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Wiad Lek ; 74(3 cz 2): 761-766, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33843650


OBJECTIVE: The aim: To realize analysis and assessment of completeness and efficacy in the field of perinatal aid regionalization in Ukraine. PATIENTS AND METHODS: Materials and methods: A retrospective analysis has been carried out as well as assessment of inculcation steps concerning regionalization of perinatal health care in Ukraine according to the data of state and branch statistics and monitoring (in 2013-2017). The methods used here are systemic approach, bibliography method, and statistical data evaluation. CONCLUSION: Conclusions: It is shown the modern globally acknowledged three-level system of perinatal health care has been organized and functions in Ukraine, perinatal tertiary level centers are now act in the majority of regions. The perinatal health care realization during these last years is shown to be able to assure the providing of adequate perinatal aid taking into consideration the calculated data concerning the pregnant women concentration with high perinatal risks in third level institutions; these patients include pregnant women with heart defects (63.2-69.9%), circulatory system defects (48.5-50.5%), diabetes mellitus (46.7-53.3%); in institutions of the second-third levels, there are 74.2-83.0% of patients with severe gestoses. According to functional possibilities of perinatal aid institutions of different levels, they assure 62%-64.5% of births with body mass 500-999 g and 53.9%-55.3% of ones with body mass 1000-1499 g in perinatal clinics of the third level; it guarantees the survival of newborn babies with body mass 500-999 g and 1000-1499 g during their first 168 h reaching 60.1-65.1% and 89.4%-90.4%, respectively. Efficacy of perinatal aid regionalization is confirmed by a positive tendency of perinatal mortality index; it has become significantly lower: in 2010, the perinatal mortality reached 10.54 cases per 1,000 of newborn alive and dead babies, this index having dropped to 8.89 in 2019. The maternal mortality levels have also decreased from 23.5 up to 14.9 cases per 100,000 of babies born alive. Perinatal aid regionalization in Ukraine is being realized according to international strategies permitting to provide effective perinatal aid to patients at each level of its provision depending on patient's need.

Medicina , Mortalidade Perinatal , Criança , Feminino , Humanos , Mortalidade Infantil , Recém-Nascido , Assistência Perinatal , Gravidez , Estudos Retrospectivos , Ucrânia
Ann Clin Psychiatry ; 33(2): e8-e12, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33878290


BACKGROUND: In representative cases of Munchausen by internet (MBI), an individual (or "poser") goes online to falsely report or exaggerate illnesses or life crises. The principal goal, as in factitious disorder imposed on self or another, is to garner emotional satisfaction. We provide the first evidence that MBI can target a specific type of health care provider-in this case, birthing doulas. METHODS: We describe 5 cases in which individuals have utilized social media platforms to report factitious perinatal illnesses and crises, including neonatal death, in real time. Current health headlines, such as those involving the COVID-19 pandemic, can be relevant to the ruses. Posers can engage in deceptions with several health care professionals concurrently or serially, and may portray multiple people ("sock puppets") at the same time. RESULTS: MBI has consequences that can be highly disruptive. In the cases highlighted in this report, many hours of support were given to individuals who had fabricated their pregnancies, infants, and perinatal complications. The doulas experienced feelings ranging from resignation to anger and betrayal. CONCLUSIONS: Health care professionals of all types who offer services online should be vigilant to the risks of potential MBI.

Decepção , Doulas , Transtornos Autoinduzidos , Simulação de Doença , Síndrome de Munchausen , Telemedicina , Adulto , Comunicação , Doulas/ética , Doulas/psicologia , Transtornos Autoinduzidos/diagnóstico , Transtornos Autoinduzidos/psicologia , Feminino , Comportamento de Busca de Ajuda , Humanos , Síndrome de Munchausen/diagnóstico , Síndrome de Munchausen/epidemiologia , Síndrome de Munchausen/psicologia , Assistência Perinatal , Telemedicina/ética , Telemedicina/métodos
BMC Pediatr ; 21(1): 150, 2021 03 29.
Artigo em Inglês | MEDLINE | ID: mdl-33781214


BACKGROUND: Prematurity escalates the crisis of the infants a susceptible group of the society. Multiple delivery further intensifies the susceptibility of both family and health system. A comprehensive care is, thus, necessary to ensure the optimal growth and development of such multiple-births. Accompanied by trainings, challenges, and strategies, the present study was conducted based on a two-year report of comprehensive care management experience on two sets of multiple infants. METHODS: A qualitative case study approach was used to survey these two sets of premature infants (quadruplet and quintuplet) and their families. The data were collected through medical files, interviews, questionnaire, field presence, phone call and WhatsApp application, and continued follow-ups. Content analysis was performed based on survey and interventions during a period of two years in Isfahan, Iran (2018-2020). RESULTS: Case presentation and comprehensive care management are the main areas resulted from this study. The results of the study were categorized in eight challenging areas (categories) and strategies including sterility and infertility period, transition from the intrauterine to neonatal intensive care unit (NICU), discharge process, physical and developmental status, home visit and home care, development of care plan, socio-economic support, and coronavirus nightmare. CONCLUSION: Based on challenges and strategies during these two years, the situation of the multiple-birth infants and their families' needs should be identified as the first prerequisites in an inter-professional approach and in collaboration with the health providers. Isfahan University of Medical Sciences, Welfare Organization, and the charities were the parties involved with this process in our study. It was also found that developing a separate specific package of comprehensive care management plan for multiple-births is a necessity.

Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Assistência Perinatal/organização & administração , Gravidez Múltipla , Feminino , Humanos , Lactente , Recém-Nascido , Irã (Geográfico) , Alta do Paciente , Gravidez , Cuidado Pré-Natal , Quadrigêmeos , Quíntuplos
BMC Pregnancy Childbirth ; 21(1): 171, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33648450


BACKGROUND: Psychological stress and coping experienced during pregnancy can have important effects on maternal and infant health, which can also vary by race, ethnicity, and socioeconomic status. Therefore, we assessed stressors, coping behaviors, and resources needed in relation to the COVID-19 pandemic in a sample of 162 perinatal (125 pregnant and 37 postpartum) women in the United States. METHODS: A mixed-methods study captured quantitative responses regarding stressors and coping, along with qualitative responses to open-ended questions regarding stress and resources needed during the COVID-19 pandemic. Logistic and linear regression models were used to analyze differences between pregnant and postpartum participants, as well as differences across key demographic variables. Qualitative content analysis was used to analyze open-ended questions. RESULTS: During the COVID-pandemic, food scarcity and shelter-in-place restrictions made it difficult for pregnant women to find healthy foods. Participants also reported missing prenatal appointments, though many reported using telemedicine to obtain these services. Financial issues were prevalent in our sample and participants had difficulty obtaining childcare. After controlling for demographic variables, pregnant women were less likely to engage in healthy stress-coping behaviors than postpartum women. Lastly, we were able to detect signals of increased stressors induced by the COVID-19 pandemic, and less social support, in perinatal women of racial and ethnic minority, and lower-income status. Qualitative results support our survey findings as participants expressed concerns about their baby contracting COVID-19 while in the hospital, significant others missing the delivery or key obstetric appointments, and wanting support from friends, family, and birthing classes. Financial resources, COVID-19 information and research as it relates to maternal-infant health outcomes, access to safe healthcare, and access to baby supplies (formula, diapers, etc.) emerged as the primary resources needed by participants. CONCLUSIONS: To better support perinatal women's mental health during the COVID-19 pandemic, healthcare providers should engage in conversations regarding access to resources needed to care for newborns, refer patients to counseling services (which can be delivered online/via telephone) and virtual support groups, and consistently screen pregnant women for stressors.

Adaptação Psicológica , Recursos em Saúde/organização & administração , Acesso aos Serviços de Saúde , Poder Familiar/psicologia , Assistência Perinatal , Educação Pré-Natal/métodos , /epidemiologia , /psicologia , Feminino , Alocação de Recursos para a Atenção à Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/normas , Acesso aos Serviços de Saúde/tendências , Humanos , Recém-Nascido , Saúde Mental/normas , Determinação de Necessidades de Cuidados de Saúde , Assistência Perinatal/métodos , Assistência Perinatal/organização & administração , Assistência Perinatal/tendências , Gravidez , Estresse Psicológico/etiologia , Estresse Psicológico/prevenção & controle , Telemedicina/métodos , Telemedicina/organização & administração , Estados Unidos
Child Psychiatry Hum Dev ; 52(2): 200-204, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33619672


The COVID-19 pandemic exposed mothers to stress and social isolation during the pre- and post-natal periods. The deleterious effects of stress on both pregnant women and their infants are well documented, with research suggesting that effects are exacerbated by reduced social support. In this brief report, we summarize evidence linking stress and social isolation to negative outcomes for mothers and infants and present a conceptual model featuring inflammation as a driving mechanism. There is strong evidence that the coronavirus pandemic will affect mothers and infants through immune pathways that, in previous research, have been shown to link stress and social isolation during the pre- and post-natal periods with deficits in maternal mental health and infant well-being and development across developmental stages. We close with recommendations for novel research, policy changes, and integrated clinical care that can address these biological threats to infants and mothers while leveraging the anti-inflammatory effects of social support.

Desenvolvimento Infantil , Mães/psicologia , Assistência Perinatal , Isolamento Social/psicologia , Estresse Psicológico , /epidemiologia , /psicologia , Saúde da Família/tendências , Feminino , Previsões , Humanos , Recém-Nascido , Saúde Mental/tendências , Assistência Perinatal/métodos , Assistência Perinatal/normas , Gravidez , Sistemas de Apoio Psicossocial , Estresse Psicológico/epidemiologia , Estresse Psicológico/etiologia , Estresse Psicológico/psicologia
Obstet Gynecol ; 137(3): 487-492, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33543895


The use of telemedicine in U.S. perinatal care has drastically increased during the coronavirus disease 2019 (COVID-19) pandemic, and will likely continue given the national focus on high-value, patient-centered care. If implemented in an equitable manner, telemedicine has the potential to reduce disparities in care access and related outcomes that stem from systemic racism, implicit biases and other forms of discrimination within our health care system. In this commentary, we address implementation factors that should be considered to ensure that disparities are not widened as telemedicine becomes more integrated into care delivery.

/prevenção & controle , Assistência à Saúde/normas , Disparidades em Assistência à Saúde , Assistência Perinatal/métodos , Telemedicina/economia , /epidemiologia , Feminino , Política de Saúde , Humanos , Aceitação pelo Paciente de Cuidados de Saúde , Gravidez , Estados Unidos
Z Geburtshilfe Neonatol ; 225(1): 74-79, 2021 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-33601453


INTRODUCTION: Since 2014 outcome data for the treatment of very low birth weight (VLBW) infants in Germany have been available at This study explores the relationship between volume of VLBW infants and outcome. METHODS: Volumes of VLBW infants for each perinatal centre are available for the 5-year period from 2014 to 2018, and survival and survival without severe morbidity in relation to the national average survival rate is reported. In addition to volume an adjusted volume is specified considering several risk factors. Using regression, the relationship between volume, adjusted volume and survival was investigated. RESULTS: Of 212 perinatal centres 163 (77%) were level 1 centres (highest level in Germany) and 49 (23%) were level 2 centres caring for 9300 (94%; median 51; min 13 max 186) and 538 (6%; 9; 4-28) VLBW infants per year, respectively. No significant correlation between volume and survival and survival w/o severe morbidity was found. Adjusted volumes showed a weak linear correlation to survival w/o severe morbidity (p=0.02, R2=0.03). Non-parametric regression was significant for adjusted volumes of more than 170 (survival) and 100 (survival w/o severe morbidity) VLBW infants per year and centre, respectively. Below these limits volume does not affect variation. CONCLUSION: Linear and non-linear regression between adjusted volumes and survival was only weak and was driven by the very large perinatal centres.

Mortalidade Infantil , Recém-Nascido de muito Baixo Peso , Terapia Intensiva Neonatal/estatística & dados numéricos , Assistência Perinatal/estatística & dados numéricos , Qualidade da Assistência à Saúde , Assistência à Saúde , Feminino , Alemanha/epidemiologia , Humanos , Lactente , Recém-Nascido , Gravidez , Fatores de Risco , Taxa de Sobrevida
J Med Internet Res ; 23(1): e23410, 2021 01 27.
Artigo em Inglês | MEDLINE | ID: mdl-33502326


BACKGROUND: Despite potential for benefit, mindfulness remains an emergent area in perinatal mental health care, and evidence of smartphone-based mindfulness training for perinatal depression is especially limited. OBJECTIVE: The objective of this study was to evaluate the effectiveness of a smartphone-based mindfulness training intervention during pregnancy on perinatal depression and other mental health problems with a randomized controlled design. METHODS: Pregnant adult women who were potentially at risk of perinatal depression were recruited from an obstetrics clinic and randomized to a self-guided 8-week smartphone-based mindfulness training during pregnancy group or attention control group. Mental health indicators were surveyed over five time points through the postpartum period by online self-assessment. The assessor who collected the follow-up data was blind to the assignment. The primary outcome was depression as measured by symptoms, and secondary outcomes were anxiety, stress, affect, sleep, fatigue, memory, and fear. RESULTS: A total of 168 participants were randomly allocated to the mindfulness training (n=84) or attention control (n=84) group. The overall dropout rate was 34.5%, and 52.4% of the participants completed the intervention. Mindfulness training participants reported significant improvement of depression (group × time interaction χ24=16.2, P=.003) and secondary outcomes (χ24=13.1, P=.01 for anxiety; χ24=8.4, P=.04 for positive affect) compared to attention control group participants. Medium between-group effect sizes were found on depression and positive affect at postintervention, and on anxiety in late pregnancy (Cohen d=0.47, -0.49, and 0.46, respectively). Mindfulness training participants reported a decreased risk of positive depressive symptom (Edinburgh Postnatal Depression Scale [EPDS] score>9) compared to attention control participants postintervention (odds ratio [OR] 0.391, 95% CI 0.164-0.930) and significantly higher depression symptom remission with different EPDS reduction scores from preintervention to postintervention (OR 3.471-27.986). Parity did not show a significant moderating effect; however, for nulliparous women, mindfulness training participants had significantly improved depression symptoms compared to nulliparous attention control group participants (group × time interaction χ24=18.1, P=.001). CONCLUSIONS: Smartphone-based mindfulness training is an effective intervention in improving maternal perinatal depression for those who are potentially at risk of perinatal depression in early pregnancy. Nulliparous women are a promising subgroup who may benefit more from mindfulness training. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR1900028521;

Depressão/psicologia , Saúde Mental/normas , Atenção Plena/métodos , Assistência Perinatal/métodos , Smartphone/normas , Telemedicina/métodos , Adulto , Feminino , Humanos , Gravidez , Inquéritos e Questionários
An Pediatr (Barc) ; 94(3): 173-178, 2021 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-33431332


INTRODUCTION: The impact of maternal SARS-CoV-2 infection and its risk of vertical transmission is still not well known. Recommendations from scientific societies seek to provide safety for newborns without compromising the benefits of early contact. The aim of the study is to describe characteristics and evolution of newborns born to mothers with SARS-CoV-2 infection, as well as the implemented measures following recommendations from the Sociedad Española de Neonatología. METHODS: Observational, prospective and single-center cohort study. A specific circuit was designed for mothers with SARS-CoV-2 infection and their newborns. Epidemiological and clinical data were collected. PCR were performed in newborns at delivery and at 14 days of age. RESULTS: 73 mothers and 75 newborns were included in the study. 95.9% of maternal infections were diagnosed during the third trimester of pregnancy, 43.8% were asymptomatic. Median gestational age was 38 weeks (IQR: 37-40), 25.9% of newborns required admission to Neonatology. Skin-to-skin mother care was performed in 68% of newborns, 80% received exclusive maternal or donated breast milk during hospital stay. No positive PCR results were observed in newborns at delivery, one case of positive PCR was observed in an asymptomatic neonate at 14 days of age. CONCLUSIONS: Risk of SARS-CoV-2 transmission is low when complying to the recommendations issued by Sociedad Española de Neonatología, allowing rooming-in and promoting breastfeeding.

Transmissão Vertical de Doença Infecciosa/estatística & dados numéricos , Complicações Infecciosas na Gravidez , Adulto , Aleitamento Materno , /epidemiologia , /transmissão , Feminino , Humanos , Cuidado do Lactente/métodos , Recém-Nascido , Masculino , Assistência Perinatal/métodos , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/terapia , Estudos Prospectivos , Espanha/epidemiologia
Rev Med Suisse ; 17(720-1): 38-41, 2021 Jan 13.
Artigo em Francês | MEDLINE | ID: mdl-33443829


In Switzerland, tobacco smoking is a major public health problem, especially among pregnant women. Health problems encountered by pregnant women and their fetuses require specific care to assist smoking cessation. A specific consultation to support smoking cessation during pregnancy was created in May 2019 at the maternity ward of the University Hospitals of Geneva, with the support of the Fondation Privée des Hôpitaux Universitaires de Genève and Carrefour addictionS/CIPRET-Genève. The creation of a network of health professionnals trained in smoking cessation is an important step to support women during their cessation process.

Ginecologia/métodos , Obstetrícia/métodos , Assistência Perinatal/métodos , Complicações na Gravidez/prevenção & controle , Gestantes , Abandono do Hábito de Fumar/métodos , Prevenção do Hábito de Fumar/métodos , Feminino , Humanos , Gravidez , Suíça
J Homosex ; 68(1): 157-172, 2021 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-31194920


In recent decades, there has been an increasing tendency among lesbians to realize their desire to become parents. Nurses provide perinatal care to lesbians at women's healthcare centres from the pregnancy planning stage until childbirth, serving as a source of information, advice and support. However, little is known about nurses' personal and professional characteristics, including knowledge and attitudes concerning perinatal care of lesbians at women's health centres. The current study was a cross sectional study that assessed a convenience sample of 184 nurses who provide perinatal care to lesbians at women's health centres belonging to the two largest health organizations in Israel. The average score received by participants on a homosexuality knowledge questionnaire was 10.4 on a scale of 0-17, indicating moderate levels of factual knowledge about homosexuality. Of all nurses surveyed, 83.2% had negative attitudes with regard to the treatment of lesbians. Nurses' personal and professional characteristics were found to be associated with these attitudes.

Atitude do Pessoal de Saúde , Enfermeiras e Enfermeiros/psicologia , Assistência Perinatal , Minorias Sexuais e de Gênero , Adulto , Atitude , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Homossexualidade Feminina , Humanos , Israel , Pais , Gravidez , Inquéritos e Questionários , Saúde da Mulher
J Obstet Gynaecol Res ; 47(4): 1253-1255, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33354868


A screening of coronavirus disease 2019 (COVID-19) polymerase chain reaction (PCR) tests using saliva for pregnant women and their partners was performed at all 12 maternity facilities located in Himeji city between May 29 and September 5, 2020. Pregnant women at 37 or more weeks of gestation or who experienced threatened labor and their partners who cared for an infant underwent a saliva PCR test with informed consent. As a result, all of 1475 pregnant women and 1343 partners tested negative for COVID-19 PCR. There were no cases of false positive or false negative PCR tests. This cohort study revealed for the first time that a screening of COVID-19 PCR tests using saliva may be useful to sustain perinatal medical care during the pandemic period in Japan.

/diagnóstico , Complicações Infecciosas na Gravidez/diagnóstico , Saliva/virologia , Estudos de Coortes , Programas de Triagem Diagnóstica , Reações Falso-Negativas , Reações Falso-Positivas , Feminino , Humanos , Japão , Masculino , Assistência Perinatal , Gravidez , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Cônjuges
Esc. Anna Nery Rev. Enferm ; 25(2): e20200080, 2021.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1133830


RESUMO Objetivo Conhecer as potencialidades e limitações da atuação do enfermeiro no Centro de Parto Normal (CPN). Método abordagem qualitativa, do tipo exploratório e descritivo, realizado em 2018, com seis enfermeiras atuantes em CPN intra-hospitalar público na região metropolitana de Fortaleza, Ceará, Brasil. A coleta das informações ocorreu por meio de entrevista individual, com análise a partir dos pressupostos da sociologia das profissões, com foco nos temas: conhecimento e autonomia; credencialismo; divisão do trabalho; mercado de trabalho e quadro de valores. Resultado A atuação do enfermeiro no CPN potencializa as boas práticas para o parto e nascimento, bem como amplia a importância e visibilidade deste profissional no cuidado materno-infantil. O cuidado clínico e a gestão emergem como foco da ação do enfermeiro no CPN. No entanto, mesmo com a indução do Estado para essa atuação, ainda há a necessidade de reconhecimento das competências e autonomia do enfermeiro no cuidado obstétrico por outros profissionais. Conclusão e implicações para a prática Há desafios que precisam ser superados como a ampliação da autonomia e do respeito ao credenciamento do enfermeiro para atuação no CPN e a harmonização entre a gestão do processo de trabalho e gestão do cuidado clínico por este profissional.

RESUMEN Objetivo Conocer las potencialidades y limitaciones del desempeño de la enfermera en el Centro de Parto Normal (CPN). Método Enfoque cualitativo, del tipo exploratorio-descriptivo, realizado en 2018, con seis enfermeras que trabajan en el CPN intrahospitalario público en la región metropolitana de Fortaleza, Ceará, Brasil. La recopilación de información se realizó mediante una entrevista individual, con análisis basado en los supuestos de la sociología de las profesiones, centrándose en los temas: conocimiento y autonomía; credencialismo; división del trabajo; mercado de trabajo y tabla de valores. Resultado El desempeño de la enfermera en la CPN mejora las buenas prácticas para el parto y el nacimiento, así como aumenta la importancia y la visibilidad de este profesional en el cuidado de la madre y el niño. El cuidado clínico y la gestión surgen como el foco de la acción de la enfermera en la CPN. Sin embargo, incluso con la inducción del Estado a esta acción, sigue siendo necesario que otros profesionales reconozcan las aptitudes y la autonomía de la enfermera en la atención obstétrica por otros profesionales. Conclusión e implicaciones para la práctica Hay desafíos que deben superarse, como el aumento de la autonomía y el respeto de la acreditación de las enfermeras para trabajar en la CPN y la armonización de la gestión del proceso de trabajo y la gestión de la atención clínica por parte de este profesional.

ABSTRACT Objective To know the potentialities and limitations of the nurse's performance in the Center for Normal Birth (CPN). Method Qualitative approach, exploratory-descriptive type, carried out in 2018, with six nurses working in public intra-hospital CPN in the metropolitan region of Fortaleza, Ceará, Brazil. The collection of information occurred through individual interview, with analysis from the assumptions of the sociology of professions, focusing on the themes: knowledge and autonomy; credentialism; division of labor; labor market and value chart. Result The nurse's performance in the Center for Normal Birth (CPN)enhances good practices for childbirth and birth, as well as increases the importance and visibility of this professional in maternal and child care. Clinical care and management emerge as the focus of the nurse's action in the CPN. However, even with the induction of the State to this action, there is still the need for recognition of the competencies and autonomy of the nurse in obstetric care by other professionals. Conclusion and implications for practice There are challenges that need to be overcome such as the expansion of autonomy and respect for the accreditation of the nurse to work in the CPN and the harmonization between the management of the work process and management of clinical care by this professional.

Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Autonomia Profissional , Assistência Perinatal , Papel do Profissional de Enfermagem , Humanização da Assistência , Enfermeiras Obstétricas , Condições de Trabalho , Parto Humanizado , Pesquisa Qualitativa , Enfermagem Baseada em Evidências
MMWR Morb Mortal Wkly Rep ; 69(5152): 1638-1641, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33382678


Decreased use of health care services (1), increased exposure to occupational hazards, and higher rates of substance use (2) might contribute to men's poorer health outcomes when compared with such outcomes for women (3). During the transition to fatherhood, paternal health and involvement during pregnancy might have an impact on maternal and infant outcomes (4-6). To assess men's health-related behaviors and participation in fatherhood-related activities surrounding pregnancy, the Puerto Rico Department of Health and CDC analyzed data from the paternal survey of the Pregnancy Risk Assessment Monitoring System-Zika Postpartum Emergency Response (PRAMS-ZPER)* study. Fewer than one half (48.3%) of men attended a health care visit for themselves in the 12 months before their newborn's birth. However, most fathers attended one or more prenatal care visits (87.2%), were present at the birth (83.1%), and helped prepare for the newborn's arrival (e.g., by preparing the home [92.4%] or purchasing supplies [93.9%]). These findings suggest that opportunities are available for public health messaging directed toward fathers during the perinatal period to increase attention to their own health and health behaviors, and to emphasize the role they can play in supporting their families' overall health and well-being.

Promoção da Saúde/métodos , Saúde do Homem , Assistência Perinatal , Adulto , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Porto Rico , Adulto Jovem
Esc. Anna Nery Rev. Enferm ; 25(2): e20200116, 2021. tab
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1142950


RESUMO Objetivo Estimar a ocorrência do contato pele a pele imediato e sua associação aos fatores sociodemográficos, obstétricos, assistenciais e de nascimento em uma maternidade da Zona da Mata Mineira. Método Estudo transversal realizado com 222 primíparas por meio de entrevista e dados do prontuário. Os dados foram codificados, categorizados, digitados e analisados pelo programa Epi info 7.0. Utilizou-se a regressão logística múltipla. Resultados A ocorrência do contato pele a pele imediato foi de 30% e foi associado ao: profissional do parto não ser o mesmo do pré-natal (OR 3,17; IC 95% 1,52 -6,62), presença de acompanhante (OR 3,35; IC 95% 1,67-6,73) e realização de parto normal (OR 15,59; IC 95% 7,50-32,41). Conclusão e implicações para a prática É primordial incentivar o parto normal, sensibilizar profissionais e empoderar as mulheres sobre o direito do acompanhante e contato pele a pele, pois este minimiza as intervenções na primeira hora, estimula o vínculo e promove a amamentação.

RESUMEN Objetivo Estimar la prevalencia del contacto inmediato piel a piel y su asociación con factores sociodemográficos, obstétricos, asistenciales y de nacimiento en una sala de maternidad en la Zona de la Mata Minera (Brasil). Método Estudio transversal realizado con 222 mujeres primíparas, a través de entrevistas y datos de registros médicos. Los datos fueron codificados, categorizados, tipificados y analizados por el programa Epi info 7.0. Se utilizó la regresión logística múltiple. Resultados La incidencia del contacto inmediato piel a piel fue del 30% y se asoció con: profesional del parto que no es lo mismo que de la asistencia prenatal (OR 3.17; IC del 95% 1.52 -6.62), presencia de acompañante (OR 3.35; IC 95% 1.67-6.73) y parto normal (OR 15.59; IC 95% 7.50-32.41). Conclusión e implicaciones para la práctica Es esencial fomentar el parto normal, sensibilizar a los profesionales y empoderar a las mujeres sobre el derecho del acompañante y el contacto piel a piel, ya que esto minimiza las intervenciones en la primera hora, estimula el vínculo y promueve la lactancia materna.

ABSTRACT Objective To estimate the prevalence of early skin-to-skin contact and its association with sociodemographic, obstetric, assistance and birth factors in a maternity located in the Forest Zone of Minas Gerais (southeast Brazil). Method A cross-sectional study was carried out with 222 primiparous women, by means of interview and data from the medical records. The data were coded, categorized, typed and analyzed using the Epi info 7.0 software. Multiple logistic regression was used. Results The occurrence of skin-to-skin contact was 30% and was associated with: professional delivery not being the same as prenatal care (OR 3.17; 95% CI 1.52 -6.62), presence of companion (OR 3.35; 95% CI 1.67-6.73) and normal delivery (OR 15.59; 95% CI 7.50-32.41). Conclusion and implications for practice It is essential to encourage normal childbirth, sensitize professionals and empower women about the right of the companion and skin-to-skin contact, as this minimizes interventions in the first hour, stimulates mother-baby bond and promotes breastfeeding.

Humanos , Feminino , Gravidez , Recém-Nascido , Período Pós-Parto , Relações Mãe-Filho , Fatores Socioeconômicos , Cesárea/estatística & dados numéricos , Estudos Transversais , Assistência Perinatal , Parto Normal/estatística & dados numéricos , Apego ao Objeto
Esc. Anna Nery Rev. Enferm ; 25(2): e20200075, 2021.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1149293


Resumo Objetivo descrever os incidentes na assistência das parturientes e recém-nascidos, seus fatores contribuintes e medidas preventivas na perspectiva das enfermeiras e médicos. Método pesquisa qualitativa em maternidade pública do Município do Rio de Janeiro, com Núcleo de Segurança do Paciente registrado. Realizaram-se entrevistas com 18 enfermeiras e médicos atuantes no centro obstétrico e duas enfermeiras integrantes desse Núcleo, de fevereiro a abril de 2019. Utilizaram-se referenciais da Análise de Conteúdo Temática e Segurança do Paciente. Resultados os principais incidentes são erros na identificação dos pacientes, quedas da mãe e do bebê e eventos danosos causados pelas práticas inadequadas; desrespeito e maus-tratos às parturientes; ausência de notificações dos eventos; restrições de pessoal e recursos; limitações no conhecimento da equipe e apoio da gestão às ações de segurança do paciente. As medidas de prevenção são pertinentes às adequações e às melhorias da estrutura e processo de assistência e gerência dos cuidados. Conclusão e implicações para a prática os incidentes são erros e danos, cuja prevenção requer qualificação do processo e estrutura da assistência, comprometimento dos profissionais e gerentes com a segurança das pacientes, e mudanças na cultura organizacional que também abarquem o enfrentamento da violência institucional obstétrica.

Resumen Objetivo describir incidentes en el cuidado de parturientas y recién nacidos, los factores que contribuyen a ellos y las medidas preventivas para evitarlos, desde la perspectiva de enfermeras y médicos. Método investigación cualitativa en una maternidad pública del municipio de Río de Janeiro que cuenta con un Núcleo de Seguridad del Paciente registrado. Se realizaron entrevistas a 18 enfermeras y médicos que trabajan en el centro obstétrico y dos enfermeras que forman parte del NSP, entre febrero y abril de 2019. Se utilizaron como referencia los aportes del Análisis de Contenido Temático y de Seguridad del Paciente. Resultados los principales incidentes corresponden a errores en la identificación de los pacientes, caídas de la madre y el bebé y eventos dañinos causados por prácticas inadecuadas; falta de respeto y maltrato a las parturientas; ausencia de notificaciones de los eventos; restricciones de personal y recursos; limitaciones en los conocimientos del equipo y en el apoyo a la gestión de las acciones de seguridad del paciente. Las medidas de prevención son relevantes para los ajustes y mejoras en la estructura, el proceso y la gestión de los cuidados. Conclusión e implicaciones para la práctica los incidentes son errores y daños, cuya prevención requiere la evaluación del proceso y la estructura de los cuidados, el compromiso con la seguridad de los pacientes por parte de los profesionales y gestores, además de los cambios en la cultura organizacional, que incluyen el enfrentamiento a la violencia obstétrica institucional.

Abstract Objective to describe the incidents in the care provided to parturient women and newborns, their contributing factors, and preventive measures, from the perspective of nurses and physicians. Method qualitative study conducted in a public maternity hospital in the city of Rio de Janeiro, RJ, Brazil, with a registered Patient Safety Center. Interviews were held with 18 nurses and physicians working at the obstetric center and two nurses from the patient safety center, from February to April of 2019. The Thematic Content Analysis and Patient Safety references were used. Results the main incidents were errors in patient identification, mother and newborn falls, and harmful events caused by inappropriate practices, disrespect and mistreatment of parturient women, lack of incident reporting, insufficient personnel and resources, limited knowledge of the team, and lack of support on the part of management to patient safety actions. Preventive measures are needed to adjust and improve the care structure, process, and management. Conclusion and implications for practice the incidents are errors and harm, the prevention of which requires qualification of the care process and structure, the commitment of professionals and managers to patient safety, and changes in the organizational culture that also encompass coping with institutional obstetric violence.

Humanos , Masculino , Feminino , Recém-Nascido , Adulto , Pessoa de Meia-Idade , Idoso , Qualidade da Assistência à Saúde , Assistência Perinatal , Segurança do Paciente , Gestão da Segurança , Parto , Pesquisa Qualitativa
JAMA Netw Open ; 3(12): e2029655, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33337494


Importance: Worldwide, preterm birth (PTB) is the single largest cause of deaths in the perinatal and neonatal period and is associated with increased morbidity in young children. The cause of PTB is multifactorial, and the development of generalizable biological models may enable early detection and guide therapeutic studies. Objective: To investigate the ability of transcriptomics and proteomics profiling of plasma and metabolomics analysis of urine to identify early biological measurements associated with PTB. Design, Setting, and Participants: This diagnostic/prognostic study analyzed plasma and urine samples collected from May 2014 to June 2017 from pregnant women in 5 biorepository cohorts in low- and middle-income countries (LMICs; ie, Matlab, Bangladesh; Lusaka, Zambia; Sylhet, Bangladesh; Karachi, Pakistan; and Pemba, Tanzania). These cohorts were established to study maternal and fetal outcomes and were supported by the Alliance for Maternal and Newborn Health Improvement and the Global Alliance to Prevent Prematurity and Stillbirth biorepositories. Data were analyzed from December 2018 to July 2019. Exposures: Blood and urine specimens that were collected early during pregnancy (median sampling time of 13.6 weeks of gestation, according to ultrasonography) were processed, stored, and shipped to the laboratories under uniform protocols. Plasma samples were assayed for targeted measurement of proteins and untargeted cell-free ribonucleic acid profiling; urine samples were assayed for metabolites. Main Outcomes and Measures: The PTB phenotype was defined as the delivery of a live infant before completing 37 weeks of gestation. Results: Of the 81 pregnant women included in this study, 39 had PTBs (48.1%) and 42 had term pregnancies (51.9%) (mean [SD] age of 24.8 [5.3] years). Univariate analysis demonstrated functional biological differences across the 5 cohorts. A cohort-adjusted machine learning algorithm was applied to each biological data set, and then a higher-level machine learning modeling combined the results into a final integrative model. The integrated model was more accurate, with an area under the receiver operating characteristic curve (AUROC) of 0.83 (95% CI, 0.72-0.91) compared with the models derived for each independent biological modality (transcriptomics AUROC, 0.73 [95% CI, 0.61-0.83]; metabolomics AUROC, 0.59 [95% CI, 0.47-0.72]; and proteomics AUROC, 0.75 [95% CI, 0.64-0.85]). Primary features associated with PTB included an inflammatory module as well as a metabolomic module measured in urine associated with the glutamine and glutamate metabolism and valine, leucine, and isoleucine biosynthesis pathways. Conclusions and Relevance: This study found that, in LMICs and high PTB settings, major biological adaptations during term pregnancy follow a generalizable model and the predictive accuracy for PTB was augmented by combining various omics data sets, suggesting that PTB is a condition that manifests within multiple biological systems. These data sets, with machine learning partnerships, may be a key step in developing valuable predictive tests and intervention candidates for preventing PTB.

Perfilação da Expressão Gênica/métodos , Metabolômica/métodos , Assistência Perinatal , Gravidez , Nascimento Prematuro , Melhoria de Qualidade/organização & administração , Adulto , Causalidade , Regras de Decisão Clínica , Países em Desenvolvimento , Diagnóstico Precoce , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Aprendizado de Máquina , Assistência Perinatal/métodos , Assistência Perinatal/normas , Mortalidade Perinatal , Gravidez/sangue , Gravidez/urina , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/diagnóstico , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/prevenção & controle
Rev. enferm. UERJ ; 28: e51503, jan.-dez. 2020.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1146353


Objetivo: identificar os fatores associados ao uso de complemento lácteo entre recém-nascidos no ambiente hospitalar. Método: estudo transversal desenvolvido em instituição pública no interior do estado do Rio de Janeiro, a partir da coleta de dados em prontuários de nascidos vivos. Foram realizadas associações entre variáveis utilizando-se o teste de Qui-quadrado e a Regressão Logística Binária. Resultados: entre os 351 prontuários consultados, 43 (12,0%) recém-nascidos fizeram uso de complemento lácteo durante a internação na maternidade. O contato pele a pele precoce na sala de parto (OR: 0,286; IC: 0,086- 0,954; p: 0,042) constituiu-se como fator que diminuiu as chances do recém-nascido necessitar desse tipo de complemento. Conclusão: colocar o recém-nascido despido em contato direto com a pele do tórax ou abdome da mãe na sala de parto contribui para a redução do uso de complemento lácteo durante a internação na maternidade, o que pode favorecer o início precoce do aleitamento materno exclusivo.

Objective: to identify factors associated with the use of milk supplement among newborns in the hospital environment. Method: this cross-sectional study conducted at a public institution in Rio de Janeiro state was based on data collected from medical records of live births. Associations between variables were identified using Chi-square test and Binary Logistic Regression. Results: of the 351 medical records consulted, 43 (12.0%) newborns used milk supplements during hospitalization. One factor that decreased the newborn's chances of needing this type of complement was early delivery room skin-to-skin contact (OR: 0.286; CI: 0.086-0.954; p: 0.042). Conclusion: placing the naked newborn in direct contact with the skin of the mother's chest or abdomen in the delivery room contributes to reducing the use of milk supplements during hospitalization in the maternity ward, which may favor early initiation of exclusive breastfeeding.

Objetivo: identificar factores asociados al uso de complementos lácteos en recién nacidos en el ámbito hospitalario. Método: este estudio transversal realizado en una institución pública en el estado de Río de Janeiro se basó en datos recolectados de registros médicos de nacidos vivos. Las asociaciones entre variables se identificaron mediante la prueba de Chi-cuadrado y la regresión logística binaria. Resultados: de las 351 historias clínicas consultadas, 43 (12,0%) recién nacidos utilizaron suplementos lácteos durante la hospitalización. Un factor que disminuyó las posibilidades del recién nacido de necesitar este tipo de complemento fue el contacto piel a piel en la sala de partos temprano (OR: 0,286; IC: 0,086-0,954; p: 0,042). Conclusión: colocar al recién nacido desnudo en contacto directo con la piel del tórax o abdomen de la madre en la sala de partos contribuye a reducir el uso de suplementos lácteos durante la hospitalización en maternidad, lo que puede favorecer el inicio temprano de la lactancia materna exclusiva.

Humanos , Masculino , Feminino , Recém-Nascido , Alimentação Artificial , Aleitamento Materno , Assistência Perinatal , Maternidades , Alojamento Conjunto , Brasil , Distribuição de Qui-Quadrado , Estudos Transversais , Salas de Parto , Hospitais Públicos