (BF) in the Municipal Education System of the city of São Paulo. We established a set of four actions: elaboration of instructional material, training of daycare centers employees, development of a communication campaign, and monitoring. Instructional material was elaborated to guide the maintenance of BF after the child's enrollment and videos were produced to disseminate the information. Annual training in all territories of the city was provided to guide pedagogical interventions. The campaign, called CEI Amigo do Peito, established criteria to recognize daycare centers committed to BF promotion. The number of daycare centers committed to BF went from 93 (2018) to 875 (2022). Electronic form was sent to all daycare centers to evaluate the following indicators: interest of family members in maintaining BF, room available for breastfeeding, development of projects, presence of mothers breastfeeding, and delivery of breast milk. Respondents' adherence ranged from 40.8% to 50.9%. The results show the urgency of shared responsibility among government sectors to promote BF.
RESUMO
OBJECTIVE: To evaluate the effects of iso-osmolar doses of 18% mannitol and 3% sodium chloride (NaCl) solutions in decreasing intracranial pressure (ICP) in animals with severe traumatic brain injury (TBI). DESIGN: Prospective uncontrolled interventional study. SETTING: Veterinary university teaching hospital. ANIMALS: Two cats and 1 dog with TBI with a modified Glasgow Coma Scale score ≤8 after hemodynamic stabilization, and with brain magnetic resonance imaging changes suggestive of intracranial hypertension. INTERVENTIONS: Animals were surgically instrumented for direct ICP measurement, then randomly treated with iso-osmolar doses of 18% mannitol or 3% NaCl. Direct ICP and cerebral perfusion pressure (CPP) were recorded both before treatment and for 120 minutes following drug administration. MEASUREMENTS AND MAIN RESULTS: Direct ICP and CPP were recorded both before treatment and at 5 additional time points following administration over the subsequent 120 minutes. Case 1 received 3% NaCl without any response to therapy; refractory posttraumatic hypertension was suspected. Case 2 was treated with 3% NaCl; ICP decreased by 40.7% and CPP increased by 15%; however, these effects were transient. Case 3 received 18% mannitol, and ICP decreased by 19% and CPP increased to normal. However, there was a rebound increase in ICP that was higher than pretreatment values, and CPP decreased slightly before it gradually increased to normal values towards the end of the study. CONCLUSIONS: Both mannitol and hypertonic saline decrease ICP and improve CPP, but the effect observed in this pilot study suggests that there might be differences in the duration of these effects. Appropriately designed studies in a larger and homogeneous population are warranted to further investigate these findings.
