Sífilis na gestação: conhecimento de gestantes e puérperas / Syphilis in pregnancy: knowledge of pregnant and puerperous women / Sífilis durante el embarazo: conocimientos de las mujeres embarazadas y puérperas

Objetivo: identificar o conhecimento de gestantes e puérperas acerca da sífilis. Método: pesquisa descritiva, com abordagem qualitativa. A coleta de dados ocorreu por meio de instrumento semiestruturado, entre abril a julho de 2021, com 18 gestantes/puérperas com diagnóstico de sífilis na gestação. As respostas foram gravadas e transcritas na íntegra, sendo utilizado para análise a técnica do Discurso do Sujeito Coletivo. Resultados: identificou-se três ideias centrais: 1) Conhecimento sobre a sífilis, 2) Buscando conhecimento sobre a sífilis e 3) Falsa prevenção. O conhecimento das participantes mostrou-se conflitante, pois algumas apresentaram algum conhecimento e outras nenhum, sendo que todas deveriam ter sido orientadas sobre a doença. Considerações finais: identificou-se uma falha no atendimento ofertado nos serviços de saúde. Assim, estratégias voltadas à educação em saúde devem ser incentivadas e implementadas no acompanhamento de pré-natal, ofertando a promoção e prevenção da saúde, a fim de reduzir os casos de sífilis na gestação.

Objective: to identify the knowledge of pregnant and postpartum women about syphilis. Method: descriptive research, with a qualitative approach. Data collection took place using a semi-structured instrument, between April and July 2021, with 18 pregnant/postpartum women diagnosed with syphilis during pregnancy. The responses were recorded and transcribed in full, using the Collective Subject Discourse technique for analysis. Results: three central ideas were identified: 1) Knowledge about syphilis, 2) Seeking knowledge about syphilis and 3) False prevention. The knowledge of the participants was conflicting, as some had some knowledge and others none, and all of them should have been educated about the disease. Final considerations: a flaw in the care offered in health services was identified. Therefore, strategies aimed at health education should be encouraged and implemented in prenatal care, offering health promotion and prevention, in order to reduce cases of syphilis during pregnancy.

Objetivos:identificar el conocimiento de las mujeres embarazadas y puérperas sobre la sífilis. Método: investigación descriptiva, con enfoque cualitativo. La recolección de datos se realizó mediante un instrumento semiestructurado, entre abril y julio de 2021, con 18 mujeres embarazadas/puérperas diagnosticadas con sífilis durante el embarazo. Las respuestas fueron grabadas y transcritas en su totalidad, utilizando para su análisis la técnica del Discurso del Sujeto Colectivo. Resultados: se identificaron tres ideas centrales: 1) Conocimiento sobre sífilis, 2) Búsqueda de conocimiento sobre sífilis y 3) Falsa prevención. El conocimiento de los participantes fue contradictorio, ya que algunos tenían algún conocimiento y otros ninguno, y todos deberían haber sido educados sobre la enfermedad. Consideraciones finales: se identificó una falla en la atención ofrecida en los servicios de salud. Por lo tanto, se deben fomentar e implementar estrategias orientadas a la educación en salud en la atención prenatal, ofreciendo promoción y prevención de la salud, con el fin de reducir los casos de sífilis durante el embarazo.

Effectiveness of mobile-based intervention Self-care for Pregnant Women at Work: A randomized controlled trial.

OBJECTIVES: While the number of employed women has increased worldwide, they still have difficulties in practicing prenatal care at work. Previous studies have found that smartphone-based prenatal education has increased access to healthcare and contributed to improving pregnant women's health. The objective of this study was to evaluate the effectiveness of a mobile-based intervention-Self-care for Pregnant Women at Work (SPWW)-in enhancing the self-care practices of pregnant women who work. METHODS: A randomized repeated measures design was used in the study. The 126 women were randomly assigned to either an intervention group that used the SPWW mobile application for 4 weeks or a control group that used an application that only had surveys. Both groups completed surveys at preintervention, week 2, and week 4 of their participation in the study. The primary study variables were work stress, pregnancy stress, fear of childbirth, pregnancy experience, and health practices in pregnancy. RESULTS: A total of 116 participants' data (60 in the intervention group and 56 in the control group) were analyzed. Significant group-by-time interaction effects were noted for pregnancy stress, pregnancy hassles, and health practices in pregnancy. The effect size of the intervention was small to medium for pregnancy stress (d = -0.425), pregnancy uplifts (d = 0.333), pregnancy hassles (d = -0.599), and health practices in pregnancy (d = 0.490). CONCLUSIONS: A mobile-based intervention using a comprehensive health application is effective in pregnant women at work. Developing educational content and methods targeted at this population would be helpful.

Efectividad del programa educativo “Sonrisas desde el vientre”. Hogar Materno Isabel María de Valdivia en Sancti Spíritus / Effectiveness of the educational program "Smiles from the womb". Isabel María de Valdivia Maternity Home in Sancti Spíritus

Fundamentación:En el período de gestación el organismo de la mujer sufre modificaciones, transformaciones fisiológicas y psicológicas, además de cambios en los tejidos bucales y cambios de conducta que pueden iniciar enfermedades bucodentales o agravar las ya establecidas.Objetivo:Evaluar la efectividad del programa educativo “Sonrisas desde el vientre” en embarazadas del Hogar Materno Isabel María de Valdivia en Sancti Spíritus.Metodología:Se realizó un estudio preexperimental, con diseño antes y después en el período de enero a junio del 2022, la población estuvo constituida por 20 embarazadas ingresadas en el Hogar Materno Isabel María de Valdivia en Sancti Spíritus. Se utilizaron métodos del nivel teórico, empírico (encuesta) y estadísticos. Se midió la variable conocimiento sobre salud bucodental.Resultados:Los conocimientos antes de la aplicación de programa educativo eran insuficientes (65 porciento), después de aplicado el programa educativo el 75 porciento de las embarazadas presentó conocimientos suficientes.Conclusiones:Al culminar la implementación del programa educativo “Sonrisas desde el vientre”, se logró un nivel de conocimiento suficiente sobre salud bucodental en la tercera parte de las embarazadas de este hogar materno.[AU]

Efectividad del programa educativo "Sonrisas desde el vientre". Hogar Materno Isabel María de Valdivia en Sancti Spíritus / Effectiveness of the educational program " Smiles from the womb". Isabel María de Valdivia Maternity Home in Sancti Spíritus

Fundamentación: En el período de gestación el organismo de la mujer sufre modificaciones, transformaciones fisiológicas y psicológicas, además de cambios en los tejidos bucales y cambios de conducta que pueden iniciar enfermedades bucodentales o agravar las ya establecidas. Objetivo: Evaluar la efectividad del programa educativo "Sonrisas desde el vientre" en embarazadas del Hogar Materno Isabel María de Valdivia en Sancti Spíritus. Metodología: Se realizó un estudio preexperimental, con diseño antes y después en el período de enero a junio del 2022, la población estuvo constituida por 20 embarazadas ingresadas en el Hogar Materno Isabel María de Valdivia en Sancti Spíritus. Se utilizaron métodos del nivel teórico, empírico (encuesta) y estadísticos. Se midió la variable conocimiento sobre salud bucodental. Resultados: Los conocimientos antes de la aplicación de programa educativo eran insuficientes (65 %), después de aplicado el programa educativo el 75 % de las embarazadas presentó conocimientos suficientes. Conclusiones: Al culminar la implementación del programa educativo "Sonrisas desde el vientre", se logró un nivel de conocimiento suficiente sobre salud bucodental en la tercera parte de las embarazadas de este hogar materno.

Background: During pregnancy, the women's body goes through many changes, physiological and psychological transformations, as well as changes in the oral cavity tissues and behavioral changes that may initiate oral diseases or aggravate the stablished ones. Objective: To evaluate the effectiveness of the educational program "Smile from the Womb" among pregnant women at the Isabel María de Valdivia Maternity Home in Sancti Spíritus. Methodology: A pre-experimental study with a before and after design was conducted from January to June 2022, the population consisted of 20 pregnant women hospitalized at Isabel María de Valdivia Maternity Home in Sancti Spíritus. Theoretical, empirical (survey) and statistical methods were used. The variable oral health knowledge was measured. Results: Before applying the educational program the knowledge was insufficient (65%), after applying the educational program 75% of pregnant women showed sufficient knowledge. Conclusions: By the end of the "Smile from the Womb" educational program, one third of the pregnant women in this maternity home had achieved a sufficient level of knowledge about oral and dental health.

Saúde bucal materno-infantil: orientação, conhecimento, práticas e atitudes de gestantes e profissionais de saúde / Maternal and Child Oral Health: guidance, knowledge, practices, and attitudes of pregnant women and healthcare professionals

A presente dissertação consiste em dois estudos e dois produtos técnicos. O estudo 1 é uma revisão com mineração de dados de artigos provenientes de uma busca sistemática em 6 bases de dados para analisar o conhecimento de gestantes e profissionais da saúde sobre saúde bucal (SB) na gestação. Dados bibliométricos (ano de publicação e país) e do estudo (população, desenho, instrumento utilizado para avaliação e nível de conhecimento avaliado) foram coletados e analisados por meio dos softwares VantagePoint® e Microsoft Office Excel 2010®. De 5.216 artigos, 85 foram incluídos (publicados de 1964 a 2023). O Brasil é o país com maior número de publicações (n=24; 27,9%). Dentre os participantes, a maioria foi de gestantes (n=42; 49,4%), seguidas por dentistas (n=19; 22,3%), ginecologistas/obstetras (n=14; 16,4%) e enfermeiros obstetras (n=13; 15,2%). Estudos transversais foram os mais frequentes (n=80; 94,1%), com questionários como instrumentos mais utilizados (n=69; 80,2%). Em 29 (69%) estudos, o conhecimento das gestantes foi considerado ruim e, entre os profissionais de saúde, os dentistas apresentaram o maior nível de conhecimento (n=6; 31,6%). O estudo 2 desenvolveu, validou um instrumento e avaliou a influência de fatores socioeconômicos, culturais, demográficos e gestacionais sobre o nível de conhecimento, práticas e atitude de gestantes acompanhadas na Maternidade Escola da UFRJ frente a questões de SB materno-infantil (SBMI). Os dados foram obtidos por meio de um questionário, em que variáveis como renda familiar, dados sociodemográficos, escolaridade, histórico da gestação, conhecimento sobre SBMI, práticas de higiene, de consumo de açúcar, de frequência de ida ao dentista e a influência do medo a esse profissional foram analisadas. Pontuações foram atribuídas para as questões (n=7) de conhecimento (0-7) e para as de práticas/atitude (n=5) (0-5), classificados como baixo (SBMI ≤3) ou alto (SBMI >4) e negativas (pontuações <4) ou positivas (pontuações ≥4), respectivamente. Regressões lineares múltiplas foram conduzidas. Para validação estrutural e de estabilidade, foi realizada uma análise fatorial exploratória (AFE) e o índice de correlação intraclasse (ICC). AFE demonstrou validação de dois constructos de conhecimento (n=7 questões) e um de práticas/atitude (n=5 questões); e o ICC variou de 0,669 a 0,780 para o conhecimento e de 0,770 a 0,921 para práticas/atitude. Das 245 gestantes (29,6±6,8 anos), a maioria era multípara (n=153; 62,4%), com ganho de 1 a 2 salários-mínimos (n=118; 48,2%), e cursaram até o ensino médio (n=142; 58%). O baixo conhecimento para SBMI foi mais frequente (n=148; 60,4%) e foi associado às multíparas (p=0,02) e àquelas com menor nível de escolaridade (p<0,05). Das participantes, 156 (63,7%) escovavam os dentes no mínimo 3×/dia, 95 (38,8%) ainda não tinham ido ao dentista na gestação, cujo medo foi relatado (72; 29,4%). Gestantes que foram ao dentista tiveram práticas/atitude mais positivas (p=0,000) em SB e maior escolaridade (p<0,05). Os produtos 1 e 2 foram desenvolvidos como ferramentas de orientação em SB para gestantes/cuidadores e profissionais de saúde, através da criação de uma página no Instagram® (@clibin.ufrj) e um capítulo de e-book (disponível no Repositório Institucional da UFRJ), respectivamente. Em outubro/2023, a página no Instagram apresentava 672 seguidores e o e-book 449 downloads. Conclui-se que nos últimos anos, um baixo conhecimento de gestantes e profissionais da saúde sobre SB é reportado na literatura mundial; o que não foi diferente em relação ao conhecimento sobre SBMI das gestantes avaliadas no estudo 2, por meio de um questionário que demonstrou ser válido e confiável, onde se observou influência direta da multiparidade e do baixo nível de escolaridade. Em acréscimo, a ida ao dentista na gestação e maior nível escolar foram preditores de práticas/atitude positivas dessas participantes, enfatizando ainda mais a importância das novas tecnologias de orientação criadas, para promoção de SB de gestantes. (AU)

The present dissertation consists of two studies and two technical products. The Study 1 is a data mining review of articles obtained from a systematic search across 6 databases to analyze the knowledge of pregnant women and healthcare professionals regarding oral health (OH) during pregnancy. Bibliometric data (year and country of publication) and study data (population, design, assessment instrument used, and level of knowledge assessed) were collected and analyzed using Vantage Point® and Microsoft Office Excel 2010® software. Out of 5,216 articles, 85 were included (published from 1964 to 2023). Brazil had the highest number of publications (n=24; 27.9%). Among the participants, the majority were pregnant women (n=42; 49.4%), followed by dentists (n=19; 22.3%), gynecologists/obstetricians (n=14; 16.4%), and obstetric nurses (n=13; 15.2%). Cross-sectional studies were the most frequent (n=80; 94.1%), with questionnaires being the most used instrument (n=69; 80.2%). In 29 (69%) studies, pregnant women's knowledge was considered poor, and among healthcare professionals, dentists exhibited the highest level of knowledge (n=6; 31.6%). The Study 2 developed, validated an instrument, and evaluated the influence of socioeconomic, cultural, demographic, and gestational factors on the level of knowledge, practice, and attitude of pregnant women receiving care at the Maternidade Escola da UFRJ regarding maternal and child oral health (MCOH) issues. Data were obtained through a questionnaire, in which variables such as family income, sociodemographic data, education, pregnancy history, knowledge about MCOH, hygiene practices, sugar consumption, dental visit frequency, and fear of dental professionals were analyzed. Scores were assigned for questions (n=7) of knowledge (0-7) and of practice/attitude (n=5) (0-5), classified as low (MCOH ≤3) or high (MCOH >4) and negative (scores <4) or positive (scores ≥4), respectively. Multiple linear regressions were conducted. For structural and stability validation, an exploratory factor analysis (EFA) and the intraclass correlation index (ICC) were performed. EFA demonstrated validation of two knowledge constructs (n=7 questions) and one practices/attitude construct (n=5 questions); and the ICC ranged from 0.669 to 0.780 for knowledge and from 0.770 to 0.921 for practices/attitude. Out of 245 pregnant women (29.6±6.8 years old), the majority were multiparous (n=153; 62.4%), earned 1 to 2 minimum wages (n=118; 48.2%), and had completed high school (n=142; 58%). Low knowledge about MCOH was more frequent (n=148; 60.4%) and was associated with multiparity (p=0.02) and lower educational levels (p<0.05). Among the participants, 156 (63.7%) brushed their teeth at least 3 times/day, 95 (38.8%) had not visited the dentist during pregnancy yet, and 72 (29.4%) reported fear. Pregnant women who visited the dentist had more positive practices/attitude (p=0.000) of OH and higher education (p<0.05). The Products 1 and 2 were developed as guidance tools for pregnant women/caregivers and healthcare professionals regarding OH through the creation of an Instagram® page (@clibin.ufrj) and an e-book chapter (available in the UFRJ Institutional Repository), respectively. In October of 2023, the Instagram page had 672 followers, and the e-book had 449 downloads. In conclusion, in recent years, low knowledge about OH among pregnant women and healthcare professionals has been reported in the global literature, which was not different regarding knowledge about MCOH among the pregnant women evaluated in the Study 2, which was no different in relation to the knowledge about SBMI of the pregnant women evaluated through a questionnaire that demonstrated to be valid and reliable in study 2, where it was observed the influence of multiparity and low education level. Additionally, visiting the dentist during pregnancy and a higher education were predictors of positive practices/attitude for these participants, further emphasizing the importance of the newly created guidance technologies for promoting pregnant women's OH. (AU)

O pré-natal odontológico: contribuição da ESF, atendimento integral e conhecimento, uma revisão da literatura / The dental pre-natal: ESF contribution, comprehensive care and knowledge, a review of the literature / La atención prenatal odontológica: contribución del ESF, la atención integral y el conocimiento, una revisión bibliográfica

O pré-natal odontológico vem sendo alvo de ações estratégicas na atenção básica. É necessária a compressão que a mulher em período gestacional necessita de cuidados bucais, por esse fato o pré-natal necessita de reforços para o estabelecimento efetivo na atenção básica de forma a ser desmistificado na odontologia, e possibilitar que o cirurgião-dentista possa ser integrado com as ações voltadas para a saúde gestacional. Diante disso objetiva-se relatar sobre o pré-natal odontológico, e abordar sobre a contribuição da Estratégia Saúde da Família (ESF) nesse contexto, atuação multidisciplinar, e importância da educação e capacitação para desmistificação do atendimento a gestantes. Para isso foi realizado um levantamento bibliográfico nas bases de dados eletrônicas Scielo, portal BVS e Google Acadêmico. É visto ainda há baixa adesão das gestantes ao atendimento odontológico, embora haja uma notória representação da ESF na universalização desse cuidado. A equipe multidisciplinar no atendimento de gestantes parece colaborar para a motivação do atendimento, e fundamentar ações estratégicas interdisciplinares. Ainda é importante ressaltar que o conhecimento sobre os aspectos norteadores da gestação tem papel fundamental para desmistificar o atendimento odontológico e preparar os profissionais. Infere-se que o pré-natal odontológico vem ganhando expressividade, onde as ações da ESF, a atuação da equipe multidisciplinar e a ampliação do conhecimento acerca do assunto podem influenciar positivamente para a adesão desse grupo.

Dental prenatal care has been the target of strategic actions in primary care. It is necessary the compression that women in gestational period need oral care, for this reason prenatal care requires reinforcements for the effective establishment in primary care in order to be demystified in dentistry, and enable the dentist to be integrated with actions aimed at gestational health. Therefore, the objective is to report on dental prenatal care, and to address the contribution of the Family Strategy Health (ESF) in this context, multidisciplinary work, and the importance of education and training to demystify the care for pregnant women. For this, a bibliographic survey was carried out in the electronic databases Scielo, BVS portal and Google Scholar. It is seen that there is still low adherence of pregnant women to dental care, although there is a notorious representation of the ESF in the universalization of this care. A multidisciplinary team in the care of pregnant women seems to collaborate to motivate care, and to fundamentalize interdisciplinary strategic actions. It is also important to emphasize that knowledge about the guiding aspects of pregnancy has a fundamental role to demystify dental care and prepare professionals. It is inferred that prenatal in the dentistry has been gaining expressiveness, where the actions of the ESF, the performance of the multidisciplinary team and the expansion of knowledge on the subject can lead positively to the adhesion of this group.

La atención prenatal dental ha sido objeto de acciones estratégicas en la atención primaria. Es necesario que la mujer en el período de gestación necesite cuidados bucales, por lo que el prenatal necesita refuerzos para el establecimiento efectivo de la atención básica de forma que sea desmitificado en la odontología, y que la cirugía-dentista pueda integrarse con las acciones volcadas a la salud gestacional. Por ello, el objetivo es informar sobre la atención prenatal odontológica y abordar la contribución de la Estrategia de Salud Familiar (ESF) en este contexto, la actuación multidisciplinar y la importancia de la educación y la formación para desmitificar la atención a las embarazadas. Para ello, se realizó un estudio bibliográfico en las bases de datos electrónicas Scielo, portal BVS y Google Acadêmico. Aún así, se observa una baja adhesión de las gestantes a la atención odontológica, aunque hay una notable representación del FSE en la universalización de este cuidado. El equipo multidisciplinar en la atención a la mujer embarazada parece colaborar a la motivación de los cuidados, y basar las acciones estratégicas interdisciplinares. También es importante destacar que el conocimiento de los aspectos orientativos del embarazo desempeña un papel fundamental en la desmitificación de la atención odontológica y la preparación de los profesionales. Se infiere que el prenatal odontológico viene ganando expresividad, donde las acciones de la ESF, la actuación del equipo multidisciplinario y la ampliación del conocimiento sobre el tema pueden influir positivamente en la adherencia de este grupo.

Elaboration and analysis of psychometric properties of a questionnaire to assess pregnant women's knowledge about toxoplasmosis / Elaboração e análise de propriedades psicométricas de um questionário para avaliar o conhecimento de gestantes sobre toxoplasmose

Abstract Objectives: to elaborate and analyze the psychometric properties of a questionnaire to assess among pregnant women's knowledge about toxoplasmosis. Methods: methodological study elaborating an instrument conducted in the north of Minas Gerais in 2019. The steps followed were: 1. Elaboration of the questionnaire items based on medical literature available in indexed databases. 2. Content validation. 3. Apparent validation. 4. Construct validation with hypothesis testing after the application of the questionnaire and comparison of the mean scores using the Mann-Whitney U test. 5. Reliability analysis with internal consistency analysis and test-retest. Results: the final instrument consisted of 26 items. Content validation reached 90% agreement among experts. The hypothesis test found a significant diference among the scores of the groups evaluated (p<0.001). Cronbach's alpha found a value of 0.84 and the test-retest showed an intra-class correlation index of 0.78 (p<0.001). Conclusions: the instrument elaborated proved to be valid and reliable and could be used to assess among pregnant women's knowledge about toxoplasmosis and, therefore, guiding to the educational and preventive measures.

Resumo Objetivos: elaborar e analisar as propriedades psicométricasde um questionáriopara avaliação do conhecimento sobre toxoplasmose entre gestantes. Métodos: estudo metodológico de elaboração de instrumento, realizado no norte de Minas Gerais, em 2019. O estudo seguiu os seguintes passos: 1. Elaboração dos itens a do questionário, com base na literatura médica disponível em bases indexadas. 2. Validação de conteúdo. 3. Validação aparente. 4. Validação de constructo, com teste de hipóteses, após aplicação do questionário e comparação de médias dos escores por meio do teste U de Mann-Whitney. 5. Análise de confabilidade, com análise da consistência interna e teste-reteste. Resultados: o instrumento final foi composto por 26 itens. Na validação de conteúdo alcançou 90% de concordância entre os experts. O teste de hipótese registrou diferença significativa entre os escores dos grupos avaliados (p<0,001). O alfa de Cronbach apresentou valor de 0,84 e o teste-reteste apresentou índice de correlação intra-classe de 0,78 (p<0,001). Conclusão: o instrumento elaborado apresentou-se válido e confável e poderá ser utilizado para avaliação de conhecimento sobre toxoplasmose entre gestantes, norteando medidas educativas e preventivas.

Awareness of fetal movements and care package to reduce fetal mortality (AFFIRM): a trial-based and model-based cost-effectiveness analysis from a stepped wedge, cluster-randomised trial.

BACKGROUND: The AFFIRM intervention aimed to reduce stillbirth and neonatal deaths by increasing awareness of reduced fetal movements (RFM) and implementing a care pathway when women present with RFM. Although there is uncertainty regarding the clinical effectiveness of the intervention, the aim of this analysis was to evaluate the cost-effectiveness. METHODS: A stepped-wedge, cluster-randomised trial was conducted in thirty-three hospitals in the United Kingdom (UK) and Ireland. All women giving birth at the study sites during the analysis period were included in the study. The costs associated with implementing the intervention were estimated from audits of RFM attendances and electronic healthcare records. Trial data were used to estimate a cost per stillbirth prevented was for AFFIRM versus standard care. A decision analytic model was used to estimate the costs and number of perinatal deaths (stillbirths + early neonatal deaths) prevented if AFFIRM were rolled out across Great Britain for one year. Key assumptions were explored in sensitivity analyses. RESULTS: Direct costs to implement AFFIRM were an estimated £95,126 per 1,000 births. Compared to standard care, the cost per stillbirth prevented was estimated to be between £86,478 and being dominated (higher costs, no benefit). The estimated healthcare budget impact of implementing AFFIRM across Great Britain was a cost increase of £61,851,400/year. CONCLUSIONS: Perinatal deaths are relatively rare events in the UK which can increase uncertainty in economic evaluations. This evaluation estimated a plausible range of costs to prevent baby deaths which can inform policy decisions in maternity services. TRIAL REGISTRATION: The trial was registered with www. CLINICALTRIALS: gov , number NCT01777022 .

Effect of Pro-Environmental Prenatal Education Program on Pregnant Women's Environmental Health Awareness and Behaviors based on the Protection Motivation Theory.

This study aimed to verify whether a pro-environmental prenatal education program has an effect on pregnant women's environmental health awareness and behaviors in Korea. This quasi-experimental study employed a nonequivalent control group and nonsynchronized design based on the protection motivation theory as a theoretical framework. In total, 96 pregnant women had their data collected and analyzed in Korea (40 in the experimental group; and 56 in the control group). Data collection through self-reported questionnaire was conducted between September 2017 and August 2018. The program consisted of lectures and group activities aimed at educating participants on environmental awareness and behaviors. The data were analyzed using t-test, chi square test, and ANCOVA using SPSS 24.0 program. After the intervention, the experimental group showed significantly higher sensitivity (54.78 ± 9.47 and 49.75 ± 5.42; F = 15.13, P < .001), susceptibility (26.30 ± 5.18 and 24.28 ± 4.53; F = 53.94, P < .001), response efficacy (27.40 ± 3.40 and 25.18 ± 4.23; F = 39.42, P < .001), self-efficacy (22.43 ± 4.15 and 21.35 ± 4.25; F = 41.13, P < .001), individual environmental behavior (58.59 ± 12.25 and 51.93 ± 12.64; F = 172.75, P < .001), and communal environmental behavior (18.45 ± 9.68 and 13.13 ± 8.24; F = 126.26, P < .001) than the control group. The developed pro-environmental prenatal education program contained content on the environment and pregnancy, environmental toxin, effects of endocrine disruptors, airborne pollutants, water pollutant, soil pollutant, radio-electronic exposure, and pro-environmental health behaviors during pregnancy. Pregnant women who participated in the pro-environmental prenatal education program had positive changes in environmental health perceptions and behaviors. As environmental hazards continue to increase, pregnant women should receive effective motivational education on eco-environmental protection to increase their sensitivity to environmental risk factors and to encourage active environmental health behaviors.

Plano de parto no pré-natal: conhecimento dos enfermeiros da atenção primaria à saúde / Pre-natal delivery plan: nurses' knowledge of primary health care / Plan de parto prenatal: conocimientos de las enfermeras sobre atención primaria de la salud

Introdução: É fundamental implementar medidas direcionadas a assegurar a melhoria da cobertura e da qualidade do acompanhamento do pré-natal, da assistência ao parto e puerpério e da assistência à criança. Objetivos: Identificar o conhecimento dos enfermeiros da Atenção Primária à Saúde sobre o plano de parto; realizar ação educativa com os enfermeiros da Atenção Primária à Saúde acerca do plano de parto e identificar seu impacto; informar e destacar junto aos enfermeiros da Atenção Primária à Saúde a importância e a abordagem do plano de parto durante o Pré-Natal. Método: Trata-se de um estudo, descritivo, exploratório de abordagem mista. O Município de Catanduva tem cerca de 121.862 habitantes e 23 unidades de Saúde para atendimento em Atenção Básica, com 46 enfermeiras atuando diretamente no acompanhamento do Pré-Natal e nas ações educativas com as gestantes. Resultados: Nota-se defasagem quanto ao conhecimento e aplicação do instrumento referente ao plano de parto pelos enfermeiros da Atenção Primária à Saúde, evidenciando a importância da criação de treinamentos e protocolos dentro dessa temática. Conclusão: Com o desenvolvimento do estudo, foi possível concluir o quão importante é o Plano de Parto, tanto para a gestante no âmbito de expressar suas vontades, desejos, sanar suas dúvidas e medos, como também é fundamental para o profissional inserido na assistência, já que ele é um documento escrito e de caráter legal, o que o torna meio de respaldo para possíveis contratempos.(AU)

Introduction: It is essential to implement measures aimed at ensuring improved coverage and quality of prenatal care, childbirth and puerperium care and child care. Objectives: To identify the knowledge of Primary Health Care nurses about the birth plan; to carry out educational action with Primary Health Care nurses about the birth plan and to identify its impact; To inform and highlight the importance and approach of the birth plan during the Prenatal Care with the nurses of the Primary Health Care. Method: This is a descriptive, exploratory study with a mixed approach. The city of Catanduva has about 121,862 inhabitants and 23 health units for primary care, with 46 nurses working directly in the monitoring of prenatal care and educational actions with pregnant women. Results: There is a lag in knowledge and application of the instrument related to the birth plan by nurses in Primary Health Care, showing the importance of creating training and protocols within this theme. Conclusion: With the development of the study, it was possible to conclude how important is the Birth Plan, both for the pregnant woman in the context of expressing her wishes, desires, remedy her doubts and fears, as well as is fundamental for the professional inserted in the assistance, since it is a written and legal document, which makes it a means of support for possible setbacks.(AU)

Introducción: Es fundamental implementar medidas encaminadas a garantizar una mejor cobertura y calidad de la atención prenatal, atención al parto y puerperio y atención al niño. Objetivos: Identificar el conocimiento de los enfermeros de la Atención Primaria de Salud (APS) sobre el plan de parto; realizar actividades educativas con enfermeras de la Atención Primaria de Salud sobre el plan de parto e identificar su impacto; informar y resaltar con las enfermeras de la Atención Primaria de Salud la importancia y el abordaje del plan de parto durante la atención prenatal. Metodo: Se trata de un estudio descriptivo, exploratorio, con enfoque mixto. El Municipio de Catanduva tiene cerca de 121.862 habitantes y 23 Unidades de Salud de Atención Básica, con 46 enfermeras actuando directamente en el prenatal y en actividades educativas con gestantes. Resultados: Existe discrepancia en cuanto al conocimiento y aplicación del instrumento referente al plan de parto por parte de los enfermeros de la Atención Primaria de Salud, destacando la importancia de la creación de capacitaciones y protocolos en esta temática. Conclusión: Con el desarrollo del estudio se pudo concluir cuán importante es el Plan de Parto, tanto para la gestante en el contexto de expresar sus deseos, deseos, resolver sus dudas y temores, como también es fundamental para el profesional insertado en la asistencia, ya que es un documento escrito de carácter legal, lo que lo convierte en un medio de apoyo para posibles contratiempos.(AU)

Cuidados de enfermagem e manifestações clínicas de gestantes HIV positivo: revisão da literatura / Nursing care and clinical manifestations of hiv positive pregnant women: literature review / Atención de enfermería y manifestaciones clínicas de mujeres embarazadas positivas al vih: revisión de la literatura

Objetivo: identificar os cuidados de enfermagem necessários às gestantes com HIV partindo das manifestações clínicas encontradas em revisão da literatura. Método: revisão na literatura realizada na Biblioteca Virtual de Saúde e na Medline/Pubmed, entre abril e junho do ano 2021.Resultados: quanto aos cuidados de enfermagem 24(50%) referiram acompanhar e orientar no tratamento da terapia antirretroviral; 14(29,2%) orientar quanto aos cuidados; principal manifestação clínica/alteração com 13(27%) foi o medo do julgamento, transmissão vertical, efeitos da terapia antirretroviral, de morrer, de infecções oportunistas, estigma, discriminação, complicação obstétrica. Quanto aos diagnósticos de enfermagem destaca-se o medo relacionado a cenário pouco conhecido evidenciado por apreensão, sensação de medo e foco direcionado para a fonte do medo. Conclusão: os cuidados de enfermagem direcionados a gestante diagnosticada com HIV contribuirão para uma assistência mais assertiva, eficaz, inclusiva e respeitosa.

Objective: to identify the necessary nursing care for pregnant women with HIV based on clinical manifestations found in a literature review. Method: literature review conducted in the Virtual Health Library and Medline/Pubmed, between April and June 2021. Results: regarding nursing care, 24 (50%) reported following and guiding the treatment of antiretroviral therapy; 14(29.2%) provide guidance regarding care; main clinical manifestation/alteration with 13 (27%) was fear of judgment, vertical transmission, effects of antiretroviral therapy, dying, opportunistic infections, stigma, discrimination, obstetric complications. As for the nursing diagnoses, the fear related to a little-known scenario, evidenced by apprehension, feeling of fear and focus directed to the source of fear stands out. Conclusion: nursing care aimed at pregnant women diagnosed with HIV will contribute to a more assertive, effective, inclusive and respectful care.

Objetivo: identificar los cuidados de enfermería necesarios para la gestante con VIH, a partir de las manifestaciones clínicas encontradas en una revisión de la literatura. Método: revisión de la literatura realizada en la Biblioteca Virtual en Salud y Medline / Pubmed, entre abril y junio de 2021. Resultados: en el cuidado de enfermería, 24 (50%) refirieron seguir y orientar el tratamiento de la terapia antirretroviral; 14 (29,2%) brindan orientación sobre la atención; La principal manifestación / alteración clínica con 13 (27%) fue miedo al juicio, transmisión vertical, efectos de la terapia antirretroviral, muerte, infecciones oportunistas, estigma, discriminación, complicaciones obstétricas. En cuanto a los diagnósticos de enfermería, destaca el miedo relacionado con un escenario poco conocido, evidenciado por aprensión, sentimiento de miedo y enfoque dirigido a la fuente del miedo. Conclusión: la atención de enfermería dirigida a la gestante diagnosticada con VIH contribuirá a una atención más asertiva, eficaz, inclusiva y respetuosa.

Decision-making for prenatal genetic screening: how will pregnant women navigate a growing number of aneuploidy and carrier screening options?

BACKGROUND: Prenatal genetic screens, including carrier screening (CS) and aneuploidy screening (AS), comprise an important component of reproductive healthcare delivery. Clinical practice guidelines emphasize the importance of informed decision-making and patient's preferences regarding the use of these screens. Yet, it is unclear how to achieve this ideal as prenatal genetic screening options rapidly become more complex and increasingly available to patients. With increased complexity and availability of reproductive testing options, decision-support strategies are critical to prepare patients to consider AS and/or CS. METHODS: A self-administered survey evaluated knowledge and decision-making preferences for expanded carrier (CS) and aneuploidy (AS) prenatal screening. The survey was administered to participants before their first prenatal visit to assess baseline decision-making needs and preference at the initiation of prenatal care. Analysis was approached as a descriptive process. RESULTS: Participants had similar familiarity with the concepts associated with AS compared to CS; mean knowledge scores for CS was 0.59 [possible range 0.00 to 1.00] and 0.55 for AS. Participants reported preferences to learn about a range of conditions, including those with severe or mild impact, childhood-onset, and adult-onset. Decision-making preference with respect to learning about the associated disease phenotypes for the contained on AS and CS panel shifted with the complexity of the panel, with a greater preference to learn about conditions post-test compared pre-test education as panels increased from 5 to 100 conditions. CONCLUSION: Patients' baseline knowledge of prenatal genetic screens coupled with evolving decision-making preferences presents challenges for the delivery of prenatal genetic screens. This calls for the development and implementation of innovative approaches to support pregnant patients' decision-making commensurate with advances in prenatal genomics.

Ministério da Saúde lança protocolo de uso do Guia Alimentar para gestantes

O Guia Alimentar para a População Brasileira é um dos documentos mais importantes já lançados pelo Ministério da Saúde, reconhecido e aclamado mundialmente. Agora a pasta lançou um complemento específico sobre a alimentação durante a gravidez: o Protocolo de uso do Guia Alimentar para a População Brasileira na orientação alimentar da gestante, disponível online e para download.

The Effect of an Education and Counseling Program on Maternal/Neonatal Outcomes in Pregnant Women at Risk of Preeclampsia.

OBJECTIVE: To evaluate, in pregnant women at risk for preeclampsia, the effect of an education and counseling program on healthy lifestyle behaviors, self-efficacy, and maternal/neonatal outcomes. METHODS: This study had a randomized controlled trial design and was conducted with 132 pregnant women at risk of preeclampsia and attending an antenatal clinic for routine care. The intervention group received education and counseling focused on preventing preeclampsia and were given a preeclampsia booklet; the control group received standard prenatal care. The members of the 2 groups were seen 4 times during their pregnancies, and once after giving birth. Data were gathered with the Health Promoting Lifestyle Profile-II, the Self-Efficacy Scale (SES), pregnant woman and fetal follow-up forms, and a postpartum data collection form. Permission from the ethics committee was obtained for the study. RESULTS: Education and counseling about preeclampsia had a statistically significant effect on healthy lifestyle behaviors (P < .008). However, we found no statistically significant differences in the total SES scores (P > .0125), systolic and diastolic blood pressure averages, edema status, or feeling the baby move (P > .05). We found differences in terms of physical activity in the first and third follow-ups, and in terms of breathing exercises in the first, second, and third follow-ups (P < .05). Preeclampsia developed in 4 of the pregnant women (7.6%) in the control group but not at all in the intervention group. CONCLUSION: A preeclampsia education and counseling program could help to develop healthy lifestyle behaviors in pregnant women at risk of preeclampsia.

Enhancing nutrition knowledge and dietary diversity among rural pregnant women in Malawi: a randomized controlled trial.

BACKGROUND: In many sub-Saharan African countries, such as Malawi, antenatal care (ANC) services do not deliver sufficient nutrition awareness to improve adequate dietary intake in pregnancy. We therefore compared the effects of supplementary nutrition education and dietary counselling with routine ANC service on nutrition knowledge and dietary intakes among Malawian pregnant women. METHODS: We used data from a two-armed cluster randomised controlled trial (RCT) of which the intervention group received supplementary nutrition education, dietary counselling and routine ANC services whereas the controls received only routine ANC services. The RCT was conducted in 10 control and 10 intervention villages in Mangochi, Southern Malawi and included pregnant women between their 9th and 16th gestational weeks. We examined the changes in nutrition knowledge and dietary diversity from enrolment (baseline) to study end-point of the RCT (two weeks before expected delivery). We used three linear multilevel regression models with random effects at village level (cluster) to examine the associations between indicators of nutrition knowledge and diet consumption adjusted for selected explanatory variables. RESULTS: Among 257 pregnant women enrolled to the RCT, 195 (76%) were available for the current study. The supplementary nutrition education and counselling led to significant improvements in nutrition knowledge, dietary diversity and nutrition behaviour in the intervention group compared with controls. Most women from both study groups had a moderate consumption of diversified foods at study end-point. A significant positive association between nutrition knowledge and consumption of a diversified diet was only observed in the intervention group. CONCLUSIONS: Nutrition knowledge and dietary diversity improved in both study groups, but higher in the intervention group. Increased nutrition knowledge was associated with improved dietary diversity only in the intervention women, who also improved their nutrition perceptions and behaviour. Antenatal nutrition education needs strengthening to improve dietary intakes in pregnancy in this low resource-setting. TRIAL REGISTRATION: Clinical trials.gov ID: NCT03136393 (registered on 02/05/2017).

[Development and Evaluation of Prenatal Education for Environmental Health Behavior Using Cartoon Comics].

PURPOSE: This study aimed to develop and examine the effects of a prenatal program on environmental health behavior using cartoon comics among Korean pregnant women. METHODS: This study used a non-equivalent control group pre-test/post-test design. The program used cartoon comics to explore environmental health behaviors during pregnancy. The program consisted of the following four components: environmental toxicants during pregnancy, avoiding particulate matter during pregnancy, environmental toxicants during baby care, and making a healthy environment for children. In total, 35 pregnant women participated in the study: 18 in the experimental group and 17 in the control group. Data collection and program adaptation were conducted between November 3, 2020 and January 19, 2021. The effect of the prenatal education program was evaluated by t-test and repeated measures ANOVA. RESULTS: Learning experience (t = - 2.35, p = .025), feasibility (t = - 2.46, p = .019), satisfaction (t = - 2.23, p = .032) were higher in the experimental group than in the control group in the first post-test. Feasibility (t = - 2.40, p = .022) was higher in the experimental group than in the control group in the second post-test. Repeated-measures ANOVA showed significant interactions between time and group in environmental susceptibility (F = 9.31, p < .001), self-efficacy (F = 3.60, p = .033), and community behavior (F = 5.41, p = .007). CONCLUSION: This study demonstrates the need for a prenatal education program to promote environmental health perceptions and behavior during pregnancy. We suggest a prenatal class adopting the creative cartoon comics to promote the maternal environmental health behaviors.

Clinical characteristics and sociodemographic factors associated with COVID-19 infection in pregnant women in a maternal and children's public hospital. / Características clínicas y factores sociodemográficos asociados a infección por COVID-19 en gestantes de un hospital público materno infantil.

OBJECTIVE: To describe the clinical characteristics and sociodemographic factors associated with COVID-19 among pregnant women in a maternal and children's hospital in Lima, Peru. METHODS: Quantitative observational study. The population under study consisted of pregnant women who attended an emergency room and had a COVID-19 test. These women were assessed for age, gestational age, place of origin, occupation, education, marital status, number of children, previous body mass index, gestational body mass index, tetanus vaccination, prenatal controls, and hemoglobin. After bivariate analysis, a generalized linear regression model was applied. RESULTS: We included 200 women aged between 18 and 34 years (84.5%) with a median gestational age of 36 weeks. More than half were from Lima (52.5%), most were housewives (79%), had high school education (71.9%), and had a cohabiting marital status (60%). The COVID-19 test positivity was 31.5% by rapid tests. Pregestational body mass index assessment showed that 36.7% of normal weight, 38,1% of overweight, and 30.3% of obese pregnant women had COVID-19 infection. 39.7% of patients with hemoglobin levels greater than or equal to 11 g/dL, 21.2% of patients with values between 10 and 10.9 g/dL, and 20% of patients with values between 7 and 9.9 g/dL had COVID-19 infection. The prevalence ratio (with a 95% confidence interval) found that cohabitation was associated with a lower risk of having COVID-19 infection in pregnant women (prevalence ratio: 0.41, p < 0.001). CONCLUSION: Cohabiting pregnant women had a lower risk of COVID-19 infection compared with other marital statuses. Further research is needed to evaluate COVID-19 associated factors in pregnant women and possible sociodemographic or economic factors behind cohabiting marital status association among this population.

OBJETIVO: Describir las características clínicas y factores sociodemográficos asociados a COVID-19 en gestantes de un hospital materno infantil de Lima, Perú. MÉTODO: Estudio cuantitativo observacional. La población estuvo compuesta por gestantes atendidas en la unidad de emergencia, con la prueba para el diagnóstico de COVID-19. A las madres se les valoró edad, edad gestacional, lugar de procedencia, ocupación, nivel de estudios, estado civil, número de hijos, índice de masa corporal previa, índice de masa corporal de la gestación, vacuna antitetánica, controles prenatales, y hemoglobina. Después de un análisis bivariado se aplicó un modelo de regresión lineal generalizado. RESULTADOS: Incluimos a 200 mujeres, con edades de 18 a 34 años (84,5%). Más de la mitad procedía de Lima (52,5%), 79% tenía como ocupación el ser ama de casa, 71,9% alcanzó estudios secundarios y 60% registró estado civil de conviviente. La incidencia de COVID-19 fue de 31,5% mediante pruebas rápidas. La mediana de edad gestacional al momento de la evaluación para COVID-19 fue de 36 semanas. El índice de masa corporal pregestacional, comparado entre las gestantes con COVID-19 y las que no lo tuvieron, fue normal en 36,7 y 63,3%. Se detectó sobrepeso en 38,1 y 61,9% de las pacientes, obesidad en 30,3 y 69,7%, respectivamente. Los niveles de hemoglobina superiores o iguales a 11 gramos por decilitro se reportaron en 39,7 y 60,3% en cada grupo; hemoglobina entre 10 y 10,9 gramos por decilitro, en 21,2 y 78,8%; y hemoglobina entre 7 y 9,9 gramos por decilitro, en 20 y 80%, respectivamente. La razón de prevalencia con un intervalo de confianza al 95%, identificó al estado civil conviviente asociado a menor riesgo de tener COVID-19 en gestantes (razón de prevalencia: 0,41, valor p < 0,001). CONCLUSIÓN: Las gestantes cuyo estado civil fue de conviviente presentaron menor riesgo de experimentar COVID-19. Es necesario seguir estudiando los factores que se asocian a la presencia de COVID-19 en gestantes, así como posibles factores sociodemográficos o económicos detrás del estado civil conviviente.

Effect of Personalized Support at Home on the Prevalence of Anemia in Pregnancy in Burkina Faso: A Cluster Randomized Trial.

Burkina Faso has high prevalence of anemia in pregnancy (hemoglobin < 11 g/dL), despite the implementation of the WHO recommended guidelines. This study aimed to test the effects of personalized support for pregnant women at home on the trend of anemia prevalence in pregnancy. A cluster randomized trial was conducted from January 2015 to August 2016 at Sindou health district in Burkina Faso. Data were collected from 617 women in their first or second trimester of pregnancy, including 440 and 177 women in the intervention and control groups, respectively. The intervention consisted of a monthly home-based visit to the pregnant woman, focusing on nutritional counseling and pregnancy management, alongside an improvement antenatal visit quality. Compared with the prevalence of anemia in pregnancy in the control group [64.0% (95% confidence interval [CI]: 52.1-74.4%)], that of the intervention group was significantly lower from the fifth home visit onward [36.8% (95% CI: 32.1-41.8%)] (P < 0.001). The adjusted difference-in-differences in anemia prevalence between the two groups was -19.8% (95% CI: -30.2% to -9.4%) for women who received more than four home visits (P < 0.001). The corresponding difference in hemoglobin levels was 0.644 g/dL (95% CI: 0.309-0.167; P < 0.001). Personalized support for pregnant women at home, combined with appropriate antenatal care, can significantly reduce anemia prevalence during pregnancy in rural Burkina Faso.